The Drive to Sustain Zero: How Case Reviews Helped Sustain CLABSI Rates
Topic of Interest
Quality Initiatives
Capture Value of the CNS
Abstract
Title: The Drive to Sustain Zero: How Case Reviews Helped Sustain CLABSI Rates
Significance & Background: Central line-associated bloodstream infections (CLABSI) are the eighth leading cause of death in the United States (US), accounting for 250,000 bloodstream infections annually, and have a 12-25 percent mortality rate. Of all the healthcare-associated infections, CLABSIs are associated with a high-cost burden, accounting for approximately $46,000 per case. In the US, the CLABSI rate in Intensive Care Units (ICUs) is estimated to be 0.8 per 1000 central line days. Patients in ICUs are at an increased risk for CLABSI because 48 percent of ICU patients have indwelling central venous catheters.
Evaluation Methods: After a thorough investigation it was determined a potential cause of the CLABSIs may have been due to inappropriate testing. The Clinical Nurse Specialist (CNS) team, in collaboration with Infectious Disease and Infection Prevention, developed a case review form with specific evidence-based criteria to ensure cultural stewardship. The case review form required a comprehensive chart review and leadership approval. To sustain compliance with the form, the CNS team developed a “Question the Culture” initiative that included flyers, huddles, and in-person education sessions.
Outcomes: Before case review implementation, in quarter two of 2019, the CLABSI rate for the organization was 0.1 per 1,000 patient days. After implementation of case reviews in quarter four of 2019 the CLABSI rate was 0, in quarter one of 2020 it was 0.05, quarter two was 0.1, and quarter three declined to a rate of 0. With the implementation of the case reviews we were able to keep the rate stable or show a reduction through some quarters.
Implications: Obtaining a CLABSI rate of zero has been challenging, but cultural stewardship has afforded us the insight to optimize patient outcomes. This comprehensive undertaking became part of the “culture of the organization” from an interdisciplinary standpoint as several disciplines were involved in the development and education for this process. This initiative, if further adopted within other health care systems, has the potential to reduce unnecessary antibiotic exposure, mortality, and cost burden.