58 - An Interprofessional Quality Improvement Project to Reduce Community Acquired Central Line Associated Bloodstream Infection in the Pediatric Intestinal Failure Population

Poster Number: 58
Publication Number: 58.215

Jan A. Schriefer, Golisano Children's Hospital at The University of Rochester Medical Center, Pittsford, NY, United States; Megan Gabel, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States; Jeffrey Meyers, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Acadia Fairchild, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States; Julie A. Gottfried, University of Rochester School of Nursing, Rochester, NY, United States; Brenda Tesini, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States

Background: Central line-associated bloodstream infections (CLABSIs) result in significant morbidity but are largely preventable.  Methods to reduce CLABSIs in the inpatient setting are well-described, but there are few recommendations for how these practices might translate to patients with central lines in the home/community/ambulatory settings.

Objective: Our objective was to develop a novel way to track CLABSI in the outpatient setting and to implement a CLABSI prevention bundle of practices to reduce CLABSI over time.

Design/Methods: We sought to reduce the community-acquired CLABSI (CA-CLABSI) rate by 25% from 11.7 to 8.8 per 1,000 line days by August 2020 in children with intestinal failure who require home parenteral nutrition (PN).  An interprofessional quality improvement (QI) team was formed including a QI coach, nurse from the outpatient clinic, neonatologist,  infectious disease physician, advanced practice provider and pediatric gastroenterologist.  Fishbone and Key Driver Diagrams were created to understand factors contributing to CA-CLABSI.  Following baseline data collection, plan-do-study-act (PDSA) cycles began.  Tests of change consisted of a central venous catheter (CVC) maintenance bundle, CVC care tote including supplies and improved educational materials and ethanol lock prophylaxis (ELP).  A control chart was used to display the monthly CA-CLABSI rate and observe for special cause variation.

Results: The mean number of monthly catheter days during this initiative was 112,  At baseline during July 2018-October 2019, the average monthly CA-CLABSI rate was 11.7 per 1,000 catheter days.  The home CVC maintenance bundle and ELP was implemented.  in November 2019, following which we observed 5 consecutive months of no infections.  Following enhancements to the case bundle and tote, special cause variation was noted beginning in May 2020 and the average CA-CLABSI rate declined by 66% to 4 per 1,000 catheter days.  Special cause variation was noted at two other time points (March 2021, May 2021) due to a single patient developing multiple infections.  A lower CA-CLABSI rate has been sustained for 24 months and reflects approximately 12 fewer infections per year in this at-risk population.

Conclusion(s): Interprofessional QI efforts can successfully reduce CA-CALBSI and underscores the value of multidisciplinary teams in the improvement process.  Partnering with families was critical to develop sustainable improvements and may yield better practices to ultimately eliminate CA-CLABSI.