What strategies can be implemented to reduce Central Line-Associated Bloodstream Infections (CLABSI) in a boarding unit?

CLABSI Statistical Attribution in Boarding Units

CLABSIs should be attributed to the boarding unit where the patient is physically located, not to the admitting service, because the physical care environment—including nurse-to-patient ratios, catheter care practices, and daily line access—directly determines infection risk. 1

Rationale for Location-Based Attribution

The physical location of patient care is the primary determinant of CLABSI risk for several critical reasons:

• Nurse-to-patient ratios and care by float nurses are independent CLABSI risk factors, both of which are characteristics of the physical care environment rather than the admitting service 2, 1
• Inadequate catheter care and daily line access practices occur at the bedside, making the physical location where these activities happen the primary source of infection risk 2, 1
• Environmental factors in the boarding unit directly influence CLABSI risk, including the availability of supplies, adherence to hand hygiene protocols, and implementation of maintenance bundles 1

Surveillance Methodology Standards

Central line-days must be counted based on physical patient location, not service attribution, to ensure accurate surveillance and meaningful quality improvement 1:

• The CLABSI definition requires that the central line be in place within 48 hours before infection development, focusing on the temporal and physical relationship rather than administrative service assignment 1
• Device utilization ratios should be calculated per physical unit to enable meaningful benchmarking against CDC/NHSN data 2, 1
• Validate central line-days obtained from information systems by comparing to manual methods, with acceptable error not exceeding ±5% 2, 1

Quality Improvement and Accountability Implications

Attribution to the boarding unit enables the correct team to implement prevention strategies where they are most needed 1:

• Infection prevention programs require accurate location-based data to identify unit-specific problems and target interventions effectively 1
• Misattribution would obscure true infection rates in both the boarding unit and the admitting service's home unit, preventing appropriate quality improvement efforts 1
• The team providing direct bedside care must receive performance feedback to improve compliance with insertion and maintenance bundles 2

Implementation Requirements

To ensure accurate attribution in boarding situations:

• Establish clear documentation protocols for physical patient location to enable accurate central line-day counting 1
• Create effective communication channels between infection prevention teams and unit managers to ensure accurate location tracking 1
• Implement real-time surveillance systems that automatically capture patient location data with IT support for gathering central line-days and patient-days 2

Common Pitfalls to Avoid

• Do not attribute CLABSIs based on admitting service or billing location, as this disconnects the infection from the actual care practices that caused it 1
• Avoid splitting attribution between units, as this dilutes accountability and prevents targeted quality improvement 1
• Do not delay attribution decisions pending transfer, as the 48-hour window before infection development determines the responsible location 1