SLUG Bug: Quality improvement with orchestrated testing leads to NICU CLABSI reduction

Anthony J. Piazza; Beverly Brozanski; Lloyd Provost; Theresa R. Grover; John Chuo; Joan R. Smith; Teresa Mingrone; Susan Moran; Lorna Morelli; Isabella Zaniletti; Eugenia K. Pallotto

doi:10.1542/peds.2014-3642

SLUG Bug: Quality improvement with orchestrated testing leads to NICU CLABSI reduction

Anthony J. Piazza, Beverly Brozanski, Lloyd Provost, Theresa R. Grover, John Chuo, Joan R. Smith, Teresa Mingrone, Susan Moran, Lorna Morelli, Isabella Zaniletti, Eugenia K. Pallotto

Division of Newborn Medicine

Research output: Contribution to journal › Article › peer-review

41 Scopus citations

Abstract

Objective: Reduce central line-associated bloodstream infection (CLABSI) rates 15% over 12 months in children's hospital NICUs. Use orchestrated testing as an approach to identify important CLABSI prevention practices. METHODS: Literature review, expert opinion, and benchmarking were used to develop clinical practice recommendations for central line care. Four existing CLABSI prevention strategies (tubing change technique, hub care monitoring, central venous catheter access limitation, and central venous catheter removal monitoring) were identified for study. We compared the change in CLABSI rates from baseline throughout the study period in 17 participating centers. Using orchestrated testing, centers were then placed into 1 of 8 test groups to identify which prevention practices had the greatest impact on CLABSI reduction. Results: CLABSI rates decreased by 19.28% from 1.333 to 1.076 per 1000 line-days. Six of the 8 test groups and 14 of the 17 centers had decreased infection rates; 16 of the 17 centers achieved > 75% compliance with process measures. Hub scrub compliance monitoring, when used in combination with sterile tubing change, decreased CLABSI rates by 1.25 per 1000 line-days. Conclusions: This multicenter improvement collaborative achieved a decrease in CLABSI rates. Orchestrated testing identified infection prevention practices that contribute to reductions in infection rates. Sterile tubing change in combination with hub scrub compliance monitoring should be considered in CLABSI reduction efforts.

Original language	English
Article number	e20143642
Journal	Pediatrics
Volume	137
Issue number	1
DOIs	https://doi.org/10.1542/peds.2014-3642
State	Published - Jan 2016

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10.1542/peds.2014-3642

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@article{107cc16e6d184b7985e64ae606ed8d7c,

title = "SLUG Bug: Quality improvement with orchestrated testing leads to NICU CLABSI reduction",

abstract = "Objective: Reduce central line-associated bloodstream infection (CLABSI) rates 15% over 12 months in children's hospital NICUs. Use orchestrated testing as an approach to identify important CLABSI prevention practices. METHODS: Literature review, expert opinion, and benchmarking were used to develop clinical practice recommendations for central line care. Four existing CLABSI prevention strategies (tubing change technique, hub care monitoring, central venous catheter access limitation, and central venous catheter removal monitoring) were identified for study. We compared the change in CLABSI rates from baseline throughout the study period in 17 participating centers. Using orchestrated testing, centers were then placed into 1 of 8 test groups to identify which prevention practices had the greatest impact on CLABSI reduction. Results: CLABSI rates decreased by 19.28% from 1.333 to 1.076 per 1000 line-days. Six of the 8 test groups and 14 of the 17 centers had decreased infection rates; 16 of the 17 centers achieved > 75% compliance with process measures. Hub scrub compliance monitoring, when used in combination with sterile tubing change, decreased CLABSI rates by 1.25 per 1000 line-days. Conclusions: This multicenter improvement collaborative achieved a decrease in CLABSI rates. Orchestrated testing identified infection prevention practices that contribute to reductions in infection rates. Sterile tubing change in combination with hub scrub compliance monitoring should be considered in CLABSI reduction efforts.",

