Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2025-01-02T13:23:08.592Z Has data issue: false hasContentIssue false
  • English
  • Français

Central venous catheter bundle adherence: Kamishibai card (K-card) rounding for central-line–associated bloodstream infection (CLABSI) prevention

Published online by Cambridge University Press:  04 June 2020

Jennifer A. Ormsby ,
Julie Cronin ,
Jane Carpenter ,
Dionne A. Graham ,
Gail Potter-Bynoe ,
Ana M. Vaughan ,
Lindsay Weir ,
Kathleen A. Flaherty ,
Celeste J. Chandonnet  and
Gregory P. Priebe
...Show all authors
Jennifer A. Ormsby
Affiliation:
Infection Prevention and Control, Boston Children’s Hospital, Boston, Massachusetts
Julie Cronin
Affiliation:
Department of Clinical Education and Informatics, Boston Children’s Hospital, Boston, Massachusetts
Jane Carpenter
Affiliation:
Infection Prevention and Control, Boston Children’s Hospital, Boston, Massachusetts
Dionne A. Graham
Affiliation:
Center for Applied Pediatric Quality Analytics, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
Gail Potter-Bynoe
Affiliation:
Infection Prevention and Control, Boston Children’s Hospital, Boston, Massachusetts
Ana M. Vaughan
Affiliation:
Infection Prevention and Control, Boston Children’s Hospital, Boston, Massachusetts Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
Lindsay Weir
Affiliation:
Infection Prevention and Control, Boston Children’s Hospital, Boston, Massachusetts
Kathleen A. Flaherty
Affiliation:
Infection Prevention and Control, Boston Children’s Hospital, Boston, Massachusetts
Celeste J. Chandonnet
Affiliation:
Infection Prevention and Control, Boston Children’s Hospital, Boston, Massachusetts
Gregory P. Priebe
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts
Thomas J. Sandora*
Affiliation:
Infection Prevention and Control, Boston Children’s Hospital, Boston, Massachusetts Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
*
Author for correspondence: Thomas J. Sandora, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To institute facility-wide Kamishibai card (K-card) rounding for central venous catheter (CVC) maintenance bundle education and adherence and to evaluate its impact on bundle reliability and central-line–associated bloodstream infection (CLABSI) rates.

Design:

Quality improvement project.

Setting:

Inpatient units at a large, academic freestanding children’s hospital.

Participants:

Data for inpatients with a CVC in place for ≥1 day between November 1, 2017 and October 31, 2018 were included.

Intervention:

A K-card was developed based on 7 core elements in our CVC maintenance bundle. During monthly audits, auditors used the K-cards to ask bedside nurses standardized questions and to conduct medical record documentation reviews in real time. Adherence to every bundle element was required for the audit to be considered “adherent.” We recorded bundle reliability prospectively, and we compared reliability and CLABSI rates at baseline and 1 year after the intervention.

Results:

During the study period, 2,321 K-card audits were performed for 1,051 unique patients. Overall maintenance bundle reliability increased significantly from 43% at baseline to 78% at 12 months after implementation (P < .001). The hospital-wide CLABSI rate decreased from 1.35 during the 12-month baseline period to 1.17 during the 12-month intervention period, but the change was not statistically significant (incidence rate ratio [IRR], 0.87; 95% confidence interval [CI], 0.60–1.24; P = .41).

Conclusions:

