A Novel Five-tier Approach to Reduce Central Line-associated Blood Stream Infections in an Academic Medical Center

Abstract Background Central line-associated bloodstream infections (CLABSI) are one of the leading healthcare-acquired infections (HAI) with significant morbidity and mortality. We aimed to identify risk factors of CLABSI at an academic medical center to determine high-risk populations and target interventions. Methods This is an observational retrospective cohort study at William P. Clements Jr. University Hospital from January 1, 2017 to December 31, 2020. Retrospective chart review was conducted to identify demographics and co-morbidities of hospitalized patients diagnosed with CLABSI as defined by National Healthcare Safety Network (NHSN). Infections due to mucosal barrier injuries were excluded. Means were compared using independent-samples T-test and proportions were compared using chi-square. Results Ninety-three CLABSI events were identified with an increase in the standardized infection ratio from 0.38 in 2017 to 0.74 in 2020 (Figure 1). Bacterial organisms were identified in 71 (76%) cases while fungal organisms were identified in 22 (24%) (Table 2). There was no significant difference in the timing of CLABSI after line insertion (p=0.09) or organism identified (p=0.61) in PICC lines (n=33, 34%) vs all other central lines (n=60, 67%). When comparing immunocompromised patients with CLABSI (n=47, 51%) vs non-immunocompromised (n=46, 50%), there was a significant difference in the indication for line (chemotherapy), but no difference was seen in the number of line days prior to event (p=0.57), line type (p=0.17), or organism identified (p=0.94). Of all CLABSI, 46% (n=43) were in the intensive care unit (ICU) with significantly more Candida species (p=0.018) identified compared to non-ICU patients with CLABSI (n= 50, 54%). Figure 1. CLABSI Rate and SIR from 2017 to 2020 by Quarter Conclusion Candida species were more likely to be found in ICU patients with CLABSI as compared to non-ICU counterparts with further investigation in the ICU population revealing lack of flushing after administration of total parenteral nutrition. Otherwise, this observational cohort of CLABSI events did not identify any difference in immunosuppression status or line type. Given this information, infection prevention efforts will continue to be directed towards proper central line maintenance and removal when no longer indicated. Disclosures All Authors: No reported disclosures

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The Impact of 2015 NHSN Catheter-associated Urinary Tract Infection (CAUTI) Definition Change on Central Line-associated Bloodstream Infection (CLABSI) Rates and CLABSI Prevention Efforts at an Academic Medical Center

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.78 ◽

2018 ◽

Vol 39 (07) ◽

pp. 878-880 ◽

Cited By ~ 1

Author(s):

Sonali D. Advani ◽

Rachael A. Lee ◽

Martha Long ◽

Mariann Schmitz ◽

Bernard C. Camins

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Bloodstream Infection ◽

Medical Center ◽

Academic Medical Center ◽

Bloodstream Infections ◽

Central Line ◽

Academic Medical ◽

The Impact

The 2015 changes in the catheter-associated urinary tract infection definition led to an increase in central line-associated bloodstream infections (CLABSIs) and catheter-related candidemia in some health systems due to the change in CLABSI attribution. However, our rates remained unchanged in 2015 and further declined in 2016 with the implementation of new vascular-access guidelines.Infect Control Hosp Epidemiol 2018;878–880

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Implementing Inter-Professional Approach to Decrease the Incidence of Central Line-Associated Bloodstream Infections (CLABSI) House-Wide in a Large Academic Medical Center

American Journal of Infection Control ◽

10.1016/j.ajic.2018.04.034 ◽

2018 ◽

Vol 46 (6) ◽

pp. S17

Author(s):

Rashida Khalid ◽

Martha Long ◽

Benard C. Camins ◽

Rachael A. Lee

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Bloodstream Infections ◽

Central Line ◽

Academic Medical

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Pitfalls of a Staged Implementation of an Automated Hand Hygiene System: Lessons Learned

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.970 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s353-s353

Author(s):

Lori Sisler ◽

Kathy Nigh

Keyword(s):

Hand Hygiene ◽

Blood Stream Infection ◽

Medical Center ◽

Academic Medical Center ◽

Blood Stream ◽

Central Line ◽

Lessons Learned ◽

Improve Hand Hygiene ◽

Reminder System ◽

Implementation Team

Background: Hand hygiene is the first defense against healthcare-associated infections, yet studies show that adherence to hand hygiene still remains low. An academic medical center selected a beacon-based automated hand hygiene reminder system to improve hand hygiene adherence. Accountability is challenging to enforce without a reliable means to measure hand hygiene adherence. The hospital used secret shoppers to observe hand hygiene adherence. This method captures an estimated 0.5%–1.7% of opportunities and may be influenced by the Hawthorne effect. Methods: In November 2018, a phased trial of an electronic hand hygiene reminder system began in 4 intensive care units (ICUs). The system selected used a badge and beacon technology. The badge identifies each care provider and displays colored lights to show adherence status. Beacons are present on the patient’s bed, soap, and hand sanitizer dispenser. These beacons establish a “patient zone” that captures opportunities for hand hygiene. The specialty beds in the ICUs were supposed to remain on the units. A patient transferring to a lower level of care would be placed on another bed or gurney when leaving the ICU. ICU staff were badged for the system. Results: The phased implementation strategy had challenges with beds, badges, and the system. Despite planning, education, and communication, the beds left the ICU area, so the beaconed beds were outside the ICU, and staff did not always wear their assigned badge. There were issues with the system router as well. Unit leadership and the infection control team worked on processes to get beds back into the units. The implementation team decided to provide badges to staff who regularly worked in the ICU to differentiate from consultation groups that came to the ICU (and were not badged). The system routers were plugged in at various places on the units and had become unplugged so information was not sent for reports. Despite these issues, over the year of implementation, the units did achieve an increase in hand hygiene adherence from 48% to 85%. Collectively, the units achieved a 53% reduction in central-line–associated blood stream infection (CLABSI), reducing infections from 13 to 7 and a 35% reduction in methicillin-resistant Staphylococcus aureus (MRSA), reducing infections from 8 to 3 as defined by the NHSN. Conclusions: When implementing a beacon-based, automated hand hygiene system, staged implementation can be challenging. To avoid these challenges, facility-wide implementation is preferable.Funding: NoneDisclosures: None

