QI Phase 2

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Dec 6, 2023

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Central Line-Associated Bloodstream Infections (CLABSI)- Phase 2- Scheider Topic: Decreasing CLABSI rates with the implementation of a CLABSI rounding/prevention team. The topic for this change is to decrease the rates of Central line- associated bloodstream infections (CLABSI) within my unit. The rationale for this change is that each year CLABSIs result in thousands of deaths and adds billions of dollars to the U.S. healthcare system costs, even though CLABSIs are preventable (Centers for Disease Control and Prevention, n.d.). Patients with CLABSIs see an increase of nearly $16,000 in their hospital bills (Centers for Disease Control and Prevention, n.d.). CLABSIs result in increased mortality, lengths of stays, morbidity, and increased costs for patients and organizations (Pate, et al., 2022). Within the U.S., there are about 250,000 CLABSIs each year, with 80,000 occurring within ICUs (Centers for Disease Control and Prevention, n.d.). Though there is protocol in place regarding patients with central lines, it is often overlooked or not adhered to as it should be. In addition, the ICU sees a wide variety of central lines, often for long periods of time and with some patients having multiple central lines. With implementation of a CLABSI rounding/prevention team, this will result in decreased CLABSI rates, decreased costs for the healthcare system and patients, and an increase in patient safety. Research has shown that implementing a CLABSI rounding/prevention team has led to decreased rates of CLABSIs. One hospital showed that the implementation of a CLABSI rounding/prevention team resulted in their hospital CLABSI SIR rate decreasing from 0.9 in November 2017 to 0.53 in June of 2021 (Hugo, et al., 2022) while another hospital showed their CLABSI SIR rate to decrease from 2.747 in May 2020 to 0 in June and July, 1.844 in August, and 0.424 in September (Pate, et al., 2022). Plan for Change: • Obtain approval from management for the creation of a CLABSI rounding/prevention team. • Recruit RNs from the ICUs to be the different units of CLABSI rounding/prevention leaders. Items such as experience levels, standings with previous unit leadership committees, or quality improvement work are considered. • Provide educational materials to units regarding CLABSI and prevention measures to decrease rates. • Create visual reminders in patient rooms regarding dressing changes and central line care techniques.

• Audit charts to determine dressing status, change dates, CHG measures in place, date of line insertion, integrity of lines, and assessment of necessity of the central line (Pate, et al., 2022). • Provide real-time feedback to nurses and providers regarding audits, what areas need improvement, and what areas staff have been exceeding in. • Provide further education as needed regarding audit findings and CLABSI rates. The timeframe for this implementation would take a few months to begin, as auditing tools and recruiting members with the group may take a few weeks to a month to start up. The goal is that by the end of 6 months, we will be able to see a decrease in CLABSI rates and have increased the education and knowledge surrounding CLABSI prevention. Financially, this will not have a large cost to the unit and organization. Though the members will be clocked in while auditing or providing education, the overall savings to the organization will outweigh the costs, as CLABSI incidences lead to an increase in costs for the healthcare system. The feasibility depends on the engagement of the group and the employee's implementation of the education provided, compliance, and communication amongst team members and other healthcare providers. References: Centers for Disease Control and Prevention. (n.d.). Central line-associated bloodstream infections. https://www.cdc.gov/hai/bsi/clabsi-resources.html Hugo, M., Rzucidlo, R., Weisert, L., Parakati, I. & Schroeder, S. (2022). A quality improvement initiative to increase central line maintenance bundle compliance through nursing-led rounds. Pediatrics Quality and Safety, 7 (1), 1-8. https://doi.org/10.1097/pq9.0000000000000515 Pate, K., Brelewski, K., Rutledge, S., Rankin, V. & Layell, J. (2022). CLABSI rounding team: A collaborative approach to prevention. Journal of Nursing Care Quality, 37 (3), 275-281. https://doi.org/10.1097/NCQ.0000000000000625

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