Central Line-Associated Bloodstream Infection Prevention

Central Line-Associated Bloodstream Infection Prevention: A Q&A with Sandra Miller, MHSM, RN, NE-BC 

The oncology unit at Seton Medical Center Austin, located in Austin, Texas, a member of Ascension Health, has achieved remarkable results reducing central line-associated bloodstream infections (CLABSIs).  Since 2008, CLABSIs have decreased by 65 percent; the combined central venous catheter (CVC) infection rates have plummeted to lower than the Centers for Disease Control and Prevention (CDC)'s National Healthcare Safety Network (NHSN) pooled mean; the units rate for combined line types (tunneled and non-tunneled catheters) is 1.1 per 1,000 line days, versus CDC NHSNs pooled means of 1.9 per 1,000 for non-tunneled and 3.2 per 1,000 for tunneled catheters. Setons low rate is all the more significant since it represents infections among high-risk cancer patients. Infection Control Today talked to Sandra Miller, MHSM, RN, NE-BC, director of oncology, pulmonary and renal services at Seton Austin, to learn more about this achievement.

Q: What was it that led Seton to focus on reducing CLABSIs?
A: As a member of Ascension Health, Seton Austin is committed to providing excellent clinical care with no preventable injuries or deaths.  To achieve this goal, we have focused on multiple priorities, including preventable infections.  Cancer patients, with weakened immune systems and frequent visits to hospitals and physician offices, are especially susceptible to CLABSIs, so we started looking at ways to eliminate those infections.

Q: What best practices did you put in place specifically and what have you learned from your results?
A: Our staff adopted an evidence-based care bundled approach to CLABSI prevention, making it easier for care teams to comply with infection prevention and control steps. These steps include:
- Revising and expanding the care guidelines for PICC and PAC site and line care
- Making sure the nursing staff and clinical assistants always practice good hand hygiene and use protective measures
- Developing a complex series of bundled process measures, including stickers on patients charts and IV tubing as well as a sign on the chart that warns protective measures should be taken to avoid infection
- Providing daily bath and linen change for all neutropenic patients
- Ensuring housekeeping completes daily, detailed room cleaning
- Tracking performance and providing data-driven feedback to all participants
Our staff also provides educational materials for patients and families on infection prevention. We work with families to make sure they understand the importance of baths, clean linens and hand hygiene once the patient returns home.
We have also taken the extra step of reaching out to physicians offices outside of the hospital setting to present the new guidelines and share best practices for infection prevention. This ensures that everyone on the patients care team supports our prevent infection practices.
Since implementing this simple infection control bundle in 2008, we have reduced CLABSI infections by 65 percent.

Q: What would you tell a hospital chief executive officer who might feel these efforts would be too costly?
A: Our efforts actually have reduced costs considerably. One BSI can cost more than $83,000. However, the cost of the supplies for the Seton bundle is only $27 per patient. These savings pale in comparison, however, to an improved quality of life as well as the lives that can be saved.  Central line infections kill up to a quarter of the patients who contract them. 

Q: Beyond the obvious, such as more frequent handwashing, what would you tell other hospitals that would like to achieve similar results?
A: The key to Setons success has been our close collaboration between hospital staff, physicians, families and patients, including involvement from all departments, such as the emergency department, radiology and environmental services. Every member of our staff and even doctors and staff outside our hospital has been taught the best practices we use. Everyone is trained to recognize best practices and know when something isnt being done appropriately. Patients and families are encouraged to speak up when they observe a caregiver who breaks with our infection prevention practices.

Q: How does this effort fit into larger infection control or patient safety initiatives?
A: Seton and Ascension Health are committed to patient safety as part of our mission. In 2003, Ascension Health set a bold goal of eliminating preventable injuries and deaths, and its hospitals have seen consistent improvement over the last eight years. A study recently published in Health Affairs documented some of the other results Ascension Health facilities have achieved since 2003. It shows that, compared to national averages, Ascension Health hospitals have achieved the following:
- 25 percent lower mortality
- 65 percent fewer birth traumas
- 89 percent lower neonatal mortality rates
- 94 percent lower in hospital-acquired pressure ulcers
- 74 percent lower in ventilator-associated pneumonia
- 43 percent lower in central line-associated bloodstream infections