Background In 2018 there was an increase in Central Line Associated Bloodstream Infections (CLABSIs) in the Neurosurgical and Surgical Intensive Care Units at NYC Health + Hospitals/Kings County

Objectives We initiated a CLABSI reduction project with a goal to reduce the CLABSI rate by 50% by the end of 2019, which was achieved.

Methods Through root cause analysis (RCA) of patients with central line catheters, CLABSI event data was analyzed and a special cause variation was revealed in patients on total parenteral nutrition (TPN). Retrospective review of data from January 2017 – March 2019 revealed 7 TPN-related candidemias. An interdisciplinary team was assembled to perform multiple tests of change. Using point prevalence data, we observed a 47% bundle compliance rate at the project’s onset, with the initial PDSA cycle focusing on bundle adherence for line maintenance. After implementing and sustaining our initial PDSA cycle, we focused additional cycles to included empiric treatment with fluconazole for patients on TPN over 7 days and implementation of dedicated ICU multidisciplinary care team rounds.

Results Following these improvement cycles, we reduced our total CLABSI rate by 50% and we saw 0 TPN-related candidemia over 10 consecutive months. From 2018–2019, our overall CLABSI rate in the ICU decreased from 3.6 to 1.8 per 1000 central line days. Using the Association for Professionals in Infection Control and Epidemiology (APIC) Cost of Healthcare-Associated Infections Model we estimate a $100,854 cost savings and 51 avoided excess hospital days in 2019.

Conclusions Through focused unit-based education, implementation of a standardized bundle compliance monitoring tool and capture/circulation of staff feedback, we saw rates improve to 98%, which has sustained over time. We observed patients on TPN greater than 7 days are most susceptible to infection. However, multidisciplinary rounds with shared accountability improved compliance with bundle.