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PICU reaches new milestone in fight against infections

Feb. 7, 2013, 8:31 AM

Like other units, the Pediatric Intensive Care Unit displays the number of days since the last cases of certain hospital-acquired infections. (photo by Steve Green)

On Jan. 10, the Pediatric Intensive Care Unit at the Monroe Carell Jr. Children’s Hospital at Vanderbilt reached impressive new territory — 365 days without a single case of central line associated blood stream infection (CLABSI), catheter associated urinary tract infection (CAUTI) or ventilator associated pneumonia (VAP).

These are by definition hospital acquired infections. According to the Centers for Disease Control and Prevention, reported rates of CLABSI mortality range between 12 percent and 25 percent. Regarding VAP mortality, one study of patients in a single 25-bed pediatric intensive care unit found 19.1 percent mortality among patients with VAP, much higher than the unit’s overall mortality rate of 7.2 percent, though it’s not clear how much of this difference was attributable to VAP.

CAUTI is generally much less serious and costly than CLABSI or VAP, but if it evades notice it can lead to more dangerous blood stream infection.

“Our unit’s infection prevention committee has generated awareness, and that has led to nurses taking ownership of the issue. And now we’re seeing what nurses can accomplish,” said the nurse who leads the committee, Caroline Dilbeck, R.N.

Earlier this month the unit held a celebratory breakfast. Like other hospital units at VUMC, the PICU publically displays the total days since the last cases occurred for each of these three infections.

These daily tallies are also displayed on the main page of the PICU staff website.
It’s been more than 460 days since the PICU’s last case of CLABSI and more than 700 days since its last case of VAP. In 2012, if its performance had reflected current national pediatric intensive care rates for these infections, the PICU in those 12 months alone would have seen four cases of CLABSI and two cases of VAP.

The PICU saw a single case of CAUTI in 2012, occurring early in January, bringing their CAUTI rate for the year to 2.1 cases per 1,000 urinary catheter days, just below the current national pediatric intensive care rate of 2.2.

“I think this has been a priority for the leadership at Children’s Hospital. They’ve brought it into our awareness so that it’s at the forefront of our thought,” said Lauren Tierney, R.N.

Tanika Wilson, R.N., is manager of the PICU. “I think keeping those days posted and available for staff to see has made the biggest difference in creating staff ownership,” she said.

Where ventilators, central lines and urinary catheters are concerned, the PICU has standardized equipment and practice.

At the start of its infection control initiative the PICU held special team rounds exclusively focused on prompt removal of central lines. Discussions about removing central lines, mechanical ventilation and urinary catheters now figure routinely in daily team rounds. A multi-disciplinary team meets to analyze and address all cases of CLABSI, CAUTI and VAP.
Most PICU central line dressing changes are done by a small pool of procedure nurses.

News and messages about hospital acquired infections figure periodically in the unit’s weekly email newsletter.

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