2.50
Hdl Handle:
http://hdl.handle.net/10755/157099
Category:
Abstract
Type:
Presentation
Title:
Little Kids + Little Bugs = Big Problems Eliminating CA-BSI in Pediatric Critical Care
Author(s):
Ellis, Rebecca; Ryan, Kristi
Author Details:
Rebecca Ellis, Duke Children's Hospital, Durham, North Carolina, USA, email: ellis006@mc.duke.edu; Kristi Ryan
Abstract:
PURPOSE: Elimination of hospital acquired infections was identified as a priority by national regulatory agencies and reimbursement companies. CA-BSIs (Catheter Associated - Blood Stream Infections) increase hospital length of stay, cost, and morbidity and mortality. NACHRI (National Association of Children's Hospitals and Related Institutions) coordinated a group of 29 PICUs (Pediatric Intensive Care Units) and PCICUs (Pediatric Cardiac Intensive Care Units) in a collaborative to eliminate CA-BSIs. BACKGROUND: Duke Children's Hospital had a 16 patient bed combined PICU/PCICU that increased to 20 beds in April 2006. The average CA-BSI rate was 5.44 per 1000 catheter line days for the seven quarters prior to October 2006, including 31 CA-BSIs in the prior 11 months. Cost for a single CA-BSI was conservatively estimated to be $33,000 of increased hospital costs. In October 2006, the PICU/PCICU at Duke Children's Hospital became a founding team in the NACHRI led collaborative. METHODS: Pre-implementation baseline data was obtained from Infection Control. Project coordination involved data collection and management, education for all staff including evidence-based insertion and maintenance practice changes, and facilitating interdisciplinary collaboration. All central venous catheter insertions were observed to determine adherence of the practice standard. Each day, patients with central venous lines (CVL) were identified, including catheter location, continued need, and functionality. Patient care nurses completed random surveys, evaluating adherence to the maintenance bundle including daily line review and access practices related to hand washing and hub scrub. RESULTS: Standardization of the dressing change process was identified as having the biggest impact on the CA-BSI rate. The PICU/PCICU had an increase in number of days between CA-BSI from less than 30 days to 80 days. CA-BSIs were reduced from 32 in the 12 months before the collaborative began to 10 CA-BSI in the latest 12 months. For each CA-BSI, a multi-disciplinary team Root Cause Analysis was performed. Several potential contributory causes were identified including non-adherence to the maintenance bundle. Central line utilization remained unchanged both for total number of CVLs per month and the number of patients with a CVL despite an increase in average daily census. CONCLUSIONS: Since the implementation, the PICU/PCICU has demonstrated a statistically significant decrease in CA-BSIs with a longer time between CA-BSI. Additionally, increased average daily census without change in the average number of CVLs may demonstrate successful daily review of CVL need and functionality. This, in turn, leads to decreased opportunity to acquire a CA-BSI. The PICU/PCICU remains committed to decreasing CA-BSI to a goal of zero.
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.
Conference Date:
2009
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
New Orleans, Louisiana, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleLittle Kids + Little Bugs = Big Problems Eliminating CA-BSI in Pediatric Critical Careen_GB
dc.contributor.authorEllis, Rebeccaen_GB
dc.contributor.authorRyan, Kristien_GB
dc.author.detailsRebecca Ellis, Duke Children's Hospital, Durham, North Carolina, USA, email: ellis006@mc.duke.edu; Kristi Ryanen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157099-
dc.description.abstractPURPOSE: Elimination of hospital acquired infections was identified as a priority by national regulatory agencies and reimbursement companies. CA-BSIs (Catheter Associated - Blood Stream Infections) increase hospital length of stay, cost, and morbidity and mortality. NACHRI (National Association of Children's Hospitals and Related Institutions) coordinated a group of 29 PICUs (Pediatric Intensive Care Units) and PCICUs (Pediatric Cardiac Intensive Care Units) in a collaborative to eliminate CA-BSIs. BACKGROUND: Duke Children's Hospital had a 16 patient bed combined PICU/PCICU that increased to 20 beds in April 2006. The average CA-BSI rate was 5.44 per 1000 catheter line days for the seven quarters prior to October 2006, including 31 CA-BSIs in the prior 11 months. Cost for a single CA-BSI was conservatively estimated to be $33,000 of increased hospital costs. In October 2006, the PICU/PCICU at Duke Children's Hospital became a founding team in the NACHRI led collaborative. METHODS: Pre-implementation baseline data was obtained from Infection Control. Project coordination involved data collection and management, education for all staff including evidence-based insertion and maintenance practice changes, and facilitating interdisciplinary collaboration. All central venous catheter insertions were observed to determine adherence of the practice standard. Each day, patients with central venous lines (CVL) were identified, including catheter location, continued need, and functionality. Patient care nurses completed random surveys, evaluating adherence to the maintenance bundle including daily line review and access practices related to hand washing and hub scrub. RESULTS: Standardization of the dressing change process was identified as having the biggest impact on the CA-BSI rate. The PICU/PCICU had an increase in number of days between CA-BSI from less than 30 days to 80 days. CA-BSIs were reduced from 32 in the 12 months before the collaborative began to 10 CA-BSI in the latest 12 months. For each CA-BSI, a multi-disciplinary team Root Cause Analysis was performed. Several potential contributory causes were identified including non-adherence to the maintenance bundle. Central line utilization remained unchanged both for total number of CVLs per month and the number of patients with a CVL despite an increase in average daily census. CONCLUSIONS: Since the implementation, the PICU/PCICU has demonstrated a statistically significant decrease in CA-BSIs with a longer time between CA-BSI. Additionally, increased average daily census without change in the average number of CVLs may demonstrate successful daily review of CVL need and functionality. This, in turn, leads to decreased opportunity to acquire a CA-BSI. The PICU/PCICU remains committed to decreasing CA-BSI to a goal of zero.en_GB
dc.date.available2011-10-26T19:25:12Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:25:12Z-
dc.identifier.citation2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.en_GB
dc.conference.date2009en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationNew Orleans, Louisiana, USAen_GB
dc.identifier.citation2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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