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Published on: July 13, 2019
Multimodal intervention to decrease central line-associated bloodstream infection rate in pediatric intensive care
Soravee Subroongruang1, Napaporn Chantasrisawad1,2,3, Lalida Kongkiattikul4
1Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Background:
Central line-associated bloodstream infections (CLABSIs) are the most common healthcare-associated infections, leading to increased mortality, hospital stays, and costs. Despite evidence-based prevention bundles, adherence is often suboptimal. This study aimed to evaluate the impact of a multimodal intervention on CLABSI rates in the pediatric intensive care unit (PICU), particularly in tertiary care settings with high infection rates.
Methods:
A quasi-experimental study was conducted from September 2022 to March 2024, involving pediatric patients under 15 years with central venous catheters (CVC). The multimodal intervention included guideline revisions, education, compliance monitoring, feedback, and reward. CLABSI rates during pre-intervention, intervention, and post-intervention phases were compared using a Poisson regression model and Kaplan-Meier survival analysis. Cox proportional hazards models were used to assess risk factors for CLABSIs.
Results:
A total of 265 patients across three phases were included, with 3324 CVC days and a mean duration of 8.5 days per central line. The intervention reduced CLABSI rates from 8.3 to 1.0 per 1000 catheter-days during the intervention phase (p = 0.049), with a rebound to 5.9 per 1000 catheter-days post-intervention. Kaplan-Meier analysis demonstrated a statistically significant CLABSI incidence reduction in the intervention group versus the pre-intervention group (p = 0.011). Gram-negative bacteria, predominantly Acinetobacter baumannii, were the leading pathogens (46.1%). Cox regression identified the multimodal intervention as a protective factor, with a hazard ratio of 0.27 (95% CI 0.18-0.39, p < 0.005).
Conclusions:
A multimodal intervention significantly reduced CLABSI rates in the PICU, demonstrating the importance of comprehensive strategies in infection prevention. However, sustained compliance is essential to maintain these improvements.
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