Using a Comprehensive On-Site Assessment Process to Reduce Central Line-Associated Bloodstream Infection Rates

Rebecca Bartles; Andria Moore; Rosemary Martin; Rebecca Clarkson; Laura Ebinger

doi:10.1097/NAN.0000000000000512

Using a Comprehensive On-Site Assessment Process to Reduce Central Line-Associated Bloodstream Infection Rates

J Infus Nurs. 2023 Sep-Oct;46(5):266-271. doi: 10.1097/NAN.0000000000000512.

Authors

Rebecca Bartles^{1

2

3

4

5

6}, Andria Moore^{1

2

3

4

5

6}, Rosemary Martin^{1

2

3

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6}, Rebecca Clarkson^{1

2

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6}, Laura Ebinger^{1

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4

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6}

Affiliations

¹ Providence, Maple Valley, Washington.
² Rebecca (Becca) Bartles, DrPH, MPH, CIC, FAPIC, is the executive director of infectious disease management and prevention for Providence. Dr Bartles has practiced infection prevention for the last 17 years in a variety of health care settings and has numerous publications focused on infection prevention staffing and endoscope safety. She received both her BS in Public Health, Health Education, and her MPH in Epidemiology from East Tennessee State University. She completed her Doctorate in Public Health in 2021 with a dissertation topic of "Assessing Efficacy of an Evidence-Based Clostridioides difficile Screening Tool Using Electronic Medical Record Data." Dr Bartles also teaches courses at the University of Providence for a Masters in Infection Prevention degree program that she founded in 2016. She has been CIC certified since 2008 and is an Association for Professionals in Infection Control and Epidemiology fellow. Most notably, though, Dr Bartles is the mother of 4 beautiful daughters, ages 8 to 23.
³ Andria Moore, MN, RN, CPHQ, CCRN-K, is a senior program manager for nursing practice and quality at Providence Health System. She completed her nursing degree at Georgetown University and her Master's in Nursing from the University of Washington. She holds credentials in both critical care nursing and health care quality. She has over a decade of experience in various health care settings. Currently she works in close partnership with interdisciplinary teams across Providence to drive system-wide quality and practice strategic initiatives. Her work focuses on reduction of nurse sensitive quality indicators, optimizing nursing workflows, and leading practice change to ensure alignment with the latest evidence-based care standards.
⁴ Rosemary Martin, ASCP (M)CM, CLSSBB, CIC, is the system infection prevention program manager for the Providence Health System, a 54-hospital system across 7 states. She has 20 years of experience as a careered clinical microbiologist and process improvement consultant; her projects currently focus on developing a process improvement program for system infection prevention and creating dashboards for the enterprise that aggregates various data at the system, regional, and local level. She provides support to the system team as a subject matter expert in leveraging technological platforms for governance and team management. She holds a degree in microbiology from the University of Washington, is certified as an Infection Preventionist (CIC), Clinical Microbiologist ASCP(M)CM, and Lean Six Sigma Black Belt (CLSSBB).
⁵ Rebecca (Bex) Clarkson, RN, MSN, CIC, is a senior infection preventionist with Providence Health System. She is a registered nurse by background and has practiced since 2009 in multiple settings across the hospital, including emergency medicine, cardiac, oncology, acute observation, and charge nurse. Her nonacute experience includes work in home infusion, business consultation, envenomation and animal educational presentations, curriculum development, and filming set compliance officer. Ms Clarkson received her MSN with an emphasis in nursing education with an intent to teach nursing school when she fell into infection prevention in 2015 and realized that this is where she belongs. Her publications and national presentations revolve around topics related to central line-associated bloodstream infection and catheter-associated urinary tract infection prevention, displaying her passion and dedication to patient safety.
⁶ Laura Ebinger, CIC, is a system infection preventionist for Providence Health. Laura has practiced infection prevention and epidemiology for the last 17 years in several health care settings. She received her BS in psychology through the University of Washington. Ms Ebinger worked as an instructional designer for 4 years for a private university creating online modules for master-level programs. She also has her own infection prevention consulting business, which provides consultative expertise to health care facilities and businesses. She has been CIC-certified since 2007. Ms Ebinger has a passion for incorporating the latest technology with infection prevention practices, creating practical and efficient work processes.

PMID: 37611284
DOI: 10.1097/NAN.0000000000000512

Abstract

Central line-associated bloodstream infection (CLABSI) rates increased substantially in the United States following the emergence of COVID-19 and subsequent surges. The pandemic resulted in hospital capacities being exceeded and crisis standards of care being implemented for sustained periods. As COVID-19 rates in the United States began to stabilize, some facilities did not return to previous CLABSI rates, indicating a change in practices that had a longer-term impact on CLABSI prevention. The authors' large health care system observed similar increases in CLABSI following the emergence of COVID-19, prompting investigation and intervention in the form of a quality improvement project. To identify changes related to ongoing increases in CLABSI, an assessment team conducted standardized on-site assessments at 11 facilities. Site assessments were considered an intervention, as they involved rigorous preassessment investigations and interviews, case reviews, practice observations, on-site staff interviews, and postassessment support for additional interventions. Nine facilities had enough postassessment data to analyze the impact of intervention. The overall CLABSI rate (infections per 1000 line days) at the 9 facilities in the 6 months prior to intervention was 1.42, and the postassessment rate in the 6 months following intervention was 0.44. This indicates the effectiveness of facility-specific investigation followed by targeted performance improvements to reduce the rate of CLABSI.

MeSH terms

COVID-19* / prevention & control
Catheter-Related Infections* / epidemiology
Catheter-Related Infections* / prevention & control
Catheterization, Central Venous* / methods
Cross Infection* / epidemiology
Cross Infection* / prevention & control
Humans
Infection Control / methods
Sepsis* / prevention & control
United States / epidemiology