Reducing Catheter Associated Blood Stream Infections in Thirteen California Regional/Surgical Neonatal Intensive Care Units. Paul Kurtin, MD Chief Quality and Safety Officer Rady Children’s Hospital San Diego. Audience Participation. Question One
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Paul Kurtin, MD
Chief Quality and Safety Officer
Rady Children’s Hospital San Diego
Do you think the rate of CABSIs in your NICU can be reduced to zero…and stay there?
Question Two: Do you agree with this statement? “In my unit it is easy to speak up when something isn’t going right”
13 sites aim California. 8 Children’s Hospitals,
4 UC Hospitals, Sutter Health
Aim: to reduce/eliminate CABSIs in NICU patients
Metrics: infections/1000 catheter days stratifiedby weight, days between infections
Methods: improvement collaboratives microsystem assessment, site visits
Partner with CPQCC
CCS, the oldest managed care program for CSHCN in the country, wanted to evolve from a payer, standard setter, and regulator, to an active partner in improving care. This led to the historic collaboration between CCS and CCHA.
1. Hand hygiene
2. Maximum barrier precautions
3. Chlorhexidine skin antisepsis
4. Optimal site selection
5. Daily review of line necessity
Chlorhexidine for infants < 2 months
Optimal site selection
Clinical sepsis? Contaminants?
Number and volume of blood specimens?
Overall CABSIs were reduced by 29%. Varied by site and weight group
Year Two: High Risk Requires Hospitals Association NICU High Reliability “When One is One Too Many”
Focus on uniform process guidelines and bundles and their adherence rates
Feedback: real-time and aggregated
Hand hygiene: stop the line and
Going Where No One Has Gone Before!