In 2018, all four inpatient units at MassGeneral Hospital for Children (MGHfC) achieved 365 consecutive days without central line-associated bloodstream infections (CLABSI). This includes the Neonatal Intensive Care Unit (NICU), Pediatric Intensive Care Unit (PICU), Ellison 17 and 18 and the Special Care Nursery. The record still going strong into 2019.
CLABSI is a primary bloodstream infection in a central line that develops within 48 hours of a patient experiencing symptoms. A CLABSI is not related to or caused by infections found elsewhere in the body. The Centers for Disease Control and Prevention (CDC) estimates that there are 41,000 CLABSIs in the United States every year.
In 2018, there was a total of 5,000 inpatient days among all inpatient units (total days in which all patients stayed at the hospital for one night or more).
“What our nursing and physician teams have achieved is a major accomplishment in our efforts to provide the best care possible,” said Ronald Kleinman, MD, Physician-in-Chief at MGHfC. “This represents the work of so many individuals working together to reduce the risk of hospital-acquired infections and this record of more than a year without any central line infections is such an incredible testament to their skill and commitment to optimal patient care. My deepest appreciation and congratulations go to those who lead and participated in this major achievement.”
Most CLABSIs are preventable through correct insertion, cleaning and care practices. One of the most significant changes made throughout all MGHfC pediatric inpatient units to reduce CLABSIs was using ethanol locks and chlorhexidine wipes when inserting and cleaning central lines in place of alcohol wipes. During daily rounds, providers also discuss which patients need central lines.
Each unit assessed its practices and implemented new best practices, depending on patients’ needs. In the PICU, the team regularly receives education on best practices surrounding central line maintenance and obtaining blood cultures. They also establish a separate intravenous (IV) infusion site for medications typically given by syringe. This decreases the need to constantly plug medications into and out of the central line tubing. Weekly CLABSI and catheter-associated urinary tract infections (CAUTI)-free days are also posted on boards near the nurses’ stations and reminder cards near each patients’ bedside provide best practices for inserting, cleaning and caring for central lines.
“We have a unit-based, multidisciplinary CLABSI committee that has worked on these practices changes in the PICU,” said Arlene Kelleher, RN, MS, clinical nurse director of the PICU at MHGfC. “This is a very proud moment for the entire pediatric department. The PICU team strives for excellence in patient care each and every day. It is wonderful to see in numbers that we’ve met our goal for the year and continue to press on to sustain this achievement.”