Texas Regional Template: CLABSI Workgroup Organization: Texas Children’s Hospital

The Texas Regional Hospitals Baylor Scott & White McLane Children’s Medical Center Children’s Health, Children’s Medical Center Children’s Memorial Hermann Hospital Cook Children’s Medical Center Covenant Children’s Dell Children’s Medical Center of Central Texas Driscoll Children’s Hospital Medical City Children’s Hospital Texas Children’s Hospital (Houston) The Children’s Hospital of San Antonio

Insertion Bundle Elements Hand Hygiene prior to insertion Individuals actively participating wear mask, cap, sterile gown and gloves Patient covered with head to toe drape Sterile dressing applied after insertion CHG prep unless contraindicated Checklist completed by observer in real time

Maintenance Bundle Elements Line necessity Dressing clean, dry and intact Dressing labeled and dated Hand hygiene with all line entries Clean gloves with all entries 15/15 scrub with all entries 15/15 scrub with each disconnection Tubing labeled with date hung and day to change Appropriate process followed for tubing and dressing change

CLABSI Data Collection Methods Insertion – Collected by direct observation Maintenance Collected by direct observation Collected Central Line Resource Nurse 450 observations /month

Improvement Strategies CL Resource RN Operational Leadership Central Line Champions CLABSI HAC Team System Education

Improvement Strategies Educated over 2300 RN’s Precursor to inception of CL champion program Didactic instruction Skills validation and check-off stations Module and video technology as adjunct teaching tools Policies and procedures review and revisions Increased staff engagement, awareness, and comfort level

Improvement Strategies Over 200 central line champions across the system Serves as department level subject matter experts Performs monthly direct observations Assists in patient and staff educational efforts Partners with UEC’s to validate and check-off skills Attends monthly meetings Serves as s succession planning strategy for the CLRN role

Improvement Strategies Implemented in critical areas (NICU, HemeOnc, and BMT) Dedicated unit resource Performs high risk technical skills (declotting agents, pull lines) Assists with central line maintenance tasks (cap changes, etc.) Provides and develop comprehensive patient education Assists with staff education and skills validation efforts Serves as the catheter maintenance subject matter expert Assists with policies and procedures revisions and review Partners with CS and UEC’s with product selection and trials

CLABSI Rate

CLABSI Best Practice Recommendations Consider conducting “hands on” skills validation Observation, observation, observation Ensure standardization of practice Consider central line resource nurse role as a unit based subject matter expert

CLABSI Requests for Assistance Elaine Whaley Director Quality & Safety emwhaley@texaschildrens.org Katie Basta Assistant Director Quality & Safety kchengst@texaschildrens.org

Questions?