Clabsi Reduction: No Longer Just an Inpatient Initiative

Significance and Background

BMT patients are frequently discharged to outpatient care with a central line catheter in place.  These patients are at increased risk for developing a central line- associated bloodstream infection (CLABSI).  A review of literature and comparison CLABSI rates showed a paucity of studies in the outpatient population. An outpatient who develops a CLABSI usually requires admission to the hospital, where treatment costs may range from $35,000-53,000.  CLABSI surveillance began in January 2009 for our outpatient BMT population utilizing the same NHSN definition used for inpatients.  An analysis of data collected over 18 months prompted nursing staff to implement a plan to target reduction of CLABSIs.   

Interventions

BMT Treatment Center nurses were educated on CLABSI, current rates, and implications for patients as well as the department.  The nurses researched ways to reduce CLABSIs and developed a post-insertion bundle for central line care utilizing CDC CLABSI prevention strategies and other evidence-based practices. Patient education materials were developed and a post-line insertion patient education plan was initiated.  Nursing compliance with the bundle is continually monitored by retrospective reviews of central line charting, monthly central line audits, and review of electronic patient education tools.  CLABSI surveillance is ongoing with an in-depth review of all CLABSIs for defects in nursing care.   

Results

The 18 month pre-bundle CLABSI rate was 1.66 per 1000 patient visits.  The 18 month post-bundle rate fell to 0.88 per 1000 patient visits.  The actual number of CLABSIs fell by 30.  This resulted in 30 fewer hospital admissions and a minimal savings of over $1,000,000 dollars to the facility.  Specifically, the number of coagulase- negative staph infections, frequently associated with indwelling devices, dropped from 32 pre bundle to 7 post bundle implementation.  Nursing compliance with CLABSI prevention strategies continues to be well over 90%.