Reducing home infusion CLABSI through a dashboard and toolkit implementation

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OBJECTIVES: To evaluate the implementation and effectiveness of a novel home infusion central line-associated bloodstream infection (CLABSI) and home infusion-onset bloodstream infection (HiOB) dashboard and prevention toolkit. DESIGN: Mixed methods study. SETTING AND PARTICIPANTS: Five home infusion agencies participating in the first CLABSI prevention collaborative. METHODS: Agencies uploaded CLABSI and HiOB data to a comparative dashboard. The dashboard started in December 2022 and accepted retrospective data from June 2021. A CLABSI prevention toolkit was made available in June 2024. Using an interrupted time series, we present CLABSI and HiOB rates before and after dashboard and toolkit implementation. We surveyed and interviewed participants about the tools and toolkit, using directed content analysis to analyze the interviews. RESULTS: After dashboard implementation, there was a decrease in CLABSI (-0.23/10,000 home-CVC days, 95% CI -0.28 to -0.18) and HiOB (-0.25/10,000 home-CVC days, 95% CI: -0.31 to -0.18) over time. With toolkit implementation, there was a further decrease in CLABSI (-0.17/10,000 home-CVC days, 95% CI: -0.30 to -0.044) and HiOB (-0.23/10,000 home-CVC days, 95% CI: -0.37 to -0.089) over time. Themes were associated with use of the tools (accessible, adaptable, patient-centered tools; user-friendly education to enhance understanding; barriers identified; tool mismatches; and strategies for tool delivery) and toolkit implementation (structural barriers, user-centered design, collaborative engagement and communication, toolkit used to enhance workforce competency, and concerns related to consistency). CONCLUSIONS: Implementation of a dashboard and a CLABSI prevention toolkit were each associated with both CLABSI and HiOB reduction in a collaborative of home infusion agencies.

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