Prospective Quality Improvement Project Addressing Central Line-Associated Bloodstream Infection Risk with the Reduction of Central Line Days in Autologous Stem Cell Transplant Patients

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Topic Significance & Study Purpose/Background/Rationale In Fall 2022, central line-associated bloodstream infection (CLABSI) rates among autologous stem cell transplant (aSCT) patients at our academic medical center exceeded targets. Prior to May 2023, most autologous stem cells were collected via tunneled trifusion catheters, which often remained unused for 2-3 weeks before infusion. The lack of standardized procedures for central line selection and use duration contributed to CLABSI risk and practice variability. This quality improvement project aimed to develop and implement a standardized line algorithm to enhance consistency and reduce CLABSI occurrences. Methods, Intervention, & Analysis A comprehensive literature review identified minimizing lumens and reducing line days as effective strategies for lowering CLABSI risk. A multidisciplinary team created an evidence-based algorithm for central line selection. Plan-Do-Study-Act (PDSA) #1 (May – December 2023) trained Apheresis RNs to use large-bore peripheral IVs, reducing long-term central venous catheter use. PDSA #2 (January – June 2024) implemented two-line algorithms: one for collection and one for transplant. For collection, patients ineligible for peripheral access received a temporary hemodialysis line, removed within 24 hours. For aSCT, multiple myeloma patients received a double-lumen peripherally inserted central catheter at conditioning, used during transplant and recovery, and removed after two outpatient infusion visits not requiring caustic medications. Findings & Interpretation Baseline data (January – May 2023) showed 24% of apheresis collections were peripheral. After PDSA #1, peripheral collections increased to 47%, reaching 90% by November 2023. Median line days decreased from 34 to 30. Six months post-PDSA #2, median line days further decreased to 20. CLABSI incidence decreased from 4 to 2 when comparing before and after implementation (January – June), adjusted for annual transplant volumes. Discussion & Implications Standardizing line procedures reduced line days and correlated with a decrease in CLABSIs among aSCT patients. Future steps include refining line algorithms to minimize lumens and using ultrasound for peripheral insertions to further increase peripheral collections.

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