Expert CLABSI guidance adds real world implementation strategies

CHICAGO (June 1, 2014) – As central-line associated bloodstream infections (CLABSIs) pose a danger to vulnerable patients, infection prevention and control experts released new practical recommendations to assist acute care hospitals in implementing and prioritizing prevention efforts.

The guidance was published in the July issue of Infection Control and Hospital Epidemiology and produced in a collaborative effort led by the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America, the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology and The Joint Commission.

"There is no shortage of guidelines and recommendations to prevent CLABSI, including those from government, public health and professional organizations. But translating this evidence into practice, while challenging, is critically important," said Leonard Mermel, DO, ScM, co-lead author of the guidelines with Jonas Marschall, MD. "We've included examples of successful implementation approaches and references to published examples that can be adapted and adopted by hospitals."

An estimated 41,000 cases of CLABSI occur in U.S. hospitals and are usually serious infections typically causing increased length of hospital stay and risk of mortality – contributing to an increase in healthcare cost of up to an additional $39,000 per episode. Factors which make patients susceptible to CLABSIs include prolonged hospitalization before catheterization, prolonged duration of catheterization, and heavy microbial colonization at the insertion site and catheter hub.

The updated guidance includes a special section on implementation, emphasizing engagement with healthcare personnel through the supportive, vocal healthcare leaders and sharing of data with employees on the frontlines to track prevention progress. Implementation recommendations are highlighted below.

• Engage both hospital frontline staff and senior leadership in the process of an outcome improvement plan. Focus on a culture of safety including teamwork, technical process and promotion of accountability. Work to make the problem real to all those involved by identifying a patient in the unit who has suffered harm as a result of developing a CLABSI and sharing that story with the team.
• Educate healthcare personnel involved in the insertion and care of central lines. Educational programs should employ multiple teaching strategies to best engage diverse learners.
• Execute best practices by standardizing the care process to help increase staff compliance. Consider using quality improvement methodologies to structure prevention efforts.
• Evaluate the impact of strategies. Multidisciplinary strategies, using quality improvement collaboratives, should be used to set goals and identify the key factors to be measured. Feedback should be given to all personnel with the goals for improvement clearly and frequently articulated.

The new practice recommendations are a part of Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2014 Updates, a series of articles to be published over several months sharing evidence-based strategies to help healthcare professionals effectively control and prevent the spread of healthcare-associated infections (HAIs).

The 2014 release revises the initial 2008 Compendium publication.

Jonas Marschall, Leonard Mermel, Mohamad Fakih, Lynn Hadaway, Alexander Kallen, Naomi O'Grady, Ann Marie Pettis, Mark Rupp, Thomas Sandora, Lisa Maragakis, Deborah Yokoe. "Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals: 2014 Update." Infection Control and Hospital Epidemiology 35:7 (July 2014)

Published through a partnership between the Society for Healthcare Epidemiology of America and The University of Chicago Press, Infection Control and Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. ICHE is ranked 13 out of 158 journals in its discipline in the latest Web of Knowledge Journal Citation Reports from Thomson Reuters.

SHEA is a professional society representing more than 2,000 physicians and other healthcare professionals globally with expertise in and passion for healthcare epidemiology and infection prevention. SHEA's mission is to prevent and control healthcare-associated infections and advance the field of healthcare epidemiology. The society promotes science and research, develops expert guidelines and guidance for healthcare workers, provides high-quality education, promotes antimicrobial stewardship, encourages transparency in public reporting related to HAIs, works to ensure a safe healthcare environment, and facilitates the exchange of knowledge. SHEA upholds the value and critical contributions of healthcare epidemiology to improving patient care and healthcare worker safety in all healthcare settings. Visit SHEA online at http://www.shea-online.org, http://www.facebook.com/SHEApreventingHAIs and @SHEA_Epi.

The Infectious Diseases Society of America (IDSA) is an organization of physicians, scientists, and other health care professionals dedicated to promoting health through excellence in infectious diseases research, education, prevention, and patient care. The Society, which has more than 10,000 members, was founded in 1963 and is based in Arlington, VA. For more information, see http://www.idsociety.org.

The AHA is a not-for-profit association of health care provider organizations and individuals that are committed to the improvement of health in their communities. The AHA is the national advocate for its members, which include nearly 5,000 hospitals, health care systems, networks and other providers of care. Founded in 1898, the AHA provides education for health care leaders and is a source of information on health care issues and trends. For more information visit the website at http://www.aha.org.

APIC's mission is to create a safer world through prevention of infection. The association's more than 15,000 members direct infection prevention programs that save lives and improve the bottom line for hospitals and other healthcare facilities. APIC advances its mission through patient safety, implementation science, competencies and certification, advocacy, and data standardization. Visit APIC online at http://www.apic.org. Follow APIC on Twitter: http://twitter.com/apic and Facebook: http://www.facebook.com/APICInfectionPreventionandYou. For information on what patients and families can do, visit APIC's Infection Prevention and You website at http://www.apic.org/infectionpreventionandyou.

Founded in 1951, The Joint Commission seeks to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. The Joint Commission evaluates and accredits more than 20,000 health care organizations and programs in the United States, including more than 10,300 hospitals and home care organizations, and more than 6,500 other health care organizations that provide nursing and rehabilitation center care, behavioral health care, laboratory and ambulatory care services. The Joint Commission currently certifies more than 2,000 disease-specific care programs, focused on the care of patients with chronic illnesses such as stroke, joint replacement, stroke rehabilitation, heart failure and many others. The Joint Commission also provides health care staffing services certification for more than 750 staffing offices. An independent, not-for-profit organization, The Joint Commission is the nation's oldest and largest standards-setting and accrediting body in health care. Learn more about The Joint Commission at http://www.jointcommission.org.