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Rapid cycle development of a multifactorial intervention achieved sustained reductions in central line-associated bloodstream infections in haematology oncology units at a children’s hospital: a time series analysis
  1. Christopher E Dandoy1,2,
  2. Jackie Hausfeld3,
  3. Laura Flesch1,
  4. Deanna Hawkins4,
  5. Kathy Demmel2,
  6. Deanna Best1,2,
  7. Erin Osterkamp4,
  8. Tracey Bracke2,
  9. Rajaram Nagarajan4,
  10. Sonata Jodele1,
  11. Julie Holt3,
  12. Mary Jo Giaccone2,
  13. Stella M Davies1,
  14. Uma Kotagal2,
  15. Jeffrey Simmons2,5
  1. 1Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  2. 2James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  3. 3Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  4. 4Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  5. 5Division of Pediatric Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  1. Correspondence to Dr Christopher E Dandoy, Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 11027, Cincinnati, OH 45229 USA; christopher.dandoy{at}cchmc.org

Abstract

Background Immunocompromised children are at high risk for central line-associated bloodstream infections (CLABSIs) and its associated morbidity and mortality. Prevention of CLABSIs depends on highly reliable care.

Purpose Since the summer of 2013, we saw an increase in patient volume and acuity in our centre. Additionally, CLABSIs rates more than tripled during this period. The purpose of this initiative was to rapidly identify and mitigate potential underlying drivers to the increased CLABSI rate.

Methods Through small tests of change, we implemented a standard process for daily hygiene; increased awareness of high-risk patients with CLABSI; improved education/assistance for nurses performing high-risk central venous catheter procedures; and developed a system to improve allocation of resources to de-escalate system stress.

Results The CLABSI rate from June 2013 to May 2014 was 2.03 CLABSIs/1000 line days. After implementation of our interventions, we saw a significant decrease in the CLABSI rate to 0.39 CLABSIs/1000 line days (p=0.008). Key processes have become more reliable: 100% of dressing changes are completed with the new two-person standard; daily hygiene adherence has increased from 25% to 70%; 100% of nurses are approached daily by senior nursing for assistance with high-risk procedures; and patients at risk for a CLABSI are identified daily.

Conclusions Stress to a complex system caring for high-risk patients can challenge CLABSI rates. Identifying key processes and executing them reliably can stabilise outcomes during times of system stress.

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