A MULTI-LEVEL INTERVENTION USING LEARNING AND EDUCATION (MILE) TO IMPROVE CHLORHEXIDINE GLUCONATE USE AND REDUCE CENTRAL LINE- ASSOCIATED BLOODSTREAM INFECTIONS

Problem: Approximately 28,000 preventable deaths in the United States result from central line-associated bloodstream infections, contributing to over $2 billion in healthcare costs. Theseinfections primarily develop from gram-positive organisms entering the bloodstream throughcentral venous catheters. Current infectious disease guidelines recommend daily antisepticchlorhexidine gluconate use to reduce infection rates in individuals requiring these catheters dueto elevated morbidity and mortality risks.Purpose: At an academic Southeastern U.S. hospital on an adult inpatient Bone MarrowTransplant unit, central line-associated bloodstream infection rates (2.15/1,000 device days) werehigher than the hospital-wide rate (1.28/1,000 device days). Overall documented chlorhexidinegluconate adherence on the Bone Marrow Transplant unit was lower than the hospital-widechlorhexidine gluconate adherence rate at 53.54% compared to 63.31%. Given the increased riskin this vulnerable population, this project aimed to address the low chlorhexidine gluconateadherence and elevated central line-associated bloodstream infection rates.Methods: This 12-week quality improvement project implemented the chlorhexidine gluconateMulti-level Intervention using the Learning and Education (MILE) pilot program. The programidentified barriers among nursing staff and provided staff and Bone Marrow Transplant patientsiiiwith evidence-based training on chlorhexidine gluconate usage and documentation. Daily chartaudits were conducted to monitor adherence.Results: Overall chlorhexidine gluconate adherence increased from 53.54% in the pre-intervention phase to 64.82% by the end of the implementation period. Zero central line-associated bloodstream infections were detected during the first eight weeks of the study period,while two infection events occurred during the final four weeks. Overall, the Bone MarrowTransplant unit lowered the infection rate to 0.66/1,000 device days compared to the baseline of2.15/1,000 device days.Discussion and Further Considerations: Analysis suggests that implementing the MILEprogram improved chlorhexidine gluconate adherence and reduced overall central line-associatedbloodstream infection rates on the Bone Marrow Transplant unit. Regarding the two infectionevents, a hospital shortage of IV fluids in late October 2024 due to Hurricane Helene resulted intemporary practice changes to conserve resources. This included less frequent IV changes topreserve fluids, suggesting an association between the impact of natural disasters and infectionrates as planetary disasters can disrupt data collection.