Related Experiment Video
Updated: Nov 4, 2025
A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit
Published on: July 13, 2019
Elimination of hospital-acquired central line-associated bloodstream infection on a mixed-service pediatric unit
Ethan A Mezoff1,2,3, Erika Roberts2, Daniel Ernst2
1Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA.
Insights
Hospital-acquired central line-associated bloodstream infections (CLABSI) were significantly reduced through a multidisciplinary effort. This initiative improved patient safety for children with intestinal failure and all central venous catheter patients.
Area of Science:
- Infection Control and Hospital Epidemiology
- Pediatric Critical Care
- Patient Safety
Background:
- Hospital-acquired central line-associated bloodstream infections (CLABSI) are serious adverse events, particularly for pediatric patients with intestinal failure (IF) requiring long-term central venous catheter (CVC) use.
- Reducing CLABSI is a national healthcare priority, necessitating effective strategies for vulnerable patient populations.
Purpose of the Study:
- To describe the outcomes of a multidisciplinary CLABSI elimination initiative on a specialized medical-surgical unit caring for children with IF.
- To evaluate the impact of interventions on CLABSI rates in both IF patients and the general patient population with CVCs.
Main Methods:
- A retrospective evaluation of CLABSI events from January 2012 to April 2020 on a 24-bed unit.
- Data were extracted from clinical registries and National Healthcare Safety Network (NHSN) reports, including patient demographics, ethanol lock use, and CVC days.
- Interventions were developed using expert consensus, CDC guidelines, and frontline staff engagement, with data analyzed using descriptive statistics and non-parametric tests.
Main Results:
- Over the study period, 12 hospital-acquired CLABSI events occurred among 95 IF patients and 862 non-IF patients (20,372 CVC days).
- Following a definition change, 7 CLABSI events were recorded (0.56 per 1,000 CVC days).
- After December 2016, no unit CLABSI events occurred over 7,117 CVC days.
Conclusions:
- A multidisciplinary approach, fostering a culture of collaborative care, significantly reduced hospital-acquired CLABSI.
- The successful CLABSI elimination in the IF population extended to all other unit patients with CVCs.
- Sustained CLABSI reduction resulted from a combination of practices, staff support, and empowerment, not a single intervention.
Introduction:
Hospital-acquired central line-associated bloodstream infections (CLABSI) are "never events" in U.S. healthcare. National efforts to improve CLABSI rates are ongoing. Efforts are important for all patients with a central venous catheter (CVC) and critical to children with intestinal failure (IF) who depend on long-term, daily use of a CVC and undergo extended hospitalizations. We describe outcomes of a multidisciplinary CLABSI elimination effort on a 24-bed medical-surgical unit caring for children with IF.
Methods:
Unit CLABSI events from 1/9/2012 to 4/16/2020 were evaluated with multiple improvement interventions. We leveraged prospectively maintained clinical registries and National Healthcare Safety Network (NHSN) reporting data to extract patient and unit demographics, ethanol lock utilization, and unit CVC days. Interventions were developed utilizing expert consensus and CDC guidelines with active frontline staff engagement. Descriptive statistics and tests of non-parametric data were employed for analysis.
Results:
Ninety-five patients with IF and 862 non-IF patients experienced a total of 1,629 admissions with 20,372 CVC days. Twelve hospital-acquired CLABSI events occurred during the study period, including 7 following NHSN definition change on 1/1/2015 (0.56 per 1,000 CVC days). After the last unit CLABSI on 12/5/2016, there were 7,117 CVC days through study conclusion.
Conclusions:
Described interventions with an enhanced culture of collaborative care profoundly improved hospital-acquired CLABSI occurrence. Success in a specific population translated to all other unit patients with a CVC. Findings suggest elimination is not the result of a single new product or practice, but also includes support and empowerment of those caring for the patient and their CVC.
Related Concept Videos
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
01:26Standard Precaution
Hand hygiene is the most crucial means to prevent the transmission of disease. Employers are legally required to provide their workers with personal protective equipment (PPE) to minimize exposure or contact with...
01:26Healthcare Associated Infections I: Iatrogenic, Exogenic and Endogenic
HAIs significantly increase the cost of health care. Extended stays in healthcare institutions, increased disability, increased costs of medications, including specialized antibiotics, and prolonged recovery times add to the patient's expenses and the healthcare institution and funding bodies.
01:29Endocarditis IV: Nursing Management
01:25Transmission-based Precautions II: Airborne and Protective Environment
Airborne precautions:
Use airborne precautions when treating patients known or suspected to have diseases that spread through the air—for example, tuberculosis or measles. These organisms are present in smaller droplets expelled by an infected person and...