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Frequently Asked Questions

General

What is Bright STAR?

The Blood Culture Improvement Guidelines and Diagnostic Stewardship for Antibiotic Reduction in Critically Ill Children, or Bright STAR Collaborative, is a quality improvement project to optimize the use of blood cultures in patients in the PICU. It is a joint effort between your site and the Bright STAR Team.

Why is this important now?

Research has demonstrated that the yield of blood cultures for detecting bacteremia is as low as 5 percent to 15 percent, with a 50 percent false positive rate. Excessive or inappropriate blood cultures may lead to unnecessary antibiotics and a longer hospital stay. In addition, repeated entry into central venous catheters to obtain blood cultures may contribute to unit-wide issues with central line-associated blood stream infections (CLABSIs), and the yield of blood cultures—especially surveillance or repeated testing—in critically ill patients may be quite low.

How will the Bright STAR Collaborative help our site improve blood culture practices?

Unit leadership at your site will work with the Bright STAR team, who has already successfully helped implement this project in three PICUs. Two tools have been developed for clinicians to use when deciding if a patient should have a blood culture: a Fever Checklist (infection assessment tool) and a Blood Culture Decision Algorithm. Together, these two documents help the medical team decide if a blood culture should be obtained and from which source (a peripheral venipuncture versus from a central line). Your site and the Bright STAR team will track rates and sources of cultures along with patient outcomes to monitor project results.

Teams

Is the project requesting a single M.D.-R.N. with a quality improvement team support?

Each site is best equipped to pull together a core team that suits them best. At a minimum we request a PICU M.D. and infectious diseases M.D. join the project.

Are other institutions including microbiology leadership in this project?

Each local team will be best suited to decide their team structure and who will add most value.

Data

When reporting patient days, do half-days count?

Most units count the discharge day of one patient and the admit day of the next patient separately, so the room is counted twice on the same day. That is fine as long as your site remains consistent in its counting method over time.

Is length of stay PICU admit to PICU discharge, or PICU admit to hospital discharge?

Length of stay is defined as PICU admission through PICU discharge.

Do you want community-onset rates or only hospital-onset rates for Clostridium difficile?

We will collect C. diff in two ways: using ICD-10 codes for C. diff infection and using National Healthcare Safety Network CDI LabID for unit-acquired, hospital-onset C. diff infection. We will provide standard operating procedures on how to collect these data. Sites who are in the Pediatric Health Information System will only need to provide us with CDI LabID.

What data points are you collecting?

All data collection and transfer details will be provided to the sites in an standard of practice. Sites will provide summary-level data to the coordinating center including but not limited to: number of blood culture, broad spectrum antibiotic use, number of episodes of C. diff infection, number of episodes of sepsis and septic shock and de-identified patient demographic data in the form of median ICU length of stay, mortality rates, number of episodes hospital and ICU readmission and other information collected through their quality improvement program. These aggregate data will be used to determine whether appropriate use of blood cultures can safely reduce antibiotic use and antibiotic resistance in a large and diverse group of hospitals. Data obtained will not contain personal or sensitive health information.

Does our site need institutional review board approval?

Some sites are finding they do not need IRB approval for the QI element of this project. Other sites are obtaining Non-Human Subjects IRB approval to share summary-level data.

Do we need a data use agreement with the coordinating center?

Many sites do not need a DUA since the data being collected by the coordinating center is summary level de-identified data. Some sites are sending a DUA that indicates the de-identified summary level data that will be shared.

Logistics

When did the Bright STAR Collaborative begin?

The kickoff event for the collaborative was held in January 2018.

How often does your collaborative meet?

 Each month we will have a collaborative-wide all-site call to cover general topics that apply to all sites. Each month we will also hold site calls to address the individual needs of each specific site.

Can our site join the Bright STAR collaborative?

As of 2018, the Bright STAR Collaborative is happy to be working with over 15 sites across the nation. We encourage you to reach out for more information, but we are not bringing more sites into the collaborative at this time.

Who do I contact?

Each site is assigned a dedicated coordinator.  You are free to contact the coordinating team directly at brightSTAR@jhmi.edu.

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