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Major infections following pediatric cardiac surgery pre- and post-CLABSI bundle implementation
Somthida Vachirapuranon1, Chodchanok Vijarnsorn1, Supaluck Kanjanauthai1
1Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Insights
Implementing a central-line associated bloodstream infection (CLABSI) bundle significantly reduced bloodstream infections in pediatric cardiac surgery patients. While ventilator-associated pneumonia showed a trend toward reduction, surgical site infections remained unchanged.
Area of Science:
- Pediatric cardiac surgery
- Infection control
- Public health
Background:
- Postoperative infections, including surgical site infection (SSI), bloodstream infection (BSI), and ventilator-associated pneumonia (VAP), negatively impact outcomes in congenital cardiac surgery (CCS).
- A central-line associated bloodstream infection (CLABSI) bundle was implemented in April 2019 to enhance preventive measures.
Purpose of the Study:
- To compare the incidence of major infections after pediatric CCS before and after the CLABSI bundle implementation.
- To identify risk factors associated with major infections in this patient population.
Main Methods:
- A single-center, retrospective study was conducted assessing major infections (BSI, SSI, VAP) in pediatric CCS patients.
- Data were collected one year before and after the CLABSI bundle implementation (April 2018-March 2020).
- Multivariate analysis was used to identify risk factors for major infections.
Main Results:
- A total of 548 children underwent CCS; 126 (23%) experienced major postoperative infections.
- Following CLABSI bundle implementation, BSI incidence decreased significantly from 8.4% to 3.1% (p=0.01).
- VAP showed a non-significant trend toward reduction (21% to 17.6%), and SSI incidence remained unchanged (1.7% to 1.9%).
- Independent risk factors for major infections included age <6 months, postoperative ventilation >2 days, central line use >4 days, and the pre-CLABSI bundle period.
Conclusions:
- The CLABSI prevention bundle significantly reduced BSI incidence in pediatric CCS.
- While VAP showed a trend toward decrease, SSI rates were unaffected.
- Sustaining these preventive measures requires ongoing efforts, including nurse empowerment and compliance audits.
Background:
Postoperative infection contributes to the worsening of congenital cardiac surgery (CCS) outcomes. Surgical site infection (SSI), bloodstream infection (BSI) and ventilator associated pneumonia (VAP) are common. An additional bundle of preventive measures against central-line associated bloodstream infection (CLABSI) bundle was implemented in April 2019.
Objectives:
To compare the incidence of major infections after pediatric CCS before and after the implementation of the CLABSI bundle and to identify risk factors for major infections.
Methods:
We conducted a single-center, retrospective study to assess the incidence of major infections including bloodstream infection (BSI), surgical site infection (SSI), and ventilator-associated pneumonia (VAP) after pediatric CCS one year before and after implementation of the CLABSI bundle during April 2018-March 2020. The demographics and outcomes of the patients were explored, and risk factors for major infections were identified using multivariate analysis.
Results:
A total of 548 children (53% male) underwent CCS with a median age of 1.9 years (range 0.01-17.5 years). The median Aristotle Basic Complexity score was 7.1 (range 3-14.5). The CLABSI bundle was applied in 262 patients. Overall mortality was 5.5%. 126 patients (23%) experienced major postoperative infections. During the year after the implementation of the CLABSI bundle, BSI was reduced from 8.4% to 3.1% (p = 0.01), with a smaller reduction in VAP (21% to 17.6%; p = 0.33). The incidence of SSI was unchanged (1.7% to 1.9%; p = 0.77). The independent risk factors for major infections were age at surgery <6 months (p = 0.04), postoperative ventilator usage >2 days (p < 0.01), central line usage >4 days (p = 0.04), and surgery during the pre-CLABSI bundle period (p = 0.01).
Conclusion:
Following the implementation of the CLABSI prevention package in our pediatric CCS unit, the incidence of BSI was significantly reduced. The incidence of VAP tended to decrease, while the SSI was unchanged. Sustainability of the prevention package through nurse empowerment and compliance audits is an ongoing challenge.
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