41 months is the equivalent of 1,248 days, and can certainly be considered a long time. That’s how long Mount Nittany Medical Center’s Intensive Care Unit (ICU) has gone without a central line associated blood-stream infection, and that’s something to celebrate.
A central line associated blood-stream infection, referenced by the acronym CLABSI, is a confirmed infection in the blood stream that stems from the insertion of a central line, and can be highly deadly. According to the Centers for Disease Control and Prevention, approximately 41,000 patients contract CLABSIs every year in hospitals.
So how has Mount Nittany Medical Center achieved such success? In 2010, the Medical Center participated in “On the CUSP: Stop BSI,” a national initiative to eliminate healthcare-associated infections—with a focus on CLABSI prevention—through use of a Comprehensive Unit-based Safety Program (CUSP).
The overarching goal of CUSP projects is creating efficiencies and a culture of safety within a healthcare organization. One of the biggest and arguably well-known healthcare-associated infections is the blood stream infection, hence the Medical Center choosing to take on the CLABSI project.
Through the CUSP/CLABSI project, Medical Center employees began focusing on ways to control blood stream infections in the ICU caused by central lines. A central line is a long flexible tube that is inserted into a main vein through the arm, neck, chest, or in rare cases the groin, to provide the patient with fluids, medication, nutrition, or blood products.
“We already had a framework in place for preventing infections when we began working on this project,” said Marlene Stetson, coordinator, infection prevention and control, Mount Nittany Medical Center. “We had not had a CLABSI since June of 2010, but we knew there were additional safeguards for preventing future infections.”
The team began by having the staff trained and educated on CLABSI prevention. Then, the team created a catheter pre-insertion checklist. Because there are different types of catheters and different ports to begin a central line, the checklist helped ensure that the right equipment was being used on the right patient at the right time.
“We did this by developing what we call ‘line boxes.’ Each type of central line has its own box that has the insertion kit right inside of it. These boxes are prepared ahead of time with everything that’s needed for central line insertions. This makes it a safe and streamlined process when a patient requires a central line,” said Stetson.
In addition to the line boxes, a new disinfecting cap is also being used. This orange cap, called a “swab cap” is a newer type of technology that actively disinfects the central line port, aiding in infection prevention. These caps, coupled with state-of-the-art catheters, have helped to prevent CLABSIs at the Medical Center within their 12-bed ICU for 41 months.
Prevention of CLABSIs is imperative, as central line infections can add days to a patient’s length of stay, require extra time and resources in care coordination, and necessitates constant monitoring.
While staff members are trained to monitor central lines for any sign of infection, it’s important for patients to understand the complexities of having a central line. Patient should take notice if their dressings are becoming moist or if the integrity of the site has been compromised.
“It’s also important that patients speak openly with their physician about their central line. It’s perfectly acceptable to ask why the central line is necessary and how long it will be in place. And if a patient has to go home with a central line still in place, they must understand the importance of keeping the site clean,” Stetson said.
With continued diligence and a strong, open relationship between patients and staff, CLABSIs can remain preventable. For more information on how Mount Nittany Health is preventing infections, visit mountnittany.org. For more information about the CUSP project, please visit onthecuspstophai.org.