Santa Clara Valley Medical Center first heightened its focus on central line-associated bloodstream infections (CLABSIs) in 2006, when the hospital joined two Institute for Healthcare Improvement (IHI) initiatives that eventually helped the facility cut its intensive care unit (ICU) CLABSI rates from 0.4 per 1,000 patient days at baseline to 0.14 per 1,000 patient days in 2011.
Despite these gains, Santa Clara recognized the advantage of addressing CLABSI from a systemic level and launched a companion effort to sustain existing CLABSI improvements and spread impactful practices to all units. As a result, Santa Clara reduced its yearly CLABSI count by 50 percent, from six in 2011 to three in 2012.
Santa Clara in 2011 joined the California Health Care Safety Net Institute (SNI) Sepsis/CLABSI collaborative through California’s Delivery System Reform Incentive Payment (DSRIP) Program to continue its CLABSI improvements and build a performance improvement infrastructure. Using an IHI model, Santa Clara formed a multidisciplinary CLABSI committee led by a physician champion and nursing leader.
Despite financial constraints, the essential hospital — whose patient population is 75 percent Medicaid recipients or uninsured patients — also hired three quality coordinators as a part of the DSRIP project, including one dedicated entirely to the CLABSI team. Executive and medical leadership recognized that such an investment would provide the support necessary to ensure success, both financially and clinically.
The CLABSI committee used a multipronged strategy to improve collection, reporting, and compliance with the central line insertion practices (CLIP) bundle, which included:
- building an internal database to track all central lines and to ensure that CLIP forms were completed for every such line;
- educating nurses and physicians on proper line maintenance and necessity;
- providing a CLIP cart on every ICU to ensure access to supplies and tools;
- instituting a new line protocol to standardize practices for maintenance, dressing change, blood sampling, accessing and de-accessing implanted vascular ports, and needleless connector/cap change; and
- distributing a letter from executive leadership empowering staff to report improper central line practices.
As a result, CLIP compliance rates skyrocketed from 29 percent in November 2011 to 82 percent in September 2012. While reliably implementing the CLABSI bundle, Santa Clara held its standard infection ratio (SIR) below 1.0. Starting in April 2013, Santa Clara planned to trial the use of daily chlorhexidine baths in three of its ICUs to prevent patient exposure to contaminants in bath basins.
The team members summed up the key to their success in one word: “collaboration.” They said collaboration among physicians and nurses, executive leadership, and front-line staff was essential to making progress, as it encouraged staff to become active team members and to feel accountable for results. As one Santa Clara quality leader said, “It’s all about the team.”