Cardiovascular Critical Care Complex stamps out central-line-associated blood stream infections

The staff of Christiana Care’s Cardiovascular Critical Care Complex (CVCCC) is quietly celebrating a run of success in the continual battle against central-line-associated blood stream infections (CLABSIs).

The Centers for Disease Control estimates that 41,000 CLABSIs occur in U.S. hospitals each year. These serious infections prolong length of hospital stays and increase costs and risk of mortality.

In February, the CVCCC, comprising the units formerly known as Cardiovascular Intensive Care (CVICU) Cardiac Intensive Care (CICU), and open-heart step-down, all on 2E at Christiana Hospital, marked a full year without a single CLABSI infection and continues its winning streak.

“The entire CVCCC team deserves credit for this tremendous accomplishment,” said Janice Nevin, M.D., MPH, chief medical officer and executive champion of the program. “The staff demonstrates that effective leadership, engagement of all of the members of the care team and a disciplined approach to problem solving makes a difference in reaching Christiana Care’s long-term goal of eliminating preventable harm. I appreciate their outstanding commitment to the safety of our patients.”

“Although we are viewed as one unit, CVCCC has a unique mix of medical, surgical, intensive care, and step-down patients,” said Sharmila Johnson, MSN, APN, ACNS-BC, CCRN, and clinical nurse specialist for CVCCC. “All of our surgical patients have central lines inserted in a sterile setting. However, medical ICU patients have lines that are not always placed in a sterile setting, which puts them at a higher risk for CLABSI.”

Midge Greenfield, RN III, CCRN, who championed the anti-CLABSI initiative in CVCCC, said, “Change for the better is traceable to the Comprehensive Unit-Based Safety Program (CUSP). On the CUSP: Stop BSI is a program developed by Peter Pronovost, M.D., Ph.D., an expert on fighting hospital-acquired infections at the Johns Hopkins University School of Medicine.

Christiana Care joined the nationwide CUSP project several years ago, initially to address and eliminate CLABSI and other safety issues. “It expanded to include ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections,” Greenfield said. The program kickstarted an excellent infection-free record in the Wilmington ICU, which has currently achieved a CLABSI-free duration of 18 months and counting.

“Using a checklist at the time of central-line insertion is a key measure for reducing CLABSI,” Greenfield said. “Another measure that makes a difference is having a nurse present whenever a resident or PA does an insertion. Two years ago, having an experienced nurse at the bedside for central-line insertions became a rule rather than an idea.” In addition, the use of chlorhexidine for skin prep has helped with the initiative, as has Nursing’s diligent monitoring of central line dressing changes.

“Decreasing occasions for blood draws was another major factor in eliminating CLABSI. The CUSP-minded nurses insisted on limiting blood draws to no more than two draws a day to minimize risk of infection, and their campaign was largely successful. Other safety measures included avoiding femoral insertion sites, ongoing education, reinforcement of best practices in line maintenance and removing lines as early as possible.

Kirstan Baxter, RN, BSN, CCRN-CSC, CVCCC’s nurse manager, said Christiana Care’s focus on several opportunities has reaped great benefits. “Early line removal was a major focus,” Baxter says. “Old-school wisdom held that lines should be left in ‘in case we need them,’ but when lines remain in place, the risk of infection increases. It helps having nursing leadership present on rounds to remind residents or physician assistants of the importance of getting lines out quicker.”

Although Christiana Care no longer participates in CUSP, safety efforts in CVCCC and other units continue through value-improvement teams. The value-improvement team program, like CUSP, is multidisciplinary, but it encompasses other potential safety defects within the unit. The teams comprise every member of the patient care unit, including nursing, providers, pharmacy, respiratory, cardiac rehabilitation, physical therapy, dietary, WOC, and VAN, among others.

“Every nurse in CVCCC is to be congratulated,” Baxter said. “It is through our teamwork and collaboration that we are able to achieve this great accomplishment. Having support from our physician leaders, Dr. Michael Banbury and Dr. Gilbert Leidig, and our executive champion Dr. Janice Nevin, also helps.”