Sandeep Tripathi, MD, MS
Associate Professor of Pediatrics
University of Illinois College of Medicine at Peoria
Peoria, Illinois
Disclosure information not submitted.
Jonathan Gehlbach, MD
Physician
University of Illinois College of Medicine - Peoria, United States
Disclosure information not submitted.
LaMonica Henrekin, BSN, RN, NE-BC
Peds ICU & Peds INT Nurse Manager
OSF Healthcare Children's Hospital of IL
Peoria, Illinois
Disclosure information not submitted.
Ann Neavor, MSN, RN, PCNS-BC, CPN, CCRN
Cardiac Nurse Educator
OSF Saint Francis Medical Center/Children's Hospital of Illinois, United States
Disclosure information not submitted.
Tammy Woods-duvendack, RN, PhD
Vice President Quality and Safety
OSF St Francis Medical Center, United States
Disclosure information not submitted.
Title: CLABSI maintenance bundle and CLABSI rates: Is there more to it than compliance?
Introduction: Implementation of a group of evidence-based best practice measures (“bundle”) have been shown to decrease the rates of Central Line Associated Bloodstream Infection (CLABSI). While high compliance with bundle is often targeted as process measures, in quality improvement interventions, it is not known if there is correlation between compliance with the bundle and the CLABSI rates. Specific aim of this project was to assess the correlation of monthly bundle compliance with CLABSI rates in pediatric population.
Methods: A CLABSI maintenance bundle within the guidelines of the Solutions for Patient Safety was implemented in Children’s Hospital of Illinois from 05/2016 across all hospital units. Bundle compliance was assessed by 20 random audits. CLABSI surveillance was done as per CDC definitions. Bundle compliance and CLABSI rates were monitored with a statistical process control locally and with network (SPS) rates. Spearman correlation was calculated between monthly bundle compliance and CLABSI rate.
Results: Over 63-month period (05/16- 06/21), 2265 Central venous catheters were audited of which 1741 (76.9%) had 100% compliance with the maintenance bundle (PICU 386/692, 55.8%; NICU 823/929, 88.6%; floor 525/637, 82.4%). Median compliance was 100% for individual bundle elements of “daily discussion of need”, “accurate charting of dressing change”, “dressing clean dry and intact” and “line tubing within hang times”. Median compliance was 83% for “antiseptic bath” and 92% for “accurate charting of tubing change”. Median CLABSI rate in 2016 was 0.55/1000-line days, it was highest in 2019 (1.25/1000-line days), and zero for the year 2020 and 2021. The bundle compliance and median CLABSI rates stayed within 3σ limits. During this period network average bundle compliance was 86% and CLABSI rate 1.2/1000-line days. There was no correlation between overall (-0.04, p = 0.75) or any individual bundle element compliance with CLABSI rates. Separate analysis for NICU (0.18, p= 0.20) and PICU (-0.06, p= 0.68) also did not show any significant correlation.
Conclusions: Adherence to good practices impacts CLABSI rates; however, bundle compliance percentage by itself does not correlate with CLABSI. Further reduction in CLABSI would require additional innovative measures to control and modify practices and behaviors.