Program Evaluation of a Central Line-Associated Bloodstream Infection Prevention Program in the ICU

Abstract

Purpose: This project aims to perform a summative program evaluation to determine the effectiveness of a quality improvement program at reducing central line-associated bloodstream infections. The quality improvement program used an audit tool to assess compliance with a central line bundle at HonorHealth Shea ICU. During this evaluation, the goal was to assess how an audit tool impacts central line infections via standardized infection ratios. Background: Central line-associated bloodstream infections are the most frequently acquired hospital blood infections, with 87% of blood infections occurring in patients with a central line. Specifically, in the intensive care unit, 30,000 infections occur each year. Central line infections increase mortality rates by 12-25% and cost around $45,000 per patient. These infections are tracked using standardized infection ratios. Central line bundles and audit tools that assess compliance have been shown to be successful at reducing infections. Therefore, the hospital implemented an audit tool to reduce central line infections. Methods: This project is a summative program evaluation of a quality improvement program. The purpose was to compare central line standardized infection ratios before and after implementation of an audit tool, identify the total number of central line device days and identify the number of audit tools completed. This was to determine the effectiveness of the quality improvement program and if it successfully changed the organization's safety culture. Results: During the pre-implementation period, there were nine central line infections per 2,245 central line days. This was determined to be a standardized infection ratio of 3.553. During the post-implementation period, there were five infections per 2,643 central line days. This is a standardized infection ratio of 1.677. Therefore, the implementation of the audit tool successfully achieved a reduction in central line infections. Conclusions: Data showed that central line infections decreased in the post-implementation period despite the increase in number of central line days. This highlights the success of the program. Further research should be done to see if this evidence can be applied to other units in the hospital and develop into a hospital-wide permeant practice change.