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Pediatric Nurses Reduce Deadly Blood Infections

by Whitney L. J. Howell

IOM Recommendation 2“Everyone scrutinizes their own practice,” said clinical nurse specialist Judy Ascenzi, MSN, RN. “There’s that little person on their shoulder, telling them to re-think: Did they wash their hands? Do they need to give medication or draw blood now, or can they wait?”

Since 2006, Ascenzi and other Hopkins nurses have been working to reduce central line-associated blood stream infections (CLABSIs). They serve as the “little person on the shoulder,” making sure their units do what’s necessary to prevent these potentially deadly infections.

Their efforts are part of the National Pediatric Quality Improvement program, directed by the National Association of Children’s Hospitals and Related Institutions. Since Hopkins joined the program in 2006, the JHH team has prevented 47 CLABSI-related hospital admissions, saving the hospital $2.1 million in care costs.

Nurses in all units conduct weekly self-audits, examining their behavior, said Cindy Herpst, RN, pediatric oncology outpatient nurse. They monitor how they’ve flushed lines, whether they’ve followed proper procedures for changing intravenous fluid hanging bags, and if they’re attentive to wearing gloves to preserve line sterility.

Audits also provide data about infection root causes, Herpst said. This knowledge can support changes to central-line practices, further reducing risk.

The CLABSI Collaborative Team also has impact outside JHH. Staff from Mount Washington Long Term Care and Kennedy Krieger Institute attend monthly meetings and implement the same central-line management strategies. This network facilitates a fluid continuum of care, making patient transfers safer and easier.

The Collaborative’s ultimate benefit, however, has been fostering family involvement, said Michael Rinke, MD, a Hopkins pediatrician with a National Institutes of Health grant to study pediatric CLABSIs.

“Nurses earned buy-in from families and changed the culture,” he said.  “Families expect everyone will touch their children’s central lines in the same high-quality way. It’s made families vigilant advocates.”

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