TABLE 2.

Interventions to Improve Compliance With Bundle Elements

Intervention	Date	Leadership Impression of Efficacy	Improvements After Implementation
Nurse education: "Scrub the hub," "Mask for the task," "Prime the line," "Disconnect and you infect." "Be a line saver campaign"	Fall 2009	Very effective, used visual cues, and slogans. Rolled out each task individually.
Developed and implemented nursing audit tool	Fall/winter 2009/2010	Very effective and still in use.
Central line on-line data entry system to track central line days and types of lines	Fall 2009	Eased paper data recording requirement for central line days. Allowed multiple stakeholders to access the data.	Website logic implemented and 1 nurse responsible for data entry to decrease data entry errors
Central line entry cards attached to IV poles to track number of times nurses entering central lines	Fall 2010	The cards were difficult to maintain on IV poles, frequently lost, felt like double charting to RN staff.	Created daily line entry sheet and changed to tracking 2 days per week.
Discussing central line entries on daily rounds with all disciplines present. Laminated cards placed on conference table to remind clinicians to decrease line entries.	Fall 2010	Initially effective with some attending physicians, but not embraced by all.	Placed "Are there problems with the patient’s central line?" on the resident sign-out sheet and nursing charge report sheets
Developed "workgroup" of pediatric oncology nurses to keep the momentum of the study going, assist with disseminating information to the nursing staff, and developing projects.	Fall 2010	Improved unitwide acceptance of intervention and still in use.
Presenting "Root Cause Analysis" results on CLABSI bulletin board in nursing break room.	Winter 2010	Helpful for the staff to see the patient information and any changes we made to our practice based on our findings of the infection.	Added board where nurses can anonymously write "Who is at risk for the next CLABSI" and why. This helps get them engaged and likely focused on vulnerable patients.
Parent wallet cards were created to identify patients’ central line type and proper maintenance techniques. The cards are kept by parents and presented to outside hospitals for education on how to handle the central line.	Spring 2011	Cards are very much appreciated by the families. Compliance with making them for each patient when they receive a new CL has been an issue. Still in use.	Planning on printing out the 4 different versions and having them located on the nursing unit to be individualized and laminated by the nurses when needed. We are hoping this will improve compliance.
CLABSI newsletter –“CABSI in the know” includes information on recent CLABSIs and changes made as a result of them.	Spring 2011	Helpful in disseminating information in a creative way.	Working to produce newsletters at least quarterly.