(1301) Aiming for Zero! CLABSI Reduction Through TPN Best Practice

Introduction: Total parenteral nutrition (TPN) has been identified as an independent risk factor for an increased risk of Central Line Associated Blood Stream Infections (CLABSI) by ASPEN and the CDC. Adherence to practice guidelines may reduce the risk of infection. An increase in CLABSI in patients receiving TPN was identified in our academic, tertiary care medical center in 2022 where we have an average of 25-35 patients on TPN daily. A plan-do-check-act (PDCA) cycle identified and addressed practice gaps around supply access, lumen designation, TPN infusion interruptions, and daily maintenance to significantly reduce CLABSI in TPN patients.

Methods: In June 2022, 352 observational audits of 85 patients receiving TPN on 27 inpatient units were done by 2 designated RNs. Practice gaps were identified in 39% of patients. These gaps included not using a designated lumen and switching the lumen, not using a needleless access device (NAD), unlabeled tubing, and interrupting the infusion for care such as activity and hygiene. A root cause analysis identified lack of knowledge and supply availability as key issues. Collaboration with our pharmacy addressed supply issues by delivering tubing, filter, NAD, and label with TPN daily. Three pilot units were used to test improvements to address knowledge gaps and designated lumen labeling. Knowledge gaps were addressed with signage that was hung on the IV pole with TPN by clinical dieticians in September 2023. EPIC MAR administration instructions that matched the signage went live in November 2023. Nurses in the pilot areas evaluated 2 TPN designated lumen labels from November to January 2024 for durability. The pharmacy then updated the TPN kits to provide signage and the selected TPN lumen label for all TPN patients.

Results: The TPN patient CLABSI rate in 2022 was 20.8% with 32 CLABSls. The 2023 TPN clabsi rate was reduced to 12.7% with 20 infections. From January to June 2024, the TPN CLABSI rate is 4.6% with 4 infections. Staff report improved satisfaction with the just in time education, supply delivery with TPN, and MAR update.

Conclusions: Staff input and multiprofessional collaboration between nursing, pharmacy, and dieticians has eliminated practice gaps and led to significant CLABSI reduction in patient receiving TPN at our academic medical center.