768. Gaining Compliance-Getting Results

Abstract Background Compliance with the chlorhexidine gluconate (CHG) daily application component of the CLABSI prevention bundle potentially could negatively affect infection rates. In an attempt to increase CHG compliance, a 3-month trial for soap based CHG bathing was undertaken on two pediatric oncology units with long term central line patients. Methods The current bathing process involved 2 steps, a soap and water bath followed one hour later by a CHG wipe. It was time consuming and received complaints from staff and parents resulting in lower documented compliance rates. A one step process was implemented combining skin cleansing and CHG application with one product. Staff, parents and patients were educated on proper bathing technique. Instruction brochures printed in multiple languages were employed and discussed for education. An electronic survey was developed to collect parent feedback. Results The trial was from October - December 2020 and included 25 select patients in the cancer center. Patients and parents provided positive feedback with the new process. Audits measured both line maintenance and bathing. If one step was missed-than non- compliance with the bundle was noted . Bundle adherence increased with auditors noting that this was due entirely to an increase in bathing compliance. From April to September 2020 prior to implementation of the soap based CHG bathing, CHG compliance on the Stem Cell Transplant Unit (SCTU) averaged 48%. During the three month period after the trial, CHG compliance has averaged 64%. CHG monthly compliance reached 85% by April 2021. In addition, patients compliant with CHG bathing demonstrated a significant reduction in coagulase negative staphylococcus (CoNS ) blood stream infections due to the reduction of CoNS skin colonization. Cost analysis for the one week in the 15 bed BMT unit and 10 HemONC patients showed that the one step soap based CHG was &161.50 and the CHG wipe cost &960,75; a difference of &799.25per week or &41,561.00 annually. Conclusion Any infection prevention strategy needs to involve staff and parents for compliance and outcome success. Disclosures All Authors: No reported disclosures


Gaining Compliance-Getting Results
Background. Compliance with the chlorhexidine gluconate (CHG) daily application component of the CLABSI prevention bundle potentially could negatively affect infection rates. In an attempt to increase CHG compliance, a 3-month trial for soap based CHG bathing was undertaken on two pediatric oncology units with long term central line patients.
Methods. The current bathing process involved 2 steps, a soap and water bath followed one hour later by a CHG wipe. It was time consuming and received complaints from staff and parents resulting in lower documented compliance rates. A one step process was implemented combining skin cleansing and CHG application with one product.
Staff, parents and patients were educated on proper bathing technique. Instruction brochures printed in multiple languages were employed and discussed for education. An electronic survey was developed to collect parent feedback.
Results. The trial was from October -December 2020 and included 25 select patients in the cancer center. Patients and parents provided positive feedback with the new process.
Audits measured both line maintenance and bathing. If one step was missed-than non-compliance with the bundle was noted . Bundle adherence increased with auditors noting that this was due entirely to an increase in bathing compliance. From April to September 2020 prior to implementation of the soap based CHG bathing, CHG compliance on the Stem Cell Transplant Unit (SCTU) averaged 48%. During the three month period after the trial, CHG compliance has averaged 64%. CHG monthly compliance reached 85% by April 2021. In addition, patients compliant with CHG bathing demonstrated a significant reduction in coagulase negative staphylococcus (CoNS ) blood stream infections due to the reduction of CoNS skin colonization. Cost analysis for the one week in the 15 bed BMT unit and 10 HemONC patients showed that the one step soap based CHG was $161.50 and the CHG wipe cost $960,75; a difference of $799.25per week or $41,561.00 annually.
Conclusion. Any infection prevention strategy needs to involve staff and parents for compliance and outcome success. Background. Central line-associated bloodstream infections (CLABSI) are one of the leading healthcare-acquired infections (HAI) with significant morbidity and mortality. We aimed to identify risk factors of CLABSI at an academic medical center to determine high-risk populations and target interventions.

Risk Factors of Central Line-associated Bloodstream Infection in an Academic Medical Center
Methods. This is an observational retrospective cohort study at William P. Clements Jr. University Hospital from January 1, 2017 to December 31, 2020. Retrospective chart review was conducted to identify demographics and co-morbidities of hospitalized patients diagnosed with CLABSI as defined by National Healthcare Safety Network (NHSN). Infections due to mucosal barrier injuries were excluded. Means were compared using independent-samples T-test and proportions were compared using chi-square.
Results. Ninety-three CLABSI events were identified with an increase in the standardized infection ratio from 0.38 in 2017 to 0.74 in 2020 (Figure 1). Bacterial organisms were identified in 71 (76%) cases while fungal organisms were identified in 22 (24%) ( Table 2). There was no significant difference in the timing of CLABSI after line insertion (p=0.09) or organism identified (p=0.61) in PICC lines (n=33, 34%) vs all other central lines (n=60, 67%). When comparing immunocompromised patients with CLABSI (n=47, 51%) vs non-immunocompromised (n=46, 50%), there was a significant difference in the indication for line (chemotherapy), but no difference was seen in the number of line days prior to event (p=0.57), line type (p=0.17), or organism identified (p=0.94). Of all CLABSI, 46% (n=43) were in the intensive care unit (ICU) with significantly more Candida species (p=0.018) identified compared to non-ICU patients with CLABSI (n= 50, 54%).