author = "Piazza, {Anthony J.} and Beverly Brozanski and Lloyd Provost and Grover, {Theresa R.} and John Chuo and Smith, {Joan R.} and Teresa Mingrone and Susan Moran and Lorna Morelli and Isabella Zaniletti and Pallotto, {Eugenia K.}",

note = "Funding Information: Jeanette M. Asselin, MS, RRT-NPS, David J. Durand, MD, Francine D. Dykes, MD, Jacquelyn R. Evans, MD (Chair), Karna Murthy, MD, Michael A. Padula, MD, MBI, Eugenia K. Pallotto, MD, MSCE, Kristina M. Reber, MD, and Billie Lou Short, MD are members of the Children''s Hospital Neonatal Consortium (CHNC), Inc. The CHNC (http://www.thechnc.org) has partnered with Children''s Hospital Association to design, launch, and maintain the Children''s Hospital Neonatal Database (CHND). Children''s Hospital Association provides administrative and analytic support for CHND. We express our gratitude to Rick McClead, MD and John Lantos, MD for providing mentoring and advice on this project and manuscript. We are indebted to the following institutions that serve the infants and their families, and these institutions have participated in this collaborative: Children''s Healthcare of Atlanta, Atlanta, Georgia (Francine Dykes, MD; Cheryl Hulbert, BSN, RN; Chrystine Fields, BSN, RN); Children''s Healthcare of Atlanta at Scottish Rite, Atlanta, Georgia (Gregory Sysyn, MD; Kathy Tucker, BSN, RN; Robin Bagby, RN); Le Bonheur Children''s Hospital, Memphis, Tennessee (Bobby Bellflower, DNSC, NNP-BC; Mary Gatson, RN; Ramsubbareddy Dhanireddy, MD); Children''s Hospital Boston, Boston, Massachusetts (Celeste Chandonnet, BSN, RN CCRN, CIC; Hillary Bishop Kuzdeba, MPH; Michele DeGrazia, PhD, RN, NNP-BC, Anne Hansen, MD, MPH); Nationwide Children''s Hospital, Columbus, Ohio (Margaret R. Holston, RN, MSN; Kris R. Reber, MD); Children''s Medical Center, Dallas, Texas (Rashmin C. Savani, MBChB; Kerry Wilder, RN, BSN, MBA; Becky Ennis, MD); Children''s Hospital Colorado, Aurora, Colorado (Sheila Kaseman, RNC; Tera Carter, RN); Texas Children''s Hospital, Houston, Texas (Yvette Johnson, MD; Stacey Norris Hudspeth, BSN, RNC-NIC, VA-BC; Kathy Ware, RN, BSN, CIC); Children''s Mercy Hospitals & Clinics, Kansas City, Missouri (Nesha Park, RN, BSN; Yolanda Ballam, BS, CIC; Eugenia Pallotto, MD, MSCE); Children''s Hospital Los Angeles, Los Angeles, California (Julie Evans, RN; Nancy McNeil, RN; Sharon Fichera, RN, MSN, NNP-BC); The Children''s Hospital of Philadelphia, Philadelphia, Pennsylvania (John Chuo, MD, MS; Theresa O''Connor, BSN, RNC, CPHQ; Jacquelyn Evans, MD); Children''s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania (Beverly Brozanski, MD; Teresa Mingrone, MSN, RN; Becky Graves, CRNP); St Louis Children''s Hospital, St Louis, Missouri (Joan R. Smith, PhD, NNP-BC; Amy Distler, RN; Tasnim Najaf, MD, Amit Mathur, MD); All Children''s Hospital, St Petersburg, Florida (JoEllen Harris, RN, CIC; Carine Stromquist, MD; Stacey Stone, MD); Children''s National Medical Center, Washington, DC (Lamia Soghier, MD; Tracie Harris, MT(ASCP), CIC; Kimberly Nelson MSN/MHA, RNC-NIC); Children''s Hospital of Wisconsin, Milwaukee, Wisconsin (Michael Uhing, MD; Tzong-Jin Wu, MD; Vijender Karody, MD); and Children''s Hospital of Omaha, Omaha, Nebraska (Jamie McClintic, RN; Kindra Ndebele, APRNNNP-BC; Jessica Fitzgerald, MSN, RN, CCRN). Publisher Copyright: {\textcopyright} 2016 by the American Academy of Pediatrics.",

year = "2016",

month = jan,

doi = "10.1542/peds.2014-3642",

language = "English",

volume = "137",

journal = "Pediatrics",

issn = "0031-4005",

number = "1",

}

TY - JOUR

T1 - SLUG Bug

T2 - Quality improvement with orchestrated testing leads to NICU CLABSI reduction

AU - Piazza, Anthony J.

