A Recipe for Success: Conducting a Gap Analysis to Decrease Central Line-associated Bloodstream Infection (CLABSI) Rates in a Post-COVID-19 World

BACKGROUND: During the 2020 COVID-19 pandemic hospitals nationwide saw significant increases in central line-associated bloodstream infections (CLABSIs). Factors that likely influenced this include staffing challenges, personal protective equipment practices and drift in compliance with infection prevention bundles. To prevent further infections in 2021, a 788-bed teaching hospital established a multidisciplinary team to conduct a gap analysis to identify practice drifts that may have resulted due to the COVID-19 pandemic and develop targeted interventions. METHODS: A team composed of infection prevention, nursing, physicians, and environmental services conducted a gap analysis that included re-evaluation of policies, procedures, and infection prevention bundles in conjunction with a frontline staff survey of current practices to assess for practice drift. Inconsistent use of a central line insertion checklist and nursing maintenance handoff tool and lack of frontline staff participation in a CLABSI committee were identified and targeted for modification & re-implementation in January 2021. To assess intervention effectiveness 2020 pre-implementation CLABSI rate and standardized infection ratio (SIR) (January – December) were compared to 2021 post-implementation CLABSI rate (January -September) and SIR using the exact binomial test and mid-p 95% confidence. RESULTS: During the pre-implementation period, there were 34 CLABSIs with a rate 0.745 CLABSIs per 1,000 central-line days and an SIR of 0.691. After implementation, 18 CLABSIs occurred with rate of 0.494 per 1,000 central-line days and SIR of 0.463. While not statistically significant this represented a 47.0% decrease in CLABSI events, a 33.7% decrease in rate (IDR p-value: 0.1583) and 33.0% decrease in SIR (two-tailed p-value: 0.1679, 95% Conf. Interval: 0.371 – 1.178) between the two periods. CONCLUSIONS: Multidisciplinary gap analysis identified practice drifts in use of evidence-based tools during the COVID-19 pandemic. Re-implementation of these modified tools and improved participation in the CLABSI committee lead to an approximate 33% reduction in CLABSI rate and SIR.