Golisano Children's Hospital joins national quality effort

SYRACUSE, N.Y. Upstate Golisano Children's Hospital is part of a collaboration of more than 80 hospitals nationwide that has worked to reduce and prevent central line infections in hospitalized children. Over a five year period, the collaboration helped to prevent 2,964 central line infections in this patient population and passed the $100 million mark for cost savings to the healthcare industry.

The collaboration-Quality Transformation Network (QTN) is an initiative of the National Association of Children's Hospitals and Related Institutions (NACHRI). The network's goal is to eliminate catheter-associated blood stream infections among hospitalized pediatric patients.

The NACHRI initiative is the first coordinated effort to deal with CLABSIs among the pediatric population.

"We are proud to be associated with this critical initiative that allows us to continually find new, proven ways to provide quality care to our pediatric patients," said Thomas Welch, MD, medical director of the Upstate Golisano Children's Hospital. "We have made great strides in decreasing the number of infections that have an extraordinary impact on the quality of care delivered to our patients."

"This project has allowed us to share our successes and challenges with others across the country and ensure a level of consistency across all of our care areas at the Upstate Golisano Children's Hospital," said Leola Rodgers, MPH, associate administrator of the Upstate Golisano Children's Hospital.

Catheter-associated blood stream infections (CLABSIs) occur in the central intravenous lines used to provide long-term treatment to patients, such as medications and fluids. Such preventable infections are costly and can put patients at greater risk for serious complications. In adult intensive care, CLABSIs have been decreased significantly through intervention.

According to Pediatric Clinical Nurse Specialist Bonnie Miner, MS, RN, of the Upstate Golisano Children's Hospital, NACHRI's QTN hospitals have learned that reducing such infections requires an approach that combines evidence-based guidelines from catheter insertion to daily care for central lines.

Miner coordinates Upstate's QTN effort and she has formed two teams from the Pediatric Intensive Care Unit (PICU) and the Pediatric Hematology/Oncology unit, also known as The Dr. William J. Waters Center for Children's Cancer and Blood Disorders, to ensure success. Team members include Neal Seidberg, MD, Diane Kwaczala, BS, RN, and Carol Hauck, BS, RN, (PICU); and Sharon Bauer, BA, RN, Trisha Tavares, MD and Melissa Doupe, BS, RN (Hemotology/Oncology). Critical to the success of the effort is Paul Suits, of Infection Control, who works with both teams.

"The multidisciplinary involvement of the hospital's pharmacists, nurses, physicians, patients and families is also important in making the necessary changes in our QTN process," Miner said.

"Because we are a member of the initiative, we have access to an extensive database of information on best practices," Miner said. "We have used this information to establish evidence-based quality improvement and performance practices at the Upstate Golisano Children's Hospital."

In addition, to support greater compliance and constant improvement, Miner says that QTN provides its members with a range of tools, including a Listserv, workshops, and webinars, for seeking and sharing advice and experiences.

Included among the best practices that Miner and her teams have established are improved ways to handle intravenous lines (IVs) prior to and during insertion and a continuous collection of data regarding adherence to these practices and any event associated with IVs, such as infection.

"If an event should occur, we look at ways to prevent it from happening again," Miner said. "We are committed to following systematic improvement methodologies and to testing a common set of interventions to improve care and outcomes in our high-impact clinical areas."

Since joining QTN, the Upstate's Pediatric Intensive Care Unit went nearly a year without an infection and the Hematology/Oncology Unit currently is at 291 days free of a catheter-associated blood stream infection.

Miner adds that Upstate's QTN initiative will be expanded to the outpatient areas, beginning in the Pediatric Hematology/Oncology outpatient unit.

See the NACHRI website for a related article about the QTN initiative.