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Winnipeg Childrens Hospital: Central Venous Line Bloodstream Infection Reduction in the Pediatric In

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Title: Winnipeg Childrens Hospital: Central Venous Line Bloodstream Infection Reduction in the Pediatric In


1
Winnipeg 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
2
Winnipeg 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.

3
Winnipeg 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!
4
Winnipeg 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.

5
Winnipeg 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
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