Reducing Central Line Associated Bloodstream Infections (CLABSIs) by Reducing Central Line Days

Background Central line-associated bloodstream infections (CLABSIs) are preventable complications that pose a significant health risk to patients and place a financial burden on hospitals. Central line simulation-based education (SBE) efforts vary widely in the literature. The aim of this study was to perform a value analysis of published central line SBE and develop a refined method of studying central line SBE. Methods A database search of PubMed Central and Cumulative Index to Nursing and Allied Health Literature (CINAHL) was performed for articles mentioning “Cost and CLABSI,” “Cost and Central line Associated Bloodstream Infections,” and “Cost and Central Line” in their abstract and article body. Articles chosen for qualitative synthesis mentioned “simulation” in their abstract and article body and were analyzed based on the following criteria: infection rate before vs. after SBE, cost of simulation, SBE design including simulator model used, and learner analysis. Results Of 215 articles identified, 23 were analyzed, 10 (43.48%) discussed cost of central line simulation with varying criteria for cost reporting, 8 (34.8%) numerically discussed central line complication rates (7 CLABSIs and 1 pneumothorax), and only 3 (13%) discussed both (Figure). Only 1 addressed the true cost of simulation (including space rental, equipment startup costs, and faculty salary) and its longitudinal effect on CLABSIs. Conclusion Current literature on central line SBE efforts lacks value propositions. Due to the lack of value-based data in the area of central line SBE, the authors propose a cost reporting standard for use by future studies reporting central line SBE costs.

Download Full-text

Pathogens Associated With Repeat Versus Single Central-Line–Associated Bloodstream Infections, Acute-Care Hospitals, NHSN

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.956 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s343-s344

Author(s):

Margaret A. Dudeck ◽

Katherine Allen-Bridson ◽

Jonathan R. Edwards

Keyword(s):

Acute Care ◽

National Level ◽

Bloodstream Infections ◽

Acute Care Hospitals ◽

Central Line ◽

Patient Specific ◽

Healthcare Associated Infections ◽

Healthcare Associated ◽

Repeat Infection ◽

Single Versus

Background: The NHSN is the nation’s largest surveillance system for healthcare-associated infections. Since 2011, acute-care hospitals (ACHs) have been required to report intensive care unit (ICU) central-line–associated bloodstream infections (CLABSIs) to the NHSN pursuant to CMS requirements. In 2015, this requirement included general medical, surgical, and medical-surgical wards. Also in 2015, the NHSN implemented a repeat infection timeframe (RIT) that required repeat CLABSIs, in the same patient and admission, to be excluded if onset was within 14 days. This analysis is the first at the national level to describe repeat CLABSIs. Methods: Index CLABSIs reported in ACH ICUs and select wards during 2015–2108 were included, in addition to repeat CLABSIs occurring at any location during the same period. CLABSIs were stratified into 2 groups: single and repeat CLABSIs. The repeat CLABSI group included the index CLABSI and subsequent CLABSI(s) reported for the same patient. Up to 5 CLABSIs were included for a single patient. Pathogen analyses were limited to the first pathogen reported for each CLABSI, which is considered to be the most important cause of the event. Likelihood ratio χ2 tests were used to determine differences in proportions. Results: Of the 70,214 CLABSIs reported, 5,983 (8.5%) were repeat CLABSIs. Of 3,264 nonindex CLABSIs, 425 (13%) were identified in non-ICU or non-select ward locations. Staphylococcus aureus was the most common pathogen in both the single and repeat CLABSI groups (14.2% and 12%, respectively) (Fig. 1). Compared to all other pathogens, CLABSIs reported with Candida spp were less likely in a repeat CLABSI event than in a single CLABSI event (P < .0001). Insertion-related organisms were more likely to be associated with single CLABSIs than repeat CLABSIs (P < .0001) (Fig. 2). Alternatively, Enterococcus spp or Klebsiella pneumoniae and K. oxytoca were more likely to be associated with repeat CLABSIs than single CLABSIs (P < .0001). Conclusions: This analysis highlights differences in the aggregate pathogen distributions comparing single versus repeat CLABSIs. Assessing the pathogens associated with repeat CLABSIs may offer another way to assess the success of CLABSI prevention efforts (eg, clean insertion practices). Pathogens such as Enterococcus spp and Klebsiella spp demonstrate a greater association with repeat CLABSIs. Thus, instituting prevention efforts focused on these organisms may warrant greater attention and could impact the likelihood of repeat CLABSIs. Additional analysis of patient-specific pathogens identified in the repeat CLABSI group may yield further clarification.Funding: NoneDisclosures: None

Download Full-text

A Decade in Trying to Increase Hand Hygiene—Finally Success

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.592 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s93-s94

Author(s):

Linda Huddleston ◽

Sheila Bennett ◽

Christopher Hermann

Keyword(s):

