In the Journals

‘The results are worth it’: Peer auditing reduces CLABSI rate at NC hospital

Shelley Summerlin-Long, MPH, MSW, BSN, RN
Shelley Summerlin-Long

Real-time peer auditing reduced the rate of central-line-associated bloodstream infections, or CLABSIs, by 12% at a hospital in North Carolina, researchers reported.

“Our paper showed what infection preventionists and health care providers have always known — that every small step of a patient’s care is critical to preventing infections,” Shelley Summerlin-Long, MPH, MSW, BSN, RN, Quality Improvement Lead, for infection prevention at the University of North Carolina Medical Center and adjunct instructor at UNC’s Gillings School of Global Public Health, told Healio.

Following years of decline, the CLABSI rate at UNC Medical Center “stagnated” at less than 2 CLABSIs per 1,000 central-line days, the researchers reported. The 2017 baseline rate was 2.11 in 2017, and the hospital set a 10% reduction goal for 2018.

According to the study, the intervention was implemented in three phases before being launched hospitalwide.

The peer audit was created and first piloted by a team of nurses, infection preventionists and quality improvement staff. Then, units that already had their own audit program were asked to use the hospitalwide auditing process. Finally, the other units received training from the infection prevention staff and further effort was put into raising awareness of the intervention to secure stakeholder buy-in.

The training focused on the “‘why’ and ‘how’ of central line dressing/tubing peer audits” and detailed the measures of the intervention, which included noting the line type; determining if the dressing and/or tubing was labeled correctly and not expired; and checking that the dressing was clean, dry, intact, and applied correctly, the researchers explained. The training also covered how to give and receive feedback and how to praise colleagues to reinforce good habits.

As part of the initiative, 10 or more audits per month were recommended for any units with 365 central-line days or more per year, but the researchers emphasized that units experiencing higher CLABSI rates should audit more regularly. It was also recommended that as many staff as possible on each unit partake in the intervention to “increase awareness and balance workload.”

“In the case of central line-associated bloodstream infections, our health care providers, and especially our nurses, must be diligent every day about caring for patients’ central line dressings and IV tubing,” Summerlin-Long said.

Compliance increased from 80% to 90% throughout fiscal year 2018. More than 9,800 audits were submitted during the year, and the researchers observed a statistically significant inverse relationship between the number of audits and CLABSI rates reported in a month (P = .05).

In 2018, the CLABSI rate was 1.86 per 1,000 central-line days, a 12% reduction from FY2017.

“Peer audits help serve as a prompt to look at these key areas regularly, to be accountable to themselves and others for their care, and to provide just-in-time education when there are issues that can be fixed in order to prevent infections in real time,” Summerlin-Long said. “While getting a peer audit program up and running takes considerable work, the results are worth it because they amount to culture change.” – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.

Shelley Summerlin-Long, MPH, MSW, BSN, RN
Shelley Summerlin-Long

Real-time peer auditing reduced the rate of central-line-associated bloodstream infections, or CLABSIs, by 12% at a hospital in North Carolina, researchers reported.

“Our paper showed what infection preventionists and health care providers have always known — that every small step of a patient’s care is critical to preventing infections,” Shelley Summerlin-Long, MPH, MSW, BSN, RN, Quality Improvement Lead, for infection prevention at the University of North Carolina Medical Center and adjunct instructor at UNC’s Gillings School of Global Public Health, told Healio.

Following years of decline, the CLABSI rate at UNC Medical Center “stagnated” at less than 2 CLABSIs per 1,000 central-line days, the researchers reported. The 2017 baseline rate was 2.11 in 2017, and the hospital set a 10% reduction goal for 2018.

According to the study, the intervention was implemented in three phases before being launched hospitalwide.

The peer audit was created and first piloted by a team of nurses, infection preventionists and quality improvement staff. Then, units that already had their own audit program were asked to use the hospitalwide auditing process. Finally, the other units received training from the infection prevention staff and further effort was put into raising awareness of the intervention to secure stakeholder buy-in.

The training focused on the “‘why’ and ‘how’ of central line dressing/tubing peer audits” and detailed the measures of the intervention, which included noting the line type; determining if the dressing and/or tubing was labeled correctly and not expired; and checking that the dressing was clean, dry, intact, and applied correctly, the researchers explained. The training also covered how to give and receive feedback and how to praise colleagues to reinforce good habits.

As part of the initiative, 10 or more audits per month were recommended for any units with 365 central-line days or more per year, but the researchers emphasized that units experiencing higher CLABSI rates should audit more regularly. It was also recommended that as many staff as possible on each unit partake in the intervention to “increase awareness and balance workload.”

“In the case of central line-associated bloodstream infections, our health care providers, and especially our nurses, must be diligent every day about caring for patients’ central line dressings and IV tubing,” Summerlin-Long said.

Compliance increased from 80% to 90% throughout fiscal year 2018. More than 9,800 audits were submitted during the year, and the researchers observed a statistically significant inverse relationship between the number of audits and CLABSI rates reported in a month (P = .05).

In 2018, the CLABSI rate was 1.86 per 1,000 central-line days, a 12% reduction from FY2017.

“Peer audits help serve as a prompt to look at these key areas regularly, to be accountable to themselves and others for their care, and to provide just-in-time education when there are issues that can be fixed in order to prevent infections in real time,” Summerlin-Long said. “While getting a peer audit program up and running takes considerable work, the results are worth it because they amount to culture change.” – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.