Hospital-wide CVC K-card rounding facilitated standardized data collection, discussion of reliability, and real-time feedback to nurses. Maintenance bundle reliability increased after implementation, accompanied by a nonsignificant decrease in the CLABSI rate.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 9 , September 2020 , pp. 1058 - 1063
Check for updates
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Goudie, A, Dynan, L, Brady, PW, Rettiganti, M. Attributable cost and length of stay for central line-associated bloodstream infections. Pediatrics 2014;133:1525–1532.Google ScholarPubMed
Wilson, MZ, Rafferty, C, Deeter, D, Comito, MA, Hollenbeak, CS. Attributable costs of central line-associated bloodstream infections in a pediatric hematology/oncology population. Am J Infect Control 2014;42:1157–1160.CrossRefGoogle Scholar
Dudeck, MA, Weiner, LM, Allen-Bridson, K, et al.National Healthcare Safety Network (NHSN) report, data summary for 2012, Device-associated module. Am J Infect Control 2013;41:1148–1166.10.1016/j.ajic.2013.09.002CrossRefGoogle ScholarPubMed
How-to guide: prevent central line-associated bloodstream infections. Institute for Healthcare Improvement website. http://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventCentralLineAssociatedBloodstreamInfection.aspx. Updated March 2012. Accessed May 17, 2020.Google Scholar
Choi, SW, Chang, L, Hanauer, DA, et al.Rapid reduction of central line infections in hospitalized pediatric oncology patients through simple quality improvement methods. Pediatr Blood Cancer 2013;60:262–269.CrossRefGoogle ScholarPubMed
Duffy, EA, Rodgers, CC, Shever, LL, Hockenberry, MJ. Implementing a daily maintenance care bundle to prevent central line–associated bloodstream infections in pediatric oncology patients. J Pediatr Oncol Nurs 2015;32:394–400.CrossRefGoogle ScholarPubMed
Miller, MR, Griswold, M, Harris, JM, et al.Decreasing PICU catheter-associated bloodstream infections: NACHRI’s quality transformation efforts. Pediatrics 2010;125:206–213.10.1542/peds.2009-1382CrossRefGoogle ScholarPubMed
Ormsby, JA, Bukoye, B, Lajoie, D, et al.Enhanced central venous catheter bundle for pediatric parenteral-dependent intestinal failure. Am J Infect Control 2018;46:1284–1289.CrossRefGoogle ScholarPubMed
Schulman, J, Stricof, R, Stevens, TP, et al.Statewide NICU central-line–associated bloodstream infection rates decline after bundles and checklists. Pediatrics 2011;127:436–444.10.1542/peds.2010-2873CrossRefGoogle ScholarPubMed
Smulders, CA, Van Gestel, JPJ, Bos, AP. Are central-line bundles and ventilator bundles effective in critically ill neonates and children? Intensive Care Med 2013;39:1352–1358.10.1007/s00134-013-2927-7CrossRefGoogle ScholarPubMed
Wheeler, DS, Giaccone, MJ, Hutchinson, N, et al.A hospital-wide quality-improvement collaborative to reduce catheter-associated bloodstream infections. Pediatrics 2011;128:e995–e1004.10.1542/peds.2010-2601CrossRefGoogle ScholarPubMed
Rinke, ML, Chen, AR, Bundy, DG, et al.Implementation of a central-line maintenance care bundle in hospitalized pediatric oncology patients. Pediatrics 2012;130:e996–e1004.CrossRefGoogle ScholarPubMed
Costello, JM, Morrow, DF, Graham, DA, Potter-Bynoe, G, Sandora, TJ, Laussen, PC. Systematic intervention to reduce central-line–associated bloodstream infection rates in a pediatric cardiac intensive care unit. Pediatrics 2008;121:915–923.10.1542/peds.2007-1577CrossRefGoogle Scholar
Marschall, J, Mermel, LA, Fakih, M, et al.Strategies to prevent central-line–associated bloodstream infections in acute-care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:753–771.10.1086/676533CrossRefGoogle ScholarPubMed
Sacks, GD, Diggs, BS, Hadjizacharia, P, Green, D, Salim, A, Malinoski, DJ. Reducing the rate of catheter-associated bloodstream infections in a surgical intensive care unit using the Institute for Healthcare Improvement central-line bundle. Am J Surg 2014;207:817–823.CrossRefGoogle Scholar
SPS Prevention Bundles December 2019. Children’s Hospitals’ Solutions for Patient Safety website. https://www.solutionsforpatientsafety.org/wp-content/uploads/SPS-Prevention-Bundles_DECEMBER-2019.pdf. Accessed May 27, 2020.Google Scholar
