1.  Central line-associated bloodstream infections (CLABSI) are a significant national problem resulting in morbidity and mortality.  According to the CDC there are an estimated 92,000 bloodstream infections per year in the United States associated with central lines at a cost of $6,000 - $26,000 each. ¹  Some recent estimates are as high as $45,000 with an annual cost to the U.S. healthcare system of $2.3billion²

2.  At Hendrick we observed a high rate of central line-associated line contamination and colonization as determined by skin flora and yeast in blood cultures drawn from lines.  We theorized that excessive cost were associated with these false positives with unnecessary antibiotic treatment, additional blood cultures, unnecessary line replacement, and extended lengths of hospital stays.

3.  We knew that at Hendrick positive blood NIMs (Nosocomial Infection Markers as measured by our electronic surveillance system) was costing us for each NIM: ◦ DRG adjusted additional cost of $8,768 ◦ DRG adjusted additional LOS of 8.30 days ◦ DRG adjusted additional loss of $6,025

4.  Over time we had successfully addressed sources of defined extraluminal catheter infection. ³  “Scrub the Hub” campaigns had only produced limited or temporary improvement.  We proposed a trial of the continuous passive disinfection cap SwabCap. The trial was to take place on our long term acute care (LTAC) because of the high use of central lines and long-term hospitalization days to facilitate following patient results.

5.  The SwabCap is a luer access valve disinfection cap impregnated with a sponge saturated in 70% alcohol for (1) preventing of reducing bacterial colonization of the intraluminal space and (2) preventing bacterial CLABSIs.  We chose this technology because it: ◦ promotes technique standardization and compliance ◦ no alcohol swabbing in necessary after removal ◦ it acts as a physical barrier ◦ it is highly visible to help in accessing staff compliance with use

6.  The device trial was conducted on our LTAC from December 2011-May 2012.*  The LTAC staff was educated by the Excelsior representatives and was to use the cap as instructed on all lines (both peripheral and central lines) throughout the study period.  The number of CLABSIs and line colonization and/or contaminations were compared by the Infection Preventionist to the equivalent baseline period of December 2010-May 2011 *Special thanks to Cressie Mills, Nurse Manager and her staff for their contributions to this trial

7. Baseline Study Period  4 CLABSI ◦ 2 PICC lines ◦ 1 Mediport ◦ 1 Right IJ  1 PICC with colonization  Zero CLABSI  Zero colonized lines (2 hemodialysis lines with colonization- SwabCap does not fit on these hubs due to size)

8.  Because of the excellent results from this trial, house-wide inpatient use of the SwabCap was instituted in December 2012 with the following results: ◦ December 2012 - 0 CLABSI, 0 contaminants ◦ January 2013 – 0 CLABSI, 1 HD line colonization ◦ February 2013 – 2 CLABSI (1 GI origin, 1 from “outside” no SwabCap in use), 0 contaminants  Please see the excellent published paper from Marc-Oliver Wright in the January 2013 American Journal of Infection Control

9.  ¹Scott RD. The Direct Medical Costs of Healthcare- Associated Infections in U.S. Hospitals and the Benefits of Prevention. Atlanta. 2009.  ²Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355(26):2725  ³Marschall J, Mermel LA, Classen D, Arias KM, Podgorny K, Anderson DJ, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29:S22-30.

10. Hendrick Medical Center