REDUCING CLABSI

RATES
Taylor Brashears, Kellie Jones, Ashley Haugen, Kristianna Deblasio, Dina Spahic, Malek Saleh
University of South Florida
College of Nursing
CLABSI Statistics
◦ 41,000 CLABSI cases each year1
◦ Most costly HAI
◦ About $46,000 per case2
◦ Lengthens hospital stay by 10.4 days on average3
◦ Hospitals are not reimbursed for care provided to a patient who contracts an HAI3
◦ Vast majority of cases are preventable through proper aseptic techniques,
surveillance, and management strategies4
◦ Pathogenesis
◦ Gram positive organisms4
◦ 34.1% Coagulase-negative staphylococci, 16% Enterococci, 9.9% Staphylococcus aureus
◦ Gram negative organisms4
◦ 5.8% Klebsiella, 3.9% Enterobacter, 3.1% Psuedomonas
Proposed Change
◦ A decrease in CLABSI cases result in a decrease of forfeited money,
due to non-reimbursement, medications, supplies, surveillance,
laboratory work, and any other necessary interventions used to
treat a CLABSI patient
◦ As a result, it is proposed that specific guidelines be set forth and
followed during the insertion period and post-insertion period in
order to significantly reduce the risks and occurrences of CLABSI
Plan – Do – Study – Act
◦ Objective: Reduce the CLABSI rate
◦ Prediction: CLABSI rates will be reduced by 43%5
◦ Insertion Bundle:5
◦ Guidelines explaining interventions to be performed during the time period before insertion
leading up to the actual insertion of the central line
◦ Maintenance Bundle:5
◦ Guidelines explaining interventions to be performed after the central line has been inserted
Plan – Do – Study – Act
◦ Insertion Bundle5
◦ Wash hands before the procedure
◦ For all children aged more than 2 months, use chlorhexidine gluconate to scrub the insertion
site for 30 seconds for all areas except the groin, which should be scrubbed for 2 minutes.
Scrubbing should be followed by 30 to 60 seconds of air drying.
◦ No iodine skin prep or ointment is used at the insertion site.
◦ Prepackage or fill the insertion cart, tray, or box, including full sterile barriers.
◦ Create an insertion checklist, which empowers staff to stop a non-emergent
◦ procedure if it does not follow sterile insertion practices.
◦ Use only polyurethane or Teflon catheters
◦ Conduct insertion training for all care providers, including slides and video.
Plan – Do – Study – Act
◦ Maintenance Bundle5
◦ Assess daily whether catheter is needed.
◦ Catheter-site care
◦ No iodine ointment.
◦ Use a chlorhexidine gluconate scrub to sites for dressing changes(30-second scrub, 30-second air-dry).
◦ Change gauze dressings every 2 days unless they are soiled, dampened, or loosened.
◦ Change clear dressings every 7 days unless they are soiled, dampened, or loosened
◦ Use a prepackaged dressing-change kit or supply area.
◦ Catheter hub, cap, and tubing care
◦ Replace administration sets, including add-on devices, no more frequently than every 72 hours unless they are
soiled or suspected to be infected.
◦ Replace tubing that is used to administer blood, blood products, or lipids within 24 hours of initiating infusion.
◦ Change caps no more often than72hour s(or according to manufacturer recommendations); however, caps
should be replaced when the administration set is changed.
◦ Use the prepackaged cap-change kit, or supply area elements to be designated by the local institution.
Plan – Do – Study – Act
◦ Evaluate:
◦ Determine the number of CLABSIs that occur at the prospective hospital unit for the
implementation of the change
◦ Determine the healthcare provider’s beliefs and attitudes towards CLABSIs and the effect the
proposed change will have
◦ Educate:
◦ Teach the doctors who perform the insertion of central lines the Insertion Bundle5
◦ Evaluate understanding and willingness to comply
◦ Teach the nurses and healthcare providers who perform care of central lines the Maintenance
Bundle5
◦ Evaluate understanding and willingness to comply
Plan – Do – Study – Act
◦ Engagement:
◦ Develop a Leadership Team to:6
◦ Work with staff to overcome barriers
◦ Interface with frontline staff during multidisciplinary rounds, staff meetings, or educational programs
◦ Ensure that there is a culture of safety at the unit and organizational level
◦ Implement Culture of Safety6
◦ Collaboration among staff at all levels of the organization in seeking solutions to patient safety issues
◦ Recognition of the high-risk nature of an organization’s activities and the desire to maintain consistently
safe operations
◦ Blame-free environment that encourages staff to report errors or close calls
◦ Implementation of Insertion Bundle and Maintenance Bundle5
◦ Data collection, feedback, and documentation of CLABSI rates6
◦ Insertion of Central Line Checklist
◦ Daily Central Line Maintenance Checklist7
Plan – Do – Study – Act
◦ During and 3 months following implementation of the Insertion Bundle and the
Maintenance Bundle:
◦ Determine the number of CBLASIs that occur
◦ Compare with the rate before implementation
◦ Compare with the predicted reduction rate
◦ Analyze the Insertion of Central Line Checklist
◦ Determine whether or not the Insertion Bundle was completed thoroughly
◦ Analyze the Daily Central Line Maintenance Checklists
◦ Determine whether or not the Maintenance Bundle was completed thoroughly daily
◦ Analyze the cost benefits, if any, associated with implementing the bundles
◦ Based upon the results, alterations in the bundles may be made to achieve optimal success in
prevention CLABSI rates
Plan – Do – Study – Act ✔
◦ Implementation of the Insertion and Maintenance Bundle throughout the hospital
◦ Education, training, and competency assessment resources for health care personnel on
Insertion Bundle and Maintenance Bundle6
◦ Insertion of Central Line Checklist and Daily Central Line Maintenance Checklists made
readily available to all those involved with the insertion and care of central lines
◦ Necessary supplies and equipment, conveniently located or packaged in supply carts
or kits6
References
1. Ullman, A., Marsh, N., Mihala, G., Cooke, M., & Rickard, C. (2015). Complications of
central venous access devices: A systematic review. American Academy of Pediatrics.,
136(5). Retrieved from http://pediatrics.aappublications.org/content/136/5/e1331.long
2. Zimlichman, E., Henderson, D., Tamir, O., et al. (2013). Health care–associated
infections: A meta-analysis of costs and financial impact on the US health care
system. JAMA Intern Med.,173(22):2039–2046. doi:10.1001/jamainternmed.2013.9763
3. Becker’s Hospital Review. (2015). How HAIS lead to direct, indirect, and unintended
hospital costs. Retrieved from https://www.beckershospitalreview.com/quality/how-hais-
lead-to-direct-indirect-and-unintended-hospital-costs.html
4. Haddadin Y., & Regunath H. (2018). Central line associated blood stream infections
(CLABSI). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK430891/
References (continued)
5. The Joint Commission. (2013). CVC maintenance bundles. Retrieved from
https://www.jointcommission.org/assets/1/6/CLABSI_Toolkit_Tool_3-
22_CVC_Maintenance_Bundles.pdf
6. The Joint Commission. (2013). Overview of factors affecting the success of
improvement initiatives. Retrieved from
https://www.jointcommission.org/assets/1/6/CLABSI_Toolkit_Tool_4-
1_Overview_of_Factors_Affecting_the_Success_of_Improvement_Initiatives.pdf
7. The Joint Commission. (2013). Daily central line maintenance checklist. Retrieved from
https://www.jointcommission.org/assets/1/6/CLABSI_Toolkit_Tool_3-
23_Daily_Central_Line_Maintenance_Checklist_-_Template.pdf