Related Experiment Video
Updated: May 7, 2026
A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit
Published on: July 13, 2019
Implementation of a children's hospital-wide central venous catheter insertion and maintenance bundle
Onno Helder1, René Kornelisse, Cynthia van der Starre
1Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands. o.helder@erasmusmc.nl.
Insights
Implementing central venous catheter bundles in pediatric hospitals can prevent bloodstream infections. This study evaluated a new bundle and multifaceted strategy to improve patient safety and care consistency.
Area of Science:
- Pediatric healthcare safety
- Infection prevention and control
- Healthcare system implementation science
Background:
- Central venous catheter-associated bloodstream infections (CVC-BSIs) are a significant, preventable safety concern in pediatric patients globally.
- Central venous catheter (CVC) bundles are effective in preventing CVC-BSIs, but successful implementation requires systemic and behavioral changes.
- This study focuses on implementing a state-of-the-art CVC insertion and maintenance bundle in a major children's hospital.
Purpose of the Study:
- To evaluate the process and outcomes of implementing a comprehensive CVC bundle.
- To assess the effectiveness of a multifaceted implementation strategy guided by the Pronovost model.
- To analyze the cost-effectiveness of the implemented CVC bundle program.
Main Methods:
- An interrupted time series design will track all pediatric patients requiring a CVC over 48 months.
- A tailored, multifaceted implementation strategy includes reminders, feedback, management support, opinion leaders, and education.
- Primary outcome: CVC-associated infections per 1000 line-days. Secondary outcome: adherence to CVC bundle protocols.
Main Results:
- Data collection spans baseline, pre-intervention, and post-intervention periods to monitor changes.
- The study will quantify infection rates and adherence levels to assess bundle effectiveness.
- Cost-effectiveness analysis will provide economic insights into the intervention's value.
Conclusions:
- The model-based implementation strategy will illuminate challenges in hospital-wide safety program rollout.
- Findings will contribute to the understanding of implementation science in healthcare settings.
- Healthcare worker adaptation to state-of-the-art care highlights the drive for consistent quality improvement.
Background:
Central venous catheter-associated bloodstream infections in children are an increasingly recognized serious safety problem worldwide, but are often preventable. Central venous catheter bundles have proved effective to prevent such infections. Successful implementation requires changes in the hospital system as well as in healthcare professionals' behaviour. The aim of the study is to evaluate process and outcome of implementation of a state-of-the-art central venous catheter insertion and maintenance bundle in a large university children's hospital.
Methods/Design:
An interrupted time series design will be used; the study will encompass all children who need a central venous catheter. New state-of-the-art central venous catheter bundles will be developed. The Pronovost-model will guide the implementation process. We developed a tailored multifaceted implementation strategy consisting of reminders, feedback, management support, local opinion leaders, and education. Primary outcome measure is the number of catheter-associated infections per 1000 line-days. The process outcome is degree of adherence to use of these central venous catheter bundles is the secondary outcome. A cost-effectiveness analysis is part of the study. Outcomes will be monitored during three periods: baseline, pre-intervention, and post-intervention for over 48 months.
Discussion:
This model-based implementation strategy will reveal the challenges of implementing a hospital-wide safety program. This work will add to the body of knowledge in the field of implementation. We postulate that healthcare workers' willingness to shift from providing habitual care to state-of-the-art care may reflect the need for consistent care improvement. Trial registration: Dutch trials registry, trial # 3635.
Trial Registration:
Dutch trials registry (http://www.trialregister.nl), trial # 3635.
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