Children's Healthcare of Atlanta nurses strive to improve patient care with innovative research
New Study Helps Reduce Blood Stream Infections in Pediatric Patients

ATLANTA (August 27, 2007) – Nicole Jarrell, RNC, MSN, Nurse Expert in the Cardiac Intensive Cardiac Unit (CICU) at Children’s Healthcare of Atlanta’s Sibley Heart Center, in collaboration with Renee Watson, RN, CIC, Manager of Infection Control and Occupational Health at Children’s, are leading new research initiatives to minimize infection risks in high risk pediatric patients. The CICU conducted a study specifically addressing the risk of catheter-related blood stream infections from multiple line accesses. Jarrell was recently accepted to present these results at the 21st annual Association for Vascular Access (AVA) Conference in Phoenix, AZ, September 7-10, 2007. 

   "Nurses are the gatekeepers of patient care. It is more than checking vital signs and administering medications,” Jarrell says. “It is assessing the patient and knowing when to intervene and facilitate the redirection of the plan of care for the best patient outcome."

   Watson utilized this same concept on a unit level when she met with Jarrell and the clinical staff in the CICU. She provided a detailed assessment of infection risks and worked with staff to create and implement performance improvement initiatives aimed at minimizing these risks. Watson’s recommendations served as a catalyst for Jarrell and the CICU staff to shift the overall focus to infection prevention, expanding on the already established BSI reduction task force initiatives. Jarrell soon began serving as a liaison between the Quality department and the CICU, which in collaboration with Watson, brought a team approach to the bedside where infection prevention really happens. 

   Identifying and minimizing the specific risks for blood stream infections was a top priority. “We have estimated that central lines in our CICU are entered approximately 13,000 times per month for blood sampling and medication administration, which is an average of 26 times per patient, per day,” Jarrell says. “In an effort to provide better, safer patient care, we have conducted extensive research that determined this particular risk of infection is reduced when CICU clinical staff uses chlorhexidine/70% isopropyl (CHG) wipes instead of alcohol wipes, prior to accessing all patient lines.” 

   All patients, ages 0-21 years old, admitted to the 17 bed Children’s Sibley Heart Center CICU from 8/1/06-11/30/06 had their bedside carts randomly stocked with wipes containing alcohol or 3.15% CHG for disinfection prior to accessing all lines for blood sampling, medication administration or line flushing. During the four month trial period, a total of nine blood stream infections were diagnosed in 295 total patients. The 170 CHG patients had just two infections versus the alcohol group with seven infections in 125 patients. 

   The study concluded that wipes containing CHG were superior to alcohol in their prevention of infection when used as a disinfectant prior to accessing central lines in this group of high risk pediatric patients. Since the study’s completion, all patients have received the benefit of the CHG wipes and the infection rates have remained substantially below NHSN (National Health Safety Network) standards for the past nine consecutive months.

   The Children's Sibley Heart Center continually works to improve patient care by performing clinical research and clinical trials, sometimes referred to as translational research as its findings are quickly translated into practice. In 2006, the Children’s research staff conducted more than 100 clinical trials in researching a variety of pediatric cardiovascular conditions and their complications.

   arrell’s research is part of a larger, ongoing initiative at Children’s to improve the quality of care provided to children. According to Watson, the initiatives in the CICU have lead the way for similar programs to roll out system-wide in all critical care areas at Children’s. “One of the goals of the new Quality department at Children’s is to create a multi-tiered program that provides various levels of clinical quality education,” said Watson. “We’ll do this by matching the education levels with the roles, responsibilities, and accountabilities of individuals.” This new direction builds bridges by taking research and quality initiatives to the caregivers at the bedside, and ultimately benefiting the children we serve.