(1313) Reducing CLABSI by Utilizing a Clinical Decision Support Tool

Introduction: Central-line associated blood stream infections (CLABSIs) carry significant morbidity, mortality and cost. Initial efforts to reduce CLABSI focused on education and line day reduction. Retroactive CLABSI reviews revealed some CLABSI cases were deemed a CLABSI by National Healthcare Safety Network (NHSN) definitions because no other cultures or images were performed to attribute infection to an alternate source. Literature review revealed no specific CDS tool aimed at CLABSI reduction. Our hypothesis is real-time surveillance and CDS can guide providers toward additional culture and/or imaging data to prevent a CLABSI 'by default'.

Methods: Real-time, intermittent intervention project, utilized EPIC to identify blood cultures ordered within a CLABSI infection window. The intervention group occurred Tu, Th, Sa, with real-time alert and CDS tool upon ordering blood cultures within a CLABSI infection window. Non-intervention group occurred Mon, Wed, Fri, Su. The CDS tool provides data including Tmax over preceding 24 hours, recent WBC and culture data. If blood cultures remained clinically indicated, the CDS tool provides suggestions for sputum culture, urinalysis, wound culture and/or chest x-ray to assist in diagnosing alternate infectious sources.

Results: 663 blood culture orders were initiated for patients within a CLABSI window from Jun 21, 2023 to Jan 31, 2024. The intervention group occurred on 96 of 226 days (42.48% of total days) with 271 alerts (40.8%), compared to the non-intervention group which occurred on 130 of 226 days (57.52% of total days) with 392 silent alerts (59.2%). Our healthcare system experienced 10 CLABSIs during this timeframe. 2 CLABSIs occurred within the intervention group at a rate of 0.738% of blood cultures ordered within a CLABSI window vs. 8 CLABSIs occurred within the non-intervention group at a rate of 2.041%.

Conclusions: Utilization of a real-time CLABSI infection window alert with CDS tool has potential to reduce CLABSIs. While CLABSI volume remains low and comparing intervention vs non-intervention group has its limitations, the increased awareness with a real-time alert and CDS tool was deemed favorable and implemented system-wide after Jan 31, 2024. Additional data is under review to evaluate changes in culture practices as a result.