P40 – Early Removal of Unnecessary Central Lines is the Most Important Element of CLABSI (central line associated blood stream infection) Prevention Bundle

Author(s):
Phillip Chang, Andrea Flinchum, Dan Davenport, Kimberly Blanton, Paul Kearney, University of Kentucky

Background: CLABSI is a serious complication for the hospitalized patients. Numerous advances and practices have been advocated to decrease CLABSI rate with varying degrees of success. In 2008, the University of Kentucky formed a multi-disciplinary group that aimed to reproduce the excellent results published by Dr. Pronovost in the Keystone Project. The five elements were: hand hygiene, maximal barrier precautions, chlorhexidine skin antisepsis, optimal site selection and daily review of necessity with early removal of unnecessary lines.

Hypothesis: For practical reasons, we were unable to fully implement the entire bundle. We therefore hypothesized that the last element of the bundle, which is early removal of unnecessary lines, is the most impactful one.

Methods: In March of 2009, early removal of unnecessary central lines was implemented, while the remaining bundle elements were strongly encouraged but not enforced. Early line removal was achieved with diligent daily rounding of unit managers with the bedside care teams. In April of 2010, the full bundle was implemented and tracked.

Results: In the twelve months following implementation of just a single component of the bundle, the CLABSI rate dropped from a six-month average of 5.6 infections per 1,000 line days to a rate of 2.6 per 1,000 line days, using the same months to account for seasonable variation (p = 0.037). Our infection rates were tracked by utilizing surveillance techniques and NHSN (National Healthcare Safety Network) definitions and benchmark. Surprisingly, we were not able to demonstrate further decrease in CLABSI rate after implementing of the rest of the bundle. The twelve-month CLABSI rate did not show any statistically significant decrease in rate, from 2.6 to 2.3 (p = 0.263)

Conclusions: While all elements of the bundle are important, our single-institution experience suggests that the most important element of the 5-element bundle as described by Keystone ICU project is to diligently remove central lines when they are no longer necessary.