Background: Central line associated bloodstream infections (CLABSI) are preventable hospital-acquired infections associated with increased morbidity and mortality, and cost. CLABSIs are the most expensive healthcare associated infection (HAI) with a cost upwards of 90,000perinfection.Thiscostdoesnotaccountforincreasedlengthofstayorfuturereadmissions.ThecriteriausedtodefineCLABSIsinanacutecaresettingisbasedontheCentersforDiseaseControlandPrevention’sNationalHealthcareSafetyNetwork(NHSN)definitions.Aninfectionwindowperiod(IWP)isusedtoreviewinfectioncriteriatomeetthesurveillancedefinition.Thisisdefinedasa7dayperiod,whichincludesthe3calendardaysbeforeandafterthefirstpositivediagnostictest(Table1).Ifnosecondarysourcesareidentifiableasacauseofthebloodstreaminfection(BSI)withintheIWP,itwillqualifyasaCLABSIbasedontheNHSNdefinition.Healthcareorganizationsareencouragedtoadheretoevidencebasedcentralline(CL)insertionandmaintenancepracticestoreduceinfection,whichinclude:AdherencetohandhygienepracticesInsertionbundlesMaintenancebundlesRemovalofCLwhentheyarenolongerindicatedDespiteimprovedcompliancewiththeseinfectionpreventioninterventions,thesurgicalintensivecareunit(SICU)atHenryFordHospital(HFH)continuedtoexperiencehighCLABSIratesin2019and2020.Aims:Usinganinterprofessionalproactiveapproach,thisproject2˘7sgoalwastoreducethenumberofNHSNreportableCLABSIsbyidentifyingatriskpatientsandclinicallyassessingforalternativeinfectionsources.Methods:AninterprofessionalteamformedtobetterunderstandtheoccurrenceofCLABSIonthesurgicalintensivecareunit(SICU).Theteamincluded:UnitMedicalDirectorInfectionPreventionSpecialistClinicalNurseSpecialistMultipleopportunitieswereidentifiedwhenreviewingrootcauseanalysisdata:CareteamdocumentationAssessmentsforalternativeinfection.VerificationofbloodcultureindicationfollowingHFHBloodCultureStewardshipGuidelinesIRBapprovalandawaiverofinformedconsentwereobtained.Theinterprofessionalteam(Figure1):CompleteddailychartauditsonpatientswithcentralaccessScreenedpatientsforbloodculturecollectionandresultstatusVerifiedbloodcultureindicationusingtheHFHBloodCultureStewardshipGuidelinesEstablishedanIWPandreviewedmedicalrecordforinfectionsourceoncebloodcultureswerecollectedSharedfindingswithinterprofessionalteamviasecuremessagingCommunicatedpotentialgapswiththepatientcareteams,whichincludedcollaborativeeffortsregardingthetreatmentplanandproperdocumentationofclinicalfindingsThisproactiveapproachensuredsupportingevidencewaspresenttomeetNHSNdefinitionsforsecondaryBSItoavoidCLABSIsThisquasiexperimentalretrospectivestudycompareddatafromthepreinterventionperiod(January2019toJanuary2021)totheinterventionperiod(March2021toDecember2022):CLABSIrateper1,000CLdaysBloodcultureorderrateper1,000CLdaysCLutilizationratioper1,000patientdaysStandardizedinfectionratioThettestwasusedtocomparethecontinuousvariablesandwasdeterminedstatisticallysignificantifP3˘c0.05.AllanalyseswereperformedusingIBMSPSSStatistics(Version29;Armonk,NY).Results:Afterimplementation,theinterprofessionalteamidentifiedalternativesourcesofbloodstreaminfectionin37patients(17in2021and20in2022)withqualifyingcentralaccessandpositivebloodculture.Whencomparingpreandpostinterventionperiods,significantreductionsweremade(seeTable2).Thisincludedan821.6 million difference in healthcare costs.
Discussion: This project demonstrates that an interpersonal team reviewing potential CLABSIs and identifying alternative sources of BSI can decrease CLABSI rates, improve patient management and lead to better outcomes. In addition to being a safe and effective approach, this intervention had the additional benefit of cost savings for the health system. Healthcare institutions should consider implementing this intervention to reduce unnecessary CLABSI rates, as well as cost.https://scholarlycommons.henryford.com/nursresconf2023/1001/thumbnail.jp