Morbidity of Burn Injuries after Transplantation

Abstract

transplantation and post-transplant recovery. In 2015, CLABSIs within the liver transplant ICU accounted for 39% of all CLABSI at our institution. We therefore undertook a multidisciplinary collaborative between clinical epidemiology, nursing, transplant surgery and critical care to eliminate CLABSI events. METHODS: From 2014 to 2016, LEAN methodology and plando-study-act (PDCA) cycles were implemented, in 2 phases within our 24-bed liver transplant ICU, aimed at reducing CLABSI events. Eighteen interventions focused on revised technique, increased awareness, environmental changes, and heightened monitoring were implemented which spanned education, documentation, practice modification and interdisciplinary collaborative methods. Process measures (6 for CVC lines, 6 for hemodialysis lines, 5 for IVs, and 4 for patient environment) were monitored and audited throughout the study period. CLABSIs were tracked by clinical epidemiology. All events during the study period underwent root cause analysis to inform subsequent PDCA cycles. RESULTS: Over the course of the intervention 776 CVC audits were completed. There were improvements on all process measures, and complete compliance increased from 25% to 70%. CLABSI infection rates dropped from 4.1 to 1.6/1,000 CVC days, with an average of 1 CLABSI event per month by the end of 2016. This marked a 60.7% annual reduction, which correlated with an estimated $850,000 annual savings. CONCLUSIONS: Concerted ongoing multidisciplinary collaboratives are essential in minimizing CLABSI and optimizing value and quality in a challenging high acuity patient population.