Liz North RN, BSN, CCRN, Dawn Harbour MSN, ACCNS-P, CCRN,
Elizabeth Partridge, MD, MPH and Heather Siefkes, MD, MSCI
Liz North RN, BSN, CCRN, Dawn Harbour MSN, ACCNS-P, CCRN, Elizabeth Partridge, MD, MPH and Heather Siefkes, MD, MSCI
UC DAVIS HEALTH -EVIDENCE-BASED PRACTICE
Central line-associated bloodstream infections (CLABSI)
• Major source of hospital-acquired infection (HAI) in the pediatric intensive care unit (PICU)
• Associated with increased morbidity, mortality, and health care costs
• In Fiscal Year (FY) 2019, the PICU/pediatric cardiac intensive care unit (PCICU) had a CLABSI count of 6 and Standardized Infection Ratio (SIR) of 1.3
• Reduce the CLABSI rate in the PICU/PCICU at UC Davis Children’s Hospital
• AIM: Reduce the PICU/PCICU CLABSI count to ≤ 4 and SIR to ≤ 0.5 in FY 2020
Design & Methods
Setting: 24-bed combined PICU/PCICU at UC Davis Children’s hospital
Method: Implementation of evidence-based practice for maintaining central line dressings. Evidence-based practice was discovered through a recent literature search and “deep dive” with similar institutions.
Nurse-driven team implemented 3 interventions that led to CLABSI reduction in the PICU/PCICU:
1. Daily central line dressing audits
2. Standardization of dressing supplies in the PICU/PCICU
3. Designation and training of “dressing change champions” to perform all dressing changes
Data Collection & Analysis
• Daily audits of dressings from July 2019 - June 2020: Approximately 200 per month, for 12 months, totaling approximately 2,400 audits in one year
• Data collected on audits (included but not limited to):
• Is dressing intact?
• Is dressing up to date?
• Is dressing applied appropriately?
• Does dressing need to be changed?
• Any concerns regarding dressing?
• Monthly analysis of data collected from audits to guide QI process
• Compare PICU/PCICU CLABSI count and SIR, before and after intervention
Prior to intervention, the PICU/PCICU had a CLABSI count of 6 and SIR of 1.3 in FY 2019. After intervention, the PICU/PCICU had a CLABSI count of 2 and SIR of 0.458 in FY 2020.
• Teamwork and vigilance amongst our nurse-driven, multidisciplinary team in following the interventions led to a reduced CLABSI rate and SIR in FY 2020
• Findings of this project suggest that implementing this project in your own unit may help to decrease CLABSI rate.
• Short time frame
• Single patient setting
• Other coinciding interventions limit ability to isolate effect of dressing change interventions alone
• Unpublished UCDH data may indicate improved staff hand hygiene compliance during the Covid-19 pandemic, coinciding with data for FY 2020 Q4
• Expand to other units
• Can the interventions be replicated?
• Would it result in a reduction in CLABSI rate?
• Are the interventions sustainable and result in continued lowered CLABSI rates?
• Will the alteration of the frequency of central line dressing audits affect the result?
• Will covert audits reflect a unit’s culture change?
Holzmann-Pazgal, G., et al. (2011). Utilizing a line maintenance team to reduce central- line associated blood stream infections in a neonatal intensive care unit. Journal of Perinatology, 32:281-286
Kramer, C., et al. (2019). A quality improvement approach in standardizing pediatric central venous catheter dressings and its impact on the reduction of central line-associated bloodstream infections and costs. Journal of the Association for Vascular Access, 24(2): 11-19
Wood, K.L. (2017). The impact of a team approach to central line care in preventing central line-associated bloodstream infections. American Journal of Infection Control, 45(6):S84-S85
Funding & Acknowledgements
A big THANK YOU to the PICU/PCICU multidisciplinary HAI Committee, for which this project would not be possible!