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A hospital-wide quality-improvement collaborative to reduce catheter-associated bloodstream infections
Derek S Wheeler1, Mary Jo Giaccone, Nancy Hutchinson
1Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center,Cincinnati, Ohio 45229-3039, USA. derek.wheeler@cchmc.org
Insights
A hospital-wide quality improvement collaborative significantly reduced catheter-associated bloodstream infections (CA BSIs) in children. This collaborative approach proved effective in lowering infection rates across multiple hospital units.
Area of Science:
- Healthcare Quality Improvement
- Infectious Disease Prevention
- Pediatric Critical Care
Background:
- Catheter-associated bloodstream infections (CA BSIs) increase hospital stay, costs, and mortality.
- Quality Improvement Collaboratives (QICs) are established methods for enhancing healthcare.
- Previous success in a national QIC for pediatric CA BSI reduction was noted.
Purpose of the Study:
- To test the hypothesis that a hospital-wide QIC would decrease CA BSI incidence institution-wide.
- To evaluate the effectiveness of a collaborative model in reducing healthcare-associated infections.
- To implement and assess a standardized approach to central line care across diverse hospital units.
Main Methods:
- Retrospective review of CA BSI incidence from March 2006 to March 2010.
- Hospital-wide implementation of central-line insertion and maintenance bundles.
- Involved critical care, oncology, bone marrow transplant units, and wards, with unit-specific data collection and monthly sharing.
Main Results:
- The hospital-wide CA-BSI rate decreased significantly from a baseline of 3.0 to under 1.0 CA BSI per 1000 line-days.
- Demonstrated a substantial reduction in infection rates following QIC implementation.
- Sustained decrease in CA BSI incidence across all participating units.
Conclusions:
- A hospital-wide QIC effectively reduced CA BSI incidence in a pediatric setting.
- The collaborative model, grounded in improvement science, is feasible and successful for infection control.
- Highlights the importance of standardized protocols and inter-unit collaboration for patient safety.
Background:
Catheter-associated bloodstream infections (CA BSIs) are associated with increased hospital length of stay, total hospital costs, and mortality. Quality-improvement collaboratives (QICs) are frequently used to improve health care quality. Our PICU was previously involved in a successful national QIC to reduce the incidence of CA BSI in critically ill children.
Objective:
We hypothesized that the formation of a hospital-wide QIC would reduce the incidence of CA BSI throughout our institution.
Methods:
We retrospectively reviewed the incidence of CA BSI from March 2006 to March 2010. The collaborative approach included hospital-wide implementation of central-line insertion and maintenance bundles that emphasized full sterile barrier precautions and chlorhexidine skin preparation during line insertion, daily discussion of catheter necessity, and meticulous site and tubing care. The hospital units involved were our 3 critical care units, the oncology unit, the bone marrow transplant unit, and wards. Each individual unit was responsible for collecting unit-specific data and performing event-cause analysis within 48 hours of identifying a CA BSI. These results were shared with the other hospital units during monthly meetings. Compliance with the insertion and maintenance bundles was monitored and reported to each unit monthly.
Results:
The hospital-wide CA-BSI rate decreased from a baseline of 3.0 to <1.0 CA BSI per 1000 line-days after implementation of the QIC.
Conclusions:
Our hospital-wide QIC resulted in a significant reduction in the incidence of CA BSI at our children's hospital. A collaborative model based on improvement science methodology is both feasible and effective in reducing the incidence of CA BSI.
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