BC Children’s PICU learns quality improvement lesson the hard way

The Pediatric Intensive Care Unit (PICU) at BC Children’s Hospital has achieved a significant milestone. They haven’t had a short-term central line infection in any of their patients since October 2008. Central lines are inserted in acutely ill patients who require ongoing administration of medications, fluids, or blood tests. The lines can be prone to infection if not inserted and maintained correctly.

“Hitting the two-year mark was particularly meaningful for our team,” says Tracie Northway, Quality & Safety Leader, PICU. “It highlights the hard-won lesson that quality efforts have to be sustained and continuously evaluated to ensure they are still working.”

In 2004, the PICU joined the Canadian ICU Collaborative, a national group of interdisciplinary critical care and improvement professionals focused on improving patient care and safety for critically ill patients. By tapping into this national resource, PICU was able to reduce central line associated blood stream infections (CLABSI) by 60 per cent in the first 12 months, Over the next three years, they continued to work on reducing these rates and eventually reached a point where they went 13 months without a central line infection.

However, in April 2008, the infection-free streak ended. By September, there had been four infections. While staff was disappointed, there was a certain acceptance that PICU patients were at a high risk of infection and at least some of them would get an infection, despite everyone’s best efforts. However, when three more CLABSI were confirmed in October, a full review was conducted to attempt to identify what could be contributing to the increase.

“The review was a very humbling process,” says Lynn Coolen, program manager, critical care. “While we had put many new procedures in place to decrease our infection rate, over time, these processes weren’t always being followed.”

The team redoubled their efforts. The quality leads ensured that all new staff members on the unit were properly trained on the insertion and maintenance of central lines and existing staff and physicians were given a refresher.

As well, PICU looked at increased auditing of insertion and maintenance bundle compliance via observation and discussion with staff. This feedback was very important. Once a month, quality staff posted a graph that showed central line infection rates. Instead of just showing numbers, each infection was represented by a photo of the child and their particular circumstances.

“We’ve learned that we can’t rest on our laurels – we have to constantly evaluate how we are doing,” says Tracie. “Now, everyone in the PICU understands they have a role to play in reducing central line infections. If one of our patients gets an infection, the staff want to get to the root of why it happened – they don’t simply accept that some children will get an infection.”