How a Hospital Reduced CLABSI Incidents to Zero

AdventHealth DeLand hospital reported zero central line-associated bloodstream infections from October 2023 to September 2024.

In addition to promoting a culture of quality and safety, a hospital can implement several efforts to prevent central-line associated bloodstream infections (CLABSIs).

CLABSI is one of the most common hospital-acquired infections. On an annual basis, CLABSIs are linked to thousands of deaths and result in billions of dollars of added costs for the healthcare system, according to the Centers for Disease Control and Prevention.

AdventHealth DeLand, part of the AdventHealth health system, reported zero CLABSIs from October 2023 through September 2024. The hospital began focusing on CLABSI prevention in 2020 as part of the health system's Vision 2030 initiative to promote clinical excellence.

In addition to the risk of mortality, CLABSIs have significant negative impacts on patients, according to Thomas Scoggins, MD, MBA, CMO of AdventHealth DeLand.

"Patients must be placed on antibiotics, and there is the potential for complications as a result of being on antibiotics," Scoggins says. "CLABSI also increases the time that a patient spends in the hospital, and there are risks associated with that as well as a financial impact on the patient for a longer hospital stay."

Thomas Scoggins, MD, MBA, is CMO of AdventHealth DeLand hospital. Photo courtesy of AdventHealth.

Promoting Quality and Patient Safety

Preventing CLABSI must be grounded in a strong culture of quality and patient safety.

"It starts with the organization being committed to patient safety and quality," Scoggins says. "You also must create a culture of safety in your hospital, which involves striving for continuous improvement."

AdventHealth does this by holding regular clinical excellence reviews.

"We meet with our corporate team, and they review our clinical results as well as work on plans to address areas that are gaps," Scoggins says. "So, the health system is supporting efforts to improve quality and patient safety."

Scoggins and AdventHealth DeLand's CNO, Michele Lebron, have engaged the hospital's medical and nursing staff to embrace a culture of quality and patient safety. This effort is one of Scoggins' top priorities.

"Supporting a culture of continuous improvement is key for a CMO to promote quality and safety," Scoggins says. "You can't be satisfied with what your hospital did last year—you must look at changes in best practices and incorporate them in how your hospital provides care."

CLABSI Prevention Best Practices

AdventHealth DeLand has taken several steps to prevent CLABSI.

"We have a leadership safety huddle every morning, when different units and departments call out information, including how many patients have central lines and how many of those are femoral lines," Scoggins says. "In addition, each care unit has a safety huddle before each shift, and if they have any patients with central lines that is called out during the huddle."

The hospital's infection prevention specialist rounds on patients with central lines every day.

"They assess whether the patient is getting the care that they need," Scoggins says. "They also send out a daily email on what they are finding, which includes the patients who have central lines, how long central lines have been in place, the location of central lines on patients (such as whether they are femoral or jugular), the last time there have been dressing changes, and why patients still need a central line."

Most of the hospital's patients with central lines are in the ICU. The ICU nurses have bedside handoffs, which include assessments of central lines.

AdventHealth DeLand is following best practices for maintenance of central lines. These best practices include chlorhexidine gluconate cleanings, conducting dressing changes on a regular basis, and changing dressings whenever they are saturated.

To make sure care teams adopt best practices for preventing CLABSI, AdventHealth DeLand uses the Awareness, Desire, Knowledge, Ability, and Reinforcement (ADKAR) change management model, according to Scoggins.

Under this model, care teams are made aware that they need to pay attention to CLABSI and the risk for infection for patients. Staff members are alerted to the desire to avoid even one CLABSI at the hospital.

In terms of knowledge, Scoggins and other clinical leaders make sure that care teams understand the best practices for CLABSI prevention. The hospital ensures that doctors have the ability to follow best practices for placing central lines and nurses have the ability to care for central lines. Reinforcement includes daily reviews to make sure all the steps for CLABSI prevention are being done and central lines are only in place for as long as necessary.