PURPOSE: Central line-associated bloodstream infection (CLAB) is the third most common nosocomial infection reported from the medical/surgical intensive care unit (ICU) setting. The implementation of a central line protocol utilizing a three part checklist would help to ensure that all processes related to central line placement are executed for each line placement during the time it is used, thereby leading to improved outcomes. Physician Assistants and Nurses would be empowered to supervise the checklist and to stop or change the process if warranted.
METHODS: The SICU Intensivist performed a daily needs assessment of all CVC’s (central venous catheters) in the SICU. If the CVC was deemed unnecessary it was removed. The Surgical Physician Assistants made daily assessments of all CVC’s among non-ICU inpatients. If the CVC was deemed unnecessary the CVC was removed. We hypothesized that these Physician Assistants would expedite the removal of central venous catheters among non-ICU inpatients. This would lead to a decreased number of central line days, and concomitant decrease in CLAB. Data collected was the standard data as utilized by the National Healthcare Safety Network (NHSN).
RESULTS: The Non-ICU Line Days for 2008, 2009 and 2010 was 14,658 18,210 and 11,818 respectively. The number of CLABS was 43, 68 and 34. This yielded a CLAB rate/1000 line days of 2.92, 3.73 and 2.87 for the same period. The ICU Line Days for 2008, 2009 and 2010 was 2,146 2,378 and 2,196 respectively. The number of CLABS was 2, 3 and 0. This yielded a CLAB rate/1000 line days of 0.96, 1.26 and 0.00 for the same period.
CONCLUSIONS: The number of CVC utilized in the non-ICU patient areas has decreased with a concomitant decrease line in CLAB. The majority of the CLAB now involve PICC’s and acute hemodialysis catheters. The SICU has seen a decrease in the number of CVC compared to the previous year and had no CLAB for the entire year.
CLINICAL IMPLICATIONS: Using standard policies in conjunction with a dedicated group of highly trained Physician Assistants and Nurses has lead to a reduction in ICU and Non-ICU central line days and a reduction in CLAB.
DISCLOSURE: The following authors have nothing to disclose: Garry Ritter
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