Wiping out hospital-acquired bloodstream infections
It’s a problem throughout the country that Regions Hospital has been on a mission to eliminate within its facility: Central line associated bloodstream infections (CLABSIs). These infections occur in people who have had a narrow long catheter, or central line, inserted in a large vein so that the tip lies near the heart. Patients who acquire a central line infection can experience complications which may extend their stay in the hospital.
Regions began its mission to eliminate central line associated bloodstream infections in 2005. A multidisciplinary team was charged with implementing a CLABSI prevention “bundle,” track compliance with its elements, and measure its results. A bundle is a group of evidence-based interventions for patients that, when implemented together, can result in better outcomes than when implemented individually. Components of the central line bundle include hand hygiene, site preparation, selecting the best site for inserting the line, and removing the line as soon as the patient no longer needs it.
By simply standardizing the processes used for insertion of the central line, which accounts for only part of the total bundle, the CLABSI rate quickly dropped by 50 percent. But that was just the beginning.
Another major step was creating a standardized procedure cart to be used for every patient who needed a line inserted. The cart carries all the supplies needed to place a line--dressings, insertion site prep solution and protective wear--and is brought directly to the patient’s bedside. The carts help ensure that all providers have everything they need to follow the best practices in central line insertion, as outlined by the bundle.
With staff keeping their bundle compliance rates near 100 percent, Regions was able to eliminate CLABSIs in the Surgical Intensive Care Unit (SICU) for more than a year, from August 2010 until October 2011. Since then there have been two CLABSIs, one in October and one in December. While the staff are disappointed by the recent infections, history has shown them that it is possible to eliminate them, even in this very high risk patient population.
Staff say the success is based on committed and dedicated nurses and providers, unwavering support from senior administrative, medical staff leadership and other members of the multidisciplinary team, as well as an organizational culture of continuous patient safety.
Central line bloodstream infections can prolong a hospital stay by an average of seven days, with a single bloodstream infection costing an estimated $3,700 to $29,000. Figuring an average of 13 infections prevented per year, the program has saved more than $200,000 every year.
And those are just the hard numbers. There’s no way to quantify the savings of stress and anxiety for a patient who avoids a central line acquired bloodstream infection.