CHASING ZERO!

Reducing central line-associated bloodstream infections

By Millie Russin, R.N., M.S.N.
CLINICAL PROCESS IMPROVEMENT DIRECTOR

Central line-associated bloodstream infections are deadly and costly health care-associated infections. Each year in the U.S., it is estimated that CLABSIs account for approximately 84,000 to 204,000 preventable infections, resulting in 10,400 to 25,000 deaths, costing between $1.7 billion to $21.4 billion. At Shands at the University of Florida, we are committed to doing our part to eliminate CLABSIs. Leading our efforts are Lawrence Caruso, M.D., UF College of Medicine Anesthesiologist and surgeon, and Irene Alexaitis, R.N., M.S.N., Shands at UF vice president and chief nursing officer. Their clinical teams’ results are impressive.

Factors helping us achieve this dramatic reduction in CLABSIs include:

Use of the central venous line bundle – The bundle is the combination of hand hygiene; chlorhexidine for skin preparation; full-barrier precautions during needle insertion; avoiding the femoral vein in adult patients; and removing CVLs when no longer necessary. Insertion is monitored using a checklist of required steps.

The Culture of Unit Safety Program – CUSP is a national program designed to improve patient safety through a structured process addressing evidence-based medicine, team-building and process-improvement training. It begins with a culture survey and includes submission of our CLABSI data. We participate in regular conference calls and meetings to share best practices with other hospitals committed to the elimination of CLABSI.

Mandatory education – Physicians who insert central lines and nurses who care for patients with these lines first complete required education.

Providing the tools to do the job correctly – Insertion kits are periodically revised to ensure that we have the most current recommended supplies in each kit. We purchased Site Scrub, a special alcohol wiping system to clean IV access sites.

Sharing best practices – Teams share processes that have contributed to CLABSI reduction, such as cleaning high-contact areas in the environment and using chlorhexidine baths for ICU patients.

Drilling down when infections occur – Analyzing each infection allows us to better understand factors that may contribute to infections.

Thank you to everyone involved in these efforts.