Preventing infections in pediatric intensive care units

Consumer Reports, is generally known for reviewing shiny new things we all want, like cell phones, TVs and cars. But in their most recent edition, they featured a story about things we cannot see and do not want – blood stream infections in children.

The report reviewed the central line bloodstream infection data from 2010 in pediatric intensive care units (PICU’s) of 92 children’s hospitals around the country and then ranked these hospitals based on their infection rate.

In the report, the PICU at Children’s – St. Paul was one of just five PICU’s reporting zero bloodstream infections in 2010, earning them the highest possible rating. The PICU at Children’s – Minneapolis was one of 29 hospitals who earned the second highest rating because they reported less than half as many blood stream infections as the national average.

Children’s has a track record for this kind of success. From 2006 to 2010, our PICUs combined had a 91 percent reduction in hospital acquired central line bloodstream infections.

Children’s is proud of our PICU staff for being able to accomplish this significant feat. In fact, at this writing, the PICU at Children’s –St. Paul has accomplished 891 days without a central line blood stream infection – that’s over two and a half years! What is fantastic about this is not where we land in the rankings, statistics, or even the accolades that go with this report, but the fact that patients – babies, children and teens – came to us for care and got that without acquiring a devastating, even life-threatening, infection.

We are the first to admit we are not perfect.  Blood stream infections continue to be an issue that demands vigilance.  We strive to replicate the St. Paul PICU success in all of our departments because our patients deserve a safe, healing environment. We know that every statistic on a report represents a child, and a family.  It requires constant attention to provide safe care, especially when it comes to the invisible pathogens that can take a life.

So how are we doing this? Children’s has a culture of patient safety that believes even one hospital acquired infection is unacceptable. Our ultimate goal is to get to zero bloodstream infections and then to stay there. It’s a lofty goal because we live in a world of germs; ICU patients are particularly vulnerable. But, we have already shown we know how to prevent blood stream infections through leadership commitment, bedside staff expertise, constant vigilance, measuring, reporting and by transparently sharing our results.

Our staff who insert central lines go through an insertion checklist based on best practices much like an airline pilot goes through a pre-flight checklist. Our nursing staff maintain the cleanliness of the patient and the central lines 24/7 and continue to expertly manage the care of each child, so not one leaves our hospitals sicker than when they came.

Our rounding teams ask themselves daily if central lines are still needed because, as each day passes, the lines become a greater infection risk. Parents and visitors are taught to properly wash their hands when entering a patient’s room, before and after touching the child, and family members are encouraged to speak up when they have concerns.

To ensure that we continue our transparency, departments such as infection prevention and control, quality, lab, pharmacy and many others work tirelessly behind the scenes to monitor, measure and report our progress – sharing what we know, learning from it and constantly improving.

I’m proud to be part of the team effort at Children’s that allowed us to achieve this remarkable recognition. Together we will continue to work on behalf of our little ones who count on us for only the best care.

Patsy Stinchfield, MS, CPNP
Infection Prevention and Control

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