That practice was ingrained especially in teams that worked with patients undergoing hemodialysis, because it was often tough to find a vein.
"We worked very hard with our phlebotomy team to make sure they knew the best technique to obtain these cultures by venipuncture," Dumigan says. "If the phlebotomists couldn't obtain a blood culture, they would call the IV team to assist them, and this over time eliminated blood cultures taken from catheters."
"Our IV team was able to obtain blood cultures from veins 61% of the time when our phlebotomists couldn't," she says.
Initially, dialysis teams were resistant, Kliger says. "When we said we needed to stop drawing blood from these central lines and only draw from peripheral veins, the physicians and nurses taking care of those patients said, 'No, no. For years we've been using those catheters because our patients don't have any peripheral veins.' They said, 'We're sorry, we're not going to do that.' "
"But we did find that for the vast majority of them, we could preserve our policy and get blood for culture from veins. Eventually, our nephrologists and dialysis nurses changed their minds."
Boyce says that false positives due to contaminations were reduced in subsets of patients from around 2% prior to the venipuncture process switch to 0.5%, an average excess cost saving of about $3,300 per contaminated blood culture, according to previous studies. "We found we could save hundreds of thousands of dollars a year in a hospital our size just by not having as many contaminated blood cultures, so that's a win-win."
Kliger says at last check, the reductions have been sustained, and there have been no CLABSIs at all in recent months. The Saint Raphael Campus is now working with Yale New Haven Hospital to help it change practices there as well, Kliger says.
The process changes were all great, Kliger says, but he says that what really made the difference wasn't adding steps to the bundles or some other tricks that they employed.
"We were successful because we changed the culture."
This article appears in the January/February 2013 issue of HealthLeaders magazine.