Central Line Associated Blood Stream Infections

Presented by Stephanie Dove BSN, RN-CCRN

Why is this topic a priority for your organization?
In September 2010, the central line associated blood stream infection (CLABSI) rate spiked to 6/1000 central line days in the Intensive Care Units (ICUs). CLABSIs are a deadly and costly threat to patient safety, contributing to increased lengths of stays, hospital costs, and mortality. Approximately 93,200 CLABSIs occur in the U.S. each year with an estimated 12-25% mortality rate. Hospital cost is approximately $29,156/CLABSI - $2.7 billion in the U.S./year.

What does the literature say about your topic?
Traditional infection control strategies such as hand washing and prevention bundles have been met with limited success. Chorhexidine gluconate (CHG) has broad antimicrobial activity and prolonged residual effect and is used to disinfect the skin before central line insertion. Because a CLABSI is usually caused by resident skin flora, decolonization of a larger area of skin has biological plausibility as an adjunctive approach to reduce infection rates.

How did you incorporate this change into practice?
A bathing protocol was developed using 4% CHG and disposable (non-impregnated) wash cloths. Bath basins were prohibited and CHG-compatible lotions were utilized. From Nov 1, 2010 - Feb 1, 2011 all ICU patients were bathed with CHG from the neck-down (excluding genitalia).

What are the outcomes of this change in practice?
The Nov/Dec CLABSI rates were 0 and 1, respectively. In January, a water main rupture impacted patient bathing and the CLABSI rates rose to 4.5 in the ICUs. That same month, the cardiac surgery ICU experienced an outbreak of C-Diff, which resulted in a CLABSI rate of 5.7. The rates in both units returned to 0 in Feb/Mar. CHG bathing is now a standard of care in the ICUs and efforts are underway to expand CHG baths to all patients with central lines in non-ICU units.