QAPI 20 - Bundled Approach to Reduce Blood stream infections in Patients Requiring use of Extracorporeal Membrane Oxygenation

Background: There is a high prevalence of blood stream infections (BSI) associated with Extracorporeal Membrane Oxygenation (ECMO) in adults. The increasing use of ECMO coupled with the patient risk factors places patient at high risk for BSIs. An increase in hospital associated BSI was identified in Cardiothoracic Intensive Care Unit (CTICU) ECMO patients between July 2021 to November 2021. The CTICU ECMO BSI rate peaked to 44% in October 2021.

Methods: Our facility is a 1040 bed tertiary care academic medical center in Florida. Between January to March 2022 a multidisciplinary ECMO task force was created and a collaborative practice review was performed. Multiple environmental factors and clinical practices around ECMO cannula care potentially contributing to ECMO line BSIs were identified.
The ECMO cannula site care bundle was designed as set of evidence-based interventions focused on best practices around environmental factors, cannula securement, use of end caps, dressing integrity, use of antimicrobial discs and baths, and suture markings. In addition, a highly dedicated ECMO specialist team was created within the CTICU. An education tipsheet was created for standardized ECMO disinfection and priming practices and an education block was performed. Also, practices were revised around changing ECMO filters and aseptic line interventions during circuit changes.

Results: The BSIs in CTICU ECMO patients decreased from a high of 44% in during pre-intervention in October 2021 to 0% in June 2022 post-intervention and has been sustained for last 7 months.

Conclusions: Our multidisciplinary task force was successful at identifying many environmental and clinical risk factors for ECMO BSIs and implementing care bundles with evidence-based practices in reducing ECMO BSIs.