Zeroing in on zero tolerance for central line-associated bacteremia.

Background: Central line-associated bacteremia (CLAB) is associated with increased intensive care unit (ICU) length of stay (LOS) of up to 6 days, increased hospital LOS of approximately 21 days, attributable mortality of approximately 35%, and incremental costs of approximately $56,000 per infection.

Need: In 1999 in the surgical-burn-trauma ICU at Barnes Jewish Hospital (BJH), the CLAB rate was 10.8/1000 central venous catheter (CVC) line-days, substantially higher than the National Nosocomial Infection Surveillance rate of 5.8/1000 CVC line-days.

Interventions: An educational intervention developed by a multidisciplinary team from BJC HealthCare in 1998 included a self-study module and pre- and posttests. In 2002, the Centers for Disease Control and Prevention updated guidelines for the prevention of intravascular catheter-related infections, which provided additional support. In 2000, Focus-PDCA methodology was used to chart insertion and line maintenance practices; pictorials, binders, and other informational tools were developed based on a flow charting process. At Missouri Baptist Medical Center (MBMC), another BJC HealthCare facility, after not having completed the educational module for more than a year, nurses completed the self-study module and posttest and also developed a "scrub the hub" bundle in July 2006.

Results: Implementation of the educational intervention decreased the CLAB rate at BJH from 10.8/1000 CVC line-days to 3.7/1000 CVC line-days (P < .01) between January 1998 and December 2000. From January 2001 to September 2002, use of the pictorials and other tools reduced the CLAB rate to 2.8/1000 CVC line-days. At Missouri Baptist Medical Center, as of June 2007, 1 of 2 medical/surgical ICUs had no CLAB for 334 days and the other ICU had no CLAB for 212 days. After nurses completed the educational module, there was 1 case of CLAB in 1 medical/surgical ICU and no CLABs in the other medical/surgical ICU in the 61 days after implementation of the "scrub the hub" bundle.

Conclusion: Implementation of a self-study module with pre- and posttests, the use of pictorials and other informational tools, and the implementation of a "scrub the hub" bundle were effective in reducing the rate of CLAB in ICUs and in supporting a culture of zero tolerance for infection.