Getting to Zero Strategies to Reduce Central Line Associated Bloodstream Infections (CLABs)

1. Getting to ZeroStrategies to Reduce Central Line Associated Bloodstream Infections (CLABs) Brian S. Koll, MD, FACP Medical Director, Infection Prevention Chief, Epidemiology Beth Israel Medical Center, New York, NY

2. Beth Israel Medical Center2004 • Petrie Division • Kings Highway Division • 94 ICU beds • 3,000 discharges • 824 non-ICU beds • 43,000 discharges • > 3,000 central lines placed annually

3. $1,510,000 Total Incremental CLAB Costs Costs Incurred Care of Patients with CLABs Discharges Per Year CLAB Patients Incremental Cost Per CLAB Patient Annual Incremental Costs $40,000 $960,000 94 ICU Beds 3,000 24 $25,000 $550,000 824 Non-ICU Beds 43,000 22 Used BI BSI information and discharge information from 2004

4. Leadership • Administrative • Clinical • Physician and Nursing Champions

5. American Journal of Infection Control2008;36:232-40 • Everyone has the ability, permission and responsibility to “stop the line” to prevent risk to patients (and staff) • All are empowered to identify and change (or eliminate) risky processes, no matter when, where or who is involved and always without fear of retaliation • There is participatory management at every level of the organization with both top-down and bottom-up communication • Integrity and trust are woven into the fabric of the organizational culture • Everyone is engaged in the prevention system, and there is reciprocal responsibility

6. Physicians Chief Executive Officer Chief Medical Officer Administrative Intern Associate Chairman, Department of Medicine Director ICU, MICU, SICU Emergency Room Medical Residency Programs Intensivist Critical Care Fellow Residents and Interns Medical Student Infection Control Hospital Epidemiologist Manager Practitioner Patient Care Services Vice President Director Nurse Manager ICU, MICU, SICU Nurse Education Manager New Nurses Nursing Student Other Director Materials Management Housekeeping Respiratory Therapy Quality Improvement Pharmacist Pharmacy Intern Radiology Transport Services Inter-disciplinary Team Members

7. Multi-disciplinary CLABs TeamPrinciples • It is not good enough that our infection rates are below national benchmarks. • CLABs are preventable, they are not an inevitable consequence of sophisticated, complex care that we provide to our severely ill patients. • CLABs can be eliminated by determination as opposed to additional resources.

8. Strategies to Reduce Central Line Associated Bloodstream Infections (CLABs) 8

9. Beth Israel Medical CenterCLABs Prevention ICUs

10. Beth Israel Medical CenterCLABs Prevention

11. CLABs Collaborative Infection Results CLABs Rate per 1,000 Line Days Reporting Period 11

12. CLABs Prevention ICUs 12