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CLASBI Eradication Collaborative Saves $100M

 |  By John Commins  
   September 26, 2011

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.

"One critical advance was the increasing statistical rigor that we have tried to bring to these enterprises," Niedner says. "Window dressings are no longer enough to say 'we made things better.' You want outcome and process measures that are collected in a way that you can attack the signals amidst the noise."

The QTN accelerated the learning curve at Mott, which -- like many hospitals -- had been working on infection controls on its own before it joined the collaborative. "We demonstrated a statistically significant reduction in central line infection within the institution just looking at our own data, but it took us two-and-a-half years of intervention and collecting data to detect that signal at our site," he said.

"We knew that we were doing the right thing within four months of joining the collaborative because of we were able to pool our data. The statistical power that a collaborative has that can determine whether or not you are barking up the right tree is much greater than when you are trying to do it alone."

In addition, Niedner explained, Mott's participation provided an outside perspective that they otherwise would not have had. "There is that old saying that fish don't see the water they are swimming in. You have that institutional blindness to your own set of processes that you just take for granted or you assume this is how it is or how it has to be," he said. "We had the opportunity to look at top performers and try to understand what is different in their system or approach. We can always build a better system ourselves, but it is much more pragmatic and efficient to look at other example systems."

Returning to the sustainability question, Niedner says it's understandable that when a particular threat like CLABSI is significantly reduced other concerns that will lay claim to hospitals' stretched resources.

"There does create a trade-off where you have to potentially invest increasing levels of resources into countermeasures to stop ever-diminishing threats," he said. "Those same resources might be allocated a little more deliberately across the unit -- perhaps as other nosocomial infections or other patient safety issues related to medication or blood product transfusion becomes the new, largest threat and it would be prudent to shift some attention there. That's not because you have gotten to zero in CLABSI, but in deploying your resources you want to do that in the most intelligent want to maximize safety and quality in the care environment."

 

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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