Interprofessional Approach to Reducing Central Line-Associated Bloodstream Infections in a Cardiac Surgical Intensive Care Unit

BACKGROUND Central line [catheter]-associated bloodstream infection (CLABSI) is associated with longer stays and increased cost, morbidity, and mortality. LOCAL PROBLEM An academic cardiothoracic intensive care unit had a high CLABSI incidence (standardized infection ratio of 2.3 at baseline). The hospital's executive leadership team (chief nursing officer, chief medical officer, and chief of quality and performance improvement) directed intensive care unit leaders to reduce the standardized infection ratio. METHODS Interprofessional CLABSI reduction efforts were formulated using A3 methods based on the plan-do-check-act cycle. Unit leaders (nurses, physicians, advanced practice providers, and allied health professionals) met every 2 weeks for 2 years to formulate CLABSI reduction efforts. Efficacy of CLABSI reduction was evaluated with the standardized infection ratio. INTERVENTIONS Quality improvement activities included improved hand hygiene compliance, optimization of central venous catheter insertion, improved chlorhexidine dressing adherence, daily assessment of high-risk catheters for removal, use of an electronic intensive care unit bundle checklist to highlight central venous catheter duration for clinicians, and promotion of a blood culturing stewardship program with guidance on when to obtain blood samples for culture. RESULTS Interprofessional CLABSI reduction efforts reduced the standardized infection ratio from 2.3 to 0.8 over 3 years. The standardized utilization ratio, reflecting observed to expected central venous catheter days, decreased from 1.0 to 0.89. CONCLUSION Interprofessional CLABSI reduction efforts can be effective in a cardiac surgical intensive care unit and improve patient safety. Keys to success include teamwork, accountability, acceptance from intensive care unit staff, and support from hospital executive leaders.