Reducing central line-associated bloodstream infections (CLABSI)

Central line–associated bloodstream infections (CLABSI) are a national problem and account for about 250,000 infections and 31,000 deaths per year in U.S. healthcare facilities.

CLABSIs can have severe consequences and represent a preventable hospital-acquired condition. A national collaborative has helped many hospitals dramatically reduce CLABSIs, but some are still struggling to reduce infection rates.

An article in the latest issue of Quality Management in Health Care describes the development of a peer-to-peer assessment process (called CLABSI Conversations) and the practical, actionable recommendations discovered that helped intensive care unit teams achieve a CLABSI rate of less than 1 infection per 1000 catheter-days for at least one year.

10 success strategies

CLABSI Conversations was designed as a learning-oriented process. Researchers conducted a qualitative assessment of hospitals to uncover barriers to infection prevention and to share best practices and insights from successful ICUs.

Common practices led to 10 recommendations for hospitals struggling to reduce CLABSIs:

1. CEOs, executives, and board leaders communicate the goal of zero CLABSI throughout the hospital. Commit to a goal of zero preventable CLABSI and clearly share that goal throughout the hospital, all the way to frontline caregivers.

2. Senior and unit-level leaders hold themselves accountable for CLABSI rates. Provide time for unit leaders to present infection rates and the number of weeks without an infection to senior leaders. They should also investigate every infection and report what was found.

3. Unit physicians and nurse leaders own the problem. A CLABSI is viewed as an ICU problem, not an infection control or quality department problem. Unit staff take responsibility for monitoring and taking steps to reduce CLABSIs.

4. Clinical leaders and infection preventionists build CLABSI prevention training and simulation programs, such as opportunities to practice line insertion, maintenance, and removal techniques into physician and nurse orientations and refresher training or competency assessments for all employees including trainees (residents, fellows, and students).

5. Infection preventionists work closely with unit-level teams to train, monitor, and investigate infections and improve performance. These infection preventionists are viewed as partners, rather than owners, of CLABSI reduction efforts.

6. Hospital managers should make it easy to comply with best practices. Provide a kit that meets the needs of staff in each unit where lines are inserted and consistently stock all of

the needed supplies.

7. Clinical leaders teach standardization of catheter insertion and maintenance practices across the hospital. Mindful variation is acceptable when driven by evidence, theory, or a rationale that supports the variation in care.

8. Clinical leaders also empower nurses to stop any potentially harmful acts, and create and enforce policies that empower nurses to stop a line insertion deemed unsafe.

9. Unit leaders and infection preventionists investigate each CLABSI to identify root causes. Each investigation should examine whether the central line insertion checklist was used appropriately, where the catheter was placed, and whether the infection appeared to result from insertion or maintenance practices based upon the timing of the infection relative to line placement. Results should be collated and shared to develop a plan to prevent future infections.

10. Unit nurses and staff review and audit catheter maintenance policy and practices. Work with infection preventionists to post the quarterly CLABSI rate and the weeks since last CLABSI in clinical units where infections are measured and report these data to senior leaders. All unit staff members should know their CLABSI rates and weeks without an infection.

Nurses can help in the effort to prevent and reduce CLABSIs by identifying best practices and opportunities for improvement, which enhance the facility's overall safety culture.

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