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Purpose: We tracked the effect that a newly implemented intensivist program following a restrictive venous access policy emphasizing mid-lines and peripheral IVs over central lines had on central line days, central line utilization ratio, and central line associated blood stream infections in a non-academic hospital. Methods: Prior to June 2021, Mobile Infirmary’s intensive care units (ICU) were open units staffed with physicians with combined ICU, ward, and outpatient responsibilities. In June of 2021, an intensivist program was started to transition the hospital to a closed ICU model with intensivists whose sole responsibility was the ICU. Concurrently, a policy was implemented that emphasized avoidance of central lines unless indicated by defined criteria (MICAR Criteria). We tracked central line days (CLD), central line utilization ratio (CLUR) and central line associated blood stream infections (CLABSI) rates and compared it to these same unit for the 2 years prior to the start of the program. Results: There was a reduction in CLD from 628 per month to 425 per month (RRR of 32%), a reduction in CLUR from 0.62 to 0.46 (RRR of 26%), and a reduction in CLABSI rate from 1.65 to 0.78 (RRR of 51%). When looking at the number of central line infections per expected line days, there was a reduction from 20.2 to 6.6 (P=0.04). The central line infection rate relative to patient days showed a reduction from 10.3 to 3.6 (P=0.04). Conclusions: Over utilization of central lines and the subsequent increase in central line infections represents a major complication of ICU care. By combining an intensivist program with a venous access policy designed to reduce dependence on central lines, we showed a clinically significant reduction in central line infections and a reduction in central line days and central line utilization ratio without any significant increase in IV extravasations.
Michael Wilson (Fri,) studied this question.