AU - Brozanski, Beverly

AU - Provost, Lloyd

AU - Grover, Theresa R.

AU - Chuo, John

AU - Smith, Joan R.

AU - Mingrone, Teresa

AU - Moran, Susan

AU - Morelli, Lorna

AU - Zaniletti, Isabella

AU - Pallotto, Eugenia K.

N1 - Funding Information: Jeanette M. Asselin, MS, RRT-NPS, David J. Durand, MD, Francine D. Dykes, MD, Jacquelyn R. Evans, MD (Chair), Karna Murthy, MD, Michael A. Padula, MD, MBI, Eugenia K. Pallotto, MD, MSCE, Kristina M. Reber, MD, and Billie Lou Short, MD are members of the Children''s Hospital Neonatal Consortium (CHNC), Inc. The CHNC (http://www.thechnc.org) has partnered with Children''s Hospital Association to design, launch, and maintain the Children''s Hospital Neonatal Database (CHND). Children''s Hospital Association provides administrative and analytic support for CHND. We express our gratitude to Rick McClead, MD and John Lantos, MD for providing mentoring and advice on this project and manuscript. We are indebted to the following institutions that serve the infants and their families, and these institutions have participated in this collaborative: Children''s Healthcare of Atlanta, Atlanta, Georgia (Francine Dykes, MD; Cheryl Hulbert, BSN, RN; Chrystine Fields, BSN, RN); Children''s Healthcare of Atlanta at Scottish Rite, Atlanta, Georgia (Gregory Sysyn, MD; Kathy Tucker, BSN, RN; Robin Bagby, RN); Le Bonheur Children''s Hospital, Memphis, Tennessee (Bobby Bellflower, DNSC, NNP-BC; Mary Gatson, RN; Ramsubbareddy Dhanireddy, MD); Children''s Hospital Boston, Boston, Massachusetts (Celeste Chandonnet, BSN, RN CCRN, CIC; Hillary Bishop Kuzdeba, MPH; Michele DeGrazia, PhD, RN, NNP-BC, Anne Hansen, MD, MPH); Nationwide Children''s Hospital, Columbus, Ohio (Margaret R. Holston, RN, MSN; Kris R. Reber, MD); Children''s Medical Center, Dallas, Texas (Rashmin C. Savani, MBChB; Kerry Wilder, RN, BSN, MBA; Becky Ennis, MD); Children''s Hospital Colorado, Aurora, Colorado (Sheila Kaseman, RNC; Tera Carter, RN); Texas Children''s Hospital, Houston, Texas (Yvette Johnson, MD; Stacey Norris Hudspeth, BSN, RNC-NIC, VA-BC; Kathy Ware, RN, BSN, CIC); Children''s Mercy Hospitals & Clinics, Kansas City, Missouri (Nesha Park, RN, BSN; Yolanda Ballam, BS, CIC; Eugenia Pallotto, MD, MSCE); Children''s Hospital Los Angeles, Los Angeles, California (Julie Evans, RN; Nancy McNeil, RN; Sharon Fichera, RN, MSN, NNP-BC); The Children''s Hospital of Philadelphia, Philadelphia, Pennsylvania (John Chuo, MD, MS; Theresa O''Connor, BSN, RNC, CPHQ; Jacquelyn Evans, MD); Children''s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania (Beverly Brozanski, MD; Teresa Mingrone, MSN, RN; Becky Graves, CRNP); St Louis Children''s Hospital, St Louis, Missouri (Joan R. Smith, PhD, NNP-BC; Amy Distler, RN; Tasnim Najaf, MD, Amit Mathur, MD); All Children''s Hospital, St Petersburg, Florida (JoEllen Harris, RN, CIC; Carine Stromquist, MD; Stacey Stone, MD); Children''s National Medical Center, Washington, DC (Lamia Soghier, MD; Tracie Harris, MT(ASCP), CIC; Kimberly Nelson MSN/MHA, RNC-NIC); Children''s Hospital of Wisconsin, Milwaukee, Wisconsin (Michael Uhing, MD; Tzong-Jin Wu, MD; Vijender Karody, MD); and Children''s Hospital of Omaha, Omaha, Nebraska (Jamie McClintic, RN; Kindra Ndebele, APRNNNP-BC; Jessica Fitzgerald, MSN, RN, CCRN). Publisher Copyright: © 2016 by the American Academy of Pediatrics.

