clinical manager Medical City Children's Hospital Dallas, Texas, United States
Abstract:
Introduction: Central-line associated bloodstream infections (CLABSI) continue to be the most common hospital-acquired condition in children, resulting in increased mortality, morbidity, length of stay, and cost (Woods-Hill et al., 2021). In 2021, our CICU experienced significant programmatic growth which correlated with a rise in CLABSI rates. A deviation in standardization of practice across disciplines was identified. Workload, limited resources, and competing priorities may be key contributors, resulting in practice drift among healthcare workers (Browne, 2018). Using a risk-adjusted CLABSI rate, the team benchmarked themselves against the Pediatric Cardiac Critical Care Consortium (PC⁴). (Figure 1a). The key objective was to reduce the pediatric CICU CLABSI pre-intervention rate (January 2021 - June 2021) of 2.94/1000-line days to 0.5/1000-line days by June 2022. (Figure 2).
Methods: A prospective observational analysis from January 1, 2021 through June 30, 2022 was conducted using Plan-Do-Study-Act (PDSA) methodology. A structured experimental framework was used for testing in a highly acute cardiac critical care population. Physician-nurse dyad led implementation strategies which included a) back to basics, b) re-education of CLABSI bundles, c) decrease number of patients with CVC/PICC line, d) fostering a culture of high reliability and accountability, and e) collaboration with like-centers.
Results: CICU CLABSI rate was reduced by 88% with a post-intervention rate of 0.37/1000 line days. A 24.7% decrease in total patients with central lines was noted, from 76.8% to 52.1% pre/post-intervention, respectively. Our CICU PC4 aggregate rank shifted below the national center line, effective June 2022 (Figure 1b). All CLABSIs were defined using NHSN standard surveillance definitions.
Conclusions: Our experience demonstrates the importance of creating and fostering a strong physician-nurse leadership dyad to drive excellence. Highly engaged front-line leaders positively leverage quality improvement strategies. During periods of high system stress (unit-program growth, 48% additional staff, mid-pandemic climate), it is paramount and non-negotiable to assure practice standardization and prevention of drift across all disciplines. Through leadership influence, front-line staff have embraced a preoccupation with failure, perpetuating a culture of safety and excellence which will reduce CLABSIs and prevent patient harm.
