Can We Eliminate Catheter-Related Bloodstream Infections in a Cardiovascular ICU?

Abstract

PURPOSE: Cardiovascular ICU patients are at a high risk for Catheter Related Blood Stream Infections (CRBSI) as they have a high number of central venous catheters in place for management CRBSI are a leading cause of Hospital acquired Infections (HAI's). With mortality ranging from 12-25% and cost up to US $45000 (1). It is estimated that there are 28,000 deaths in ICU due to BSI's. (1) Poor Compliance with Bundles, and the ability to sustain these quality initiatives are limitations to a successful campaign. Public reporting and Medicare nonreimbursement are two new factors. METHODS: A multidisciplinary team led by Critical care Intensivist started the initiative to eliminate CRBSI in a 40 bed cardiovascular patient population.. A GAP analysis was done based on national best practices and guidelines. First phase was education and awareness of CRBSI as educational interventions have shown to reduce HAI's. (2) Multi-prong strategy included, Hand Hygiene compliance, chlorhexideine prep, maximal sterile barrier precaution, use of antiseptic/antibiotic coated catheters, dressing change audits, dedicated procedure cart, glucose control protocol, daily evaluation of line need, monthly feedback on CRBSI. Number and Rate of CRBSI per 1000 central line days from January 2003 till December 2009 were measured. All CRBSI was defined per Center for Disease Control (CDC) guidelines. RESULTS: From a baseline of 43 infections/year, 3.6/1000 days in 2003 we reduced to 1 infections/year at a rate of 0.1/1000 days by 2009, with 12 months in between without any CRBSI. We prevented 205 CRBSI from baseline; cost saving of app. 9 million dollars (45000x 205). And avoided app 35 deaths from CRBSI. CONCLUSION: Critical care physician led team approach resulted in drastically eliminating CRBSI in high risk cardiovascular ICU patients with sustained effect over a 7 year period. CLINICAL IMPLICATIONS: CRBSI prevention and even elimination can be achieved in a high risk cardiovascular patient population. Team approach , education , consistent application of bundles and feedback can bring about sustained reduction in mortality and costs.