1. Reducing Adult Central Line Related Bloodstream Infections

2. Team Infection Prevention and Control Department

3. OPPORTUNITY STATEMENT Reduce adult intensive care central line bloodstream infections to below the benchmark of 3.0/1000 central line days by implementing interventions based on national guidelines and successful practice at other healthcare organizations

4. Solutions Implemented  Presentation of the project and goal to the ICU Medical Directors and managers to enlist cooperation  Multidisciplinary committee developed and implemented protocols and guidelines based on best practice  Two month surveillance of bloodstream infections in all adult ICUs to establish a baseline (November and December, 2004)  Implementation of a standardized central line insertion protocol on all ICUs  Introduction of anti microbial coated central line catheters in kits containing Chloroprep, full body sterile drape and safety devices

5. Solutions Implemented  Insertion guidelines written and disseminated to staff including daily assessment of the need for a central line  Standardized supply lists for line insertion and care posted in all ICU supply rooms  Education and testing of faculty, residents and nursing staff on central line insertion protocols through e-learning modules  Data provided to ICU Medical Directors, ICU Nurse Managers, and physician department chairs showing a significant decrease in infection rate and all reminded to continue to practice the insertion guidelines  Follow up two month surveillance of bloodstream infection in all adult ICUs to compare to previous year (Nov-Dec, 2005)

6. ADULT ICU CLR-BSI RATES FOR QUALITY IMRPOVEMENT PURPOSES ONLY p chart Set 2: UCL=0.75, Mean=0.28, LCL=none (25-38) Inspected Mean = 1087.92, Counts Mean = 3.00 1/1/20032/1/20033/1/20034/1/20035/1/20036/1/20037/1/20038/1/20039/1/2003 10/1/200311/1/200312/1/2003 1/1/20042/4/20043/4/20044/4/20045/4/20046/4/20047/4/20048/4/20049/4/2004 10/4/200411/4/200412/1/2004 1/1/20052/1/20053/1/20054/1/20055/1/20056/1/20057/1/20058/1/20059/1/2005 10/1/200511/1/200512/1/2005 1/1/2006 0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 UCL = 1.12 Mean = 0.51 UCL = 0.75 Mean = 0.28 GOAL ICU POINT PREVALENCE IN NOV AND DEC 2004 ANTIMICROBIAL CATHETERS PHASED IN OVER NEXT 6 MONTHS INSERTION GUIDELINES DISSEMINATED MARCH 11, 2005 E-LEARNING ACTIVATED MAY 27, 2005 Adult Intensive Care Central Line Related Bloodstream Infection Rates 1/12003 2/1/20033/1/20034/1/20035/1/20036/1/20037/1/20038/1/20039/1/2003 10/1/200311/1/200312/1/2003 1/1/20042/4/20043/4/20044/4/20045/4/20046/4/20047/4/20048/4/20049/4/2004 10/4/200411/4/200412/1/2004 1/1/20052/1/20053/1/20054/1/20055/1/20056/1/20057/1/20058/1/20059/1/2005 10/1/200511/1/200512/1/2005 1/1/2006 0 2 4 6 8 10 12 14 Mean = 5.1 Mean = 2.8 GOAL ICU POINT PREVALENCE IN NOV AND DEC 2004 ANTIMICROBIAL CATHETERS PHASED IN OVER NEXT 6 MONTHS INSERTION GUIDELINES DISSEMINATED MARCH 11, 2005 E-LEARNING ACTIVATED MAY 27, 2005 Bloodstream Infections per 1,000 Central Line Days

7. Results Central line related bloodstream infections in adults decreased from a mean of 5.1/1000 central line days to 2.8/1000 central line days

8. RESULTS (continued) Average cost per bloodstream infection: $56,000 * 34 fewer infections in 2005 than 2004 34 x $56,000 = $1,904,000 in savings * O’Grady NP. Alexander M, Dellinger EP, et al: Guidelines for the prevention of intravascular catheter-related infections. MM/WR Recomm Rep; 2002 51(RR-10): 1-29

9. Next Steps  In January, 2006 resume routine catheter line related bloodstream surveillance in ICUs based on the current schedule of ICU monitoring.  Present data at adult ICU Quality Improvement meetings for discussion.  Investigate the process of insertion and maintenance of central lines on patients who had infections and make improvements in practice as needed.