Association of bundle compliance with clabsi rates: a solutions for patient safety (sps) report

Introduction: Implementation of best practice evidence-based guidelines (bundles) has been shown to decrease Central Line-Associated Blood Stream Infections (CLABSI). Reliable bundle performance is the mainstay of CLABSI prevention despite an unclear relationship between bundle reliability and outcomes. The specific aim of this project was to calculate the correlation between reported bundle compliance and CLABSI rate in large safety collaborative, Solutions for Patient Safety (SPS). The secondary objective was to identify which hospital and process-related factors are associated with a negative correlation. Methods: SPS is a network of 145 Children’s Hospitals. We obtained data on network level and individual hospital bundle compliance and monthly CLABSI rates from 01/12 to 12/21. Catheter-Associated Urinary Tract Infection rates (CAUTI) were also obtained as a proxy to assess potential overreporting. Correlations at the network and the hospital level, and subgroup analysis based on various hospital characteristics were performed. A partial correlation after adjusting for the impact of the year was calculated. Comparative analysis of hospitals with negative correlation vs. those without was also done. Results: During the study period participating hospitals reported 27,196 CLABSI on 20,274,565 Central line days (1.34 CLABSI/1000-line days). A total of 2,460,133 bundle opportunities were observed, of which 2,085,700 were fully compliant (reliability 84.2%). There was a moderate negative correlation between the monthly network bundle reliability and the monthly CLABSI rate (-0.35, p< 0.001). The partial correlation after adjusting for the year was also significant at -0.24 (p= 0.006). No correlation between CLABSI rate and CAUTI bundle was observed. 73/145 sites had a negative correlation. Sites with a negative correlation had significantly more extended exposure to the culture of safety training (median 5 vs. 2 years, p< 0.001). Sites with negative correlation also had larger number of central line days per month (median, 1153 vs. 944, p= 0.04). Conclusions: Strict adherence to recommended best practice guidelines (bundles) negatively correlates with the CLABSI rate. More prolonged exposure to a safety culture and large hospitals are more likely to have a negative correlation.