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Central Line-Associated Bloodstream Infection Reduction: Lessons Learned Ken Sands, MD, MPH SVP, Silverman Institute Central Line-Associated Bloodstream Infection Reduction: Lessons Learned Ken Sands, MD, MPH SVP, Silverman Institute for Health Care Quality and Patient Safety Beth Israel Deaconess Medical Center

CL-BSI goals n n Reduce preventable nosocomial CL-BSI toward zero. Achieve 100% compliance with CL-BSI goals n n Reduce preventable nosocomial CL-BSI toward zero. Achieve 100% compliance with insertion checklists.

Program components n Multidisciplinary Central Line Work Group n Improvement in insertion practices: Continuous Program components n Multidisciplinary Central Line Work Group n Improvement in insertion practices: Continuous education n Audits of checklist use and feedback n Observation of insertion n Standardization of practice across all areas: n (ICUs, Med/surg floors, Radiology, ED, ORs)

Program components n Standardized insertion kit n Root cause analysis of all nosocomial CL-BSI Program components n Standardized insertion kit n Root cause analysis of all nosocomial CL-BSI Ø Ø n Multidisciplinary review team Includes department leadership and front line staff Standardization of care and maintenance of CLs Twice yearly audit of all CLs Ø Feedback of data to each unit and nursing leadership Ø Daily review of utility & integrity of line on rounds Ø Ordering of CLs in POE Ø

Annual ICU Nosocomial CL-BSI Rate per 1000 patient days 93% reduction Annual ICU Nosocomial CL-BSI Rate per 1000 patient days 93% reduction

Days since last nosocomial ICU CL-BSI (as of 6/19/09) ICU CCU Days 325 MICU-East Days since last nosocomial ICU CL-BSI (as of 6/19/09) ICU CCU Days 325 MICU-East MICU-6 284 517 MICU-7 324 CVICU SICU 100 135 TSICU 429

Lessons learned n Start small and expand n Multidisciplinary approach and add as you Lessons learned n Start small and expand n Multidisciplinary approach and add as you go n Senior leadership support n Continuous vigilance with data and feedback n Root cause analysis: n n Real time Front line staff