Sustaining Improvements in CLABSI Reduction in a Pediatric Cardiac Intensive Care Unit

Area of Science:

• Infection Control
• Patient Safety
• Pediatric Critical Care

Background:

• Central line-associated bloodstream infections (CLABSIs) are preventable and increase patient morbidity and mortality.
• An unacceptably high CLABSI rate in a pediatric cardiothoracic intensive care unit (CTICU) necessitated quality improvement initiatives.

Purpose of the Study:

• To reduce the incidence of CLABSIs within a pediatric CTICU.
• To evaluate the effectiveness of a multi-faceted intervention strategy.

Main Methods:

• Implementation of four key interventions: sequential cleaning, Kamishibai audits, central line utilization and entry audits, and proctored line access simulation.
• Data collection on CLABSI rates and central line utilization over a defined period.

Main Results:

• CLABSI rate decreased from 1.52 per 1,000 central line days in 2018 to 0.37 in 2020 and 0.32 in 2021.
• Central line days per 100 patient days decreased from 77 to 70.
• The unit achieved a 389-day CLABSI-free period from October 2020 to November 2021.

Conclusions:

• A combination of targeted interventions effectively reduced CLABSI incidence in a pediatric CTICU.
• The observed reduction in CLABSIs was sustained for over one year.
• These findings highlight the success of quality improvement projects in enhancing patient safety in critical care settings.