(1309) Enhancing the Central Line Bundle: Implementation of a Procedure Checklist in a Multispecialty ICU

Introduction: Central line-associated bloodstream infections (CLABSI) contribute to preventable hospital morbidity, mortality, and cost. Evidence-based prevention methods include hand hygiene, site preparation with chlorhexidine gluconate, maximum barrier precautions, site selection, and early removal. A bedside procedural checklist adapted from the AHRQ CLABSI toolkit was implemented in a 52-bed multi-specialty ICU with the goal of increasing adherence to the institution’s CVC bundle, as well as reducing the frequency of femoral vein catheterizations and the
incidence of CLABSIs over an eight-week pilot.

Methods: This pre-post test study evaluated CVC bundle compliance via site audits for two weeks before and after the implementation of a procedural checklist, as well as CVC site selection and CLABSI rate via EMR review for three months pre- and post-intervention. Staff education was provided before and
during implementation. Statistical analysis was performed using McNemar’s test.

Results: Compared to the pre-test audit (n=10), post-test compliance with full-body drape utilization improved from 80% (n=8) to 100% (n=10), p = .005 (alpha value of .05, χ2(1) = 8.00), while compliance of cap utilization decreased from 100% (n=10) to 90% (n=9), p = .007 (alpha value of .05, χ2(1) = 7.36).
There were 7 femoral vein catheterizations (n=124, 2.60%) pre- and 9 (n=145, 3.35%) post-intervention (alpha value of .05, χ2(1) = 111.23, p < .001). There were 4 CLABSI events pre-intervention and 1 CLABSI event post, a significant decrease based on an alpha value of .05, χ2(1) = 136.42, p < .001.

Conclusions: This study demonstrates a positive correlation between the utilization of a procedural checklist and increased compliance in full-body draping. However, a significant decrease in compliance with hair cap utilization and an increase in femoral vein catheterization was noted, though not thought
to be a direct result of the checklist implementation. There was a significant decrease in overall CLABSI events. Study limitations included a restricted timeline, small sample size, and the nature of a single institution study. Procedural checklists and staff education can be added to institutional CLABSI
prevention bundles to enhance awareness during CVC insertion in an ongoing multidisciplinary effort to prevent CLABSI events.