NewYork-Presbyterian Queens: Constant Evaluation and Vigilance Reduce CLABSI

The infection prevention and control team at New York-Presbyterian Queens took action after the rate of central line-associated bloodstream infections (CLABSI) rose significantly across the hospital. Each occurrence increases patients’ length of stay and increases costs.

Using classic performance improvement and patient safety tools, the IP&C team identified and prioritized problem areas and potential improvement by collecting and analyzing data. It communicated the findings with key stakeholders and committed to a continuous evaluation. Subsequently, the team expanded its “mini” successes to other areas of the hospital where its evolving best practice was applicable.

The CLABSI reduction program required a multifaceted and interdisciplinary approach. Action steps were first implemented in the hospital’s intensive care units and then extended to other medical-surgical units.

Main initiatives included:

  • Holding prompt CLABSI root cause analysis meetings with representation by key stakeholders and using a Plan-Do-Study-Act quality improvement toolkit.
  • Increasing awareness of CLABSI prevention best practices.
  • Implementing CLABSI bundle quality assurance and daily central venous catheter (CVC) accountability and necessity rounds on all units.
  • Restricting CVCs on med-surg units.
  • Removing CVCs from admitted patients in long-term care facilities.
  • Introducing alternative venous access devices such as midlines and extended dwell peripheral IVs; this has decreased CVC use and been “very important” in reducing infections.
  • Ensuring daily chlorhexidine gluconate (CHG) bathing of all ICU patients with CVCs.

Secondary initiatives included leadership communication and support; interdisciplinary education and feedback from clinicians; notification of peripherally inserted central catheter (PICC) orders in interventional radiology; increasing awareness of midline alternatives to PICCs; release of “Blood Culture Do’s and Don’ts” guidelines; and collaboration with the hospital’s palliative care team.

These infection prevention and control initiatives are sustained by constant evaluation and vigilance. Success of the initiatives required full buy-in from the nursing and medical teams as well as the entire C-suite. Across the hospital, teams have a fuller understanding of what’s required to maintain patient safety.

The IP&C team continues to validate care compliance with random audits. Continued nursing CVC accountability rounds have encouraged unit ownership of CVC maintenance. The vascular access team assists in evaluating CVC dressing status and reports its findings to the IP&C team. Blood cultures ordered from all patients with CVCs continue to be monitored. In addition, with the support of the infectious disease team, the IP&C team performs real-time education when contacting providers and also attends resident teaching sessions to share progress updates.

Key Takeaways

Targeted Problem: CLABSI
Interventions Used:

  • Performance improvement tools such as root cause analysis, Plan-Do-Study-Act cycles, and failure mode effect analysis
  • Teamwork and communication tools such as regular unit huddles and SBAR (situation, background, assessment, recommendation)
  • CLABSI prevention bundle

Impact:  Reduced SIR by 90%, and identified 88% of CLABSIs were related to catheter maintenance