Central Line-Associated Bloodstream Infection Reduction: Lessons Learned Ken Sands, MD, MPH SVP, Silverman Institute for Health Care Quality and Patient Safety Beth Israel Deaconess Medical Center

CL-BSI goals Reduce preventable nosocomial CL-BSI toward zero. Reduce preventable nosocomial CL-BSI toward zero. Achieve 100% compliance with insertion checklists. Achieve 100% compliance with insertion checklists.

Program components Multidisciplinary Central Line Work Group Multidisciplinary Central Line Work Group Improvement in insertion practices: Improvement in insertion practices: Continuous education Continuous education Audits of checklist use and feedback Audits of checklist use and feedback Observation of insertion Observation of insertion Standardization of practice across all areas: Standardization of practice across all areas: (ICUs, Med/surg floors, Radiology, ED, ORs)

Program components Standardized Standardized insertion kit Root cause analysis of all nosocomial CL-BSI  Multidisciplinary review team  Includes department leadership and front line staff Standardization of care and maintenance of CLs  Twice yearly audit of all CLs  Feedback of data to each unit and nursing leadership  Daily review of utility & integrity of line on rounds  Ordering of CLs in POE

Annual ICU Nosocomial CL-BSI Rate per 1000 patient days 93% reduction

Days since last nosocomial ICU CL-BSI (as of 6/19/09) ICUDays CCU325 MICU-East284 MICU-6517 MICU-7324 CVICU100 SICU135 TSICU429

Lessons learned Start small and expand Start small and expand Multidisciplinary approach and add as you go Multidisciplinary approach and add as you go Senior leadership support Senior leadership support Continuous vigilance with data and feedback Continuous vigilance with data and feedback Root cause analysis: Root cause analysis: Real time Real time Front line staff Front line staff