104. REDUCING CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS BY OPTIMIZING BUNDLE COMPLIANCE

Abstract

Background Central line associated bloodstream infections (CLABSIs) are a significant cause of morbidity and mortality in pediatric patients. They are associated with a mean attributable cost of $55,646 and a mean attributable length of stay of 19 days. Previous studies have addressed this issue through bundle compliance, which includes the daily discussion of line necessity. Our baseline frequency of daily line discussion was 20.6%, and our CLABSI rate at the start of this project was 1.06 per 1000 catheter days. Aim Statement We planned to double the frequency of central line discussions in pediatric patients admitted to the medical/surgical units over a 1-year period. Interventions We used the model for improvement and PDSA cycles to implement change. Individual PDSA cycles tested our interventions and guided subsequent change cycles. We first implemented provider rounding lists with prompts to discuss central lines. We then developed a multidisciplinary team to drive change. This inspired the adaptation of a safety cross auditing tool, as well as the implementation of provider education sessions. Measures The frequency that central lines were addressed during rounds was the primary outcome measure. Provider comfort level with central lines was a secondary measure, and disturbance of workflow was the balancing measure. Results The initial implementation of new rounding lists did not generate significant change. The frequency that central lines were addressed increased from a mean of 28% to 50% after creating a multidisciplinary team (month 5). The mean again increased from 50% to 74% after implementing a safety cross tool and education sessions (month 9). Provider comfort level with central lines increased from a baseline of 2.43 to 2.93 on a 1 to 4 Likert (P Conclusions and Next Steps The daily discussion of central line necessity, as well as provider comfort level with central lines, demonstrated meaningful changes with our interventions. These are crucial components of the central line bundle and played a key role in the global aim of decreasing CLABSI rates. Throughout the duration of this project, the CLABSI rates in our institution decreased from 1.06 per 1000 catheter days to 0.68 per 1000 catheter days, a 36% reduction. In the future, resident CLABSI champions will be identified to make changes from this project sustainable.