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Multi-level Intervention Program - A Quality Improvement Initiative to Decrease Central Line-Associated Bloodstream
Karla Marie Bathan Santos1, Sufia S Husain2, Vanessa Torres3
1UCLA School of Nursing, Los Angeles, CA, United States of America.
Insights
Implementing an intervention significantly reduced central line-associated bloodstream infections (CLABSIs) in pediatric patients. While staff adherence was high, parent adherence was low, highlighting a need for targeted parent education to further prevent CLABSIs.
Area of Science:
- Pediatric Healthcare
- Infection Prevention and Control
- Clinical Interventions
Background:
- Central venous catheters (CVCs) are essential for pediatric patients requiring long-term intravenous therapy.
- CVC use increases the risk of central line-associated bloodstream infections (CLABSIs).
- Effective infection control strategies are crucial in pediatric care settings.
Purpose of the Study:
- To evaluate adherence to intervention components aimed at reducing CLABSIs in pediatric units.
- To assess the impact of the intervention on CLABSI rates over a five-year period.
- To identify factors influencing adherence and infection rates.
Main Methods:
- A multi-component intervention was implemented across pediatric acute care and hematology-oncology units.
- Adherence was monitored using a CVC audit sheet.
- CLABSI rates were collected quarterly for five years, comparing pre- and post-intervention periods.
Main Results:
- CLABSI rates demonstrated a steady decrease over the five-year study period.
- Staff adherence to intervention components ranged from 90% to 100%, with lowest adherence to patient protective equipment (PPE).
- Hospital-acquired CLABSIs decreased from 41 incidents pre-intervention to 9 incidents post-intervention.
Conclusions:
- The intervention was effective in reducing CLABSI rates in pediatric units.
- Sustained high staff adherence is critical for infection prevention.
- Low parent/family adherence necessitates targeted strategies, including enhanced education and visible reminders for PPE compliance.
Introduction:
Central Venous Catheters (CVCs) are placed in pediatric patients that require frequent and/or long-term access for intravenous treatments and increase the risk for Central line-associated bloodstream infections (CLABSIs). The specific aims of the study were to evaluate adherence to the intervention components and rates of Central Line Associated Bloodstream Infections (CLABSIs) over five years.
Methods:
Implementation occurred on the acute care and hematology-oncology pediatric units of a quaternary health care setting in Southern California. Adherence rates were quantified using a CVC audit sheet and CLABSI rates were obtained quarterly before, and at year 1, 2, 3, 4, 5 of implementation.
Results:
CLABSI rates for both pediatric units decreased over the five-year period. Adherence rates were 90% to 100% on the different features of the intervention; the lowest was adherence to Patient Protective Equipment (PPE). A total of 41 incidents of hospital-acquired CLABSIs were reported the year prior to the Bug Buster Committee, which decreased steadily to 9 incidents after implementation. The quarterly CLABSI rates in the Pediatric Acute Care ranged from 2.8 to 6.6/1,000 catheter days and in Pediatric Hematology-Oncology from 2.1 to 4.3/1,000 catheter days the year prior to implementation.
Conclusions:
While adherence for staff remains high, parent/family adherence was low. We recommend including in the multi-level intervention, procedures targeting parent adherence such as patient education handouts, reviewing content on admission, placing signs on doors indicating PPE requirements, and promptly providing PPE to non-adherent family members.
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