Hand Hygiene ◽

Hand Hygiene Compliance ◽

Compliance Rate ◽

Bloodstream Infections ◽

Central Line ◽

Second Phase ◽

Two Phase ◽

Hygiene Compliance ◽

Tract Infections ◽

The Voice

Background: Over the past 10 years, a rural health system has tried 10 different interventions to reduce hospital-associated infections (HAIs), and only 1 intervention has led to a reduction in HAIs. Reducing HAIs is a goal of nearly all hospitals, and improper hand hygiene is widely accepted as the main cause of HAIs. Even so, improving hand hygiene compliance is a challenge. Methods: Our facility implemented a two-phase longitudinal study to utilize an electronic hand hygiene reminder system to reduce HAIs. In the first phase, we implemented an intervention in 2 high-risk clinical units. The second phase of the study consisted of expanding the system to 3 additional clinical areas that had a lower incidence of HAIs. The hand hygiene baseline was established at 45% for these units prior to the voice reminder being turned on. Results: The system gathered baseline data prior to being turned on, and our average hand hygiene compliance rate was 49%. Once the voice reminder was turned on, hand hygiene improved nearly 35% within 6 months. During the first phase, there was a statistically significant 62% reduction in the average number of HAIs (catheter associated urinary tract infections (CAUTI), central-line–acquired bloodstream infections (CLABSIs), methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant organisms (MDROs), and Clostridiodes difficile experienced in the preliminary units, comparing 12 months prior to 12 months after turning on the voice reminder. In the second phase, hand hygiene compliance increased to >65% in the following 6 months. During the second phase, all HAIs fell by a statistically significant 60%. This was determined by comparing the HAI rates 6 months prior to the voice reminder being turned on to 6 months after the voice reminder was turned on. Conclusions: The HAI data from both phases were aggregated, and there was a statistically significant reduction in MDROs by 90%, CAUTIs by 60%, and C. difficile by 64%. This resulted in annual savings >$1 million in direct costs of nonreimbursed HAIs.Funding: NoneDisclosures: None

Download Full-text

Temporal Changes in Central-Line–Associated Bloodstream Infection Time Between Events, 2017–2018 Versus 2015–2016

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1051 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s403-s404

Author(s):

Jonathan Edwards ◽

Katherine Allen-Bridson ◽

Daniel Pollock

Keyword(s):

Length Of Stay ◽

Patient Care ◽

Average Length ◽

Bloodstream Infections ◽

Central Line ◽

Significant Shift ◽

Care Hospital ◽

Average Length Of Stay ◽

Period 2 ◽

Hospital Bed

Background: The CDC NHSN surveillance coverage includes central-line–associated bloodstream infections (CLABSIs) in acute-care hospital intensive care units (ICUs) and select patient-care wards across all 50 states. This surveillance enables the use of CLABSI data to measure time between events (TBE) as a potential metric to complement traditional incidence measures such as the standardized infection ratio and prevention progress. Methods: The TBEs were calculated using 37,705 CLABSI events reported to the NHSN during 2015–2018 from medical, medical-surgical, and surgical ICUs as well as patient-care wards. The CLABSI TBE data were combined into 2 separate pairs of consecutive years of data for comparison, namely, 2015–2016 (period 1) and 2017–2018 (period 2). To reduce the length bias, CLABSI TBEs were truncated for period 2 at the maximum for period 1; thereby, 1,292 CLABSI events were excluded. The medians of the CLABSI TBE distributions were compared over the 2 periods for each patient care location. Quantile regression models stratified by location were used to account for factors independently associated with CLABSI TBE, such as hospital bed size and average length of stay, and were used to measure the adjusted shift in median CLABSI TBE. Results: The unadjusted median CLABSI TBE shifted significantly from period 1 to period 2 for the patient care locations studied. The shift ranged from 20 to 75.5 days, all with 95% CIs ranging from 10.2 to 32.8, respectively, and P < .0001 (Fig. 1). Accounting for independent associations of CLABSI TBE with hospital bed size and average length of stay, the adjusted shift in median CLABSI TBE remained significant for each patient care location that was reduced by ∼15% (Table 1). Conclusions: Differences in the unadjusted median CLABSI TBE between period 1 and period 2 for all patient care locations demonstrate the feasibility of using TBE for setting benchmarks and tracking prevention progress. Furthermore, after adjusting for hospital bed size and average length of stay, a significant shift in the median CLABSI TBE persisted among all patient care locations, indicating that differences in patient populations alone likely do not account for differences in TBE. These findings regarding CLABSI TBEs warrant further exploration of potential shifts at additional quantiles, which would provide additional evidence that TBE is a metric that can be used for setting benchmarks and can serve as a signal of CLABSI prevention progress.Funding: NoneDisclosures: None

Download Full-text

Comparison of Metrics Used to Track CLABSIs and CAUTIs Across a Regional Network

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.710 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s178-s179

Author(s):

Sonali Advani ◽

Becky Smith ◽

Jessica Seidelman ◽

Nicholas Turner ◽

Christopher Hostler ◽

...

