Title: Winnipeg Childrens Hospital: Central Venous Line Bloodstream Infection Reduction in the Pediatric In
1Winnipeg Childrens Hospital Central Venous
Line Bloodstream Infection Reduction in the
Pediatric Intensive Care Unit
Contestant D
- Aim
- The aim of this project was to decrease central
venous line blood stream infections (CVL BSI) in
the Pediatric Intensive Care Unit (PICU) by 50
within one year and sustain these results over
time. - Our annual baseline CVL BSI rate ranged from
1.7-6.5/1000 line days. Most critically ill
children require centrally situated multi-lumen
vascular access devices for line security, rapid
infusion of fluids and hypertonic caustic
solutions. - The American health care system has estimated a
cost of 30,000 dollars per CVL BSI, making this
an expensive complication with a risk of
significant morbidity and mortality. Included is
potential for extended duration of
antimicrobials, increased length of
hospitalization, and possible death due to severe
sepsis. This study presents interventions to
improve the outcome of this common PICU
complication. -
- Measures
- Baseline survey of insertion and maintenance
bundle practices - Monthly insertion bundle compliance
- Monthly maintenance bundle compliance
- Annual CVL BSI Rate Infections / 1000 line days
- Days between Infections
- Staff satisfaction with the project
-
Contestant A Contestant B Contestant
C Contestant E Home
2Winnipeg Childrens Hospital Central Venous
Line Bloodstream Infection Reduction in the
Pediatric Intensive Care Unit
Contestant D
- Changes
- Multiple change concepts were tested through
PDSA methodology. The table below depicts some of
the key change concepts with a brief description
of the intervention suggested. These changes
began as small scale tests until we achieved the
desired results. Subsequently, we built the
concepts into service delivery around CVLs.
3Winnipeg Childrens Hospital Central Venous Line
Bloodstream Infection Reduction in the Pediatric
Intensive Care Unit
Contestant D
Results Insertion Bundle Compliance shows
a continued increase exceeding 85 . On analysis,
the compliance breaches are related to accessing
central vein when attempting arterial cannulation
or a failure to document insertion. Maintenance
Bundle Compliance data illustrates a significant
increase as change concepts are further
incorporated, becoming the way we do
business.
Days between infections is a powerful method of
accessing impact in an infrequent event. We had
only had 4 infections since November 2004!
4Winnipeg Childrens Hospital Central Venous
Line Bloodstream Infection Reduction in the
Pediatric Intensive Care Unit
Contestant D
Results
- CVL BSI rate is the comparator for benchmarking.
It is important to note that the NNIS definition
of CVL BSI was not used for the entire period of
data reporting, which may have altered baseline
data. Currently, our reporting is consistent with
the ICU collaborative recommendation / NNIS
definition for CVL BSI. Over the past 4 years,
having saved an estimated cost of 30,000 USA per
infection, this equates to 360,000 of valuable
healthcare dollars saved. - Zero CVL BSI should be the goal.
- Based on the measured results, we have made
significant improvement in patient safety and
have spread this initiative into the larger
hospital system.
5Winnipeg Childrens Hospital Central Venous
Line Bloodstream Infection Reduction in the
Pediatric Intensive Care Unit
Contestant D
- Lessons Learned
- Recognize the power of the clinical champion the
ability for front line staff to establish change
creates ownership and pride. - Celebrate successes and major milestones as you
continue to work on opportunities. - Engage staff via the utilization of a reward
system listening to all ideas, thinking outside
the box and acting on what we heard, truly
engaged all staff. Staff engagement is crucial
as it must be part of the way we all do business. - Maintain energy of initiatives by providing
immediate feedback, including quarterly
newsletter to keep the team informed as to how we
are doing. - The full team received information and education
regularly, which lead to the evolution of the
PICU Safety Committee. - PDSA methodology and many small steps is superior
over trying to get it right the first time. - Measurement must be simple, easy to do and part
of current processes. - Changing our belief system to force failures in
the system as we can learn from these as we
introduce change. - Despite our baseline data exceeding NNIS
standards we improved need to revisit goals as
improvement is sustained. By building the change
concepts into our system the effect has been
sustained and continuously improved upon. - Revisit goals and build newly learned
information/knowledge into our systems to work
towards continuous improvements.
Contact InformationJannell Plouffe RN, BScN, MN,
Winnipeg Childrens Hospital, jplouffe_at_hsc.mb.ca