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Critical Care Leads the Way in the Prevention of Central Line Associated Bloodstream Infections
E196
American Journal of Infection Control June 2011
Presentation Number 107
Critical Care Leads the Way in the Prevention of Central Line Associated Bloodstream Infections Vicky M. Ferris, RN, Kathleen M. McMullen, MPH, CIC, Anthony J. Russo, MPH, Helen A. Wood, BSN, MA, Infection Prevention, Barnes Jewish Hospital, St. Louis, MO; Michael A. Lane, MD, Department of Infectious Diseases; Washington University School of Medicine, St. Louis, MO Background/Objective: Central line related blood stream infections (CLABSI) are associated with increased morbidity and mortality. CLABSI rates in intensive care units (ICU) at our institution are higher than desired despite several focused interventions. Hospital administration supported an evidence-based best practice education campaign for all ICU. Methods: The study was performed in 6 ICUs at a 1250 bed tertiary care institution. The following risk factors related to CLABSI were evaluated for the cases identified in 2009: days from insertion to infection, location of insertion, direct observation of the central line insertion, the integrity of the central line dressing and the practice of accessing the central line for medication administration and blood draws. Based on these results, five components were included in the LEADS program. LEADS stands for Line insertion (use of insertion checklist and preference for subclavian vein insertion site); daily Evaluation of line necessity; Assessment and maintenance of dressing integrity; Decrease blood cultures drawn from central lines; and Scrub the hub of needleless ports. An educational campaign including a LEADS poster hung next to a current CLABSI rate graph in each ICU, dissemination of a notebook containing published literature and hospital policy/procedure supporting each component, and in-person education during daily rounds and unit quality meetings was completed April 2010. Infection rates and characteristics pre- and post-intervention were compared. Results: There were 74 CLABSIs in 36353 central line days from January 2009 - March 2010 (CLABSI rate 5 2.0/1000 line days). After implementation of the LEADS program, there were 18 CLABSI in 16177 central line days from April November 2010 (rate 5 1.1 /1000 line days, p50.02), a 45% decrease. There was a decrease in CLABSI related to a femoral line (10% vs. 0%; p5.18). Frequency of identification of gram positive organisms as cause of CLABSI was similar pre- and post-intervention (57% vs. 55%, p50.92), as was the percent of lines related to a CLABSI that were inserted in the ICU (71% versus 65%, p50.82) and the average time from line insertion to CLABSI (11 to 12 days, p50.43). Conclusion: The LEADS program led to a statistically significant decrease in CLABSI rates without changes in other CLABSI characteristics.
Infection Prevention and Control Programs Presentation Number 108
Prevalence and Risk Factors of MRSA Colonization on Admission to Inpatient Psychiatry: A Neglected Population with an Important Milieu JasonFarley, PhD, MPH, CRNP, Assistant Professor, Johns Hopkins University School of Nursing, Baltimore, MD; Ann Caston-Gaa, RN, MPH, CIC, Infection Control Preventionist, Johns Hopkins Hospital Hospital Epidemiology and Infection Control, Baltimore, MD; Tracy Howard, MT (ASCP), Laboratory Specialist, Johns Hopkins Hospital, Baltimore, MD; Jenna Krall, MSc, PhD(c), Assistant Professor, Johns Hopkins University School of Public Health, Baltimore, MD; MattHayat, PhD, Assistant Professor, Johns Hopkins University School of Nursing, Baltimore, MD; Jeffery Hsu, MD, Assistant Professor; Trish Perl, MD, MSc, Karen Carroll, MD, Professor; Johns Hopkins University School of Medicine, Baltimore, MD
American Journal of Infection Control June 2011
Presentation Number 107
Critical Care Leads the Way in the Prevention of Central Line Associated Bloodstream Infections Vicky M. Ferris, RN, Kathleen M. McMullen, MPH, CIC, Anthony J. Russo, MPH, Helen A. Wood, BSN, MA, Infection Prevention, Barnes Jewish Hospital, St. Louis, MO; Michael A. Lane, MD, Department of Infectious Diseases; Washington University School of Medicine, St. Louis, MO Background/Objective: Central line related blood stream infections (CLABSI) are associated with increased morbidity and mortality. CLABSI rates in intensive care units (ICU) at our institution are higher than desired despite several focused interventions. Hospital administration supported an evidence-based best practice education campaign for all ICU. Methods: The study was performed in 6 ICUs at a 1250 bed tertiary care institution. The following risk factors related to CLABSI were evaluated for the cases identified in 2009: days from insertion to infection, location of insertion, direct observation of the central line insertion, the integrity of the central line dressing and the practice of accessing the central line for medication administration and blood draws. Based on these results, five components were included in the LEADS program. LEADS stands for Line insertion (use of insertion checklist and preference for subclavian vein insertion site); daily Evaluation of line necessity; Assessment and maintenance of dressing integrity; Decrease blood cultures drawn from central lines; and Scrub the hub of needleless ports. An educational campaign including a LEADS poster hung next to a current CLABSI rate graph in each ICU, dissemination of a notebook containing published literature and hospital policy/procedure supporting each component, and in-person education during daily rounds and unit quality meetings was completed April 2010. Infection rates and characteristics pre- and post-intervention were compared. Results: There were 74 CLABSIs in 36353 central line days from January 2009 - March 2010 (CLABSI rate 5 2.0/1000 line days). After implementation of the LEADS program, there were 18 CLABSI in 16177 central line days from April November 2010 (rate 5 1.1 /1000 line days, p50.02), a 45% decrease. There was a decrease in CLABSI related to a femoral line (10% vs. 0%; p5.18). Frequency of identification of gram positive organisms as cause of CLABSI was similar pre- and post-intervention (57% vs. 55%, p50.92), as was the percent of lines related to a CLABSI that were inserted in the ICU (71% versus 65%, p50.82) and the average time from line insertion to CLABSI (11 to 12 days, p50.43). Conclusion: The LEADS program led to a statistically significant decrease in CLABSI rates without changes in other CLABSI characteristics.
Infection Prevention and Control Programs Presentation Number 108
Prevalence and Risk Factors of MRSA Colonization on Admission to Inpatient Psychiatry: A Neglected Population with an Important Milieu JasonFarley, PhD, MPH, CRNP, Assistant Professor, Johns Hopkins University School of Nursing, Baltimore, MD; Ann Caston-Gaa, RN, MPH, CIC, Infection Control Preventionist, Johns Hopkins Hospital Hospital Epidemiology and Infection Control, Baltimore, MD; Tracy Howard, MT (ASCP), Laboratory Specialist, Johns Hopkins Hospital, Baltimore, MD; Jenna Krall, MSc, PhD(c), Assistant Professor, Johns Hopkins University School of Public Health, Baltimore, MD; MattHayat, PhD, Assistant Professor, Johns Hopkins University School of Nursing, Baltimore, MD; Jeffery Hsu, MD, Assistant Professor; Trish Perl, MD, MSc, Karen Carroll, MD, Professor; Johns Hopkins University School of Medicine, Baltimore, MD