Device De-escalation by Infection Prevention and Pharmacy to Decrease Healthcare-associated Infections

Session Description: Removal of unnecessary devices from patients is crucial to prevent device related health care association infections (HAI) such as central line associated blood stream infections (CLABSI) and catheter associated urinary tract infections (CAUTI). At our 457-bed hospital in August 2023, the infection prevention (IP) team identified that there were many invasive devices on patients that were not needed. Despite performing line huddles daily by IP team, some devices were not appropriately addressed. With the chief medical officer’s approval, the team initiated a new process that involves not only IP and nursing teams, but also Pharmacy team and ultrasound-guided vascular access team. The process includes IP team sending device indication reports daily to nursing in the morning. Pharmacy team is responsible for reviewing every central line in patient every day before 10am for necessity for the medication during hospital stay. It if is not necessary, the Pharmacy staff add notes on chart stating no central line is needed for current medication. The ultrasound guided vascular team is responsible for reviewing all the peripherally inserted central catheter (PICC) orders inputted by physicians, and check if they are too early to initiate. If they are, the team suggests the physicians to hold off until closer to patient’s discharge date. To deescalate un-indicated indwelling urinary catheter, the IP team make in-depth discussion with nursing team as well as urology team, and check if they can be removed. In the afternoon around 3pm, the IP team send out the device indication update to nursing team as a follow up from morning discussions. After about ten months of process implementation, the device utilization has reduced to 22-30%. Moreover, overall hospital-wide HAI has been decreased; the rate of CLABSI has reduced 22% and the rate of CAUTI has reduced 80%, compared to pre process-implementation time.