Children's Minnesota reaches major patient safety milestone: its St. Paul PICU goes two years without a central line-associated bloodstream infection. Here's how the group achieved success.
CLABSIs by the numbers
- About 30,100 CLABSIs occur in U.S. intensive care units each year
- Up to 250,000 CLABSIs occur across care settings
- Mortality rates associated with CLABSIs range from 12 percent to 25 percent
- The cost of CLABSIs range from $3,700 to $36,000 per episode
Source: Health Research & Educational Trust
With excitement—and balloons—in the air, the staff of the St. Paul campus of Children's Hospitals and Clinics of Minnesota gathered to celebrate a major patient-safety milestone: its Pediatric Intensive Care Unit had just gone two years without a central line-associated bloodstream infection (CLABSI).
"It's important to pause and recognize people," says Patsy Stinchfield, M.S., RN, CPNP, CIC, senior director of Infection Prevention and Control at Children's Hospitals and Clinics of Minnesota. "It inspires staff to want to do better and better—celebrating this is a really important part of it."
The CDC reports that CLABSIs result in thousands of deaths each year and billions of dollars in added costs to the U.S. health care system, even though they are preventable. At Children's Minnesota, the result of the team's consistent, coordinated effort to prevent these infections: 2,570 central line days without a CLABSI.
And this isn't the first time the St. Paul PICU has succeeded in preventing CLABSIs. Five of the past nine calendar years were CLABSI-free there. Additionally, the PICU on Children's Minnesota's Minneapolis campus is currently in the midst of its own streak: nearly 500 days without a CLABSI.
How they got to zero
Stinchfield credits the CLABSI-free run of the St. Paul PICU to a combination of processes implemented at the hospital level and the unit level. The common thread at both levels: an "intense culture of safety," she says.
A hospital-wide campaign, Journey to Zero, stressed preventing harm—moving as closely as possible to zero harm to patients—as the primary goal for staff. Steps toward this goal are continuously measured, monitored, communicated and celebrated.
One example: A hand-washing initiative drove an increase in room-entry and room-exit hand hygiene rates from 50 percent in 2012 to more than 90 percent in 2016. And throughout the hospital, staff members at all levels are empowered to speak up when they spot a situation that could potentially be harmful to a patient.
At the unit level, Stinchfield says the tightly knit team communicates extremely well. The St. Paul PICU team consistently takes extra precautions, such as mandatory two-person dressing changes. The team was also an early adopter of daily chlorohexidine baths. And they mitigate the risk for CLABSIs by working to reduce central line days. This means assessing each patient daily to determine if a central line is still necessary and removing it when possible.
Words of advice
Stinchfield says most children's hospitals are following best practices when it comes to managing the safety of central lines. But her advice is not to ignore the human element of the team members implementing those processes.
"There's so much about this that's human behavior. It's important to recognize what it feels like when you fail because sometimes the team can get deflated,' Stinchfield says. "But if you communicate and celebrate the successes, you can make sure team members are well aware of how they're involved in doing great work for the kids."
Additional CLABSI resources
This topic was featured at the 2017 Quality and Safety in Children's Health Conference:
Here are resources from the 2016 Quality and Safety in Children's Health Conference:
And don't miss these entries from the Pediatric Quality Award:
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