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Eliminating Central Line Associated Bloodstream Infections in Pediatric Oncology Patients: A Quality Improvement
Daniel N Willis1, Karen Looper2, Rema A Malone3
1From the Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Mo.
Insights
Pediatric hematology/oncology patients experienced a 50% reduction in Central Line-Associated Bloodstream Infections (CLABSI). This was achieved through a multimodal approach, significantly improving patient safety and reducing infection rates.
Area of Science:
- Healthcare quality improvement
- Infection control in pediatric oncology
Background:
- Central Line-Associated Bloodstream Infections (CLABSI) are a significant cause of harm in pediatric hematology/oncology (PHO) patients.
- Traditional prevention strategies are often insufficient for this high-risk population.
Purpose of the Study:
- To reduce the CLABSI rate by 50% in PHO patients from a baseline of 1.89/1000 central line days to <0.9/1000 by December 31, 2021.
- Implement and evaluate targeted interventions for CLABSI prevention in a high-risk pediatric population.
Main Methods:
- Established a multidisciplinary team with defined roles and responsibilities.
- Developed a key driver diagram to guide intervention design and implementation.
- Utilized Plan-Do-Study-Act cycles and direct observation audits for accurate compliance assessment.
Main Results:
- Achieved a CLABSI rate of 0.73/1000 central line days in 2021, a reduction from 1.89/1000 in 2020.
- Increased average days between CLABSI events from 30 to 73 days.
- Attained 542 consecutive CLABSI-free days, extending into 2022.
Conclusions:
- A multimodal approach, incorporating high-reliability organization principles, significantly reduced CLABSI in PHO patients.
- Sustained engagement and a strong safety culture are crucial for maintaining reduced infection rates.
- The study demonstrated a successful strategy for approaching zero CLABSI in a vulnerable pediatric population.
Abstract:
Central Line-Associated Bloodstream Infections (CLABSI) are the largest contributor to harm across the Children's Hospital's Solutions for Patient Safety network. Pediatric hematology/oncology (PHO) patients are at increased risk for CLABSI due to multiple factors. Consequently, traditional CLABSI prevention strategies are insufficient to eliminate CLABSI in this high-risk population.
Methods:
Our SMART aim was to reduce the CLABSI rate by 50% from a baseline of 1.89/1000 central line days to less than 0.9/1000 central line days by December 31, 2021. We created a multidisciplinary team being mindful to identify roles and responsibilities upfront. We developed a key driver diagram and designed and implemented interventions to influence our primary outcome.
Results:
We implemented interventions and conducted Plan-Do-Study-Act cycles concurrently. We found that performing audits by directly observing tasks rather than auditing documentation resulted in more accurate compliance assessments. As a result, our CLABSI rate improved from 1.89/1000 central line days in 2020 with 11 primary CLABSI to 0.73/1000 central line days in 2021 with four primary CLABSI. Average days between events improved from 30 days in 2020 to 73 days in 2021, and we achieved an unprecedented 542 days CLABSI-free, extending into 2022.
Conclusions:
Through a multimodal approach and utilizing characteristics of high-reliability organizations, we significantly reduced primary CLABSI, approaching zero in our PHO population and doubling the average days between events. Future efforts will focus on the sustained engagement of all stakeholders and improving our safety culture.
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