(1264) CLABSI: Is Nurse-Driven Bundle More Sustainable During Crisis? A Four-Pronged Approach

Introduction: Although preventable, central line-associated bloodstream infections (CLABSI) are associated with higher morbidity & mortality and prolonged hospital stay. The CLABSI prevention bundle provide the ICU teams with guidelines for preventing such infections using Tier 1 and 2 interventions, though strategy for sustainability during crisis is still not studied well.

Methods: In this qualitative study, we interviewed the chief of infection control at our tertiary care facility, nursing leaders, and intensivists, after a sudden rise in CLABSI - post supply-chain disruption causing high "line days." In interviews, we discussed the impact of CLABSI bundle on long-term sustainability driven by nursing staff, particularly during a crisis. Following 4-pronged approach is applied:
1. An emphasis was placed on decreased use of femoral lines with documentation from operator in procedure note to justify the site.
2. Process and outcome surveillance is applied, which focuses on prevention and feedback. A feedback system is developed to monitor compliance, and a corrective plan is designed to emphasize that one learns from the mistakes.
3. Nurses must go through the Intensive Care On-line Network (ICON) training with the empowerment that If a nurse deems necessary, can remove central lines without a direct order from the physician.
4. When there is a controversy between clinical team, the problem is escalated to the Chief Nursing Officer, and the infection control chief intervenes.

Results: Previously, updated CLABSI bundle initiative was implemented in August 2021. Although there have been sustained improvement, in Mid to late 2022, there was a disruption of the supply chain, and an increase in infections due to longer line days was noted down the line. In January, February, and March of 2023, there were 8 CLABSI on average per month. The above 4-pronged approach was implemented in early April of 2023, This intervention led to total of only one CLABSI in the subsequent month. No escalation to Infection Control chief was reported in the study period.

Conclusions: The CLABSI bundle accompanied by process & outcome surveillances, constructive feedback, empowerment of nurses, teamwork and accountability bears a sustainability which can wither crisis like supply chain or any other disruptions.