Abstract
BACKGROUND: Central line-associated bloodstream infections (CLABSIs) pose a significant risk to patients and contribute to increased healthcare costs. They are largely preventable through evidence-based quality improvement (QI) initiatives. AIM: In the polytrauma ICU, the CLABSI rate suddenly increased to 14/1000 central line days in the latter half of 2023. This QI initiative aimed to identify the root causes and reduce the CLABSI rates by 30% (targeting 10/1000 central line days) by June 2024. METHODS: A multidisciplinary team tested several interventions using small Plan-Do-Study-Act cycles. CLABSI prevention bundles were introduced and refined, including: the use of maximum barrier precautions during line insertion, adherence to the Central Line Insertion Practice (CLIP) tool, standardized and real time bundle monitoring via direct observation, regular training and education sessions for staff. Surveillance methods and modified CLABSI definitions from the Healthcare-Associated Infection Surveillance Network were applied. RESULTS: The CLABSI rate dropped from 14 to 8 per 1,000 central line days, with 49 consecutive CLABSI-free days. Regular monitoring improved staff compliance with central line insertion and maintenance bundles including the completion of the central line (CL) insertion checklist (100%), use of full body drape (78.4%), chlorhexidine for site cleaning, aseptic conditions during CL insertion (75%) and "scrub the hub" technique (65%). Staff awareness of healthcare-associated infections (HAIs) improved through regular refresher classes, bedside teaching sessions, and daily rounds by Infection Control Nurses (HCNs) and the Quality Improvement (QI) team. CONCLUSIONS: Implementation of an evidence-based CLABSI prevention bundle, combined with direct process monitoring, led to significant and sustained reduction in CLABSI rates in the polytrauma ICU.