Associate Chief Quality Officer University of Kentucky/Kentucky Child/Vren's Hospital Lexington, Kentucky, United States
Background: Central line-associated blood Stream infections (CLABSI) are the costliest hospital acquired condition nationwide, adding to increased length of stay, morbidity, and mortality. At the outset of this project, CLABSI was the number two cause of patient harm within our children’s hospital. Evidence shows that meticulous adherence to high-reliability processes reduces CLABSI. Objective: We sought to reduce the rate of CLABSI in our Cardiac (CICU) and Pediatric Intensive Care Units (PICU) by improving adherence to our internal clinical bundle and promoting high-reliability practices. Design/Methods: We conducted a prospective quality improvement project to promote adherence to our CLABSI bundle in our PICU and CICU beginning in June 2021. Baseline bundle adherence was 67% in June of 2021. Our SMART aim was to increase adherence to >90% for all bundle elements in the Children’s Hospital ICUs and reduce CLABSIs. We identified seven key drivers thought to increase the risk of bundle non-compliance. Those drivers included nurse documentation of the bundle, training needed for new nurses, and an effective communication system between frontline staff and unit/hospital leadership. This analysis led to 17 separate interventions that included level 1, 2, and 3 reliability interventions (Figure 1). Bundle adherence is monitored in all units via electronic Kamishibai or K-card measurements. Each intervention was analyzed for effectiveness and compliance was tracked. Results: Pareto analysis demonstrated that most bundle failures were secondary to chlorhexidine bathing (51%), dressing changes (17%), and tubing and cap changes (17%) (Figure 2). Through rigorous interventions in the PICU and PCICU, bundle adherence improved from 67% to 98% by June of 2022 with no unit CLABSIs in >250 day (Figure 3).
Conclusion(s): A highly structured quality improvement project that focuses on high-reliability systems and considers human factors in design hardwired CLABSI bundle adherence in our PICU and CICU.
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