Implementation of an ICU CLABSI Prevention Checklist

Abstract

Background:

Nurses in the intensive care unit care for patients requiring critical medical treatments and life-saving measures, including patients with intravenous lines. With this type of access there are multiple risk factors. One risk factor is central line infections. Connor et al. (2023) has identified that 65 to 70% of central line-associated bloodstream infections (CLABSI) are preventable and cost approximately 960 million to 18.2 billion (about $56 per person in the U.S.) annually. Al-Shukri et al. (2022) estimated that 300 million central lines are used annually and 250,000 cases of CLABSI occur each year. Al-Shukri et al. (2022) reported that annual CLABSI cases in ICU and non-ICU settings are approximately 248,000, with 30,000 of those cases ending in mortality.

Local Problem:

The proposed project site is a thirty-one-bed intensive care unit (ICU) hospital in the Southeastern United States. Over the past five years, the proposed project site has not received a standardized infection ratio (SIR) below 1.0 and averages 275 catheter days per month. The proposed project’s purpose is to reduce CLABSI rates and increase nursing compliance.

Methods:

The model that was used to plan and implement is the Donabedian Model. The model includes a three-step approach that guided two PDSA cycles. Pre and post-intervention data were collected on line duration, CLABSI bundle nursing compliance, and CLABSI occurrences.

Intervention:

The proposed project proposes providing CLABSI checklist education to ICU staff, in addition to the current education provided, and the placement of a CLABSI bundle of care checklist in each patient’s room to assist in reminding RN’s concerning the bundle specifics and to promote compliance and therefore result in lower unit CLABSI rates/cases.

Results:

Rates of nursing compliance with dressing change compliance increased from 83.6% to 92.8% post-implementation which was clinically significant, but not statistically significant (p=.111). Rates of CHG compliance increased from 87.5% to 90%, which was clinically and statistically significant (p=019). Rates of line care compliance increased from 77.8% to 100%, which was clinically and statistically significant (p=

Conclusion:

The use of a visual CLABSI checklist and hands-on education resulted in a significant increase in nursing compliance with the checklist components. Improving compliance with these measures is a crucial first step in decreasing CLABIS infections.