title: Engaging Frontline Staff in Central Line-Associated Bloodstream Infection Prevention Practice in the Wake of Superstorm Sandy.
abstract: BACKGROUND
  Central venous catheters are crucial devices in the care of hospitalized children, both in and out of critical care units, but the concomitant risk of central line-associated bloodstream infection (CLABSI) affects 15,000 Americans annually. In 2012, CLABSI rates varied among units from 6.8/1,000 to 1.0/1,000 in a 109-bed children's service within NYU Langone Medical Center (NYULMC; New York City), a 1,069-bed tertiary care academic medical center. In response to variation in central line-related practices and infection prevention rates, a CLABSI Prevention Core Team began an effort to standardize central venous catheter (CVC) care across all pediatric units (ICU and non-ICU). Momentum in this quality improvement (QI) work was interrupted when Superstorm Sandy shuttered the flagship hospital, but the relatively decreased clinical load provided a "downtime" opportunity to address CLABSI prevention.
  
  
  METHODS
  The first phase of the collaborative effort, Booster 1, Planning/Initial Phase: Development of a Pediatric Central Venous Catheter Working Group, was followed by Booster 2, Maintenance/Sustaining Phase: Transitioning for Sustainability and Adopting Model for Improvement.
  
  
  RESULTS
  Data in the subsequent 21 months after the temporary closure of the facility (January 2013-September 2014) showed an increase in maintenance bundle reliability. The inpatient CLABSI rate for patients<18 years decreased from an annual rate of 2.7/1,000 line days (2012) to 0.6/1,000 line days (2013) to 0.5/1,000 line days as of August 2014. There was a decrease in pediatric CLABSI events and no significant change in line days.
  
  
  CONCLUSIONS
  Key elements contributing to initial success with evolving QI capacity and resources were likely multi-factorial, including staff and leadership engagement, culture change, consistent guidelines, and accountability by individuals and by our multidisciplinary core team.
authors.affiliation: Pediatric Hospitalist, NYU Langone Medical Center (NYULMC), USA.
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Rosenberg
authors.forename: Lea
authors.initials: L
authors.lastname: Devins
authors.forename: Gail
authors.initials: G
authors.lastname: Geraghty
authors.forename: Steven
authors.initials: S
authors.lastname: Bock
authors.forename: Christina A
authors.initials: CA
authors.lastname: Dugan
authors.forename: Marjorie
authors.initials: M
authors.lastname: Transou
authors.forename: Michael
authors.initials: M
authors.lastname: Phillips
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lighter-Fisher
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration; D000293:Adolescent; D055499:Catheter-Related Infections / Q000517:prevention & control*; D062905:Central Venous Catheters; D002648:Child; D002675:Child, Preschool; D003299:Cooperative Behavior; D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D055868:Floods; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control / Q000458:organization & administration*; D007318:Inservice Training; D008297:Male; D009519:New York City; D015279:Organizational Culture; D064872:Patient Care Bundles; D010557:Personnel Administration, Hospital; D058996:Quality Improvement / Q000458:organization & administration; D015203:Reproducibility of Results