Introduction of an antimicrobial PICC in response to high PICC CLABSI incidence

Michelle Devries, MPH, CIC, VA-BC;   Janice Lee, RN; Thomas Sleweon, MD

Methodist Hospitals   Gary, Indiana

Objective: To reduce the incidence of CLABSI in PICC lines through the introduction of an antimicrobial catheter as recommended in evidence-based guidelines and standards.

Design: Quality improvement project comparing incidence of infections pre- and postimplementation of the new catheter.

Setting: 582 bed community, teaching hospital in Northwest Indiana.

Methods: Ongoing analysis of surveillance data indicated that 50% of central line associated bloodstream infections (CLABSI) were occurring in patients with peripherally inserted central catheters (PICC) in situ. A gap analysis was performed to review institutional practices against evidence-based recommendations. The use of an antimicrobial catheter was supported in each ofthe documents consulted. Following introduction of the new device, performance was measured in a prospective manner using standardized Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) surveillance protocols for CLABSI and internal data sources for other measures.

Results: After 28 months of data collection, the PICC CLABSI incidence reduced from baseline rate of 1.83/1000 PICC days to 0.176/1000 PICC days (90.38% reduction, p=0.0003)

Conclusion: Combined with continued compliance with basic prevention strategies (ie, use of a central line insertion checklist/insertion bundle), and optimization of device selection and lumen justification, the introduction of an antimicrobial PICC was associated with a significant reduction in CLABSI.