Background: The clinical indication for vascular access devices (VAD), including central venous catheters (CVC) and peripheral intravenous catheters (PVC), should be assessed at least daily. If VADs are no longer indicated, they should be promptly removed to reduce the risk of catheter-associated bloodstream infections (CABSI). In 2030, the CDC’s National Healthcare Safety Network (NHSN) will adopt a new metric for BSI surveillance called Hospital Onset Bacteremia (HOB) which is device agnostic. In this new framework, all VADs, not just CVCs, will be considered potential causes of BSIs. This is supported by growing evidence that the rate of PVC-BSI and CLABSI are comparable, at least in non-ICU settings. At our organization in fiscal year 2025, 68% (32 of 47) of our CLABSIs occurred in non-ICU units. We determined that unnecessary VAD use was increasing the hospital’s CLABSI rate, particularly in non-ICU units. We partnered with hospitalists in the Patient Safety Committee and the facility’s Mission Control (MC) center to develop an intervention, called MC-CABSI, to encourage prompt removal of unnecessary VADs.
Purpose: MC-CABSI engages with patient care teams in real time with opportunities for removing CVCs and PVCs to reduce CLABSI.
Description: We developed five message categories to communicate with patient care teams via our EHR’s secure chat, using data sourced from the Lines, Drains, and Airways (LDA) flowsheets. The first category, “Central Line Not Infusing,” tracks CVCs without any documentation of infusion in the last 48 hours, suggesting a CVC placed for medication infusion is no longer needed. The second and third categories are “Central Line and Two or More PVCs” and “Three or More PVCs,” respectively. These categories indicate high Vascular Access Device Density (VADD), a metric defined as a unit’s median VAD days, including both CVCs and PVCs. The VADD also accounts for multiple devices in a given patient, unlike the Standardized Utilization Ratio currently used by NHSN for CLABSI reporting. The fourth category is “Central Line Not Meeting Necessity,” indicating a CVC has been documented by nursing as no longer indicated, but has not yet been removed. The fifth category is for any “Field-Inserted PVC,” present >24 hours after admission. Our hospital policy requires such PVCs be removed, due to the likelihood they were placed in sub-optimal conditions and pose an increased risk of CABSI. MC-CABSI messages are sent by two infection preventionists on a daily basis and include at least one nurse and Attending or Primary Responding Physician.
Conclusions: The MC-CABSI project has generated promising preliminary results. We have sent 200 messages since the intervention began July 2025, and care teams responded by removing ≥1 CVC or PVC from 102 patients (51% response rate). Hospital-wide VADD has decreased from 1.41 to 1.35 over this time compared to the previous six months. Dialogue with care teams has been collaborative, with many expressing gratitude for this infection prevention effort. As the intervention matures, we intend to track results, dialogue with providers, and hone VAD messaging to improve outcomes. We see potential to expand the real-time feedback project to cover other patient devices like indwelling urinary catheters. We also see opportunity for automation and EHR integration to improve scalability in preparation for the shift to HOB surveillance.