PURPOSE:CRBSI add significantly to morbidity and mortality of ICU patients. They also increase hospital length of stay and are associated with significant cost. The Institute for Healthcare Improvement (IHI) model of “CLB” is comprised of 5 components: hand hygiene, maximal barrier precautions upon insertion, chlorhexidine skin antisepsis, optimal catheter site selection, and daily review of line necessity. We examined CRBSI rates in a mixed medical-surgical ICU before and after an organized effort to utilize and document compliance with the CLB.
METHODS:A retrospective analysis of prospectively collected data for patients with CRBSI at Maine Medical Center’s mixed medical-surgical 32-bed ICU was conducted for 20 months, from January 2006 to August 2007. Through efforts of a multi-disciplinary team, the IHI model of CLB was implemented in January 2007. The effect of CLB implementation on CRBSI rates was analyzed using a student’s t-test. APACHE II scores were calculated to assess for differences in severity of illness that might affect risk for CRBSI.
RESULTS:The CRBSI rate before CLB was 9.87 infections/1000 device days (84 total cases and 8510 total device days). After the implementation of CLB, from January 2007 through August 2007, the CRBSI rate was 4.44 infections/1000 device days (26 total cases and 5853 total device days). A statistically significant difference was noted between the CRBSI rate in the two time periods (P = 0.0038). No statistically significant difference was found in the Apache II score between the two groups, with mean values of 15.68 in 2006 and 13.13 in 2007 (P = 0.067).
CONCLUSION:The CRBSI rate decreased significantly after the implementation of CLB. A multifaceted, multi-disciplinary team approach can be effective in developing and implementing strategies to prevent CRBSI in critically ill patients.
CLINICAL IMPLICATIONS:Implementation of a CLB is effective in decreasing CRBSI rate in critically ill patients. Continued efforts from a multi-disciplinary approach are required to monitor and maintain compliance with CLB components.
DISCLOSURE:Ranju Soni, No Financial Disclosure Information; No Product/Research Disclosure Information