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Central venous catheter bundle adherence: Kamishibai card (K-card) rounding for central-line–associated bloodstream infection (CLABSI) prevention

Published online by Cambridge University Press:  04 June 2020

Jennifer A. Ormsby ,
Julie Cronin ,
Jane Carpenter ,
Dionne A. Graham ,
Gail Potter-Bynoe ,
Ana M. Vaughan ,
Lindsay Weir ,
Kathleen A. Flaherty ,
Celeste J. Chandonnet  and
Gregory P. Priebe
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Jennifer A. Ormsby
Affiliation:
Infection Prevention and Control, Boston Children’s Hospital, Boston, Massachusetts
Julie Cronin
Affiliation:
Department of Clinical Education and Informatics, Boston Children’s Hospital, Boston, Massachusetts
Jane Carpenter
Affiliation:
Infection Prevention and Control, Boston Children’s Hospital, Boston, Massachusetts
Dionne A. Graham
Affiliation:
Center for Applied Pediatric Quality Analytics, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
Gail Potter-Bynoe
Affiliation:
Infection Prevention and Control, Boston Children’s Hospital, Boston, Massachusetts
Ana M. Vaughan
Affiliation:
Infection Prevention and Control, Boston Children’s Hospital, Boston, Massachusetts Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
Lindsay Weir
Affiliation:
Infection Prevention and Control, Boston Children’s Hospital, Boston, Massachusetts
Kathleen A. Flaherty
Affiliation:
Infection Prevention and Control, Boston Children’s Hospital, Boston, Massachusetts
Celeste J. Chandonnet
Affiliation:
Infection Prevention and Control, Boston Children’s Hospital, Boston, Massachusetts
Gregory P. Priebe
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts
Thomas J. Sandora*
Affiliation:
Infection Prevention and Control, Boston Children’s Hospital, Boston, Massachusetts Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
*
Author for correspondence: Thomas J. Sandora, E-mail: thomas.sandora@childrens.harvard.edu
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Abstract

Objective:

To institute facility-wide Kamishibai card (K-card) rounding for central venous catheter (CVC) maintenance bundle education and adherence and to evaluate its impact on bundle reliability and central-line–associated bloodstream infection (CLABSI) rates.

Design:

Quality improvement project.

Setting:

Inpatient units at a large, academic freestanding children’s hospital.

Participants:

Data for inpatients with a CVC in place for ≥1 day between November 1, 2017 and October 31, 2018 were included.

Intervention:

A K-card was developed based on 7 core elements in our CVC maintenance bundle. During monthly audits, auditors used the K-cards to ask bedside nurses standardized questions and to conduct medical record documentation reviews in real time. Adherence to every bundle element was required for the audit to be considered “adherent.” We recorded bundle reliability prospectively, and we compared reliability and CLABSI rates at baseline and 1 year after the intervention.

Results:

During the study period, 2,321 K-card audits were performed for 1,051 unique patients. Overall maintenance bundle reliability increased significantly from 43% at baseline to 78% at 12 months after implementation (P < .001). The hospital-wide CLABSI rate decreased from 1.35 during the 12-month baseline period to 1.17 during the 12-month intervention period, but the change was not statistically significant (incidence rate ratio [IRR], 0.87; 95% confidence interval [CI], 0.60–1.24; P = .41).

Conclusions:

Hospital-wide CVC K-card rounding facilitated standardized data collection, discussion of reliability, and real-time feedback to nurses. Maintenance bundle reliability increased after implementation, accompanied by a nonsignificant decrease in the CLABSI rate.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 9 , September 2020 , pp. 1058 - 1063
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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