Audits and following prevention “bundles” were among the steps infection control leaders took at the Sparrow Health System long-term acute-care hospital in Lansing, Michigan.
Many patients at long-term acute-care hospitals (LTACHs) require central-line catheters in neck, chest or groin to administer antibiotics or chemotherapy. There is, though, a serious risk of infection with central lines. Bacteria and other pathogens can get into the catheter and result in life-threatening central-line associated bloodstream infections (CLABSIs). The risk is greatest in hospital intensive care units where central lines are often used, but the infections can occur in any setting where central lines are used. Estimates vary depending on the studies being cited, but by some accounts there are 28,000 deaths from CLABSIs each year and that $2 billion in costs associated with treating CLABSI cases.
Healthcare safety experts say central-line infections are preventable events, and Centers for Disease Control and Prevention, in collaboration with other organizations, has developed protocols that reduce the risk.
In short report in the journal Infection Control & Hospital Epidemiology, Mohamed O. Adawee, system director of infection prevention and epidemiology at the Sparrow Health System in Lansing, Michigan, described a 2020 effort to reduce CLABSIs at the Sparrow’s LTACH.
From January through May 2020, 7 CLABSIs occurred at the LTACH. After the reduction was implement, there were zero CLABSIs at the LTACH from June to December. A chart review showed that the CLABSI events occurred more than five days after the central line was inserted. That timing, Adawee and his colleagues wrote, suggested that it was lapses in maintenance that resulted in CLABSI, not shortcomings in the how the line was inserted.
The reduction plan included convening a multidisciplinary team consisting of the chief nursing officer, infection “preventionists” and others to develop a plan; adhering to a CLABSI prevention “bundle” that involves hand hygiene, use of antiseptics, protocols for inserting the line, dressing changes and so on; and monthly audits to check whether the protocols in the bundle are being follow.
Adawee and his colleagues report that total compliance for central-line bundle insertion and maintenance was 79% before the reduction plan was implemented and 97% afterward. Compliance with recommendation that the need for the central line be assessed daily was 90% and 95% after the prevention plan was put into effect. Compliance with the recommendation that the area be “bathed” with chlorhexidine gluconate, an antiseptic, increased from 59% to 92% after the CLABSI reduction efforts started. Interestingly, there was actually a decrease in the recommendation that dressings be changed every seven days, from 100% to 92%.
“We were able to reduce CLABSI events at our LTACH to zero after implementing an ongoing plan comprising multidisciplinary teamwork, central-line insertion and maintenance bundle elements, caregiver education and audits,” concluded Adawee and his colleagues, who also called for more research to identify the direct effect of each part of the prevention plan.