By 2017, Cohen Children's Medical Center had brought its central line-associated blood stream infection (CLABSI) rates well below national benchmarks. But “low” wasn’t enough.
“We weren’t at zero,” said James Schneider, MD, pediatric intensivist at the hospital. “That meant preventable harm was still happening.”
The hospital’s CLABSI efforts relied on standard evidence-based bundle elements. Adherence was high, but the bundle couldn’t address every scenario for complex, high-acuity patients.
“We had to get more specific and look more closely at each patient,” said Sharon Goodman, DNP, director of clinical professional development.
The team had started conducting proactive safety huddles for patients identified as high risk, but competing schedules, distracted participants, and inconsistent follow-through limited their impact.
“They were not as effective as they needed to be,” Goodman said. "Though we saw improvement, we were still having infections, which is unacceptable.”
A solution at their fingertips
To make frontline communication more effective inside and outside the huddles, the team decided to redesign its Microsoft Teams chats with a new structure and purpose.
They launched two chats of different tiers:
- Tier 1 chat included bedside “CLABSI champion” nurses and physicians, nurse educators, and the director of patient care — all people they work with every day. CLABSI champions got protected time for the roles, meeting monthly to provide child reviews, observational audits, and education.
- Tier 2 chat included unit leaders (both physicians and nursing), infection control, infectious disease experts, and quality staff. Each high-risk specialty area had chats for their units (including Hem-Onc, PICU-2, Central, NICU).
If a bedside clinician had a concern, they turned first to their CLABSI champion in Tier 1. If needed, the co-leads in Tier 1 would escalate to Tier 2.
The clear tiers enabled staff to communicate quickly and safely without being confined by traditional hierarchies.
“Nurses could speak up without fear,” Goodman said. “They had a direct line to peer experts they knew and trusted.”
The champions named themselves the “CLABSI Crushers.” Branded swag like stress balls and t-shirts fostered camaraderie and purpose.
“Branding is one of the strongest things that we have to motivate people,” Goodman said.
Staff became comfortable asking questions in the HIPAA-compliant Teams chat — which allowed photos of IV lines and patient reports — using it to troubleshoot issues, discuss radiology reports, and escalate problems.
Trending toward zero
By the end of 2023, the hospital’s CLABSI rate had dropped to 0.31. In 2024, it fell further to 0.23 — a 26% reduction in one year, with more than 13,000 line days. Meanwhile, use of the Teams chats increased 340%, showing how deeply the strategy had taken root.
“We wanted to make transparency and communication the default,” said Schneider. “Now we have a platform where bedside nurses feel confident raising concerns. And it’s saving lives.”
What’s more, in October 2024 all three of Cohen’s medical-surgical units reached two years without a CLABSI.
“These weren’t our original high-risk units,” said Christine Marigliano, RN, MSN, director of hematology-oncology and medical-surgical services. “But by focusing our safety lens there, we closed an important gap.”
Next, they plan to integrate CLABSI prevention into interventional radiology and the OR, where many central lines are placed. The goal is to develop a scalable framework by creating standard operating procedures, identifying optimal roles, and aligning with other hospital-acquired condition groups.
This article is based on a presentation at the Children’s Hospital Association’s 2025 Transforming Quality Conference.
