Background

A CLABSI, or Central Line-Associated Bloodstream Infection, is a serious infection that occurs when bacteria or other pathogens enter the bloodstream through a catheter (a tube) placed in a large vein, usually in the neck, chest, or groin - these are called a 'central line'. Central lines are often used in hospitals to administer medications, fluids, or nutrients directly into a patient’s bloodstream or to draw blood for tests.

Risk factors for CLABSIs

Any patient with a central line is at risk for a CLABSI. However, the risk of developing a CLABSI increases if:

• it was not placed using a sterile technique,

• the central line is not well maintained,

• the patient’s overall health is poor, or

• the central line is left in place for too long.

Symptoms of a CLABSI

Patients may experience fever, chills, and signs of sepsis including rapid heart rate, low blood pressure or confusion..

Treatment and Impact

CLABSIs are treated with antibiotics, with the central line potentially being removed or replaced. CLABSIs are a significant concern in hospitals because they can be life-threatening for the patient, and they increase the patients hospital stay and care costs.

 Based on seven studies reporting cost data associated with CLABSIs, the Agency for Healthcare Research & Quality (US) has estimated the additional cost for hospital-acquired CLABSI to be $48,108 (95% CI: $27,232 to $68,983), with excess mortality estimated at 0.15 (95% CI: 0.070 to 0.027) per hospital-acquired condition: this means that for every 1,000 in-hospital CLABSI cases, there are 150 excess death¹.

Prevention

CLABSIs can be reduced with proper central line sterile insertion and maintenance, including rigorous hand hygiene, regular monitoring and removal as soon as possible to reduce the chance of infection.

How are CLABSIs proactively managed in an Accountable Care Unit with SIBR rounds?

Patients who transition from a higher level of care, e.g. an ICU, to a step-down or  medical unit with a CLABSI should be monitored closely to ensure the CLABSI is still needed and that the unit staff are proactively monitoring it.

During SIBR, the bedside nurse is required as part of step 4 of the SIBR communication protocol, i.e. during the SIBR quality-safety checklist, to report on the presence, necessity and insertion date of any central lines to the rest of the team. Ideally each unit will have a nurse-driven central line/CLABSI prevention protocol that nurses can use to prompt their critical thinking on the best central line management strategy for each patient. The ACU leadership dyad, nurse & physician co-leads, should be monitoring CLABSI events on the unit and working with the frontline staff to optimize the treatment process.

Improvement Outcomes Reported by ACUs

A medical-telemetry unit at Presbyterian St Luke's hospital utilizing the ACU care model found that their rate of central line days reduced by 18.9% after implementing SIBR rounds. This is important are it shows that the unit staff were proactively managing the use of central lines in their patients and removing the opportunity for CLABSIs to occur.

A med-surg unit at a Northwell Health hospital that implemented the ACU care model and SIBR rounds reduced their CLASBSI rate to 0 in the year post-implementation, compared to 2 CLABSIs in the previous year.

References

1. https://www.ahrq.gov/hai/pfp/haccost2017-results.html#:~:text=Based%20on%20six%20studies%20reporting,CAUTI%20cases%2C%20there%20are%2036