Central line associated bloodstream infections (CLABSIs) are hospital-acquired complications that contribute to increased patient morbidity and longer lengths of stay. Lucille Packard Children’s Hospital (LPCH) has previously reported 2.2 CLABSIs per 1000 line-days, which is higher than the national average of 1.5 CLABSIs per 1000 line-days. One of the leading strategies for reducing CLABSI rates is improving compliance with central line bundle elements – a standard of care for dressing changes, antiseptic washes, sterile line accesses etc.
Our high level objective was to use data to reduce CLABSIs by changing institutional practices and individual behaviors.
- Collect, understand and process EHR central line data
- Build a suite of analytics and visualization tools of central line data
- Collaborate with IS to develop a dashboard for bundle compliance
Re-evaluation of hospital wide line-days according to NHSN guidelines reveals that the CLABSI rate per 1000 line days at LPCH has historically been overreported. We calculated a rate of 1.8 CLABSIs per 1000 line days, compared to the previously-quoted rate of 2.2. The updated rate still exceeds the national average and has been increasing steadily over the last 3 years.
Bundle compliance varies significantly between departments. In many cases, failure to do 1-2 specific elements is leading to a low overall rate. This can help target future education campaigns.
- Predictive model for line duration: Can we use patient-level data to predict how long a line should remain in, with a view to drive target-based care.
- Patient-level risk modeling: Can we use EHR data to risk-stratify patients in terms of future CLABSI risk, in order to identify patients at highest infection risk.