Background: Central line associated bloodstream infection (CLABSI) is the 8th leading cause of death in the United States, causing 100,000 deaths annually. Each CLABSI costs about $56,000 per patient and increases length of hospital stay by an average of 3 weeks. Femoral lines have been shown to have the highest risk of infection compared to subclavian or internal jugular lines due to high bacterial burden. In 2020, Sanford Health-Fargo experienced a total of 40 CLABSIs, a higher incidence than any other hospital system in the Sanford Enterprise, and higher than the total number of CLABSIs in 2018 and 2019 combined. Many of these CLABSIs were related to a high incidence of femoral line utilization at Sanford Health-Fargo.
Purpose: A rapid cycle improvement project was created on January 5, 2021 with a goal of zero CLABSIs in 2021. The purpose of this QI project was to develop a multi-disciplinary educational session for providers and nurses at Sanford Health-Fargo focused on the prevention of CLABSI.
Description: A multidisciplinary panel including physicians, nurses, and quality improvement and infection prevention team members worked together to create an educational session offering continuing medical education (CME) and American Nurses Credentialing Center (ANCC) hours focused on evidence-based practices in managing the care and treatment of central lines. A chart review of 80 patients with femoral line related CLABSI in 2019 and 2020 at Sanford-Fargo was completed to identify areas of improvement in femoral line utilization, placement technique, and line care. The session was held three times and offered both an in-person and online attendance option for convenience. A pre-session and post-session survey were distributed to compare attendee knowledge of CLABSI prevention data and techniques prior to and following the educational session. A total of 150 participants attended the educational session, and positive feedback was received regarding the information presented. Since the initiation of the rapid cycle improvement project aimed at preventing CLABSI at Sanford Health-Fargo, there have been a total of 7 CLABSIs to date, compared to a total of 40 CLABSIs in 2020. A CLABSI currently occurs every 47 days on average compared to every 9 days on average in 2021. Femoral line utilization has decreased in 2021 with a current utilization rate of 8% per month, compared to an average utilization rate of 15% per month in 2020.
Conclusions: The educational session was well received, and the total incidence of CLABSIs has decreased in 2021 since the initiation of the rapid cycle improvement project. Effort continues to be focused on evidence-based practices shown to reduce the incidence of CLABSI in order to prevent patient harm and death.