A five-year collaborative to eradicate central line-associated bloodstream infections in pediatric intensive care units across the nation has saved 355 lives, prevented nearly 3,000 infections, and generated more than $100 million in savings, the National Association of Children's Hospitals and Related Institutions' Quality Transformation Network has announced.
Now the challenge is sustaining that success, says QTN member Matthew Niedner, MD.
"Our inspirational goal is to get to a rate of zero, but the devil is in the details. Zero for how long: a quarter; a year; a decade?" said Niedner, director of patient safety and quality improvement at the C.S. Mott Children's Hospital Pediatric ICU at the University of Michigan, in Ann Arbor.
"The pragmatist in me recognizes that there will always be central-line infections because there will always be lapses in ideal healthcare delivery. The goal is to minimize that to the greatest extent possible," he said.
Ironically, success creates its own problems for pediatric ICUs that improve CLABSI infection rates. "The nature of trying to understand and remediate relatively uncommon occurrences in any one hospital, these are things that happened before the collaborative about once a month and now we have them down to just a few each year," Niedner explained. "And the more success you have the harder it is to learn from the event because by your improvement you are making them rarer and harder to learn from."
The QTN estimates that CLABSIs cost between $25,000 and $45,000 per event and increase the risk of mortality for children by 10% to 20%. The 88 pediatric ICUs that participated in the five-year collaborative focused on using rigorous, standardized, evidence-based guidelines for catheter injection coupled with daily maintenance for the central lines.