Keyword(s):

Negative Correlation ◽

Urine Culture ◽

Bloodstream Infections ◽

Central Line ◽

Regional Network ◽

Community Hospitals ◽

Scatter Plots ◽

Preventable Harm ◽

Device Use ◽

Tract Infections

Background: The standardized infection ratio (SIR) is the nationally adopted metric used to track and compare catheter-associated urinary tract infections (CAUTIs) and central-line– associated bloodstream infections (CLABSIs). Despite its widespread use, the SIR may not be suitable for all settings and may not capture all catheter harm. Our objective was to look at the correlation between SIR and device use for CAUTIs and CLABSIs across community hospitals in a regional network. Methods: We compared SIR and SUR (standardized utilization ratio) for CAUTIs and CLABSIs across 43 hospitals in the Duke Infection Control Outreach Network (DICON) using a scatter plot and calculated an R2 value. Hospitals were stratified into large (>70,000 patient days), medium (30,000–70,000 patient days), and small hospitals (<30,000 patient days) based on DICON’s benchmarking for community hospitals. Results: We reviewed 24 small, 11 medium, and 8 large hospitals within DICON. Scatter plots for comparison of SIRs and SURs for CLABSIs and CAUTIs across our network hospitals are shown in Figs. 1 and 2. We detected a weak positive overall correlation between SIR and SUR for CLABSIs (0.33; R2 = 0.11), but no correlation between SIR and SUR for CAUTIs (−0.07; R2 = 0.00). Of 15 hospitals with SUR >1, 7 reported SIR <1 for CLABSIs, whereas 10 of 13 hospitals with SUR >1 reported SIR <1 for CAUTIs. Smaller hospitals showed a better correlation for CLABSI SIR and SUR (0.37) compared to medium and large hospitals (0.19 and 0.22, respectively). Conversely, smaller hospitals showed no correlation between CAUTI SIR and SUR, whereas medium and larger hospitals showed a negative correlation (−0.31 and −0.39, respectively). Conclusions: Our data reveal a weak positive correlation between SIR and SUR for CLABSIs, suggesting that central line use impacts CLABSI SIR to some extent. However, we detected no correlation between SIR and SUR for CAUTIs in smaller hospitals and a negative correlation for medium and large hospitals. Some hospitals with low CAUTI SIRs might actually have higher device use, and vice versa. Therefore, the SIR alone does not adequately reflect preventable harm related to urinary catheters. Public reporting of SIR may incentivize hospitals to focus more on urine culture stewardship rather than reducing device utilization.Funding: NoneDisclosures: None

Download Full-text

Reduction of Central-Line–Associated Bloodstream Infections in a Spinal Cord Injury Unit

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.998 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s370-s370

Author(s):

Stephanie L. Baer ◽

Amy Halcyon Larsh ◽

Annalise Prunier ◽

Victoria Thurmond ◽

Donna Goins ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Patient Population ◽

Bloodstream Infections ◽

Central Line ◽

Fiscal Year ◽

Improvement Project ◽

Central Lines ◽

Cord Injury ◽

Bundle Compliance

Background: Central-line–associated bloodstream infections (CLABSIs) are a complication of indwelling central venous catheters, which increase morbidity, mortality, and cost to patients. Objective: Due to increased rates in a spinal cord injury unit (SCIU), a performance improvement project was started to reduce CLABSI in the patient population. Methods: To reduce the incidence of CLABSI, a prevention bundle was adopted, and a peer-surveillance tool was developed to monitor compliance with the bundle. Staff were trained to monitor their peers and submit weekly surveillance. Audits were conducted by the clinical nurse leader with accuracy feedback. Bundle peer-surveillance was implemented in February of 2018 with data being fed back to leadership, peer monitors, and stakeholders. Gaps in compliance were addressed with peer-to-peer education, changes in documentation requirements, and meetings to improve communication and reduce line days. In addition, the use of an antiseptic-impregnated disc for vascular accesses was implemented for dressing changes. Further quality improvement cycles during the first 2 quarters of fiscal year 2019 included service-wide education reinforcement, identification in variance of practice, and reporting to staff and stakeholders. Results: CLABSI bundle compliance increased from 67% to 98% between February and October 2018. The weekly audit reporting accuracy improved from 33% to 100% during the same period. Bundle compliance was sustained through the fourth quarter of 2019 at 98%, and audit accuracy was 99%. The initial CLABSI rates the quarter prior to the intervention were 6.10 infections per 1,000 line days for 1 of the 3 SCIUs and 2.68 infections per 1,000 line days for the service overall. After the action plan was initiated, no CLABSIs occurred for the next 3 quarters in all SCIUs despite unchanged use of central lines (5,726 line days in 2018). The improvement was sustained, and the line days decreased slightly for 2019, with a fiscal year rate of 0.61 per 1,000 line days (ie, 3 CLABSIs in 4,927 central-line days). Conclusions: The incidence of CLABSI in the SCIU was reduced by an intensive surveillance intervention to perform accurate peer monitoring of bundle compliance with weekly feedback, communication, and education strategies, improvement of the documentation, and the use of antiseptic-impregnated discs for dressings. Despite the complexity of the patient population requiring long-term central lines, the CLABSI rate was greatly impacted by evidence-based interventions coupled with reinforcement of adherence to the bundle.Funding: NoneDisclosures: None

Download Full-text