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American Journal of Infection Control
June 2010
Presentation Number 12-141
Using Lean/Six Sigma Quality Improvement Methodologies to Reduce
Central Line-associated Bloodstream Infections (CLABSI) in a Pediatric
Tina Adams, RN, Infection Preventionist; Mauri Williams, RN, MBA, MHA, Manager; Vickie Brown, RN, MPH,
CIC, Associate Director; Heidi Troxler, RN, BSN, CNII; Susan Wood, RN, BSN; Ashley Tate, RN, BSN, CNP;
Jennifer McElroy, RN, BSN, Nurse Manager; David Weber, MD, MPH, Medical Director; William Rutala, PhD,
MPH, Director, UNC Health Care, Chapel Hill, NC
Issue: CLABSIs are an important problem among non-ICU pediatric patients with long-term venous access devices.
Infection usually requires surgical replacement of the catheter and a prolonged course of antibiotics. Since most
studies to reduce CLABSIs have been performed in an ICU setting among adult patients, there is limited guidance
for this patient population. During the calendar year 2008, the CLABSI rates for 4 non-ICU pediatric units were 0.076.9/1000 catheter days. The team goal was zero CLABSIs.
Project: A multidisciplinary team of Yellow Belt, Green Belt, and Black Belt Lean Six Sigma trained clinicians and a
nurse educator utilized the Lean/Six Sigma process improvement model, specifically the EXPRESS WORKOUT, to
discover the causes of and solutions to prevent CLABSIs, plan process improvements, and to develop a plan for
maintaining improvement over time. A retrospective chart review of all 2008 CLABSIs was performed to identify
infecting organisms, type of catheter, location in the body, location of insertion procedure (e.g., OR), and number of
days between insertion and infection. Frontline RNs were surveyed to ascertain their satisfaction with care of
central lines on their unit and other pediatric units, their perceived understanding of nursing policy for central line
care and their opinion of other nurses’ understanding, their ideas about the causes of CLABSIs, and what they
could do to prevent these infections. Observations were made of CL accessing, medication administration,
obtaining blood samples, delivering flushes, and central line dressing changes.
Results: Lack of compliance with CL maintenance policy was identified. Prior to the project 1/1/09-10/31/09, the
combined CLABSI rate for the pediatric units was 2.5/1000 device days (CI 1.6, 3.7). After instituting the project 11/2/
09-1/9/10, the rate decreased to 1.7/1000 device days (CI 0.4, 4.7). Assessments and feedback are ongoing to reach
the goal of zero CLABSIs.
Lessons Learned: 1. Lean/Six Sigma allowed in-depth examination of potential causes and solutions to prevent
CLABSIs. 2. Observations revealed nurses did not always follow the central line care policy. 3. Frontline nurses had
a good understanding of the potential causes and solutions for prevention of CLABSIs. 4. Including the Children’s
Hospital Nurse Educator provided a valuable resource to improve nurse competency and establish annual
competencies for CL care.
Presentation Number 12-142
Utilizing LEAN Concepts and Kaizen Methods to Standardize Processes
and Decrease Surgical Site Infection Following Coronary Artery Bypass
Grafting Surgery
Janet Curtin, BSMT (ASCP), CIC, IP, Riverside Methodist Hospital, Columbus, OH
Issue: Postoperative mediastinitis is a horrendous complication of median sternotomy associated with Coronary
Artery Bypass Grafting (CABG). Annually, there are 469,000 open heart surgeries performed in the United States.
SSI is linked with increased patient morbidity, mortality, extended length of stay, re-admission, re-operation, and
increased cost. During the period of July 2008 through December of 2008, our CABG SSI rates were above the 50th
percentile when compared to the NHSN data summary report.
Project: A multidisciplinary team was formed and charged with reducing SSI following CABG at our institution.
Team members consisted of an IP, Outcomes Management, Process Excellence, Pharmacy, an Infectious Disease