Background:

Central line–associated bloodstream infections (CLABSIs) increase length of stay, add an additional $10,000 in costs per event, and increase mortality. Education, procedure carts, and checklists to improve compliance with evidence‐based, sterile procedures have been shown to decrease CLABSI rates in intensive care units. High‐volume, specialized operators have been shown to improve outcomes for high‐risk procedures.

Purpose:

To develop and implement a comprehensive program with a subgroup of specially trained hospitalists to insert central venous catheters (CVC) in an effort to decrease or eliminate CLABSI on the medical wards.

Description:

In spring 2009, we developed and implemented a multifactorial program with the goal of eliminating CLABSIs at our urban, academic safety‐net hospital. In an effort to standardize line insertion, decrease procedure duration, and optimize insertion techniques, a subgroup of 6 hospitalists was trained by interventional radiology attendings in the micropuncture technique of CVC insertion using direct ultrasound guidance. The 6 hospital medicine proceduralists also received Web‐based education about ideal insertion practices. Checklists utilizing evidence‐based safety practices to perform the insertions were implemented, and a semisterile procedure room was dedicated to central venous access. Starting in May 2009, hospital medicine proceduralists inserted CVCs for general medical floor patients. Preliminary data collected from May 2009 through October 2010 revealed 243 CVCs placed by proceduralists. After 2770 line‐days, the CLABSI rate was zero. The average case‐mix index for these patients was 3.04. Although our institution did not monitor ward CLABSI rates prior to our program, data from the National Healthcare Safety Network indicate that the rate of non–intensive care unit CLABSIs is 1.5 per 1000 line‐days. This places our CLABSI prevention program in the top 25% of this national data set. To reach a P < 0.05, when comparing our CLABSI rates with national rates, a total of 3422 line‐days without a CLABSI are needed. Data collection continues.

Conclusions:

Hospital medicine physicians specializing in central venous access as part of a comprehensive program including formal training, Web‐based education, an evidence‐based checklist, and a dedicated procedure room may decrease or even eliminate CLABSIs.

Disclosures:

R. Allyn ‐ none; S. Bapoje ‐ none; C. Price ‐ none; B. Knepper ‐ none; A. Bahia ‐ none; S. Sharma ‐ none; V. Narayanan ‐ none; R. Allen ‐ none; E. S. Chu ‐ none