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Effectiveness of a central line associated blood stream infection protocol in a pediatric population

John S Graham1, Michelle Shroyer1, Scott A Anderson1

  • 1Division of Pediatric Surgery, Department of Surgery, University of Alabama at Birmingham, United States.

American Journal of Surgery
|May 31, 2021
PubMed

Insights

A new protocol for pediatric patients with intestinal failure (IF) presenting with central line-associated bloodstream infections (CLABSI) improved antibiotic administration efficiency and reduced intensive care unit transfers.

Area of Science:

  • Pediatric critical care medicine
  • Infectious disease management
  • Hospital quality improvement

Background:

  • Central line-associated bloodstream infections (CLABSI) are a frequent complication in pediatric patients with intestinal failure (IF).
  • Long-term central venous catheter (CVC) use in IF patients increases the risk of bacteremia and sepsis.
  • Effective management of CLABSI is crucial to prevent severe outcomes.

Purpose of the Study:

  • To evaluate the impact of a multidisciplinary protocol on the management of CLABSI in pediatric IF patients.
  • To assess the protocol's effect on antibiotic administration timeliness and patient outcomes.
  • To determine if the protocol reduces unplanned intensive care unit (ICU) transfers.

Main Methods:

  • Retrospective chart review of TPN-dependent IF patients with CLABSI admitted through the emergency department (ED).
  • Comparison of patient data before and after the implementation of a new care protocol.
  • Analysis of key metrics including time to antibiotic administration, infectious disease consultations, floor-ICU transfers, readmissions, and length of stay.

Main Results:

  • The study included 44 pediatric patients with IF and CLABSI.
  • Implementation of the protocol led to decreased mean time from ED presentation to antibiotic order and ED admission to antibiotic administration.
  • The protocol was associated with fewer unplanned floor-ICU transfers, while 30-day readmissions and mean length of stay remained similar.

Conclusions:

  • A collaborative, multidisciplinary protocol can enhance the efficiency of antibiotic management for IF patients with CLABSI in the ED.
  • The protocol effectively reduces critical outcomes such as unplanned floor-ICU transfers.
  • This approach supports improved care delivery and patient safety in a vulnerable pediatric population.
Abstract

Keywords:
BacteriaBlood stream infectionCentral lineIntestinal failureTotal parenteral nutrition

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