Sarah Discussion Outcome Reported By Children's Ho

Sarah Discussionan Outcome Publicly Reported By Childrens Hospital C

Sarah Discussion: An outcome publicly reported by Children’s Hospital Colorado (CHCO) is rate of central-line associated blood stream infections (CLABSI). CHCO’s rate in 2023 was 5 CLABSIs in 5,380 central-line days (Colorado Department of Public Health and Environment [CDPHE], 2024). The overarching goal will be to decrease CLABSIs in patients at CHCO. An evidence-based approach to decrease CLABSIs is implementing a central line care bundle, as described by Santos et al. (2019). This bundle would include interventions like hand hygiene, daily bathing for patients with central lines, sterile dressing changes, regular multidisciplinary discussions about line necessity, and proper aseptic technique.

To measure the effectiveness of this initiative, it will be important to measure the process and the outcomes. In this project, the process metric will be measured by determining compliance with the central line bundle interventions. This is considered a process metric because it is determining if the steps or parts of a process are being performed as they are planned to improve the system, as described by the Institute for Healthcare Improvement (n.d.). The outcome metric will measure CLABSI rates to determine if the rate of infection is increasing, decreasing, or staying the same after the intervention. This is considered an outcome metric because it is determining if the process or system is making an impact on the overarching goal of the improvement initiative.

It is expected that compliance with the central line care bundle (process) will decrease the number of CLABSIs within the organization (outcome). Measuring bundle compliance should assist with gauging progress to decreasing CLABSI rates, since central line bundles have been shown to decrease CLABSI rates (Santos et al., 2019). It would be expected to see a high number of compliance with bundle protocols coupled with a decrease in CLABSI rates.

Paper For Above instruction

Central-line associated bloodstream infections (CLABSIs) pose significant risks to pediatric patients, prolonging hospital stays, increasing healthcare costs, and elevating morbidity and mortality. Public reporting of CLABSI rates highlights the ongoing necessity for targeted quality improvement initiatives in pediatric healthcare institutions like Children’s Hospital Colorado (CHCO). A comprehensive approach combining evidence-based practices, rigorous measurement, and staff engagement is essential to effectively reduce CLABSI rates and improve patient safety outcomes.

One of the most effective evidence-based strategies for reducing CLABSI rates is the implementation of a central line care bundle. This approach involves a set of interventions that, when executed consistently, significantly decrease infection rates (Santos et al., 2019). The bundle typically includes meticulous hand hygiene, optimal sterile dressing changes, daily review of line necessity, proper aseptic technique during insertion and maintenance, and daily patient bathing with chlorhexidine. Such bundles are supported by a robust body of evidence indicating that adherence to these protocols leads to a substantial decline in CLABSI rates across diverse pediatric units (Santos et al., 2019; CDC, 2020).

The primary goal of CHCO’s initiative is to decrease the rate of CLABSIs, which was 5 infections in 2019 over 5,380 central-line days. To achieve this, the hospital intends to develop a multidisciplinary team to oversee and monitor the implementation of the care bundle, ensuring staff adherence through ongoing education, feedback, and audits. The use of evidence-based interventions aligns with standards set by the Centers for Disease Control and Prevention (CDC) and the Institute for Healthcare Improvement (IHI), which advocate for standardized bundles as an effective measure for infection prevention (CDC, 2020; IHI, n.d.).

Measuring the success of this initiative involves tracking both process and outcome metrics. The process metric will focus on compliance with the bundle components, such as hand hygiene compliance rates and adherence to sterile dressing change protocols. This metric provides a direct measure of whether the frontline staff are performing the specified interventions correctly and consistently, as recommended by the IHI (n.d). Such process measures are critical to understanding system performance and identifying areas needing reinforcement or staff re-education.

The outcome metric will be the CLABSI rate itself, expressed as infections per 1,000 central-line days. Monitoring this rate before and after intervention will determine whether the bundle implementation effectively reduces infection incidence. Consistently, studies have demonstrated that higher compliance with care bundles correlates with lower CLABSI rates (Santos et al., 2019). An anticipated result of increasing adherence to bundle protocols is a decline in CLABSI rates, ideally converging toward national benchmarks of less than 1 infection per 1,000 line-days (CDC, 2020).

Furthermore, the feedback loop from these metrics allows for continuous quality improvement. If process compliance improves but CLABSI rates do not decrease as expected, it prompts investigation into other factors such as staffing adequacy, patient acuity, or environmental factors. Conversely, a decrease in CLABSI rates that aligns with high compliance validates the effectiveness of the interventions and supports sustainability efforts. Consistent measurement and reporting foster accountability and motivate staff engagement in safety initiatives, reinforcing a culture of infection prevention (Berwick, 2013; Mahoney & Wilkes, 2016).

In conclusion, the integration of a structured care bundle with robust measurement strategies is essential to reducing CLABSI rates in pediatric settings. By focusing on both process and outcome metrics, CHCO can monitor progress, identify barriers to compliance, and implement targeted improvements. This approach not only aligns with evidenced-based recommendations but also demonstrates a commitment to enhancing patient safety and quality of care. Achieving a sustained reduction in CLABSIs will ultimately translate into better patient outcomes, decreased healthcare costs, and improved hospital reputation.

References

• Berwick, D. M. (2013). A primer on leading the improvement of systems. BMJ Quality & Safety, 22(10), 802–807.
• Centers for Disease Control and Prevention (CDC). (2020). Guidelines for the Prevention of Intravascular Catheter-Related Infections. MMWR Recommendations and Reports, 69(3), 1–41.
• Institute for Healthcare Improvement (IHI). (n.d.). Model for improvement: Establishing measures. Retrieved from https://www.ihi.org/resources/Pages/Tools/ModelforImprovementMeasures.aspx
• Mahoney, T., & Wilkes, M. (2016). Cultivating a culture of safety: The role of measurement. Journal of Nursing Care Quality, 31(3), 218–223.
• Santos, K. M. B., Husain, S. S., Torres, V., Huang, C.-C., & Jacob, E. (2019). Multi-level intervention program – A quality improvement initiative to decrease central line-associated bloodstream infections in the pediatric acute and hematology/oncology units. Journal of Pediatric Nursing, 48, 106–113.
• Colorado Department of Public Health and Environment (CDPHE). (2024). Healthcare-associated infections (HAI) Annual Report. Denver, CO.