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Healthcare reform is driving the hospital industry’s focus on elimination of patient harm and optimal patient outcome realization. Programs caring for highly immune compromised bone marrow transplant (BMT) patients are especially challenged, a result of the population’s extreme infection vulnerability, a leading cause of death in this population. Often, these infections are associated with the presence of a central line.
Over the past two years, central line associated blood stream infection (CLABSI) rates have doubled in our BMT unit. Prior to the increase, the unit realized historically low rates for several years. Consequently, improvement efforts were executed by bedside nurses. Evidence based practices including those from the Centers for Disease Control & Society for Healthcare Epidemiology were applied.
Methods, Intervention, & Analysis
A nursing led multidisciplinary approach utilizing improvement methodology was implemented. Key learnings from process and outcome failure analysis were utilized in developing and testing interventions targeted at meeting the BMT population's special needs. Efforts guided by key drivers included pre-occupation with failure and ongoing sensitivity to system and process integrity.
Process and outcome metrics were continuously monitored. Monthly CLABSI rate control charts were reviewed along with weekly central line care practice compliance data.
Findings & Interpretation
Learnings from failures led to new line securement methods minimizing contamination risk and a two nurse dressing change process. Feedback on the peer to peer coaching occurring throughout the complex contamination risk laden dressing change process has been positive.
Ongoing process integrity sensitivity illustrated the importance of system stabilization, including the reincorporation of abandoned practices previously proven crucial to CLABSI reduction. Intervention minimization promoting process stability is equally crucial. Subsequently, interventions that enhance and don’t directly change line care processes were adopted including daily chlorhexidine baths.
Overall impact is being realized. CLABSI rates have decreased 12% over the last year from 2.04 infections/1000 line days to 1.8 infections/1000 line days, well below the national rate of 2.8 infections.
Discussion & Implications
CLABSI rate reduction will continue to be pursued including research on mucosal barrier injury associated and secondary infection reduction. Improvement methodologies can easily be adapted to spread successful processes to programs experiencing similar challenges in their CLABSI reduction efforts.