Presentation
A New Look at CLABSI: Using a Systems-Based Task Analysis to Identify Improvement Opportunities for Infection Prevention
SessionHE6: Innovations in Methods
DescriptionCentral line associated blood stream infections (CLABSI) are common hospital acquired infections that can affect both hospitalized and outpatient patients with central venous catheter access. These infections represent a critical safety risk for patients and are associated with increased rates of morbidity, increased length of stay, and related excess medical costs.1,2 Patients being treated for oncologic and hematologic diseases are at particular risk for CLABSI due to factors such as immunosuppression and need for lengthy central access maintenance.3 Across the literature, prevention efforts and improvement work have focused on a variety of interventions including line discussions during rounds, implementation of line care bundles, cleaning and bathing protocols, and sterile dressing changes.3 Yet CLABSI prevention remains a challenging and prevention efforts remain a focus of improvement for many institutions.
Within our institution, a pediatric specialty hospital, both local unit level and institutional quality improvement projects have introduced a variety of interventions for CLABSI prevention. Despite these efforts, infection rates remain above goal level suggesting a new, systems based approach to understanding care and prevention might be of benefit. Infections in one inpatient care unit prompted unit leadership to engage with the institutional human factors engineer to identify and address additional opportunities for improving CLABSI infection rates. This presentation will detail how a systems analysis coupled with the detailed steps of a traditional behavioral task analysis were used to map current work practices on the unit and in supporting care areas for tasks related to post insertion maintenance, access, and infection prevention tasks directly and indirectly related to line care. Initial observations of the non-sterile tasks of lab draws and medication administration demonstrated high compliance with hand hygiene prior to entering the room, but a lack of routine hand hygiene and glove changes immediately prior to accessing the line. Additionally we identified the opportunity for an improved process for clinical mobile device cleaning. Findings from the task analysis helped identify opportunities for these additional infection prevention steps while the addition of a system analysis contributed ideas for improved room flow to support the additional hand hygiene and other infection prevention practice steps. We will present these and additional findings of our analysis, initial improvement opportunities, and interventions. Following these early findings, we engaged staff in a redesign process to identify optimal environmental layout to support our goal workflow. We will discuss challenges related to variable workflows related to patient and pump location (e.g. bed vs couch) and how this variability was considered in re-design while maintaining focus on patient-centered care. We will also share how we developed staff support for the work and engaged staff to refine improvement recommendations. Finally we will review the ongoing efforts to explore additional tasks and care areas that we have identified as part of the system analysis.
During this presentation we will discuss the importance and opportunities of engaging an interdisciplinary team of human factors, patient safety, infection prevention, and nursing to understand various perspectives of the care environment. This presentation will demonstrate how multiple human factors methods can be combined to understand the complexities of clinical care processes, identify variation in how work is performed, and opportunities for environmental changes to better support best practices for infection prevention. We will further describe how staff engagement and buy-in were essential in both understanding the opportunities for improvement and in identifying user-centered solutions to support how staff work while maintaining patient-centered care processes.
1. Kelada AS, Foster TB, Gagliano GC, Worley S, Tang A, Arakoni VA, Foster CB. Central-line-associated bloodstream infections and central-line-associated non-CLABSI complications among pediatric oncology patients. Infect Control Hosp Epidemiol. 2023 Mar;44(3):377-383. doi: 10.1017/ice.2022.91. Epub 2022 Apr 27. PMID: 35475427; PMCID: PMC10015264.
2. Wilson MZ, Rafferty C, Deeter D, Comito MA, Hollenbeak CS. Attributable costs of central line-associated bloodstream infections in a pediatric hematology/oncology population. Am J Infect Control. 2014 Nov;42(11):1157-60. doi: 10.1016/j.ajic.2014.07.025. Epub 2014 Oct 30. PMID: 25444262.
