6 Interventions that Helped Eliminate Central Line-Associated Blood Stream Infections in a Hospital Setting

Central venous catheters (CVCs) cause approximately 250,000 central line-associated blood stream infections (CLABSIs) annually in hospitals in the United States; this can contribute to 62,000 patient deaths annually and up to $56,000 in hospital costs per incident.[i] Dialysis catheters are a common cause of CLABSI. Fortunately, hemodialysis-related CLABSI may be preventable through a proactive approach that involves identifying and addressing the unique risk factors for CLABSI in each hospital setting.

One such approach was developed at a hospital that had experienced 14 CLABSI cases over 18 months. The team first collected source data and analyzed the results to identify the top risk factors contributing to dialysis-related CLABSIs. Seven factors were identified. Primary opportunities for improvement were related to CVC maintenance, including dressing changes, competency staff training and reinforced best practices.

After identifying these factors, the team implemented the following guidelines.

1. Upon admission, identify dialysis patients with a CVC and document:
   1. Missing or soiled dressings
   2. Patients with a fever greater than 100.4 (blood cultures should be drawn for these patients by the end of the second day of admission)
   3. Unauthorized access of CVCs by non-dialysis personnel
   4. CVCs without hemodialysis labels; the lumen dwell and date of dressing change should be documented
   5. Signs and symptoms of infection (site redness, warmth or purulent drainage)
   6. Any blood cultures obtained
2. Follow up with hospital leadership when interventions are not documented in the patient’s medical record
3. Day three of admission or after—report positive blood cultures
   1. Investigate use of CVC and insertion of all invasive lines and tubes
   2. Review CVC dialysis flow sheet documentation
4. Re-educate the dialysis nurses on the care of CVCs
5. Implement CVC training program for hospital staff
6. Report CLABSI performance during Joint Dialysis Operations Committee (JDOC) meeting

The CLABSI interventions were executed in the hospital at the end of May 2016. As of October 2017, there have been no new cases of CLABSI. These results suggest that following a clear protocol to address CLABSI incidences may significantly reduce, if not eliminate, these infections and ultimately enhance patient safety and wellbeing. Individually tailored versions of this protocol are being rolled out across other hospitals in an effort to reduce infections and help improve the quality of patient care.

[i] Preventing bloodstream infections from central line venous catheters. World Health Organization, 2017.