Decreasing CLABSI Rates and Cost Following Implementation of a Disinfectant Cap in a Tertiary Care Hospital

Presented at APIC Annual Conference 2013, June 9-11, 2013

Sharon Sumner, RN, BSN, IP; Katreena Merrill, RN, PhD; Lorraine Linford, RN, BS, CNSC and Carrie Taylor, RN, MSN, CIC
Intermountain Medical Center & BYU College of Nursing, Provo, UT

Background:

decreasing-CLABSI1

  • Central line associated bloodstream infections (CLABSI) are responsible for significant patient morbidity, mortality and increased length of stay resulting in higher healthcare costs.
  • Organisms from the hospital environment, healthcare worker hand and patient’s own flora contribute to colonization of needleless connectors. Once colonized, there is an increased risk of CLABSI.
  • Previous studies demonstrated a low compliance with disinfection practices of needleless connectors1.
  • Manual disinfection is insufficient to disinfect heavily contaminated connectors and thus prevent CLABSI.
  • Use of a disinfectant cap increases compliance and improves the quality of disinfection and contributes to CLABSI reduction.

Purposes:

  • Monitor nurses’ compliance with a disinfectant cap in a 440 bed tertiary care Trauma 1 center.
  • Determine the effect of implementation of a disinfectant cap on the rate of CLABSI and contaminated blood cultures.
  • Collaborate with front line staff on implementation strategies to prevent CLABSI.

Methods:

  • In January 2012, a disinfectant cap was implemented for all central and peripheral needleless connectors in all inpatient departments in a large tertiary care center (excluding women’s services).
  • Rates of CLABSI and blood culture contamination were compared before and after implementation.
  • Cost savings estimated using $25,000 for CLABSI and $2,500 for blood culture contamination2.
  • Weekly audits performed by nursing students, staff and PIs.

Implementation Strategies:

Education

  • Required on-line modules or vendor in-service on use of the disinfectant cap.
  • Required on-line module on proper blood culture drawing technique.

Audits

  • Weekly compliance of the disinfectant cap reported to the nurse managers.
  • Just-in-time education given to staff during the audit process, including proper care of the secondary tubing set.

Staff Collaboration

  • Solicited feedback from staff. Nurses identified need for fewer needleless connectors resulting in the purchase of no-port tubing. These changes resulted in cost savings and increased staff satisfaction.

Results:

decreasing-CLABSI2

Significant decrease in rate of CLABSI (t (22) = 2.73, p=.01):

2011 (M=1.4, SD=.37)

2012 (M=.88, SD=.61)

decreasing-CLABSI3

decreasing-CLABSI4

Significant decrease in rate of contaminated blood cultures (t (22) = 7.7, p<.01):

2011 (M=2.6; SD=.39)

2012 (M=1.5; SD=.29)

decreasing-CLABSI5

CLABSI estimated cost = $25,000/incidence; contaminated blood culture estimated = $2,500/incidence)

Conclusion/Implications:

  • The use of a disinfectant cap was effective in reducing the rate of CLABSI and contaminated blood cultures in a tertiary care center and providing substantial cost savings.
  • Use of a disinfectant cap had a greater impact on reducing gram positive organisms.
  • Nursing feedback was essential and provided unexpected savings (no-port tubing).

References:

1Karchmer TB, Cook EM, Palavecino E, Ohl CA, Sherertz RJ. Needleless valve ports may be associated with a high rate of catheter-related bloodstream infections. In: Program and abstracts of the 15th Annual Scientific Meeting of the Society for Healthcare Epidemiologists of America; April 9-12, 2005; Los Angeles. Abstract 307.
2Warren DK, Quadir WW, Hollenbeak CS, Elward AM, Cox MJ, Fraser VJ. Attributable cost of catheter-associated bloodstream infections among intensive care patients in a nonteaching hospital. Crit Care Med. 2006 Aug;34(8):2084-9.