Impact of an Eight-Year Program to Reduce Central Line-Associated Blood Stream Infection (CLABSI) in a University Teaching Hospital

Background. The province of Quebec has mandatory surveillance for nosocomial BSI and CLABSI in ICU since 2007. The MUHC is a tertiary centre with over 1000 beds, 7 ICU and 2 large dialysis units. In 2007, we observed 209 CLABSI for the institution and our 25 bed adult mixed medical- surgical-transplant ICU had an elevated CLABSI rate of 4.55/1000 catheter days (2.76 with revised definition). An initiative was implemented to reduce CLABSI throughout the hospital. Methods. A vascular access specialist was hired to coordinate the program. In 2009, an insertion bundle was introduced in the ICU which included a check list (maximal barrier, hand hygiene, CHG 2%/IPA 70% for skin prep, dedicated lumen for TPN). In 2010 a maintenance bundle was added and consisted of adequate hand hygiene prior to manipulation, vigorous scrub of cap prior to access with CHG 2%/IPA 70%, daily inspection of site and dressing change when soiled, and collective order to maintain patency. Training was given to all units with CLABSI through the institution and periodic audits were done. In 2011 the insertion bundle was extended to the interventional radiology and ER. In 2013, a media campaign “Be line Wise” was launched to high risk units. Absolute number of events and rates were given periodically to all high risk units. Time-to-event boards were placed on the units, reports of success were distributed and promotional events organized. In 2013, the program was expanded to our NICU where an impregnated alcohol cap was introduced along with use of CHG wipes for babies more than 1 kg. In 2014, a newer version of a CHA coated catheter was implemented in the OR, ER and ICU's. Results. Over the last 9 years with an increased use of central venous access devices (CVAD), absolute number of CLABSI steadily decreased from 209 to 68, a reduction of 67%. In our medical-surgical-transplant ICU, when using the same definition of CLABSI, the rate went from 2.76 to 0.44 per 1000 catheter days. In the NICU, the rate dropped from 6.8 to 0.5 per 1000 catheter days. In dialysis, the CLABSI rate went from 0.89/10 to 0.67 patient month. Conclusion. Reducing CLABSI requires a team approach and buy in from key stakeholders. Continuous surveillance, auditing and tailored interventions contributed to success throughout the institution with significant improvement in patient care outcomes. Disclosures. All authors: No reported disclosures.

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