Christopher E Dandoy1, Jackie Hausfeld2, Laura Flesch3, Deanna Hawkins4, Kathy Demmel5, Deanna Best1, Erin Osterkamp4, Tracey Bracke5, Rajaram Nagarajan4, Sonata Jodele3, Julie Holt2, Mary Jo Giaccone5, Stella M Davies3, Uma Kotagal5, Jeffrey Simmons6. 1. Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. 2. Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. 3. Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. 4. Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. 5. James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. 6. James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Division of Pediatric Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Abstract
BACKGROUND: Immunocompromised children are at high risk for central line-associated bloodstream infections (CLABSIs) and its associated morbidity and mortality. Prevention of CLABSIs depends on highly reliable care. PURPOSE: Since the summer of 2013, we saw an increase in patient volume and acuity in our centre. Additionally, CLABSIs rates more than tripled during this period. The purpose of this initiative was to rapidly identify and mitigate potential underlying drivers to the increased CLABSI rate. METHODS: Through small tests of change, we implemented a standard process for daily hygiene; increased awareness of high-risk patients with CLABSI; improved education/assistance for nurses performing high-risk central venous catheter procedures; and developed a system to improve allocation of resources to de-escalate system stress. RESULTS: The CLABSI rate from June 2013 to May 2014 was 2.03 CLABSIs/1000 line days. After implementation of our interventions, we saw a significant decrease in the CLABSI rate to 0.39 CLABSIs/1000 line days (p=0.008). Key processes have become more reliable: 100% of dressing changes are completed with the new two-person standard; daily hygiene adherence has increased from 25% to 70%; 100% of nurses are approached daily by senior nursing for assistance with high-risk procedures; and patients at risk for a CLABSI are identified daily. CONCLUSIONS: Stress to a complex system caring for high-risk patients can challenge CLABSI rates. Identifying key processes and executing them reliably can stabilise outcomes during times of system stress. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
BACKGROUND: Immunocompromised children are at high risk for central line-associated bloodstream infections (CLABSIs) and its associated morbidity and mortality. Prevention of CLABSIs depends on highly reliable care. PURPOSE: Since the summer of 2013, we saw an increase in patient volume and acuity in our centre. Additionally, CLABSIs rates more than tripled during this period. The purpose of this initiative was to rapidly identify and mitigate potential underlying drivers to the increased CLABSI rate. METHODS: Through small tests of change, we implemented a standard process for daily hygiene; increased awareness of high-risk patients with CLABSI; improved education/assistance for nurses performing high-risk central venous catheter procedures; and developed a system to improve allocation of resources to de-escalate system stress. RESULTS: The CLABSI rate from June 2013 to May 2014 was 2.03 CLABSIs/1000 line days. After implementation of our interventions, we saw a significant decrease in the CLABSI rate to 0.39 CLABSIs/1000 line days (p=0.008). Key processes have become more reliable: 100% of dressing changes are completed with the new two-person standard; daily hygiene adherence has increased from 25% to 70%; 100% of nurses are approached daily by senior nursing for assistance with high-risk procedures; and patients at risk for a CLABSI are identified daily. CONCLUSIONS: Stress to a complex system caring for high-risk patients can challenge CLABSI rates. Identifying key processes and executing them reliably can stabilise outcomes during times of system stress. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Authors: Victoria Hickey; Laura Flesch; Adam Lane; Ahna L H Pai; John Huber; Priscila Badia; Stella M Davies; Christopher E Dandoy Journal: Pediatr Blood Cancer Date: 2018-07-26 Impact factor: 3.167
Authors: Christopher E Dandoy; Soyoung Kim; Min Chen; Kwang Woo Ahn; Monica I Ardura; Valerie Brown; Saurabh Chhabra; Miguel Angel Diaz; Christopher Dvorak; Nosha Farhadfar; Aron Flagg; Siddartha Ganguly; Gregory A Hale; Shahrukh K Hashmi; Peiman Hematti; Rodrigo Martino; Taiga Nishihori; Roomi Nusrat; Richard F Olsson; Seth J Rotz; Anthony D Sung; Miguel-Angel Perales; Caroline A Lindemans; Krishna V Komanduri; Marcie L Riches Journal: JAMA Netw Open Date: 2020-01-03
Authors: Anabel Piqueras; Lakshmi Ganapathi; Jane F Carpenter; Thomas Rubio; Thomas J Sandora; Kelly B Flett; Julia R Köhler Journal: J Fungi (Basel) Date: 2021-01-22