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1174. The Impact of Multidisciplinary Central Line Stewardship Program to Decrease CLABSI Rates and Central Line Utilization Rates in an Academic Urban Medical Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1037 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S420-S421

Author(s):

Isha Bhatt ◽

Mohamed Nakeshbandi ◽

Michael Augenbraun ◽

Gwizdala Robert ◽

Michael Lucchesi

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Blood Stream ◽

Central Line ◽

Mandatory Reporting ◽

Incidence Density ◽

Post Intervention ◽

Improvement Project ◽

Stewardship Program ◽

The Impact

Abstract Background Central Line-Associated Blood Stream Infections (CLABSI) is a major healthcare dilemma, contributing to increased morbidity, mortality, and costs. We sought to reduce rates of CLABSI and device utilization by implementing a multidisciplinary Central Line Stewardship Program (CLSP). Methods In July 2017, the CLSP, multidisciplinary quality improvement project, was implemented at an academic medical center to ensure proper indication for all CVCs in the hospital and removal when no longer indicated. A CLSP team of executive leaders and infection preventionists performed daily rounds on all CVCs to review indications and maintenance. Nursing staff reported all CVCs daily. Information Technology modified the electronic health record to require daily physician documentation of CVC placement and indications, and to suggest alternatives to CVC when possible. In the event of a CLABSI, a root cause analysis was conducted within 72 hours, and feedback was shared with the clinical staff. A retrospective review was conducted 18 months before and after CLSP implementation. As a facility in a state with mandatory reporting of hospital-acquired infections, institutional data were readily available through the National Healthcare Safety Network (NHSN). To compare rates of CLABSI and device utilization pre- and post-CLSP, we reviewed the Incidence Density Rate (IDR), the standardized infection ratio (SIR), and standardized utilization ratio (SUR). Data from the NHSN website were analyzed using statistical tools provided by the NHSN analysis module. Two-tailed significance tests were conducted with α set at 0.05. Results Post-CLSP, there was a statistically significant decrease in SIR from 1.99 to 0.885, with risk reduction by 44.3% (P = 0.013, 95% CI 0.226 -0.831). CLABSI IDR per 1000 CVC days declined from 1.84 to 0.886 (P = 0.0213). CVC utilization per 1000 patient-days reduced from 155.08 to 142.35 (P < 0.001). There was also a trend toward fewer PICC line infections post-intervention (17 to 5). Conclusion With this novel CLSP, we achieved a significant reduction in rates of CLABSI and device utilization, suggesting that a multidisciplinary approach can promote sustainable prevention of line-associated infections through dedicated surveillance of CVC indications and maintenance. Disclosures All authors: No reported disclosures.

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Achieving Zero Catheter Related Blood Stream Infections: 15 Months Success in a Community Based Medical Center

Journal of the Association for Vascular Access ◽

10.2309/java.12-4-8 ◽

2007 ◽

Vol 12 (4) ◽

pp. 218-224 ◽

Cited By ~ 26

Author(s):

Sophie A. Harnage

Keyword(s):

Nursing Practice ◽

Blood Stream Infection ◽

Medical Center ◽

Blood Stream ◽

Central Line ◽

Community Based ◽

Blood Stream Infections ◽

Patient Morbidity ◽

Surgical Icu ◽

Inpatient Length Of Stay

Abstract Achieving Zero Catheter Related Blood Stream Infections: 15 Month Success In A Community Based Medical Center. Background and Purpose: Catheter related blood stream infection (CRBSI) is a major cause of patient morbidity, mortality, and cost. Lower CRBSI rates would decrease inpatient length of stay. Project: An innovative central line bundle was developed to reduce CRBSI. An innovative combination of focused nursing practice and product technologies were selected for the bundle and implemented through a defined educational program. Data was collected from thirty-two critical care beds: 16 medical/surgical ICU and 16 Trauma-Neuro ICU beds. Results: From January 2006 thru March 2007 there were Zero occurrences of CRBSI. Over this 15 month period our PICC insertions increased by 103%, and our interventional radiology referral rate decreased to less than 2%. Implications/Conclusions: A multimodality bundle, combining nursing practice interventions and technology can successfully decrease the incidence of CRBSI. While some of the bundle components have not been widely researched and instead are based on theory or accepted clinical practice, the early outcome provides a basis for additional study and refinement. It also invites research into the various components of the bundle to evaluate the effect each separate practice and product lends to its success.

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