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A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit
Published on: July 13, 2019
Rapid reduction of central line infections in hospitalized pediatric oncology patients through simple quality
Sung W Choi1, Lawrence Chang, David A Hanauer
1Pediatric Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109-5942, USA. sungchoi@med.umich.edu
Insights
Implementing bundled central line care practices significantly reduced central line-associated bloodstream infections (CLA-BSIs) in pediatric hematology-oncology patients. This initiative improved patient safety and maintained low infection rates.
Area of Science:
- Infection Control
- Pediatric Hematology-Oncology
- Patient Safety
Background:
- Pediatric hematology-oncology (PHO) patients face high central line-associated bloodstream infection (CLA-BSI) risks due to prolonged catheter use.
- Preventable CLA-BSIs necessitate effective infection control strategies in this vulnerable population.
Purpose of the Study:
- To evaluate the impact of implementing bundled central line maintenance practices on hospital-acquired CLA-BSIs in a PHO unit.
- To assess the effectiveness of tailored catheter care and a strengthened safety culture in reducing CLA-BSIs.
Main Methods:
- Analysis of CLA-BSI rates from January 2005 to June 2011 in a single-institution PHO unit.
- Implementation of a multidisciplinary quality improvement initiative in May 2008, including tailored catheter care practices.
- Time-series analysis to compare pre- and post-intervention infection rates.
Main Results:
- Pre-intervention CLA-BSI incidence was 2.92 per 1,000 patient-days, with coagulase-negative Staphylococcus as the primary pathogen.
- Post-intervention, CLA-BSI rates decreased by 45% to 1.61 per 1,000 patient-days (P < 0.004).
- Bundled practices, with added countermeasures, significantly reduced CLA-BSIs in blood and marrow transplant patients, equalizing rates with non-BMT patients.
Conclusions:
- Uniform central line maintenance practices, multidisciplinary teamwork, and a strong patient safety culture significantly reduce CLA-BSI incidence.
- The implemented strategies led to a sustained reduction in CLA-BSIs within the studied PHO population.
Background:
Pediatric hematology-oncology (PHO) patients are at significant risk for developing central line-associated bloodstream infections (CLA-BSIs) due to their prolonged dependence on such catheters. Effective strategies to eliminate these preventable infections are urgently needed. In this study, we investigated the implementation of bundled central line maintenance practices and their effect on hospital-acquired CLA-BSIs.
Materials And Methods:
CLA-BSI rates were analyzed within a single-institution's PHO unit between January 2005 and June 2011. In May 2008, a multidisciplinary quality improvement team developed techniques to improve the PHO unit's safety culture and implemented the use of catheter maintenance practices tailored to PHO patients. Data analysis was performed using time-series methods to evaluate the pre- and post-intervention effect of the practice changes.
Results:
The pre-intervention CLA-BSI incidence was 2.92 per 1,000-patient days (PD) and coagulase-negative Staphylococcus was the most prevalent pathogen (29%). In the post-intervention period, the CLA-BSI rate decreased substantially (45%) to 1.61 per 1,000-PD (P < 0.004). Early on, blood and marrow transplant (BMT) patients had a threefold higher CLA-BSI rate compared to non-BMT patients (P < 0.033). With additional infection control countermeasures added to the bundled practices, BMT patients experienced a larger CLA-BSI rate reduction such that BMT and non-BMT CLA-BSI rates were not significantly different post-intervention.
Conclusions:
By adopting and effectively implementing uniform maintenance catheter care practices, learning multidisciplinary teamwork, and promoting a culture of patient safety, the CLA-BSI incidence in our study population was significantly reduced and maintained.
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