Neonatologist, NHS Lanarkshire CLABSI A confirmed primary blood - PowerPoint PPT Presentation

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 Aim: Reduction in CLABSI to < 8 per 1000 line What are we trying to days accomplish? Measures A. Outcome measure: Number of CLABSI per 1000 line days. B. Process measure : • % compliance maintenance bundles How will we know that • % compliance with access bundles change is an improvement? • % Compliance with PVC access bundle C. Balance measure • Increased expenditure. • Early establishment of full enteral feeds • Increased incidence of feed intolerance 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.

Driver diagram or Ishikawa

Process measures Tools used

Rate per 1000 20 40 50 60 70 30 10 0 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 What the data tells us Oct-16 Nov-16 Rate of CLABSI per 1000 line days Dec-16 CVC Bundles Hub Scrub & Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 CLABSI Prevention Sep-17 Bundle Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Commenced Badger Jun-18 Jul-18 Aug-18 Sep-18 Hand hygiene Quality Week Oct-18 Focus on Nov-18 Dec-18

What the data tells us Monthly Compliance with CVC Insertion Bundle Badger commenced 100 90 80 Quality Week 70 Focus on % Compliance hand hygiene 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 Badger Quality Week Focus on 50 Commenced Hand Hygiene 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 160 CLABSI Rate in 2017 = 12.9 / 1000 line days = 19.9 / 1000 line days demonstrating a 35% 140 reduction 120 High Activity CLABSI Prevention Baby transferred on Ward Rate per 1000 line days 100 Badger Bundle with lines in situ Commenc e d 80 UCL 60 40 20 0 LCL Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18

Lessons  Always test  PDSA!  Spot data do not cut it.  Improvement is everyone’s business.  Accept marginal gains.  Ambitious aim?

Thank You