A winning streak is often associated with sporting events, but Akron Children’s has been celebrating some record-breaking milestones of a different kind – patient safety. Specifically, the hospital has been hitting it out of the park when it comes to preventing central line infections.
Known as CLABSI in the hospital setting, central line associated blood stream infections (CLABSI) can cause serious harm, extended hospital stays and even death. They also result in increased health care costs.
Jean Christopher, clinical nurse specialist in the Pediatric Intensive Care Unit (PICU), who heads up the hospital’s CLABSI initiative, says Akron Children’s has worked hard to not just reduce, but in some cases eliminate these infections.
“Back in 2005 our PICU had one of the highest CLABSI rates for pediatric ICUs in the country,” said Jean. “After joining a number of national collaboratives that looked at solutions for reducing CLABSI rates in PICUs we saw our numbers drop by 50% in one year and 90% in 18 months.”
For the last 10 years Akron Children’s PICU has remained below the national benchmark – a source of pride for Jean.
“As the hospital became more involved in the Solutions for Patient Safety (SPS) network, there was more opportunity for data sharing regarding best practices with other institutions,” she said.
SPS is a national collaborative of more than 140 children’s hospitals working together to reduce patient harm. The network standardized how central lines are inserted and cared for and infections are identified.
In 2009 the Showers Center for Cancer and Blood Disorders began using evidence-based practice bundles to help reduce CLABSI in its highly vulnerable patient population. A bundle is a group of interventions done together to reduce the likelihood of infection.
In addition to following the standardized work in the insertion of central lines and using maintenance bundles, the center also instituted its own environment of care and oral hygiene bundles.
According to Dr. Jeffrey Hord, the center’s director, “Things like daily baths with antibacterial soap and routine oral care translate into fewer infections. In 2019, we reduced our CLABSI rate by 50%.”
Denise Lahoski, MSN, education coordinator in the Showers Center, also credits working with the environmental services department.
“The environmental services team members have a passion for our patient population,” she said. “By providing a clean environment and following our specific protocol for room cleaning, they also deserve credit for our unit’s success in CLABSI reductions.”
Dr. Hord says the decline in CLABSI translates into a cost savings for health care organizations.
“We have fewer serious illnesses and deaths, and we also reduce length of stay, which means fewer health resources, supplies and medications are needed,” he said. “One case of CLABSI can cost upward of $45,000.”
SPS helps measure and track an individual unit’s compliance, and also shows the reliability that the standards of care produce.
“Over time we’ve found that the maintenance bundles that we’ve carried forward from the mid-2000s are still the foundation of the work we do today,” she said. “Things like hand hygiene, using skin antiseptics and sterile barriers, and following protocols for dressing and cap changes are all factors that reduce infections.”
“When we have an identified CLABSI case we investigate each infection and try to figure out what caused it in order to prevent it from happening in the future,” she said.
Mandy Odom, clinical nurse manager in our NICU at St. Elizabeth Boardman Hospital (Neonatal Intensive Care Unit) and Beeghly campus’ special care nursery, attributes their 3 years CLABSI-free to increased awareness and training.
“We maintain the same standards of care, training and education as the Akron campus,” she said. “We work hard to engage our families and help them understand what we are doing, why we are doing it and how it factors into their child’s care and safety. We ask that they speak up and let us know if they observe anything concerning that should be brought to our attention.”
Jean says it can be a challenge to come up with new ways to measure and monitor bundle compliance. One of the newest techniques SPS has instituted is the use of Kamishibai or K-cards. The cards are meant to start a conversation between leadership and bedside nurses who care for central lines.
“These real-time interactions allow us the opportunity to observe behaviors like dressing changes and provide opportunities for discussion if one or more element in the bundle isn’t completed correctly,” said Jean. “This feedback allows nurses to see how their actions can prevent harm.”
While happy to celebrate some big numbers – 2 years CLABSI-free in the Burn Center and 1-year in the school-age unit (6100), the Akron Children’s CLABSI prevention committee and SPS remain vigilant and committed to continuous improvement.
“If I had to name the biggest factor in reducing and preventing CLABSI I would say it is following the evidence-based bundles reliably and getting the lines out as quickly as possible,” said Jean.
According to the SPS website, through implementation of its network’s best practices, 13,952 children have been saved from serious harm and efforts have led to an estimated savings of $249.4 million.