Preventing Central Line Bloodstream Infections: An Interdisciplinary Virtual Model for Central Line Rounding and Consultation

Abstract

Background: Central line–associated bloodstream infections (CLABSI) account for many harms suffered in healthcare and are associated with increased costs and disease burden. Central line rounds, like medical rounds, are a multidisciplinary bedside assessment strategy for all active central lines on a unit. In-person line rounds in this 144-bed oncology acute care setting are challenging due to a variety of unchangeable factors. The aim was to develop a process for addressing concerning central lines in this context. Methods: The project team designed a HIPAA-protected, text-based process for assessing central lines for risk factors contributing to infection. Staff initiated a consultation via a virtual platform with an interdisciplinary team composed of oncology and infectious diseases experts. The virtual discussion included recommendations for a line-related plan of care. Results: The number of consultations averaged about five per month, with 27.4% resulting in the central line being removed, which is believed to have contributed to an overall reduction in infection rates. The CLABSI standardized infection ratio, a risk-adjusted measure which accounts for patient acuity and volumes, improved from 0.85 prior to the intervention (November 2020–October 2021) to 0.57 after the intervention (November 2021–August 2022), a 33% reduction. Conclusion: A virtual process for central line consultation and interdisciplinary planning was effective and, in this setting, perhaps optimal. This type of process could be applied to nearly any aspect of clinical care where teams are solving problems in an environment with complex geography and relationships.