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Reducing PICU central line-associated bloodstream infections: 3-year results

Marlene R Miller1, Matthew F Niedner, W Charles Huskins

  • 1Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA. mmille21@jhmi.edu

Pediatrics
|October 26, 2011
PubMed
Abstract

Insights

Pediatric central line care bundles significantly reduced central line-associated bloodstream infections (CLA-BSIs) in PICUs. Adding chlorhexidine interventions did not provide further significant reductions in CLA-BSI rates.

Area of Science:

  • Pediatric critical care medicine
  • Infectious disease prevention
  • Healthcare quality improvement

Background:

  • Central line-associated bloodstream infections (CLA-BSIs) are a significant concern in pediatric intensive care units (PICUs).
  • Implementing standardized care bundles is a key strategy to reduce healthcare-associated infections.
  • Evaluating the impact of specific antiseptic agents alongside care bundles is crucial for optimizing infection control.

Purpose of the Study:

  • To assess the long-term effectiveness of pediatric central line care bundles in decreasing CLA-BSI rates.
  • To determine the additional benefit of chlorhexidine interventions (scrub and sponges) in reducing CLA-BSIs.

Main Methods:

  • A 3-year, multi-institutional interrupted time-series study with historical controls.
  • Inclusion of 29 PICUs utilizing central line insertion and maintenance bundles.
  • A nested factorial design evaluated chlorhexidine scrub and chlorhexidine-impregnated sponges over 18 months.

Main Results:

  • A 56% sustained decrease in aggregate PICU CLA-BSI rates was observed over 36 months.
  • The CLA-BSI rate reduced from 5.2 to 2.3 per 1000 line-days.
  • No statistically significant additional reduction in CLA-BSI rates was found with the use of chlorhexidine interventions.

Conclusions:

  • Consistent adherence to pediatric central line care bundles is effective in achieving sustained reductions in CLA-BSIs.
  • Chlorhexidine interventions did not demonstrate a statistically significant added benefit in reducing CLA-BSI rates in this setting.
  • Focusing on bundle compliance remains a primary strategy for preventing CLA-BSIs in PICUs.

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