QAPI 156 - The Addition of Nasal Antiseptic to Universal Decolonization Programs Reduces Central Line Associated Blood Stream Infections in Intensive Care Units

Background: Central line-associated bloodstream infections (CLABSI) are a major healthcare burden, causing morbidity, mortality, and substantial costs due to increased lengths of stay and treatment. In 2020 our facility, began to see an increase in CLABSI numbers in critical care patients comparable to national trends. This quality improvement initiative evaluates the effectiveness of incorporating nasal decolonization into an existing skin decolonization protocol to reduce CLABSI and costs within the intensive care unit (ICU) population of an academic medical facility.

Methods: In March 2022, a multidisciplinary team initiated a new intervention for all ICU patients to receive twice daily nasal decolonization with an alcohol-based antiseptic (ABA) upon admission. Body decolonization continued per protocol with antimicrobial wipes. CLABSI numbers and infection rates were calculated pre-and-post implementation to evaluate intervention effectiveness. Baseline data was collected from 2019 until implementation in March 2022. Cost savings were estimated pre-and-post intervention.

Results: Prior to the intervention of nasal decolonization (2019-Februrary 2022), there were 11 total CLABSIs with a total of 7124 central line (CL) days for a calculated rate of 1.54. Post implementation (March 2022-October 2023), there were zero CLABSIs and 3671 CL days for a rate of 0. This decrease in CLABSI was statistically significant (p=0.01, Mid-p exact test at 95% confidence). The associated cost of CLABSI prior to intervention was calculated to be $529,188 ($48,108 per event). The annual estimated savings since the intervention was approximately 176,396, for a total savings of $352,792.

Conclusions: Our study found that universal nasal decolonization is an effective strategy to reduce CLABSIs and associated costs in the ICU population. We found significant reductions in CLABSIs and costs after implementation of an ABA for nasal decolonization. Including an ABA for nasal decolonization as a part of a universal decolonization program is a meaningful infection prevention intervention for ICU patients.