Improving CLABSI Prevention Strategies in Neonatal Care
"Discover the strategies and initiatives aimed at reducing Central Line-Associated Bloodstream Infections (CLABSI) in neonatal patients, including key measures, areas for improvement, and data analysis. Learn how healthcare professionals strive to minimize CLABSI rates and improve patient outcomes in neonatal units. Explore driver diagrams, process measures, and the human elements involved in enhancing CLABSI prevention efforts."
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Presentation Transcript
Dr Augusta Anenih Neonatologist, NHS Lanarkshire
CLABSI A confirmed primary blood stream infection in a patient that had a central line within the 48-hour period before the development of the blood stream infection, and is not related to an infection at another site.
CLABSI Infections associated with Increased mortality and morbidity Neurodevelopmental impact/ Poor outcome Increased emotional burden Increased length of hospital stay Financial burden. Use of central line bundles associated with a decrease in rates.
Xxxx What are we trying to accomplish? Aim: Reduction in CLABSI to < 8 per 1000 line days Measures A. Outcome measure: Number of CLABSI per 1000 line days. B. Process measure : % compliance maintenance bundles % compliance with access bundles % Compliance with PVC access bundle C. Balance measure Increased expenditure. Early establishment of full enteral feeds Increased incidence of feed intolerance How will we know that change is an improvement? What changes can we make that will result in improvement? Change ideas: ? Plan Do Act Study THE MODEL FOR IMPROVEMENT
Identifying areas for improvement Review of cases of CLABSI Identify themes Practices around insertion Day of onset GA Unit activity Line access Review of current process, practice and culture The human side of our everyday practice.
Process measures Tools used
What the data tells us Rate of CLABSI per 1000 line days Hub Scrub & CVC Bundles 70 60 CLABSI Prevention Bundle Badger Commenced 50 Quality Week Focus on Hand hygiene Rate per 1000 40 30 20 10 0 Jan-16 Sep-16 Jan-17 Sep-17 Jan-18 Sep-18 Feb-16 Feb-17 Feb-18 Apr-17 Jul-17 Apr-18 Jul-18 Apr-16 Jul-16 Aug-16 Aug-17 Oct-17 Oct-18 Oct-16 Aug-18 Mar-17 Mar-18 Mar-16 Dec-17 Dec-18 Dec-16 Jun-17 Nov-17 Jun-18 Nov-18 May-16 Jun-16 Nov-16 May-17 May-18
What the data tells us Monthly Compliance with CVC Insertion Bundle Badger commenced 100 90 80 Quality Week Focus on hand hygiene 70 % Compliance 60 50 Data displayed on QI Board 40 30 20 10 No Measuring ?Person Dependent 0
What the data tells us Monthly Compliance with CVC Maintenance Bundle 100 90 80 70 % Compliance 60 Quality Week Focus on Hand Hygiene Badger Commenced 50 40 Data displayed on QI Board 30 20 10 0
Where we are now U Chart showing rate of CLABSI per 1000 line days 2017/2018 Rate CLABSI Rate in 2018 = 12.9 / 1000 line days demonstrating a 35% reduction 160 CLABSI Rate in 2017 = 19.9 / 1000 line days 140 120 High Activity on Ward CLABSI Prevention Bundle Baby transferred with lines in situ 100 Rate per 1000 line days Badger Commenced 80 UCL 60 40 20 0 LCL Jul-17 Jul-18 Jan-17 Jun-17 Aug-17 Sep-17 Jan-18 Jun-18 Aug-18 Sep-18 Nov-17 Dec-17 Nov-18 Dec-18 Mar-17 Apr-17 Oct-17 Mar-18 Apr-18 Oct-18 May-17 May-18 Feb-17 Feb-18
Lessons Always test PDSA! Spot data do not cut it. Improvement is everyone s business. Accept marginal gains. Ambitious aim?
