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Description

Purpose

To improve outcomes for PICU patients with central lines by reducing central line-associated bloodstream infections (CLABSIs) and meeting a 2021 goal rate of < 1.3 infections per 1000 central line days.

Background

PICU CLABSI rates increased from 2.2 in 2019 to 2.6 in 2020. Despite this increase, Quality and Safety data showed high compliance to CLABSI prevention bundles and no evident trends to inform improvement efforts.

Methodology

PICU leadership and CNS met to discuss quality improvement solutions to supplement routine safety cards and decrease CLABSI rates. This team developed a plan for a group composed of designated bedside staff and unit leaders who would focus on reducing the CLABSI rate and developing nurse experts. The group named the CLABSI Crew was formed with a charter outlining the purpose, team member responsibilities, rounding logistics, and expected outcomes. The CLABSI Crew conducts 12 hours of weekly central line care rounding outside of staffing hours and meets monthly for education and data review. The CLABSI Crew also provides education to nurses during staff meetings and on the unit to increase confidence and provide resources for central line care. Infection Prevention partners with this group to analyze data and identify potential gaps in practice.

Results

The CLABSI Crew is composed of 10 bedside nurses, two team leaders, one manager, and one CNS. All members received additional central line training. Rounding began in November 2020 and is ongoing. As of the end of Q2, the 2021 PICU CLABSI rate decreased to 0.5, with only one infection identified. Of the nine bundle elements monitored in rounding, four were found to have <90% compliance during Q1. However, compliance for all four of these elements showed improvement by the end of Q2: dating of tubing (81% in Q1 to 90% in Q2) and dressings (86% to 95%), appropriate use of protective overlays (74% to 93%), and completion of education of family (28% to 41%).

Publication Date

2021

Disciplines

Pediatric Nursing

How a Crew of Experts Can Pave the Road to Quality Improvement inPreventing Central Line-Associated Bloodstream Infections

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