The University of Michigan C.S. Mott Childrens Hospital is among 80 hospitals taking part in a national effort to eradicate catheter-associated bloodstream infections among hospitalized pediatric patients.
The effort by member hospitals of the National Association of Childrens Hospitals and Related Institutions (NACHRI), has so far led to 365 saved lives, the prevention of 3,000 central line infections and more than $100 million saved.
"Mott was already working on this issue," says Matthew Niedner, MD, assistant professor of pediatrics and communicable diseases at U-M and a member of the association's Quality Transformation Network, a group of childrens hospitals that combine forces to work on care and outcomes for high-impact clinical issues. "But joining the collaborative has enabled us and all participants to share data and best practices. Participation has given us the statistical power to know very quickly when we were or werent on the right track. Such collaboratives are the extra edge you need in making sure your patients are as safe as possible from preventable hospital-acquired infection."
These efforts have an immediate benefit to patients, bypassing the years-long translational research pipeline.
"We had to overcome the psychological acceptance that these complications were just an unavoidable part of doing business," he adds.
Central line-associated blood stream infections are infections that occur in patients central venous catheters (a central line is flexible medical tubing inserted into the body).
Published costs for pediatric central line bloodstream infections are in the range of $25,000 to $45,000 per infection, so the Quality Transformation Network estimates cost savings by multiplying the number of infections prevented by $35,000. They also hold a mortality rate of 10 percent to 20 percent for children.
After five years of quality improvement in pediatric intensive care and hematology/oncology units, children's hospitals in NACHRI's Quality Transformation Network are estimated to have saved 365 lives, prevented about 3,000 central line infections and avoided more than $100 million in wasteful healthcare expenditures.
"Our stretch goal for central-line infections is to get to a rate of zero or at least find the limit of what is possible with current evidence, technology, and surveillance methods," says Niedner. "Our data continue to show improvements. Its humbling to think that by rigorously applying off the shelf evidence for best practices, weve been able to save so many lives. Its not just a number. Its like a child a day, every day, for a year. Its like 10 school busses of children."
Being part of the Quality Transformation Network (QTN) requires members to follow rigorous tracking and measurement protocols. Once they join the program, each participating site provides two to three years of pre-QTN baseline data in order to create a basis for calculations of infections prevented. Lives saved are then estimated based on a published pediatric CLABSI infection mortality rate of 12 percent.
QTN collaborators set out early on to test infection prevention approaches that address day-to-day care of the central line (line maintenance). Central line infections in vulnerable pediatric patients exact a higher toll in morbidity and mortality than in adult patients, yet techniques that yield big reductions in infection rates in adults - practices related to inserting the line - are not as effective in children.
"What would have taken us three years to demonstrate in our own ICU we were able to prove within four months of joining the collaborative because we were able to pool our data. We all learn faster together and with transparency, we can learn from every failure in the collaborative," Niedner adds. "Our tracking of compliance with key process measures has given us the ability to target ongoing safety and quality measures. Now we can help dispense this knowledge across the nation."