3. Willis DN, Looper K, Malone RA, Ricken B, Slater A, Fuller A, McCaughey M, Niesen A, Smith JR, Brozanski B. Eliminating Central Line Associated Bloodstream Infections in Pediatric Oncology Patients: A Quality Improvement Effort. Pediatr Qual Saf. 2023 May 29;8(3):e660. doi: 10.1097/pq9.0000000000000660. PMID: 37250614; PMCID: PMC10219729.
Within our institution, a pediatric specialty hospital, both local unit level and institutional quality improvement projects have introduced a variety of interventions for CLABSI prevention. Despite these efforts, infection rates remain above goal level suggesting a new, systems based approach to understanding care and prevention might be of benefit. Infections in one inpatient care unit prompted unit leadership to engage with the institutional human factors engineer to identify and address additional opportunities for improving CLABSI infection rates. This presentation will detail how a systems analysis coupled with the detailed steps of a traditional behavioral task analysis were used to map current work practices on the unit and in supporting care areas for tasks related to post insertion maintenance, access, and infection prevention tasks directly and indirectly related to line care. Initial observations of the non-sterile tasks of lab draws and medication administration demonstrated high compliance with hand hygiene prior to entering the room, but a lack of routine hand hygiene and glove changes immediately prior to accessing the line. Additionally we identified the opportunity for an improved process for clinical mobile device cleaning. Findings from the task analysis helped identify opportunities for these additional infection prevention steps while the addition of a system analysis contributed ideas for improved room flow to support the additional hand hygiene and other infection prevention practice steps. We will present these and additional findings of our analysis, initial improvement opportunities, and interventions. Following these early findings, we engaged staff in a redesign process to identify optimal environmental layout to support our goal workflow. We will discuss challenges related to variable workflows related to patient and pump location (e.g. bed vs couch) and how this variability was considered in re-design while maintaining focus on patient-centered care. We will also share how we developed staff support for the work and engaged staff to refine improvement recommendations. Finally we will review the ongoing efforts to explore additional tasks and care areas that we have identified as part of the system analysis.
During this presentation we will discuss the importance and opportunities of engaging an interdisciplinary team of human factors, patient safety, infection prevention, and nursing to understand various perspectives of the care environment. This presentation will demonstrate how multiple human factors methods can be combined to understand the complexities of clinical care processes, identify variation in how work is performed, and opportunities for environmental changes to better support best practices for infection prevention. We will further describe how staff engagement and buy-in were essential in both understanding the opportunities for improvement and in identifying user-centered solutions to support how staff work while maintaining patient-centered care processes.
1. Kelada AS, Foster TB, Gagliano GC, Worley S, Tang A, Arakoni VA, Foster CB. Central-line-associated bloodstream infections and central-line-associated non-CLABSI complications among pediatric oncology patients. Infect Control Hosp Epidemiol. 2023 Mar;44(3):377-383. doi: 10.1017/ice.2022.91. Epub 2022 Apr 27. PMID: 35475427; PMCID: PMC10015264.
2. Wilson MZ, Rafferty C, Deeter D, Comito MA, Hollenbeak CS. Attributable costs of central line-associated bloodstream infections in a pediatric hematology/oncology population. Am J Infect Control. 2014 Nov;42(11):1157-60. doi: 10.1016/j.ajic.2014.07.025. Epub 2014 Oct 30. PMID: 25444262.
3. Willis DN, Looper K, Malone RA, Ricken B, Slater A, Fuller A, McCaughey M, Niesen A, Smith JR, Brozanski B. Eliminating Central Line Associated Bloodstream Infections in Pediatric Oncology Patients: A Quality Improvement Effort. Pediatr Qual Saf. 2023 May 29;8(3):e660. doi: 10.1097/pq9.0000000000000660. PMID: 37250614; PMCID: PMC10219729.
Event Type
Oral Presentations
TimeTuesday, March 241:30pm - 1:52pm EDT
LocationMurray Hill West
Hospital Environments