A Journey of Elimination of CLABSIs and MDROs

September 14, 2012

By Donna Peace, RN, CPHQ, CIC

Healthcare-associated infections (HAIs) continue to negatively impact the worlds healthcare systems. With continued threats of pandemics, bioterrorism, and evolving multidrug-resistant microorganisms, Infection preventionists face conflicting priorities and must prioritize and streamline processes. In the United States, sadly 1 in 20 patients receiving care in hospitals will contract an HAI. Most HAIs originate from one of three common sources: contaminated hands of the healthcare provider and/or patient, contaminated environmental surfaces, or the contaminated skin of the patient.

Our facility is comprised of three specialty pediatric facilities serving a large demographic of pediatric patients throughout the Southeast and abroad. Each facility has a unique patient case mix, which presents unique challenges to combating both community- and healthcare-acquired microorganisms. Our system adopted the philosophy and mantra that One is Not Zero. Improving patient safety is a primary priority and even one patient harmed is too many. A bundle was created to hardwire and standardize our cleaning process. We have reduced our healthcare-acquired multidrug-resistant organisms (MDROs) by 48 percent from our baseline year in 2008, despite the rising acuity in our patient population. So that we could further reduce our incidence of central line-associated bloodstream infection (CLABSI) rates and multidrug-resistant organisms (MDROs) within our hospitals, we partnered with a preferred vendor to assist us with developing a comprehensive education plan to eliminate these infections.

The vendor partners assisted with a facility assessment to determine staff competencies on basic items such as aseptic technique, hand hygiene and compliance with evidence-based prevention bundles for bloodstream infections. Our infection prevention team worked with our vendor partner to develop and implement a robust educational program designed to reduce infections and foster a cultural transformation amongst the staff to sustain improvement. In addition, we implemented a two-minute contact time quaternary ammonium disinfectant wipe for general environmental disinfection and a 3.15 percent chlorhexidine gluconate/70 percent isopropyl alcohol swab for cleaning the needleless connectors and intravenous line hubs.

HAIs have steadily decreased at each of our facilities due to our vigilant efforts to educate, motivate and hold our staff accountable for their respective roles in the prevention of HAIs. Specifically, in the three years that we have collaborated in this initiative, our CLABSI rates have decreased by 78 percent, and our MDRO rates have decreased by 48 percent. Specifically with MDRO infection rates, our facility has demonstrated significant reductions in HAIs and cost savings. In one calendar year, as a result of this program, we have reduced the number of excess deaths by 9.36, the number of excess hospital days due to MRSA by 731, and the cost associated with excess hospital days by almost $4 million.

Utilizing your infection prevention vendors expertise, educational offerings and infection prevention programs will further strengthen your existing Infection Prevention program, as well as allow you to increase the bandwidth of your department. In a day and age of limited resources, infection preventionists should seek out vendor support for targeting zero HAIs in their facilities.

Donna Peace, RN, CPHQ, CIC, is an infection preventionist in Atlanta. For more information, email

[email protected]