QAPI 131 - Impact of Device Standardization to Prevent Hemodialysis Catheter Central Line-associated Bloodstream Infections (HD-CLABSI) in a Large Healthcare System

Background: Data through a large healthcare system identified that one-third of CLABSI cases correlated to patients with HD catheters. HD-CLABSI reduction strategies include protecting lumens and preventing non-dialysis care access. Products to protect lumens varied from non-antimicrobial caps, to gauze wrap.

Methods: An antimicrobial barrier cap specific for dialysis lines was implemented over 12 months, in adult acute care units. Phased implementation supported user education, adoption, and product availability. A software training module and virtual coaching calls provided education.
CLABSI events were sourced from the National Healthcare Safety Network (NHSN). An experienced and dedicated centralized abstraction team documented CLABSI NHSN events. Nursing documented dialysis catheters from the electronic medical record.
Product use was monitored via the supply chain department.

Results: Overall CLABSI events decreased by 33% and HD CLABSI events decreased by 14% in 2022 vs 2021. Total CLABSI events decreased by 22%, and HD CLABSI events decreased by 19% for 1st through the 3rd quarter of 2023 vs 2022. The standardized infection ratio (SIR) was reduced by 23% in 2022 vs 2021 and by 17% in the 1st through 3rd quarter of 2023 vs 2022.
Post implementation HD-CLABSI cases were sampled and reviewed for another possible primary source. In addition to patients having more than one central vascular catheter accessed, 40% had clinical wounds/pressure injuries, and 50% had clinical pneumonia, which did not meet NHSN criteria for primary infection source.

Conclusions: Device cap standardization reduces patient harm, as evidenced by sustainable clinical outcomes and cost avoidance analysis. The subsequent strategies are to prevent clinical conditions contributing to secondary bacteremia through nursing initiatives by improving foundational patient care, including skin hygiene, early mobility, and focused nutrition.