Weaving a Blanket of Success- CLABSI Reduction at a Tertiary Care Children’s Hospital

1. Weaving a Blanket of Success- CLABSI Reduction at a Tertiary Care Children’s Hospital

2. McLane Children’s Hospital and Clinics Scott and White Hospital Opened- October 4, 2011 Pending Level II Pediatric Trauma Designation Site Survey Pediatric Transport Team 112 Bed Hospital 14 Bed Emergency Department 48 Acute Care Beds 16 PICU Beds 48 Level III NICU Beds 4 Operating Rooms 4 Special Procedure Suites

3. Introduction Central line associated blood stream infections (CLABSI) account for an estimated $20,000 in additional care per harm episode with an estimated mortality of 12-25% Between 2008-2009, the NICU cost the hospital over $600,000 due to CLABSI episodes CLABSI reduction initiatives resulted in the McLane Children’s Neonatal Intensive Care Unit reaching 88% less CLABSI than anticipated by national standards for 2012 (752 days CLABSI free)

4. Rising Rate In 2011, MedSurg and PICU combined CLABSI’s spiked from 0 to 8 harm episodes All CLABSI’s associated with line maintenance and not insertion. Indicators occurring after 72 hours of insertion

5. CLABSI Rates and Trends

6. Our Goal Initiative to eliminate CLABSI’s in all hospital’s settings Methods of achieving goal based on reduction initiatives developed in the NICU Evaluation of success based on… Process Metric- compliancy of CLABSI Bundle/ # of maintenance procedures Outcome metric- #CLABSI/1000 catheter days

7. Methods Formation of HAC team Evaluation of current policies and procedures Product evaluation Staff education Promotion of family centered care Physician engagement Insertion/maintenance auditing

8. Action Plans

9. Lessons Learned Challenges Attitude: Resistance to change Education: Distribution and methods Accountability: Compliance with policy and procedures Opportunities System-wide collaboration Promotion of a culture of excellence Conclusion NICU CLABSI free 200+ days (2012-2013) Acute Care and PICU CLABSI free 100+ days (Sept 2012-Jan 2013)

10. Plans for Future February– Two CLABSI’s in the PICU. Action Plan Evaluation in the PICU of alcohol protector caps. Develop a process to evaluate care 48 hours prior to positive cultures with all care team members involved if a CLABSI does occur. Implement Parent Education via Skylight Interactive System.