PY - 2016/1

Y1 - 2016/1

N2 - Objective: Reduce central line-associated bloodstream infection (CLABSI) rates 15% over 12 months in children's hospital NICUs. Use orchestrated testing as an approach to identify important CLABSI prevention practices. METHODS: Literature review, expert opinion, and benchmarking were used to develop clinical practice recommendations for central line care. Four existing CLABSI prevention strategies (tubing change technique, hub care monitoring, central venous catheter access limitation, and central venous catheter removal monitoring) were identified for study. We compared the change in CLABSI rates from baseline throughout the study period in 17 participating centers. Using orchestrated testing, centers were then placed into 1 of 8 test groups to identify which prevention practices had the greatest impact on CLABSI reduction. Results: CLABSI rates decreased by 19.28% from 1.333 to 1.076 per 1000 line-days. Six of the 8 test groups and 14 of the 17 centers had decreased infection rates; 16 of the 17 centers achieved > 75% compliance with process measures. Hub scrub compliance monitoring, when used in combination with sterile tubing change, decreased CLABSI rates by 1.25 per 1000 line-days. Conclusions: This multicenter improvement collaborative achieved a decrease in CLABSI rates. Orchestrated testing identified infection prevention practices that contribute to reductions in infection rates. Sterile tubing change in combination with hub scrub compliance monitoring should be considered in CLABSI reduction efforts.

AB - Objective: Reduce central line-associated bloodstream infection (CLABSI) rates 15% over 12 months in children's hospital NICUs. Use orchestrated testing as an approach to identify important CLABSI prevention practices. METHODS: Literature review, expert opinion, and benchmarking were used to develop clinical practice recommendations for central line care. Four existing CLABSI prevention strategies (tubing change technique, hub care monitoring, central venous catheter access limitation, and central venous catheter removal monitoring) were identified for study. We compared the change in CLABSI rates from baseline throughout the study period in 17 participating centers. Using orchestrated testing, centers were then placed into 1 of 8 test groups to identify which prevention practices had the greatest impact on CLABSI reduction. Results: CLABSI rates decreased by 19.28% from 1.333 to 1.076 per 1000 line-days. Six of the 8 test groups and 14 of the 17 centers had decreased infection rates; 16 of the 17 centers achieved > 75% compliance with process measures. Hub scrub compliance monitoring, when used in combination with sterile tubing change, decreased CLABSI rates by 1.25 per 1000 line-days. Conclusions: This multicenter improvement collaborative achieved a decrease in CLABSI rates. Orchestrated testing identified infection prevention practices that contribute to reductions in infection rates. Sterile tubing change in combination with hub scrub compliance monitoring should be considered in CLABSI reduction efforts.

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U2 - 10.1542/peds.2014-3642

DO - 10.1542/peds.2014-3642

M3 - Article

C2 - 26702032

AN - SCOPUS:84954155663

SN - 0031-4005

VL - 137

JO - Pediatrics

JF - Pediatrics

IS - 1

M1 - e20143642

ER -

SLUG Bug: Quality improvement with orchestrated testing leads to NICU CLABSI reduction

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