Sustaining the Gain: A Units Quest to Maintain Significant Catheter Associated Blood Stream Infection (CA-BSI) Rate Reductions

Healthcare reform is nationally charging patient safety initiatives including eliminating catheter associated blood stream infections (CA-BSI).  Historically, a mid-west pediatric institution’s highest CA-BSI rates resided on the Bone Marrow Transplant (BMT) Unit housing the most severely immune compromised patients. The complex 24 bed critical care unit performs over 90 transplants annually with over 70% being allogeneic. In 2006, BMT’s CA-BSI rates reached a high of 6.35 infections per 1,000 catheter days.   

Initially, a CA-BSI maintenance bundle developed in the intensive care unit was introduced.  During the first year, a 32% CA-BSI rate reduction occurred. 

A multidisciplinary approach utilizing quality improvement methodology was implemented.   Key drivers, conditions creating the ideal state for project success, were established and guided subsequent interventions via a Plan, Do, Study, Act model.  Ongoing interventions addressed unique challenges of a highly immune compromised population leading to the “Supercharged Maintenance Bundle.” formation. Over the next two years, an additional 60% rate reduction was realized leading to a 1.98 infection rate . 

Further interventions generated by a national pediatric immune compromised patient focused collaborative resulted in 0.64 infections for FY11, an additional 50% two year decline. 

FY12 resulted in an increased rate of 0.88 infections further challenging the quest to sustain gains and eliminate CA-BSI. Continued multidisciplinary approaches focusing on high reliability concepts are essential to sustainability. Specifically, preoccupation with failure accompanied by an in-depth infection analysis providing lessons learned help continually generate heightened awareness to those identified risk factors and associated preventative strategies. These actions lead by the bedside nurse, fuel the awareness and commitment of all caring for a highly complex and vulnerable patient population leading to the current 0.61 infections rate. 

FY	Infections per 1000 Line Days
2005	5.45
2006	6.35
2007	4.83
2008	4.31
2009	1.98
2010	1.68
2011	0.64
2012 Annual Cumulative	.88  0.61 (9/11-8/12)