Furuya, EY, Dick, A, Perencevich, EN, Pogorzelska, M, Goldmann, D, Stone, PW. Central line bundle implementation in US intensive care units and impact on bloodstream infections. PLoS One 2011;6:1–6.10.1371/journal.pone.0015452CrossRefGoogle ScholarPubMed
Affolter, JT, Huskins, WC, Moss, M, Kuhn, EM, Gedeit, R, Rice, TB. The association of central-line-associated bloodstream infections with central-line utilization rate and maintenance bundle compliance among types of PICUs. Pediatr Crit Care Med 2016;17:591–597.10.1097/PCC.0000000000000736CrossRefGoogle ScholarPubMed
Fisher, D, Cochran, KM, Provost, LP, et al.Reducing central-line–associated bloodstream infections in North Carolina NICUs. Pediatrics 2013;132:e1664–e1671.10.1542/peds.2013-2000CrossRefGoogle ScholarPubMed
Iwao, S. Revisiting the existing notion of continuous improvement (Kaizen): literature review and field research of Toyota from a perspective of innovation. Evol Institutional Econ Rev 2017;14:29–59.10.1007/s40844-017-0067-4CrossRefGoogle Scholar
Jurecko, L. Kamishibai card rounding helps prevent hospital-acquired infections. Children’s Hospital Association website. https://www.childrenshospitals.org/newsroom/childrens-hospitals-today/issue-archive/issues/summer-2015/articles/lean-tools-help-prevent-hospital-acquired-infections. Published March 13, 2017. Accessed October 10, 2019.Google Scholar
Shea, G, Smith, W, Koffarnus, K, Knobloch, MJ, Safdar, N. Kamishibai cards to sustain evidence-based practices to reduce healthcare-associated infections. Am J Infect Control 2019;47:358–365.CrossRefGoogle ScholarPubMed
Ogrinc, G, Davies, L, Goodman, D, Batalden, P, Davidoff, F, Stevens, D. Standards for QUality Improvement Reporting Excellence 2.0: revised publication guidelines from a detailed consensus process. J Surg Res 2016;200:676–682.CrossRefGoogle ScholarPubMed
Mermel, LA, Allon, M, Bouza, E, et al.Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009;49:1–45.10.1086/599376CrossRefGoogle ScholarPubMed
Bell, T, O’Grady, NP. Prevention of central line–associated bloodstream infections. Infect Dis Clin North Am 2017;31:551–559.10.1016/j.idc.2017.05.007CrossRefGoogle ScholarPubMed
Harris, PA, Taylor, R, Thielke, R, Payne, J, Gonzalez, N, Conde, JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377–381.CrossRefGoogle ScholarPubMed
IHI White Paper. Using care bundles to improve health care quality. Institute for Healthcare Improvement website. http://www.ihi.org/resources/Pages/IHIWhitePapers/UsingCareBundles.aspx. Published 2012. Accessed May 18, 2020.Google Scholar
Bloodstream infection event (central line-associated bloodstream infection and non–central-line–associated bloodstream infection). Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf. Published January 2020. Accessed May 18, 2020.Google Scholar
Pope, C, Van Royen, P, Baker, R. Qualitative methods in research on healthcare quality. Qual Saf Heal Care 2002;11:148–152.CrossRefGoogle ScholarPubMed
Edwards, JD, Herzig, CTA, Liu, H, et al.Central-line–associated bloodstream infections in pediatric ICUs: longitudinal trends and compliance with bundle strategies. Am J Infect Control 2016;43:489–493.CrossRefGoogle Scholar
Rowan, CM, Miller, KE, Beardsley, AL, et al.Alteplase use for malfunctioning central venous catheters correlates with catheter-associated bloodstream infections. Pediatr Crit Care Med 2013;14:306–309.CrossRefGoogle ScholarPubMed
Thakarar, K, Collins, M, Kwong, L, Sulis, C, Korn, C, Bhadelia, N. The role of tissue plasminogen activator use and systemic hypercoagulability in central-line–associated bloodstream infections. Am J Infect Control 2014;42:417–420.Google ScholarPubMed
Supplementary material: Image

Ormsby et al. Supplementary Materials

Ormsby et al. Supplementary Materials 1

Download Ormsby et al. Supplementary Materials(Image)
Image 208.9 KB
Supplementary material: Image

Ormsby et al. Supplementary Materials

Ormsby et al. Supplementary Materials 2

Download Ormsby et al. Supplementary Materials(Image)
Image 113.3 KB