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A6304 - Reduction of Central Line Associated Bloodstream Infections and Catheter Associated Urinary Tract Infections by Utilizing a Morning Report Format in the ICU
Author Block: D. Arshed1, O. A. Abe1, P. Trivedi2, J. Gasperino1; 1Medicine- Pulmonary and Critical Care Medicine, New York Presbyterian Queens, Flushing, NY, United States, 2Medicine- Pulmonary and Critical Care Medicine, New York Presbyterian Queens, Dix Hills, NY, United States.
Introduction: Central line infections and catheter associated Urinary tract infections have been have always been a detriment to hospitals and ICUs. Care of critically ill patient accounts approximately 13% of a typical hospital’s budget. At our institution given a previously elevated CAUTI rate, and elevated CLABSI rate, we decided to reevaluate prevention of such infections. Methods We utilized a morning report system, which allowed us as a multi-disciplinary team, to assess daily, the need for invasive procedures, catheters, or central lines, as well as ensure compliance with core measures in the MICU, and CICU. As an observational cohort study, we measured VTE prophylaxis, catheter associated urinary tract infections, and catheter associated bloodstream infections. Using data collected prior to the implementation of the morning report system, we compared pre-implementation values to post-implementation values. Results A reduction in central line days from 162.5 days to 144.83 days was noted in the MICU from 2014 to 2015. The reduction in central line days was associated with decreasing CLABSI rate per 1000 days (1.538 to 0.575). We evaluated the relationship between the CAUTI rate and foley days following the establishment of morning report. The foley days in both the MICU and CCU remained relatively similar between 2014 and 2015. In the MICU, the CAUTI rate decreased from 4.31 infections per 1000 patient days in 2014 to 0.941 infections per 1000 patient days in 2015 We also evaluated the impact morning report had on compliance with hospital core measures; among which we selected venous thromboembolism prophylaxis. When the study began, a compliance rate of 98% across 11 months in 2014 was demonstrated. Subsequently after 1 year of the current morning report format being in place the compliance rate across 10 months reached 100% in the MICU Discussion The pre and post implementation data demonstrates the positive effect of the morning report system. Given the reduction with relatively similar number of patients and CL days/catheter days, we can assume that our intervention is the cause of reduction. We also ensured a 100% VTE prophylaxis compliance rate in the MICU. The success of using morning report has been validated not only in reduction, but in its amplitude. According to AHRQ, the rates of CLABSI were well below the stated goals in their study. Our results demonstrate not only the reduction in morbidity and mortality, but also the cost savings of using a morning report system.