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Enhanced central venous catheter bundle for pediatric parenteral-dependent intestinal failure

Jennifer A Ormsby1, Bola Bukoye2, Debra Lajoie2

  • 1Infection Prevention & Control, Boston Children's Hospital, Boston, MA.

American Journal of Infection Control
|May 21, 2018
PubMed

Insights

Implementing an enhanced central venous catheter (CVC) maintenance bundle significantly reduced central line-associated bloodstream infections (CLABSIs) in pediatric patients with intestinal failure (IF) dependent on parenteral nutrition (PN). This quality improvement initiative demonstrated an 85% reduction in CLABSI rates.

Area of Science:

  • Pediatric Healthcare
  • Infectious Disease Prevention
  • Quality Improvement Science

Background:

  • Central line-associated bloodstream infections (CLABSIs) are a significant concern in hospitalized children, particularly those with intestinal failure (IF) requiring parenteral nutrition (PN).
  • Rising CLABSI rates prompted the implementation of a quality improvement (QI) initiative.

Purpose of the Study:

  • To reduce CLABSI rates in pediatric patients with IF dependent on PN.
  • To evaluate the effectiveness of an enhanced central venous catheter (CVC) maintenance bundle.

Main Methods:

  • A QI methodology was used to develop and implement an enhanced CVC maintenance bundle on two pediatric units.
  • The bundle included specific elements such as chlorhexidine-impregnated patches, daily bathing, ethanol locks, and dedicated CVC care protocols.
  • CLABSI rates and bundle adherence were prospectively monitored pre- and postimplementation.

Main Results:

  • Adherence to the enhanced bundle elements exceeded 90% within three months.
  • CLABSI rates decreased from 1.41 to 0.40 per 1,000 central line days postimplementation.
  • This represents an 85% absolute reduction in CLABSI rates over a 12-month period (P=.003).

Conclusions:

  • Pediatric patients with IF are at elevated risk for CLABSIs.
  • Enhanced CVC maintenance bundles tailored to this high-risk population can effectively prevent CLABSIs.
Abstract

Keywords:
Central line–associated bloodstream infectionsbundlecentral venous catheterintestinal failureparenteral nutritionquality improvement

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