Bradley Fritz, MD, MS
Washington University in Saint Louis School of Medicine
Saint Louis, MO
Disclosure information not submitted.
Carrie Sona, BSN, CCNS, CCRN, MSN
Clinical Nurse Specialist
Barnes Jewish Hospital
Saint Louis, MO
Disclosure information not submitted.
Lisa Konzen, BSN, CCRN
Nurse Director, Tele-ICU
Barnes Jewish Hospital, United States
Disclosure information not submitted.
Jason White, BSN, CCRN-E, RN
Clinical Nurse Manager
Barnes-Jewish Hospital
Saint Louis, Missouri, United States
Disclosure information not submitted.
Jill Bertrand, MSN, RN
Assistant Nurse Manager
BJC Healthcare, United States
Disclosure information not submitted.
Shelley Meyer, BA, BSN, CCRN-E, MBA
Assistant Nurse Manager
Barnes Jewish Hosptial, United States
Disclosure information not submitted.
Robert Russell, MD, MPH
Associate Professor of Surgery
University of Alabama School of Medicine
Birmingham, Alabama
Disclosure information not submitted.
Heather Gasama, MPH
Epidemiologist Analyst
BJC Healthcare, United States
Disclosure information not submitted.
John Mazuski, MD, PhD, MCCM
Professor of Surgery
Washington University in Saint Louis SOM, United States
Disclosure information not submitted.
Title: I'll Be Watching You: The Impact of Central Line Insertion TeleICU Observations on CLABSI Rate
Introduction: Central line-associated bloodstream infection (CLABSI) is a morbid, but frequently preventable complication in ICU patients. CLABSI prevention is a national priority. Best practice bundles for insertion of these catheters have been developed and implemented, but CLABSI continues to occur despite the use of these bundles. The purpose of this quality improvement (QI) initiative was to implement line insertion observations from the TeleICU to identify gaps in use of best practice guidelines in central line insertions.
Methods: This QI project was completed in the 36-bed surgery/trauma/burn ICU at Barnes-Jewish Hospital, a quaternary referral center in St. Louis, MO. An observation audit tool was developed to include hand hygiene, full barrier precautions, skin preparation, number of attempts at vein cannulation, securement, insertion provider and site. Bedside staff were educated to notify the TeleICU whenever a line was placed in this ICU, and the staff then completed the survey in REDCap based on their observations. Attending physicians were also encouraged to complete the same tool using a QR code link. CLABSI rates during the 10 months prior to audit implementation were compared to CLABSI rates during the 10 months after audit implementation (following a 1 month wash-in period) using rate ratios.
Results: The number of central lines placed in the ICU was 527 during the pre-implementation phase and 624 during the post-implementation phase. Following implementation, 265 audits were performed (42% of line placements), with 196 completed by TeleICU personnel and 69 by bedside attending physicians. There were 13 CLABSIs during 5,555 line-days in the pre-implementation phase (rate 2.3) and 5 CLABSIs during 5,962 line-days in the post-implementation phase (rate 0.8). CLABSI rate was lower in the post-implementation phase than in the pre-implementation phase (rate ratio 0.37, 95% CI 0.11-0.98, p = 0.04).
Conclusions: Use of the TeleICU to remotely monitor central line insertions greatly increased the number of observations compared to those done by ICU attendings. Coincident with this increased monitoring, there was a decrease in CLABSI rates, suggesting this increased vigilance may have influenced insertion practices. Using the TeleICU provides a novel way to audit central line insertion practices.