Nursing Director Cleveland Clinic Children's Concord, Ohio, United States
Title: A Lessons Learned Approach to CLABSI Prevention
Abstract : Basis of Inquiry Our hospital faced an opportunity to aggressively reduce the CLABSI SIR in 2024. An interprofessional team implemented a four-tiered CLABSI prevention plan including maintenance, hand hygiene, line entries, and necessity.
Purpose/Objectives Previous CLABSI prevention strategies focused on bundle compliance, however, the lack of a comprehensive approach addressing factors outside the bundle proved ineffective. Priorities were redesigned to drive increased ownership of lines and strengthen the safety culture around central line care for our multidisciplinary teams.
Methods As a result of a lessons-learned approach, the interprofessional team strategized to reduce line entries, and improve hand hygiene, while continuing work on bundle compliance and addressing line necessity daily. Order sets were updated to optimize electrolyte replacement for line entry reduction. Gaps in hand hygiene education and related latent safety threats were addressed with simulation exercises. Process confirmation and line surveillance continued to monitor bundle compliance and line necessity checklists were completed and tracked through QR codes.
Findings/Outcomes As a result of this work, the CLABSI SIR improved from 0.71 in 2023 to 0.32 in 2024 and exceeded the hospital target of 0.49. This was achieved by improving maintenance bundle compliance from 86% to 90%, completion of the line necessity checklist from 81% to 87%, a 49% reduction in line entries for electrolyte replacements and diuretics, and improvement from 96.9% to 97.9% in hand hygiene.
The overall success of the CLABSI reduction plan has resulted in culture change throughout the Children’s Hospital which was driven by the engagement of the interprofessional team. Interventions resulted in 5 fewer infections in 2024 and a cost savings of ~$250,000. In addition to the impact in pediatrics, the hospital is conducting a hospital-wide review for the placement of hand hygiene products because of the lessons learned in the hand hygiene simulation.
