P0567 / #2026: CENTRAL LINE DRESSING QUALITY IMPROVEMENT INITIATIVES REDUCE CLABSI RATE IN THE PICU

Abstract

Aims & Objectives: The purpose of this project was to reduce the incidence of CLABSIs in a 24-bed Pediatric ICU. Our goal was to decrease from a count of 6 and standardized infection ratio (SIR) 1.3 in fiscal year (FY) 2019, to count to ≤ 4 and SIR to ≤ 0.5 in FY 2020. Methods: Our quality improvement project was devised by a nurse-driven, multidisciplinary HAI prevention committee consisting of PICU bedside nurses, a clinical nurse specialist, nurse manager, infection prevention nurse specialist, pediatric critical care and infectious disease physicians. This group conducted a root cause analysis (RCA) of our unit’s CLABSIs from 2017 to 2019. The RCA data identified central line dressing maintenance as an area for potential improvement. The committee subsequently reviewed the literature on evidence-based CLABSI prevention practices related to central line dressings and inquired about practices used at similar-acuity PICUs. Based on our findings, we devised 3 quality improvement interventions to reduce CLABSIs in the PICU: 1) initiation of daily central line dressing audits of every central line in our unit, 2) standardization of dressing supplies and 3) designation of specially-trained nurses to maintain all central line dressings. Results: The primary outcome was a reduction in CLABSI count and SIR in the post-intervention period compared to pre-intervention. For FY 2019, our PICU CLABSI count was 6 and SIR was 1.3. For FY 2020, the CLABSI count and SIR decreased to 2 (67%) and 0.458 (65%) respectively. Conclusions: CLABSI reduction occurs with the implementation of quality improvement interventions focused on central line dressings.