Director, Infection Prevention Catawba Valley Health System
Disclosure(s):
Joelle M. Calloway, MSN, RN, CIC: No financial relationships to disclose
Background: Central Line-Associated Bloodstream Infections (CLABSI) result in countless deaths and millions in added healthcare costs each year in the United States. A 258 bed community hospital experienced increased CLABSI rates beginning in 2020 and maintained higher infection rates post-pandemic when compared to pre-pandemic. Additionally, they saw consistently higher than expected utilization of central lines each quarter per the National Healthcare Safety Network (NHSN) Standardized Utilization Ratio (SUR). As a focused improvement effort, senior leadership supported a proposal submitted by leadership from the Critical Care Unit and Infection Prevention to implement a dedicated Vascular Access Team (VAT) to manage insertion and maintenance of adult Peripherally Inserted Central Catheters (PICC) and midline catheters.
Methods: Registered Nurses (RN) were hired and the VAT was implemented in September of 2022 with three areas of focus: Reduction in CLABSI, Reduction in device utilization for central lines through appropriate line placement, and Oversight of care and maintenance of central lines. The VAT team reports CLABSI bundle compliance and volume of completed line insertions to the Device Infection Prevention Team for tracking. The VAT RNs complete real-time education when opportunities for improvement are found.
Results: From October 2022 - December 2023, our hospital experienced ZERO adult CLABSI and a steady reduction in device utilization. In 3rd quarter 2023 our NHSN SUR dropped to 0.861, a decrease of 39.3% from 4th quarter 2022. The VAT completed an average of 551 patient visits per month to assess for line placement, evaluate bundle compliance or to insert a midline catheter or PICC.
Conclusions: We found that the quality improvement intervention of implementing a dedicated VAT with a clear focus to manage device assessment, insertion and care and maintenance of adult PICC has facilitated a reduction to ZERO adult CLABSI infections over the last 14 months and a 39.3% reduction in device utilization.
Learning Objectives:
Describe the process for proposal development and submission for a quality improvement effort.
Identify areas where a focused quality improvement intervention is appropriate.
Develop a program for insertion, care and maintenance of central lines.
