Decreasing bloodstream infections with a checklist

Clients:  Infection preventionists, nurses and physicians at Virginia hospitals with infection control deficiencies.

Challenge: Hospital staff place central line catheters to administer medications, blood and other fluids directly into the bloodstream of seriously ill patients. The catheter tip rests in a large vein adjacent to the heart, often for weeks. Patients can develop central line-associated bloodstream infections (CLABSI) when bacteria are introduced during the insertion process.

Solution: HQI talked with hospital staff and reviewed CLABSI data, concluding that increased adherence to evidence-based Central Line Insertion Practices (CLIP) would be the best way to improve performance. For example, details like using the proper antiseptic to clean the patient’s skin and allowing it to air-dry are essential. Our certified infection preventionist provided hospitals with a CLIP checklist and supported its implementation by central line placement teams. This included gaining leadership support for the change, making the checklist part of every central line procedure, establishing roles and accountabilities for checklist use, and reporting CLIP data.

Results: The 11 participating hospitals decreased their cumulative Standardized Infection Ratio (SIR) for CLABSI from 1.71 to 0.27 over a two-year period, well below the national SIR of 0.59. HQI subsequently performed similar work on CLABSI with more than 200 hospitals across the country for the American Hospital Association and Premier.

Sponsor:  This project was funded by the Centers for Medicare & Medicaid Services through its Quality Improvement Organization program. Preventing avoidable infections helps contain the cost of hospital care, which preserves the Medicare Trust Fund.