Reducing Central-Line-Associated Blood Stream Infections

Reducing Central-Line-Associated Blood Stream Infections

 Central-line-associated blood stream infections (CLABSIs), a hospital-associated infection monitored by the Centers for Medicare and Medicaid Services (CMS), are preventable infections that are associated with increases in mortality, morbidity, length of stay, and health care costs (Xiong & Chen, 2018). There are over 60,000 CLABSIs each year reported from United States hospitals resulting in $1.85 billion in related costs (Heimann et al., 2018). The purpose of this paper is to develop a plan for quality improvement that reduces CLABSIs using the theoretical underpinnings of Kurt Lewin and a root cause analysis (RCA) as part of the FADE quality improvement that is cost-effective, addresses process, structural, and qualitative and quantitative outcome measures, and can be visually depicted and reported. Background CLABSIs increase healthcare costs on average by $48,108 per incidence (Agency for Healthcare Research and Quality, 2017). Length of stay is increased by 10 to 19 days. The unnecessary and prolonged usage of central venous catheters are major causes of CLABSIs in the inpatient setting. During the year of 2019, Santos Health System-North, 556-bed acute care facility, experienced 24 CLABSIs. A pseudonym is used to protect the confidentiality of the organization. When using the standardized infection ratio (SIR) to compare the expected CLABSIs, calculated at 14.886, with the actual CLABSIs, the facility had a CLABSI SIR of 1.612. This CLABSI SIR indicates the facility scored worse than the national benchmark (CMS.gov, 2021; Xiong & Chen, 2018). In the past, the implementation of CLABSI bundle measures have decreased the incidence of CLABSIs by 50%; however, CLABSIs remain a significant barrier in delivering quality patient care, obtaining good outcomes, and reducing healthcare costs. The purpose of this

3 quality improvement process is to identify what barriers exist to reducing CLABSIs at Santos Health System-North and implement measures to reduce CLABSIs in the inpatient setting to below the CMS national benchmark (Xiong & Chen, 2018). Theoretical Underpinnings Lewin’s model for change emphasizes the need for a change in cultural atmosphere. Lewin’s change model includes three steps: unfreezing, moving, and refreezing. Using this theoretical basis for change, the intended change is a driving force against the status quo and a dynamic balance between opposing and supportive forces. Unfreezing involves the unlearning and destabilization of old behaviors. Moving involves the adaptation of new, more acceptable behaviors that will result in the least opposition moving forward with change. Refreezi