ABSTRACT
INTRODUCTION: The Mayo Clinic, Mankato Intensive Care Unit (ICU) has seen a steady increase in central line utilization, known to increase risk for central line-associated bloodstream infections (CLABSI). The "central line" or "device utilization rate" (DUR) for quarter 4 (Q4) 2021 was at 63%, increased from a pre-covid baseline of 45% in 2019. The CLABSI rate in Q4 of 2021 rose to 5.67, the highest in the past 5 years. The aim of this project was to decrease the ICU DUR by 36.5% from a baseline of 63% to 40% by 09/2022 without adversely impacting staff satisfaction. This effort was anticipated to positively impact patient outcomes, patient safety and the patient experience. METHOD(S): A multidisciplinary team conducted a review of current practices and potential contributors to the increased DUR were identified. The root causes of increased central line usage were determined to be lack of awareness on appropriate central line indication and gaps in communication. Interventions were implemented to address the key barriers: (a) Process: A vascular access algorithm was created to suggest the type of access needed based on duration of line and medication infusions. A rounding checklist included indications for central line placement and alternatives for vascular access. (b) Communication: Enhancement of daily interdisciplinary rounds and implementation of evening rounds to discuss central line indication and barriers to removal (c) Education: Central line education was provided during daily nurse huddles and weekly newsletters. An educational poster was created and displayed in the ICU, and (d) Closed Loop Feedback: The result of the post-intervention numeric improvement measure and sample size were monitored. Quarterly data will be reviewed for discussion. Key project milestones were recorded throughout the project. RESULT(S): The pandemic saw a surge in ICU patients, and it caused an uptick in central line placement. The project brought awareness of our DUR. Discussions of appropriate placement and early removal of central lines helped decrease our DUR. By June 2022, our DUR rate has decreased to less than 40%. CONCLUSION(S): Through a defined process we have been able to decrease central line utilization in our ICU. We will continue to monitor to ensure that our improvements are sustained.