Children’s hospital staff collaborate to go 332 days without a CLABSI
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Key takeaways:
- Interdepartmental collaborations helped cut the rate of central line-associated bloodstream infections in a children’s hospital.
- The hospital went almost a year without one of the infections.
ORLANDO — Staff at a children’s hospital in Virginia collaborated to go almost a year without a central line-associated bloodstream infection, researchers reported.
Details of the collaboration were presented at the annual meeting of the Association for Professionals in Infection Control and Epidemiology.
Central line-associated bloodstream infections (CLABSIs) can increase hospitalization by 5 to 7 days and add a cost of $48,108 per patient, the researcher reported. Last year, the Society for Healthcare Epidemiology of America published a white paper on CLABSIs in the NICU, which addressed clinical scenarios including how often central venous catheter dressings should be changed.
Staff Inova L.J. Murphy Children’s Hospital in Fairfax, Virginia, identified areas of improvement in their practices after comparing their facility’s CLABSI rates with rates at other pediatric hospitals.
“We as an organization have always made harm prevention a priority, and we participate in a lot of external collaboration with other children's hospitals,” Allison Barberio, MHSA, CPHQ, quality director of the pediatric service line at Inova Health System and a co-author of the study, told Healio. “We were not only looking at our internal performance and our trends over the years, but we're also looking at external benchmarks, [at other] children's hospitals within the nation, and we just felt like we had an opportunity.”
“We thought beyond what we know for a central line, until we thought of what people do day to day and how that impacts them,” Becky Lapian, MPH, CIC, an infection preventionist at Inova Health System and a co-author of the study, told Healio.
Lapian and Barberio began the project by meeting with staff from other departments and observing their daily operations to determine the best ways to prevent CLABSIs and other infections.
The multidisciplinary team they formed included frontline nurses and technicians, environmental services personnel, physicians, neonatologists, and operating room and emergency department staff. The team had regular harm prevention meetings to identify ways they could improve their environmental cleaning practices, line access and auditing practices.
The team focused on central line removal and proper line maintenance and made daily device rounds. Bedside nurses educated patients about oral, personal and hand hygiene practices to engage them in their own care.
“Within our maintenance of our central line, we have a very diverse patient population within pediatrics, from [infants] to 20-year-old trauma patients,” Barberio said. “So, we really looked at all of our practices and mapped out where we felt like there was opportunity within our process.”
“Becky and I both spent a lot of time with our frontline teams observing procedures, just going and talking to them about different barriers to the process as we had designed it,” Barberio said. “We truly felt like there were some things that we could tighten up. The bedside team was the first to offer really great suggestions, and we honestly just brought their ideas to life.”
Under the new approach, the hospital went 332 days without a CLABSI in any department, totaling 10,654 central line days from Oct. 21, 2021, to Sept. 18, 2022, with no significant change in risk-adjusted central line utilization ratio.
“I think it's a little unique that we were able to do this as a hospital,” Lapian said.
“This is not a team that met once a month for an hour. This was a team that was continuously talking to each other out on the unit, doing observation,” Barberio added. “Quality improvement can feel very overwhelming, and just taking it step by step on our project was helpful.”
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Lapian B, et al. One team approach: Celebration of 300 days without a CLABSI as a children’s hospital. Presented at: APIC 2023; June 16-28, 2023; Orlando.
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