Aspirus Wausau Hospital, Wausau, 2025 Quality
Our Journey to Reduce Central Line-Associated Bloodstream Infections
The problem was persistent elevation in Central Line-Associated Bloodstream Infections (CLABSIs). The beginning of this journey started in 2017 when a continually elevated CLABSI Standardized Infection Ratio (SIR), despite process improvements, prompted the upskilling of nursing staff to independently place ultrasound-guided IVs, thereby reducing the central line utilization ratio. What followed was implementation of extended dwell catheters, central line care orders sets, and standardized dressing changes. These efforts showed modest improvements but did not achieve the desired goal for CLABSI.
In FY22, research by the laboratory team led to trialing a diversion device for blood specimen collection. Based on the trial results, blood specimen collection diversion device use was expanded throughout the hospital with, again, modest improvements in CLABSI SIR. In FY24 a diversion device usage goal of 80% was set, as well as a reduced blood contamination rate goal. FY24 finished with an increase in diversion device usage (85%), a blood culture contamination rate well below the national benchmark, and a noted decrease in CLABSI cases (9 infections in FY23 to 1 infection in FY24) and CLABSI SIR (0.611 in FY23 to 0.07 in FY24).
There have been several big lessons on the path to CLABSI reduction. The team learned that process improvement can take multiple years to be successful, staff education and engagement are crucial, and that process improvement efforts need to be set against a goal to set the stage for expectations around results. The biggest lesson learned on this journey, however, has been that it takes many people with different expertise to make small wins big successes.
In FY22, research by the laboratory team led to trialing a diversion device for blood specimen collection. Based on the trial results, blood specimen collection diversion device use was expanded throughout the hospital with, again, modest improvements in CLABSI SIR. In FY24 a diversion device usage goal of 80% was set, as well as a reduced blood contamination rate goal. FY24 finished with an increase in diversion device usage (85%), a blood culture contamination rate well below the national benchmark, and a noted decrease in CLABSI cases (9 infections in FY23 to 1 infection in FY24) and CLABSI SIR (0.611 in FY23 to 0.07 in FY24).
There have been several big lessons on the path to CLABSI reduction. The team learned that process improvement can take multiple years to be successful, staff education and engagement are crucial, and that process improvement efforts need to be set against a goal to set the stage for expectations around results. The biggest lesson learned on this journey, however, has been that it takes many people with different expertise to make small wins big successes.
