QAPI 153 - Scrub Away the CLABSI: A Visual Aide for Infection Reduction

Background: Scrub the Hub (STH) is a Centers for Disease Control and Prevention and The Joint Commission recommendation for central line associated blood stream infection (CLABSI) reduction. Decontamination of vascular access devices (VAD) reduces biofilm formation and risk of VAD contamination. Oncology populations are at increased risk of CLABSI due to their limited immune response and need for VAD. How can the implementation of a visual aide enhance healthcare worker's (HCW) adherence to proper VAD scrubbing protocols and ultimately reduce the incidence of CLABSI?

Methods: The STH clock was developed with demarcations of 5 and 15 seconds that correspond to the disinfection times recommended by the manufacturer of the two prep pads available in the facility. Staff were assessed on their knowledge of STH technique, and education followed on correct scrub and dry times and how to implement the clock into the workflow. Clock borders were installed in each patient room. CLABSI surveillance was performed pre- and post- intervention using National Healthcare Safety Network (NHSN) definitions and incidence density rates (IDR) were calculated with the NHSN statistics calculator.

Results: The pre-intervention IDR was 10 infections in 9185 central line (CL) days. The post-intervention IDR was 1 infection in 3410 CL days; a decrease from 1.09 infections per 1000 CL days to 0.29 infections per 1000 CL days, a 73.4% decrease (IDR p-value of 0.1887). Control chart plots of pre and post IDR showed special cause in the post-intervention period with zero infections in the post intervention 10-month run.

Conclusions: The successful outcome of this project found that providing HCWs with a visual reminder of the best practice of scrubbing the hub can decrease CLABSI in a vulnerable population. This initiative has been presented at the Shared Governance Quality & Performance Improvement Council with plans to implement hospital-wide and across the five-hospital healthcare system.