1. Journey to Improvement
Central Line Associated Blood Stream Infections (CLABSI)

2. NHSN Methodology National Healthcare Safety Network (2005)
All + blood cultures reviewed
Line Present
Known pathogen
No other source of infection
Common skin contaminant
2 or more Cultures
Signs/Symptoms

3. CLA-BSI Surveillance Time Period: Sept 2009-Jan 2010
February One Patient (2-1-10)
PICC
7 days to infection
Yeast
+ TPN

4. NCH Overall

5. Opportunities
ICU and Floors
PICCs
Candida (TPN/Propofol)
Enteric Organisms (Lines, dressings)
Endogenous (preps)

6. January 2011 CLABSI Report Infection Prevention Department

7. NCH CLABSI

8. NCH Healthcare System CLABSI Jan 2010 thru Jul 2011

9. Critical Care CLABSI Rate

10. NCH CLABSI: Critical Care/DNH

11. NCH CLABSI: Critical Care/NNH

12. NCH CLABSI: Jan 2010 – July 2011

13. NCH CLABSI: Critical Care

14. CLABSI: Non-ICU’s Only

15. CLABSI: NCH System

16. Critical Care CLABSI Utilization
Central line utilization above NHSN 50th percentile for both hospitals.
Higher risk for infection
Doing great job but it’s a matter of time…..
Assess need for line daily.

17. NCH CLABSI Costs

18. CLABSI Analysis Number of months WITHOUT a CLABSI
in Critical Care Units:
ICU-N > 9 months
PCU > 12 months (closed for part of time)
SICU > 14 months
ICU-DTN > 23 months
CVRU > 2 years!
Number of months WITHOUT a CLABSI in all of NCH Healthcare: 2 Months in 2011 (May/Nov)

19. CLABSI Action Plan Non-ICU units have significantly decreased CLABSIs
Swab Cap trials at NNH successful and now implemented at DNH
NSG education and compliance monitoring continues to reinforce best practice
New insertion and dressing change kits implemented
High utilization requires daily assessment for lines

20. Critical Care CLABSI/Quarter
Sep 2009 – Jun 2011

21. NCH CLABSI: Critical Care versus Non-Critical Care
Jan 2010 – Mar 2011

22. Hard Work
The results have been through the ongoing efforts of the CLABSI Team, a multidisciplinary group lead by Dr. Doug Harrington including expertise from:
Critical Care, Infection Prevention, Education, Clinical Nurse Specialists and the IV Team.

23. Action Plans
Relentless execution of the following actions has resulted in significant improvements:
Monthly data feedback to the system and individual units for # of infections, causative organisms and types of lines.
The use of RCA forms to assist units with understanding the opportunities for improvement.

24. Action Plans
Standardization of policies and education for insertion and ongoing line care.
Education for all who care for patients with central lines.
Monitoring compliance with these policies to insure consistent execution.
Weekly feedback to the units regarding their compliance to recognize excellence and encourage improvement.