The Cardiac Intensive Care Unit (CICU) is a high-risk unit for central line-associated bloodstream infections (CLABSI). Several cardiac-specific exclusionary criteria exist which prevent bloodstream infections from being identified as CLABSIs. In September 2021, CICU patients experienced three CLABSIs and four additional bloodstream infections in the setting of a central line that did not meet CLABSI criteria due to presence of a ventricular assist device or intracardiac central lines. A Bloodstream Infection Safety Stand Down was initiated to 1) identify themes of infection prevention risk through focused intentional rounding and 2) develop action items to mitigate risks. 

Local key stakeholders and organizational CLABSI leads reviewed commonalities among the seven affected patients. Key drivers identified based on Bedside Review themes were environmental cleanliness, dressing integrity, hand hygiene, arterial line concerns, and situational awareness of CLABSI risk. These identified themes informed a rounding script and survey to obtain additional information from clinical staff across disciplines and on all shifts. The team completed focused intentional rounding with individual and small group discussions, guided by the rounding script. 

Twenty-seven surveys were completed with 127 unique comments which were organized into broad and specific categories via a pivot table. Results were reviewed with the key stakeholders and an impact/effort matrix developed. Action owners and timelines were identified. High impact and low effort action items were implemented immediately while longer term planning begun for higher effort items. To address environmental cleanliness concerns, Hot Zone Cleaning education was initiated and Hot Zone partnered rounding resumed. For hand hygiene concerns, additional clocks were added in areas with poor sight lines. Rounding to ensure functioning hand sanitizer dispensers were initiated by nursing support staff. To mitigate arterial line dressing integrity concerns, a product to improve arterial line dressing integrity was made available to the CICU vascular access team. 

Using quality improvement tools, a multidisciplinary team of key stakeholders diagnosed key drivers for CLABSI specific to the CICU, gained deeper understanding of vulnerabilities from the clinical teams, identified action items, and implemented the relevant changes. In the six months following the completion of the Bloodstream Infection Stand Down, the CICU CLABSI rate was 1.40 infections/1,000 line days, below the fiscal year 2021 CICU rate, below the hospital target, and below the combined rate for high-risk units.