Kathleen M. Demmel RN, MHA

1. The Power of the NACHRI Hem/Onc Central Line Associated Blood Stream Infections Collaborative on Highly Complex Pediatric Hem/Onc & BMT Units’CLABSI Rates Kathleen M. Demmel RN, MHA

2. Introduction/Objectives OBJ 1 Discuss the special challenges of pediatric Hem/Onc/BMT Central Line Associated Blood Stream Infection (CLABSI) elimination & the Hematology Oncology Central Line Associated Blood Stream Infections Collaborative’s unique solutions

3. Introduction/Objectives cont’d OBJ 2 Describe the Hem/Onc Collaborative approach to CLABSI elimination via Data management Enhanced bundle implementation Improvement methodology • OBJ 3 • Share the Collaborative’s impact on the units' CLABSI rates & lessons learned

4. Project’s AIM Reduce the Hem/Onc & BMT CLABSI rates by 50% via Alignment with similar programs tackling identical challenges Multi-institutional process improvement approach Evidence based practices

5. Project AIM cont’d Effective strategies CLABSI elimination strategies will be developed via Efficiencies and synergies Common goals Shared resources

6. Our Baseline cont’d CLABSI elimination A Cincinnati Children’s Hospital’s strategic patient safety initiative IHI’s 100,000 Lives Campaign focus Our highest rates: 2005, Hem/Onc- 3.93 infections/1000 line days 2006, BMT- 6.35 infections/1000 line days National pediatric Hem/Onc/BMT rates, .7 to 7.4 infections/1000 central line days

7. Our Baseline cont’d PICU’s CLABSI maintenance bundle Pre-Collaborative rates: Fall 2008, Hem/Onc- 1.6 infections/1000 line days Fall 2008, BMT- 3.93 infections/1000 line days 2008 Hospital goal- 1.0 infections/1000 line days

8. The Collaborative 1st Hematology/Oncology Central Line Associated Blood Stream Infections Collaborative, Oct. 2009 23 Pediatric Hem/Onc/BMT programs across the United States Super Charged Maintenance Bundle introduction

9. The Centrally Placed Catheter

10. The Super Charged Maintenance Bundle IHI’s “Bundle” definition… “ A bundle is a structured way of improving the processes of care and patient outcomes: a small, straight-forward set of evidence-based practices — generally three to five — that, when performed collectively and reliably, have been proven to improve patient outcomes. “

11. The Super Charged Maintenance Bundle cont’d The Bundle Elements Care and Maintenance Practices - Line & Tubing - Dressing - Caps Communication - Daily Team Discussion - Documentation

12. The Super Charged Maintenance Bundle cont’d The Super Charged Difference Cap change frequency Tubing change frequency Sterile gloves with open line Masking the patient when line open Masking the patient during dressing changes

13. Implementing the Super Charged Maintenance Bundle Unit based multi-disciplinary task force Bundle execution & auditing Small tests of change CA-BSI real time analysis Collaborative attendees Engage & empower staff

14. Implementing the Super Charged Maintenance Bundle cont’d Collaborative Data Collection Weekly audit data = Monthly Compliance Reports Real Time Infection Analysis + Monthly Line Day entry = Unit based monthly CLABSI Rates

15. Reports CLABSI

16. Reportscont’d Results cont’d

17. Reportscont’d Results cont’d

18. Reports cont’d BMT NACHRI Study Benefit Report Hem/Onc NACHRI Study Benefit Report

19. Results The goal: a 50% CLABSI rate reduction after one year Year One: Collaborative “Supercharged” Bundle & compliance monitoring produced a 29% Hem/Onc & a 56% BMT CLABSI rate decrease Year Two: efforts generated a 34.4 % Hem/Onc & BMT a 66.8% CLABSI rate decrease

20. Results cont’d Hem/Onc & BMT combined NACHRI data reflects 17 infections & 1 death prevented $605,394 saved Prevented infections & associated savings yielded well over 100% return on investment Results have positively impacted the hospital’s CLABSI rate as well

21. Results cont’d NACHRI Hem/Onc Collaborative Study Benefit Report • The NACHRI Hem/Onc Collaborative has prevented 208 infections, prevented 25 deaths & saved $7,292,783 • All NACHRI Quality Transformation Network’s combined have saved 396 Lives, 3224 Infections Prevented, & saved $112 Million

22. Replicating Results Optimal results: Leadership support is key Lay the foundation for efficient data collection Involve & empower the multi-disciplinary team from the beginning On-going staff education & communication of results Improvement methodology & bundle science is easily replicated

23. Lessons Learned Multi-institutional setting process improvement an effective & efficient approach to identifying clinical improvement opportunities & improving outcomes The “POWER” is in the shared learning A unit based multidisciplinary team approach core to establishing & maintaining quality patient outcomes

24. Lessons Learned cont’d Maintenance bundle compliance is key to consistently executing best practice In combination, these have resulted in on-going CLABSI rate reductions An obstacle in today’s environment, gathering the necessary resources to meet collaborative obligations in a busy complex healthcare setting

25. The Future Outpatient campaign Outpatient line day capture & associated CLABSI identification Outpatient CLABSI rates to be generated Secondary CLABSI review Better understand infections in immune-compromised pediatric patients How low can we go?.....

26. Host • Josh Mack • Director • David Hammonds • Executive Producer • David Hammonds • Producer • Thomas Long • Writer • Kathy Demmel • Editor • David Hammonds • Special Appearance • Andrea Rice-Mack • Special Thanks To: • CCHMC Hem/Onc/BMT • Multi-Disciplinary • CLABSI Task Force • CCHMC Hem/Onc/BMT • Bedside Nurses • NACHRI Hem/Onc • CLABSI Collaborative