All Hands on Deck: How Multidisciplinary Implementation of CLABSI Countermeasures Cut Our Rate in Half

Background:

Over the last 10 years, Children’s Mercy has made significant strides in reducing our Central Line Associated Blood Stream Infections (CLABSI) rate. However, we continue to have a center line average at 1.186, which is above the solutions for patient safety network centerline of 0.948. In July 2022, we had a significant uptick in infections with a hospital rate of 3.563 indicating a special cause variation. We saw a correlating drop in maintenance bundle compliance to 61%.

Objectives:

Our global aim is to reduce our total number of infections by 15% each fiscal year. With the increased rate of infections in July, we worked to: (1) reduce our total number of CLABSIs per month to under 2 by January 2023, (2) identify the top five contributing factors to our special cause variation, (3) implement three improvement projects, and (4) improve organization-wide maintenance bundle compliance to above 85%, measured using standard work confirmation K-cards.

Methods:

To start, we updated our key driver diagram (Fig. 1). Our organization-wide improvement team began meeting with increased frequency and engagement of new stakeholders with executive support. In addition to observing current state, we completed apparent cause analysis on all CLABSI events, and the contributing factors from these observations and events were trended. Gaps identified during event analyses were in the categories of bundle compliance, data transparency issues, staffing, and environmental cleaning and supply issues. We then designed interventions to address these factors. We developed and deployed an electronic standard work confirmation K-card for bundle compliance and increased observations in each inpatient area of the hospital. Collaboratively with IS, we implemented a near real-time CLABSI visibility dashboard which includes electronic K-card compliance that went live in October. Infection Prevention and Control provided monthly SIR data for evaluation of performance. Environmental services piloted and implemented new trash can products, increased adenosine triphosphate testing and UV disinfecting. We also escalated supply issues using our Daily Management system.

Fig. 1.

Children’s Mercy Kansas City CLABSI driver diagram.

Results:

Since August 2022, our rate decreased from 2.63 to 1.23 (Fig. 2). We have no CLABSIs hospital wide in January 2023. We were above the goal of 85% maintenance bundle compliance in November and December 2022 and have 90% of our units currently utilizing the electronic k-card.

Fig. 2.

Children’s Mercy Kansas City SPS CLABSI outcome control chart. SPS, solutions for patient safety.

Conclusion:

Additional multidisciplinary stakeholder engagement, executive support to remove barriers, and countermeasures aligning with the CLABSI prevention driver diagram were necessary to reduce CLABSI, including increase in data transparency, the usage of electronic bundle compliance confirmation tool, and additional environmental cleanliness processes.