New AHRQ Study Examines Early Use of Bundled Practices to Reduce CLABSI in Emergency Departments

A new study in Annals of Emergency Medicine examined issues faced by six emergency departments (EDs) that were early adopters of bundled prevention practices designed to reduce central line-associated bloodstream infections (CLABSIs). Through semi-structured interviews and focus groups conducted from 2009 to 2010 with hospital and ED staff and administrators, the researchers identified barriers and drivers for implementation of the CLABSI bundle in EDs. Although these practices have successfully been adopted in ICUs, EDs face unique barriers, such as time and space constraints, staffing, ED culture, high patient volume and acuity, and role ambiguity. Based on the experiences of these early adopters, the authors developed a list of recommendations for implementing infection prevention practices in the ED. The AHRQ-supported study and journal abstract, titled “Implementing the Central Venous Catheter Infection Prevention Bundle in the Emergency Department: Experiences Among Early Adopters,” was published online in October.

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2013 Oct 10. pii: S0196-0644(13)01347-4. doi: 10.1016/j.annemergmed.2013.09.006. [Epub ahead of print]

Implementing the Central Venous Catheter Infection Prevention Bundle in the Emergency Department: Experiences Among Early Adopters.

Lemaster CH, Hoffart N, Chafe T, Benzer T, Schuur JD.

Source

Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; David Geffen School of Medicine at UCLA, Department of Emergency Medicine, Los Angeles, CA. Electronic address: christopher.h.lemaster@kp.org.

Abstract

STUDY OBJECTIVE:

Central line-associated bloodstream infections (CLABSI) cause preventable morbidity and mortality. Hospitals have reduced CLABSI by using a bundle of evidence-based infection prevention practices. Systems factors in the emergency department (ED) present unique barriers to bundle adoption, and no guidelines exist for bundle implementation. We aim to identify barriers and facilitators to central line bundle adoption in EDs.

METHODS:

We used a qualitative, grounded theory approach, enrolling 6 EDs that were early adopters of the central line bundle. We interviewed 49 administrators and staff (nurses and physicians) through 26 semistructured interviews and 3 focus groups of 6 to 8 individuals. Investigators read each transcript and then iteratively built and refined a set of themes that emerged from the data.

RESULTS:

Barriers to central line bundle adoption included high acuity, time constraints, staffing, space, ED culture, high ED volume and acuity, role ambiguity, and a lack of methods to track compliance and infection surveillance. Facilitators included champions, staff engagement, workflow redesign that includes a checklist and central line kit or cart, clear staff responsibilities, observer empowerment, and compliance and infection surveillance data.

CONCLUSION:

The strategies for implementing and sustaining a central line infection prevention bundle in the ED are distinct from those of other clinical settings. Our findings describe the central line bundle workflow in the ED, staff motivations, and the critical systems factors that impede and foster its use. Knowledge of these systems factors should improve bundle adoption in the ED and thereby reduce hospital incidence of CLABSIs.
Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.