Central Line Blood Stream Infections (CLBSI) are one of the most common but largely preventable hospital acquired infections.   A central line is placed in a patient to deliver medications directly into large blood vessels.  

Infections cause septicemia and can be life threatening.  Almost 20% of patients that develope a CLABSI die during their hospitalization.⁶  According to the CDC, there are 92,000 CLBSI which occur each year at a cost of between $7,288 to $29,156 for each infection.¹   Vascular Catheter Associated Infections have been estimated to cost Medicare 3 billion dollars each year.²  Luckily, protocols have been devised which can eliminate up to 82% of these infections.  However, institutions have been slow to adopt these interventions.

These reductions were achieved by the introduction of rigid protocols and checklists (see below button).³  This intervention is a similar methodology to that used in the airline industry and Toyota and it works!   All healthcare providers work as a team and it empowers nurses to stop the procedure if a violation is noted.  Peter Provonost, one of the original authors, is credited for popularizing the idea.  He reported an 82% reduction in CLBSI after the introduction of checklists (p < 0.002).⁴  Similar results have been reported by Shannon, et al, who reported a reduction in infection rates from 10.5 to 1.2 infections per 1000 catheter days and a decrease in mortality from 51% to 16%.⁵

State of Michigan

ICUs reduced infections on average from 2.5 infections per 1,000 line days in 2004 to .83 infections per 1,000 line days in 2009. Further, 60% of the ICUs evaluated prevented central line infections for a year or more, and 26% went without infections for at least two years.   Click on Picture to Enlarge.⁶

State of Tennessee

A public reporting initiative in the State of Tennessee was associated with a 70% reduction in CLBSI.   Click on Picture to Enlarge

References

1. Scott, RD: CDC: Direct Medical Costs of Healthcare Acquired Infections and Benefits of Prevention. Table 6, Page 13, March 2009. http://www.cdc.gov/ncidod/dhqp/pdf/Scott_CostPaper.pdf

2. CMS Fact Sheet Monday April 14th, 2008  http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=3042

3. Berenholtz SM, Pronovost PJ, Lipsett PA, Hobson D, Earsing K, Farley JE, Milanovich S, Garrett-Mayer E, Winters BD, Rubin HR, Dorman T, Perl TM. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med. 2004 Oct;32(10):2014-20. http://www.ncbi.nlm.nih.gov/pubmed/15483409

4. Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, Sexton B, Hyzy R, Welsh R, Roth G, Bander J, Kepros J, Goeschel C. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006 Dec 28;355(26):2725-32.  http://www.ncbi.nlm.nih.gov/pubmed/17192537

5. Shannon RP, Frndak D, Grunden N, Lloyd JC, Herbert C, Patel B, Cummins D, Shannon AH, O'Neill PH, Spear SJ. Using real-time problem solving to eliminate central line infections. Jt Comm J Qual Patient Saf. 2006 Sep;32(9):479-87. http://www.ncbi.nlm.nih.gov/sites/entrez/17987871  

6. Silow-Carroll S and Edwards JN. Eliminating Central Line Infections and
   Spreading Success at High-Performing Hospitals. Commonwealth Fund. December 2011.   http://www.neverevents.org/downloads/20111200-CLBSI-HighPerformingHospitals.pdf