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Preventing CLABSIs among pediatric hematology/oncology inpatients: national collaborative results
David G Bundy1, Aditya H Gaur2, Amy L Billett3
1Division of General Pediatrics, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina; dbundy@musc.edu.
Insights
Standardizing central line care in pediatric oncology reduced bloodstream infections by 28%. This quality improvement collaborative demonstrated feasibility and effectiveness in reducing central line-associated bloodstream infections (CLABSIs).
Area of Science:
- Pediatric Hematology/Oncology
- Infectious Disease Prevention
- Quality Improvement Science
Background:
- Central lines (CLs) are critical for pediatric cancer care but pose risks, notably central line-associated bloodstream infections (CLABSIs).
- Reducing CLABSIs is a key goal in improving patient safety and outcomes for children undergoing cancer treatment.
Purpose of the Study:
- To evaluate the feasibility of a multicenter collaborative for standardizing CL care and CLABSI tracking.
- To determine the impact of standardized care on CLABSI rates in pediatric hematology/oncology patients.
Main Methods:
- A multicenter quality improvement collaborative was implemented starting November 2009.
- Participating sites used a standardized bundle of CL care practices and a common CLABSI surveillance method.
- Thirty-two units contributed data, with CL care bundle compliance monitored over time.
Main Results:
- The mean pre-collaborative CLABSI rate was 2.85 per 1000 CL-days.
- CL care bundle compliance exceeded 80% after the first year.
- The mean CLABSI rate decreased by 28% during the collaborative (2.04 per 1000 CL-days).
Conclusions:
- A multicenter quality improvement collaborative effectively reduced CLABSI rates in pediatric hematology/oncology inpatients.
- Sustaining CLABSI rates near zero for this high-risk population may require further interventions.
Objectives:
Central lines (CLs) are essential for the delivery of modern cancer care to children. Nonetheless, CLs are subject to potentially life-threatening complications, including central line-associated bloodstream infections (CLABSIs). The objective of this study was to assess the feasibility of a multicenter effort to standardize CL care and CLABSI tracking, and to quantify the impact of standardizing these processes on CLABSI rates among pediatric hematology/oncology inpatients.
Methods:
We conducted a multicenter quality improvement collaborative starting in November 2009. Multidisciplinary teams at participating sites implemented a standardized bundle of CL care practices and adopted a common approach to CLABSI surveillance.
Results:
Thirty-two units participated in the collaborative and reported a mean, precollaborative CLABSI rate of 2.85 CLABSIs per 1000 CL-days. Self-reported adoption of the CL care bundle was brisk, with average compliance approaching 80% by the end of the first year of the collaborative and exceeding 80% thereafter. As of August 2012, the mean CLABSI rate during the collaborative was 2.04 CLABSIs per 1000 CL-days, a reduction of 28% (relative risk: 0.71 [95% confidence interval: 0.55-0.92]). Changes in self-reported CL care bundle compliance were not statistically associated with changes in CLABSI rates, although there was little variability in bundle compliance rates after the first year of the collaborative.
Conclusions:
A multicenter quality improvement collaborative found significant reductions in observed CLABSI rates in pediatric hematology/oncology inpatients. Additional interventions will likely be required to bring and sustain CLABSI rates closer to zero for this high-risk population.
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