CLABSI Rates within the

CVICU at St. Mary’s Hospital

Karley Allen, Nicole Anders, Michael Gray, Rhonda
Gregory, & Tera Ruff
Brief Overview
St. Mary's Hospital is located in the heart
of Richmond, Virginia.

Originally, the hospital opened in 1966

with a capacity of 160 beds.

Is a part of Jean Watson’s implementation

of her Caring Nursing Theory

Today the hospital’s current capacity

holds nearly 400 beds.
Cardiovascular ICU (CVICU)
The Cardiovascular Intensive Care Unit is an
8 bed unit of high acuity, critical care patients.
Many patients seen have cardiac-related
conditions.

Typically the nurse-to-patient ratio is one

nurse per two patients (1:2).

In 2020, the CVICU received the Gold Level

Beacon award for Excellence from the
American Association of Critical Care Nurses
 Macro Issues

It is estimated that approximately 250,000 CLABSI infections occur

annually in the United States. CLABSI prevalence in ICUs in the US is
estimated to be 0.8 per 1000 central line days. Whereas, the international
rate is approximately 4.1 per 1000 central line days. CLABSI infections
result in an additional hospital cost of $48,108 per patient, with an
increase in mortality by 0.15% (150 deaths per 1,000 cases).

Estimated annual cost: Over

 Micro Issues

Within the first 6 months of 2020, the CVICU at SMH has a CLABSI infection
rate of 5.52.

This is a projected hospital cost of over $26 million.

Conservative combination of total cost for CLABSIs in SMH, and just the first
6 months of CVICU in 2020 is ……….$413,894,804.

Why are these numbers important?

Data Analysis of Issue -
There is a positive correlation between the number
of COVID-19 cases and CLABSI rates in the first
and second quarters of 2020 in the SMH CVICU.

It is predicted that increased rates are a result of

the line placement, patient positioning,
inconsistencies with dressing change, maintenance
bundles, and line indication protocols, and
variances between documentation and audits of
dressing status.
 Root Cause
There is a current lack in accessible technology to indicate previous or upcoming central line
dressing changes. Other discrepancies include staff understanding of when central line dressings
should be changed, insufficient staff education on dressing maintenance, inconsistencies with
line removal criteria, and poor quality and accessibility of central line bundle supplies.

Hypothesis: A study by DeGennaro (2014) concluded that scheduled dressing changes increased
staff compliance and decreased infection rates. Utilizing the EMAR to alert staff to upcoming
dressing replacements, scan supplies, and document dressing changes will result in increased
safety and compliance, improved workflow, and decreased discrepancies in documentation and
audits.
 AIM - CVICU- Proposed Solutions

● Decrease the prevalence of central line-associated bloodstream infections

● < 0.6% within 6 months of intervention initiation.
● Increase central line compliance
● Reduced CLABSI rates
● Reduce length of hospital stay
○ reducing HAI deductions from Medicaid and Medicare programs.
● Reduce financial loss
 Who, What, When, Where, and Why
Logistics Stakeholders
● Making modifications within EPIC’s charting ● Leadership, Patients, Hospitals,
system Medicare/Medicaid, Infectious Prevention,
● Brochures detailing new technologies, policies, Medical Staff.
and education for employees.
Timeline
Potential Costs ● Formulate policy and training within 4
● Upgrade of Epic EMR months, Initiate staff training within 3 months
○ Price unknown ● Initiate audits to assure compliance and
● Package or Bundle to improvement in supply effective use within 4 months.
quality
○ ~$18,000 - $90,000 per infection Data Collection
● Analytical breakdown of CLABSI rates and in
relation to their contributing factors.
 Conclusion
● CLABSI rates = health care costs, mortality, patient harm.

● Full utilization of technology = increase compliance, consistency, and

accountability = patient safety & infection risk.

● Cost to upgrade EPIC package ⥶ cost spent/not reimbursed for CLASBIs

 Reference
DeGennaro, D. (2014). Decreasing central line complication with a dedicated team approach. Walden University
ScholarWorks. https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=1392&contex

Haddadin, Y. (2020). Central Line Associated Blood Stream Infections. Retrieved from
https://www.ncbi.nlm.nih.gov/books/NBK430891/#!po=3.57143

Yaseen, M., Al-Hameed, F., Osman, K., Al-Janadi, M., Al-Shamrani, M., Al-Saedi, A., & Al-Thaqafi, A. (2016). A
project to reduce the rate of central line associated bloodstream infection in ICU patients to a target of zero. BMJ
quality improvement reports, 5(1), https://doi.org/10.1136/bmjquality.u212545.w4986.