Identifying high-risk central lines in critically ill children: A novel nurse-driven screening and mitigation...

Area of Science:

• Pediatric critical care medicine
• Infectious disease prevention
• Healthcare quality improvement

Background:

• Central line-associated bloodstream infection (CLABSI) rates remained high in pediatric intensive care units (PICU) and pediatric cardiac intensive care units (PCICU) despite adherence to standard prevention bundles.
• Existing prevention strategies were insufficient to address persistent high CLABSI rates in these specialized units.

Purpose of the Study:

• To develop and implement a novel screening tool to stratify patient risk for CLABSI.
• To improve CLABSI prevention by identifying high-risk patients and guiding targeted interventions.

Main Methods:

• A novel screening tool was developed to stratify patients into risk categories (high, moderate, low) for CLABSI.
• The tool incorporated risk mitigation strategies for different patient risk levels.
• 1,583 patient screenings were conducted to evaluate the tool's performance.

Main Results:

• The screening tool classified 30% of patients as high-risk, 27% as moderate-risk, and 43% as low-risk.
• The tool demonstrated 100% sensitivity and 100% negative predictive value for low-risk screens in identifying patients who developed CLABSI.
• CLABSI rates decreased from 1.83 to 0.98-1.02 per 1,000 catheter-days, with extended CLABSI-free periods. Clinician awareness of risk factors and mitigation strategies increased.

Conclusions:

• The novel screening tool effectively identified high-risk patients, enabling targeted resource allocation and improved CLABSI prevention processes.
• A nurse-driven approach using this tool enhanced clinician awareness and proactive risk mitigation, leading to significant reductions in CLABSI.