Learning Session 3 and celebration of both effort and success by 13 Perinatal Quality Improvement teams (PQIT’s) concluded a year and a half of focus on reducing catheter associated infections in Newborn Critical Care Centers. The work of the day, planning to hardwire the reliability of processes that support eliminating infections preceded the celebration where each team received a gift from Dave Fisher and John Paul Dame. The gift, a board to display “Days since Last Infection” in the unit, is pictured here. Preliminary examination of our infections per 1000 catheter days shows significant improvement during the PQCNC CABSI initiative. Please join PQCNC in sharing a heartfelt “Thank You” to David Fisher, the Clinical Leader for the Initiative, to Jean-Paul and all of the parents who contributed to the team’s success during this initiative, as well as to the administrators, medical staff and nursing staff working to make North Carolina the best place to be born.
The teams continue to share strategies and there is general agreement that a multi-disciplinary approach which includes family members, physician, nurse and senior sponsor champions has been critical to the successes realized so far. Teams will be challenged to design reliability into the processes they have tested and found to be useful at CABSI Learning Session 3 to be held on Thursday, September 2, 2010 in Chapel Hill. 2-4 members of each CABSI Project team, including the nurse champion, physician champion and hospital administration representative will gather to discuss holding the gains. Without attention to holding the gains made, each unit is vulnerable to rising infection rates.
The clinical lead for this CABSI initiative is David Fisher, MD, a practicing neonatologist at Levine Children’s Hospital in Charlotte. Dave shared with the group that although our time together in monthly learning sessions will be coming to an end, this is no time to slow down efforts to eliminate healthcare associated infections (HAI). One of the important discussions is transitioning to the CDC reporting rules and requirements particularly related to the opportunity to work with the NCHA Quality Center for ongoing data support. Dave is convening two discussion groups in August and invited each team to participate. Additionally, Dave requested that each team share their CABSI historical data by forwarding the number of infections and the number of line days for each month in 2008 and 2009.
The members of the collaborative continue to benefit from PQCNC philosophy “All teach-all learn.” This month members of the Intensive Care Nursery (ICN) at Duke University Medical Center presented Rally Against Infection (RAIN) initiative, their multi-media, multi-faceted campaign to eliminate blood stream infections. The campaign was initiated prior to the PQCNC CABSI initiative and includes but is not limited to computer screen savers, regular education, celebrations of days since last infection and weekly contests between and among the staff. One of the hallmarks of the campaign is the involvement of every parent with an infant in the ICN. The slide presentation can be found here and the team welcomed questions and calls from others working on eliminating these infections.
We are more than halfway to the final learning session for the initiative to significantly reduce CABSI. The majority of the teams have made improvements to the processes that impact the CABSI rate and improvements in these intermediate measures are a good proxy for the outcome measure. The PQCNC staff will meet with the NCHA Quality Center regarding ongoing support for the data repository. 10 teams responded to the survey about the possibility of continuing data collection to support your work, and all were interested in working with the Quality Center to monitor your data to reduce or eliminate these infections. Teams continue to meet monthly to share strategies that works as well as helping each other strategize about perceived roadblocks or hurdles.
In April, 12 of the 13 Teams working to reduce or eliminate CABSI met in regional meetings to share information with each other about the elements of their work. These teams have been testing changes in their units since November and collecting information that is demonstrating their success. All units have improved in the use of the insertion checklist, determining the necessity of the line, and many have newly standardized processes to assure masks are worn within a radius of sterile procedures, to name a few of the changes. Many teams are working on antiseptic use and a few are using silver patches at insertion site.
Teams immersed in work to reduce Catheter Associated Blood Stream Infections in Newborn Critical Care Nurseries will meet on either April 20 or 26 to share successes, hurdles, strategies and systems they have developed to reach their aims. The initiative preliminary data is very promising and teams will be sharing information with each other, and will be sharing the results of this work with other nurseries in the fall.
Compliance with central line bundle policies in intensive care units (ICUs) across the nation appears to be low, although complete compliance is not needed to see a reduction in central-line-associated bloodstream infections (CLABSIs), a new analysis shows.
E. Yoko Furuya, MD, MS, from Columbia University in New York City, presented the findings at an oral session here at the Fifth Decennial International Conference on Healthcare-Associated Infections 2010.
"Just having a bundle policy was not enough to reduce CLABSI rates; it was also necessary to monitor and maintain compliance," Dr. Furuya told Medscape Infectious Disease. With the new Joint Commission mandate for central line insertion checklists, bundle use will increase but, she emphasized, "we may or may not see a decrease in infection rates if people fail to maintain high compliance with the bundle, not just in terms of documentation, but also in actual practice."
Dr. Furuya and colleagues hypothesized that high compliance rates were needed to decrease CLABSI rates.