323 - Utilizing a Pediatric Vascular Access Team to Improve Central Line Bundle Compliance and Central Line- associated Bloodstream Infections (CLABSI)

Poster Number: 323
Publication Number: 323.322

Rishi Laroia, Levine Children's Hospital at Atrium Health, Charlotte, NC, United States

Background: Central line-associated bloodstream infections (CLABSI) account for an estimated 30,000-62,000 deaths and $600 million-$2.7 billion to the US healthcare system annually.

Objective: The unique circumstances of the COVID-19 pandemic led to a spike in the CLABSI rate of our urban, tertiary children's hospital from 0.73 to 2.01 CLABSI/1000 catheter days. It was apparent that reinforcement of best-care practices in CVL care was necessary; however, the complexity of the pandemic made it important for us to create a novel stop gap measure that was adaptable to the needs of the pandemic.

Design/Methods: Historically, our Pediatric Vascular Access Team (VAT) has been used to place peripheral IVs and midlines for the children’s hospital. Instead of relying on fluid staffing and units to reinforce best care CVL practices, we utilized our adaptable VAT to reinforce appropriate care through a Kamishibai Card (KCard) system on all med-surg units. They performed real time, visual auditing on all central on a daily basis, gather compliance data, provide feedback to frontline staff and begin unit specific PDSAs via a KCard process (Fig 1). The components of the CLABSI bundle that were audited and reinforced for every patient with a CVL daily included a standardized line setup, utilization of alcohol disinfecting caps, daily chlorhexidine gluconate baths, clean and intact dressings, uniform labeling system and daily surveillance of line necessity.
Data on VAT encounters, CLABSIs, catheter days and staff engagement were calculated for our pre-implementation (2/15/20 – 7/31/20) and post-implementation phases (8/1/20-4/30/21).

Results: VAT audits averaged 1050 per month (35 audits/day) for the implementation period across our hospital. Since this was a novel role for the vascular access team, this represented an increase from 0 for our VAT. Previously, nursing performed approximately 119 audits per month using our KCard process. The VAT intervention represented an increase in staff audit engagement by 882%. Our CLABSI rate decreased from 2.01 to 0.52 CLABSI/1,000 catheter days (Fig 2). This represented a 74% drop in CLABSI rate.Conclusion(s): Utilization of a VAT proved to be a reliable method to implement best-practice CLABSI maintenance compliance via a KCard process with a subsequent reduction in CVL-associated harm and enhanced staff engagement. The VAT process was imperative in refocusing CLABSI efforts during a challenging time in medical history. Along with the obvious prevention of morbidity and possible mortality, this CLABSI reduction represents a cost savings of approximately $320,000 based on the literature.
Kamishibai Card (KCard) System Utilized for Auditing of Central Lines
CLABSI Run Chart for our pre-implementation (2/15/20 – 7/31/20) and post-implementation phases (8/1/20-4/30/21)