• Article
  • March 7, 2018

Why it’s Important to Track Outpatient CLABSIs

Efforts to engage front line staff members, patients and families can lead to a decrease in CLABSI rates.

Prior to 2015, Children's Hospital & Medical Center in Omaha, Nebraska, was focused on inpatient central line-associated bloodstream infection (CLABSI) events and efforts to decrease these rates. But through participation in the Childhood Cancers and Blood Disorders Network (CCBDN), the hospital took a hard look at its ambulatory hematology/oncology CLABSI rates. The team found that its 2015 CLABSI rate was 0.46 per 1,000 central line days, with a total number of 18 events.

Why is it important to focus on ambulatory CLABSIs? "They cost $37,000 per infection, and the biggest risk is the risk placed on patients—there's the risk of sepsis and possible death," says Amanda Willits, M.S.N., R.N., Hematology/Oncology Educator at Children's Hospital & Medical Center. "Plus, they could face readmission and risk of relapse when treatments are delayed because of a central line infection." Willits shared her team's strategy for improvement at the 2018 Quality and Safety in Children's Health Conference.

Willits says not many hospitals are tracking ambulatory CLABSI rates. "Find a way to start tracking this information," she says. "And if you are tracking these rates, let staff members, providers, hospital leadership and the hospital board members know. Increase awareness, and let them know of the important work that's being done. More patients are harmed by outpatient CLABSIs than inpatient CLABSIs, and it's our job to keep patients safe."

In 2016, Children's Hospital & Medical Center set out to decrease ambulatory infection rates by 50 percent over the next year, and a component of that was to increase staff and family engagement. Online staff surveys were sent to every staff member who cared for a child seven days prior to an infection. In-person interviews with patients and caregivers provided additional information and helped providers know when to probe for more information.

For example, during an interview, a parent mentioned that her child had received care at a community hospital. Willits connected with the lead educator at the hospital to review best practices and ensure consistency in care no matter where the child was treated. "The parent interviews helped us uncover things that may not be uncovered during chart review," Willits says.

Children's Hospital & Medical Center began initiating training with caregivers as soon as the patient was medically stable. Two, hands-on training sessions were provided until the caregiver was able to complete the procedure successfully on his or her own. Then the caregiver demonstrates on the patient. The hospital supplies caregivers with a placemat that outlines the 10 steps to central line flushing, which can be sanitized after each session.

An increase in staff member representation at organizational meetings and staff member participation in the CCBDN collaborative helped them feel more involved in the work. "When staff members aren't actively involved in discussion and decision making, they feel less involved in CLABSI work," Willits says.

This work led to a statistically significant decrease in ambulatory CLABSI rates at the hospital—the hospital decreased its rate and events by more than 50 percent in 2016. Additionally, the team saved the organization about $370,000 in 2016. Through collaboration, education and inclusion of staff members, and patients and caregivers, the team increased CLABSI awareness, prevented ambulatory CLABSIs and saved lives within the organization and in the community.

Send questions or comments to magazine@childrenshospitals.org.