CLABSI-free for 16 months: 3 notes on how a Chicago hospital got there

UChicago Medicine Ingalls Memorial Hospital in Harvey, Ill., hasn't seen a central-line-associated blood infection since December 2021 — an accomplishment that took coordinated planning and multidisciplinary collaboration. 

CLABSIs increased 7 percent across U.S. hospitals in 2021. They are among the costliest healthcare-associated infections to treat, with each case costing roughly $46,000 and are among the deadliest, with a mortality rate of 12 to 15 percent. Most are preventable, though not without significant effort on hospitals' part. 

Ololade Mitchell, MSN, RN, joined Ingalls as the director of clinical excellence in September 2021. Among her first key priorities after taking on the role was working closely with the senior infection preventionist to develop a plan to improve CLABSI rates at the hospital, pulling closely on previous learnings from experience across different healthcare settings. 

"We were outside eyes to the current process that was being done, so we identified a number of things we [had done] at outside organizations along the way," Ms. Mitchell told Becker's

After listing out efforts that had worked to reduce healthcare-associated infections at other healthcare organizations, the two developed a plan to move forward. 

"We knew we couldn't just dump everything in the kitchen sink at once," she said. 

Three key components that have helped Ingalls remain CLABSI-free for nearly 16 months: 

Collaboration: A CLABSI working group was formulated to take ownership of prevention efforts, Ms. Mitchell said. This included leaders in the intensive care unit — where central lines are most commonly used — as well as nursing leaders. They also identified a physician champion: Perry Gilbert, MD, chief medical officer at Ingalls, who was able to offer support and guidance on "alternative sources for infusion of various medications," such as promoting the use of a midline instead of a central line when appropriate, Ms. Mitchell said. Supply also played a major role in researching and discussing product options. 

Promote transparency: "There was an opportunity for us to be more transparent around who has lines in our organization on a day-to-day basis," Ms. Mitchell said. As a result, it became standard for leaders to discuss that information during morning meetings. "We started to highlight how many individuals had central lines" and directed focus on patients who might be most at risk for a CLABSI, such as those with a line placed in the femoral area. In those cases, the goal is to remove or replace the line whenever possible.

Later in the day, the hospital's nursing forum recaps progress on any lines removed and assesses whether lines are still needed. This structure is still in place today and has been expanded to include foley catheters. Now, nurse leaders at Ingalls are familiar with how many lines are in place at any given time. "That's how known it is at the organization," Ms. Mitchell said. 

Doubling down on infection control practices: There's not one single step or action that has led to the 16-month CLABSI-free achievement, Ms. Mitchell said. Rather, it's been a combination of "outside of the box" thinking and improving staff education around proper infection control practices and dressing changes. 

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