QAPI 138 - Increased Compliance with Patient Hygiene Process Measures Reduced Central Line-associated Bloodstream Infection Standardized Infection Ratios

Background: At a mid-sized tertiary care community hospital, central line-associated bloodstream infection (CLABSI) standardized infection ratios (SIR) increased 6-fold in 2022 compared to 2018. Detailed contributing factor analysis (CFA) was performed on CLABSI cases from Jan. 2021-Aug. 2022 and identified opportunities for improvement in central line maintenance and patient hygiene practices.

Methods: A multi-disciplinary team, composed of infection prevention, process improvement and nursing management from affected units, identified nursing-sensitive indicators from the CFA as high priority targets for intervention. A back-to-basics approach was used with goals to increase documentation of central line maintenance bundle elements along with improving rates of patient daily bathing practices. Actions taken included increasing the frequency of rounding on patients with central lines and providing real-time feedback to nursing staff, formalizing communication among caregivers and standardizing products and protocols used for central line maintenance and daily patient hygiene. The National Healthcare Safety Network facility-wide SIR was used to determine overall effectiveness of interventions.

Results: Since implementing this program, documentation of CLABSI bundle elements has increased and daily patient hygiene practices have improved. Documentation of bathing and chlorhexidine gluconate (CHG) treatment for patients with central lines increased from < 20% to over 60%. The facility-wide SIR for CLABSI has dropped to 0.0, with no CLABSIs identified since July 2022.

Conclusions: A multipronged approach to CLABSI reduction including consistent rounding and review of patients with central lines with special emphasis on CLABSI prevention basics, standardization of products and protocols, and adherence to best practices for central line maintenance and patient hygiene resulted in increased awareness by nursing staff of CLABSI prevention measures. This led to increased charted documentation and increased daily patient hygiene practices for patients. These measures have resulted in a sustained decrease in CLABSI SIR with no infections acquired by patients in this facility for over 16 months.