CE Article: A Quality Improvement Approach in Standardizing Pediatric Central Venous Catheter Dressings and Its Impact on the Reduction of Central Line-Associated Bloodstream Infections and Costs
Background: Central venous catheters are necessary for infusion therapy and often used for blood sampling. Dressings are used to protect the skin and the catheter; however, the pediatric population presents a special challenge because of catheter size, location, and fragile skin. Methods: A quality improvement project was initiated to minimize frequent or unplanned dressing changes for pediatric catheters. Lean methodology was employed in order to decrease waste within the dressing inventory and maximize value. An interdisciplinary committee was formed to create an evidence-based dressing inventory list, and data were collected before and after implementing the new inventory to ensure that the quality of care was maintained. Results: Comparing the preimplementation and postimplementation periods, the types of dressings used were reduced from 10 to 4 types (each type in 1 to 3 sizes). We also recorded a significant reduction in central line-associated bloodstream infections (CLABSIs) postimplementation from a rate of 2.12 to 1.40 per 1000 central line days (P = 0.0297). The number of dressings (units) used decreased after the implementation, while the average monthly cost associated with products dropped from $12,684.83 to $4848.95 (P = 0.0037). Conclusions: We successfully simplified and standardized our dressing inventory for pediatric central venous catheters without compromising the quality of care. The project led to a decrease in infections and number of dressing changes and to substantial cost savings. Education and training was key in the success of this initiative.Abstract
Lean methodology steps10 and how the method was applied to our dressing inventory project. Step 1: Standardize and Streamline dressing use; reduce CLABSI. Step 2: Develop inventory of dressings in use. Step 3: Observe and document bedside CVC dressing practice and consider all dressing options. Assess if direction on which dressing to use in which situation is needed. Step 4: Trial and collect data on better dressing options as well as current value of existing dressing options. Step 5: Develop final inventory to reduce variations in practice. Validate results with CLABSI rate report.
(a) CLABSI events and central line days for each month of the study. The start of the implementation is indicated by the gray vertical line (November 2016). (b) CLABSI events per type of unit, before and after implementation of the new dressing inventory.
Monthly cost of dressing supplies for a subset of the study (months of July) and for a follow-up data point in July 2018. The start of the implementation is indicated by the gray vertical line (November 2016). The green line displays the number of dressings used per month, with the averages represented by the green dots. The blue line shows the costs for the dressings used per month, with the averages represented by the blue dots.
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