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Published on: July 13, 2019
Reduction of catheter-associated bloodstream infections in pediatric patients: experimentation and reality
Christopher McKee1, Ivor Berkowitz, Sara E Cosgrove
1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
Insights
A multifaceted intervention significantly reduced pediatric catheter-associated bloodstream infections (CA-BSI) by improving insertion practices. However, CA-BSI was not eliminated, highlighting the need for vigilance against new technologies and further research into maintenance practices.
Area of Science:
- Pediatric critical care medicine
- Infection control and prevention
- Healthcare quality improvement
Background:
- Pediatric catheter-associated bloodstream infections (CA-BSI) pose a significant threat.
- Limited data exist on successful interventions to reduce CA-BSI in pediatric intensive care units (PICUs).
Purpose of the Study:
- To implement and evaluate a multifaceted intervention to eradicate CA-BSI in a PICU.
- To adapt an intervention proven effective in adult populations for pediatric use.
Main Methods:
- A prospective cohort study with historical controls was conducted in a multidisciplinary PICU.
- The intervention included staff surveys, education, a procedure cart, a checklist, nursing empowerment, and real-time data feedback.
- The primary outcome measured was the rate of CA-BSI per 1000 catheter days.
Main Results:
- The intervention led to a statistically and clinically significant decrease in CA-BSI rates for 24 months postimplementation.
- An increase in CA-BSI was observed with the introduction of a new positive displacement mechanical valve, which decreased after its removal.
- Postintervention CA-BSI cases were acquired weeks after PICU admission and catheter insertion.
Conclusions:
- Improving central catheter insertion practices reduces CA-BSI in pediatric patients but does not eliminate it.
- Further research is necessary to establish best practices for central catheter maintenance in children.
- Healthcare institutions must remain vigilant regarding new technologies and their potential impact on infection rates.
Objective:
Few data exist on successes at reducing pediatric catheter-associated bloodstream infections (CA-BSI). The objective was to eradicate CA-BSI with a multifaceted pediatric-relevant intervention proven effective in adult patients.
Design:
Prospective cohort of pediatric intensive care (PICU) patients with historical controls.
Setting:
Multidisciplinary PICU.
Patients/Participants:
PICU patients with intervention targeting PICU providers.
Interventions:
Multifaceted intervention involving preintervention staff surveys, provider educational program, creation of central catheter procedure cart, guideline-supported central catheter insertion checklist, nursing staff empowerment to stop procedures that breached guidelines, and real-time data feedback to PICU leadership.
Measurements And Main Results:
We measured rate of CA-BSI per 1000 catheter days from August 2001 through September 2006. Reliable use of evidence-based best practices for insertion of central catheters in our PICU was associated with a statistically and clinically significant decrease in our CA-BSI rate for 24 months postintervention (p < .05). During a portion of this postintervention period, we experienced a dramatic increase in our CA-BSI rate that was ultimately found to be due to the introduction of a new positive displacement mechanical valve intravenous port in April 2004. After removal of this positive displacement mechanical valve, our CA-BSI rate dropped from 5.2 +/- 4.5 CA-BSI per 1000 central catheter days to a rate of 3.0 +/- 1.9 CA-BSI per 1000 central catheter days. Chart review of postintervention CA-BSI cases revealed that these patients acquired CA-BSI weeks after both PICU admission and after insertion of the most recent central catheter.
Conclusions:
Our data show that improving practices for insertion of central catheters leads to a reduction of CA-BSI among pediatric patients but not elimination of CA-BSI. More research is needed to identify best practices for maintenance of central catheters for children. In addition, our experience shows that even despite good interventions to control CA-BSI, institutions must remain vigilant to factors such as new technology with apparent advantages but short track records of use.
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