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Published on: July 13, 2019
Effect of a Quality Management System on Preventing Peripherally Inserted Central Catheter-Related Complications
Biyan Yu1, XiaoLi Tang, Bixia Zhang
1Author Affiliations: Department of Critical Care Medicine, Shanghai Children's Medical Center, Shanghai JiaoTong University of Medicine, Shanghai, China (Yu); Department of Critical Care Medicine, Shanghai Children's Medical Center, Shanghai JiaoTong University of Medicine, Shanghai, China (Xiang and Zhang); Department of Nursing, Shanghai Children's Medical Center, Shanghai JiaoTong University of Medicine, Shanghai, China (Tang and Shen); Department of Hematology-Oncology, Shanghai Children's Medical Center, Shanghai JiaoTong University of Medicine, Shanghai, China (Chen); Department of Hematology-Oncology, Shanghai Children's Medical Center, Shanghai JiaoTong University of Medicine, Shanghai, China (F. Zhou); Department of Hospital Infection Control, Shanghai Children's Medical Center, Shanghai JiaoTong University of Medicine, Shanghai, China (S. Zhou); Office of the Dean, Shanghai Children's Medical Center, Shanghai JiaoTong University of Medicine, Shanghai, China (Hong).
Insights
Implementing a quality management system for peripherally inserted central catheters (PICC) significantly reduced bloodstream infections in pediatric hematology patients. This PICC-Quality Management System (QMS) offers a valuable infection control strategy.
Area of Science:
- Pediatric Hematology
- Infection Control
- Medical Device Management
Background:
- Prolonged use of peripherally inserted central catheters (PICCs) in pediatric patients with hematologic disorders increases the risk of central line-associated bloodstream infections (CLABSI).
- CLABSI in this population can lead to severe outcomes, including a mortality rate as high as 25%.
Purpose of the Study:
- To assess the effectiveness of a novel PICC-Quality Management System (PICC-QMS) in mitigating CLABSI and associated complications.
- To evaluate the impact of standardized PICC care on patient outcomes in pediatric hematologic patients.
Main Methods:
- A single-center, pre-post intervention study was conducted involving pediatric patients requiring PICC placement for over 48 hours.
- Two cohorts were analyzed: a 2023 cohort (n=611) receiving conventional care and a 2024 cohort (n=693) managed under the PICC-QMS.
- Baseline characteristics were comparable between the two groups.
Main Results:
- The study analyzed 1304 pediatric patients (mean age 9.22 years).
- Implementation of the PICC-QMS was associated with a trend towards lower CLABSI incidence (22 vs. 13 cases, P=.06) and a significant reduction in thrombus formation (6 vs. 1 case, P=.039).
- Logistic regression, adjusted for ward type, revealed a significantly reduced risk of CLABSI with the PICC-QMS (adjusted odds ratio, 0.46; P=.022).
Conclusions:
- The PICC-Quality Management System (PICC-QMS) demonstrates significant efficacy in reducing CLABSI incidence among pediatric patients with hematologic disorders.
- The PICC-QMS provides a practical, reproducible framework for high-quality PICC care, serving as a potential model for other at-risk populations.
Background:
Prolonged peripherally inserted central catheter (PICC) use in pediatric patients with hematologic disorders is associated with an elevated risk of central line-associated bloodstream infection (CLABSI), which can lead to poor outcomes and a mortality rate approaching 25%.
Objective:
To evaluate the effectiveness of the PICC-Quality Management System (QMS) in reducing CLABSI and PICC-related complications in pediatric hematologic patients.
Methods:
We conducted a single-center, pre-post intervention study including pediatric patients with PICC placement exceeding 48 hours. The 2023 cohort (n = 611) received conventional care, whereas the 2024 cohort (n = 693) received care under the PICC-QMS. Baseline demographics and clinical characteristics were comparable between groups.
Results:
A total of 1304 patients (mean age ± SD, 9.22 ± 0.11 years; 34.7% female) were analyzed. Compared with conventional care, PICC-QMS implementation was associated with lower CLABSI incidence (22 versus 13 cases; P = .06) and reduced thrombus formation (6 versus 1 case; P = .039). After adjustment for ward type, logistic regression indicated a significantly reduced CLABSI risk in the PICC-QMS group (adjusted odds ratio, 0.46; 95% CI, 0.20-0.90; P = .022).
Conclusions:
The PICC-QMS effectively reduces CLABSI incidence in pediatric patients with hematologic disorders, underscoring its value as an infection control strategy.
Implications For Oncology Nursing Practice:
Standardization, refinement, and continuous monitoring under the PICC-QMS provide a practical, reproducible framework for integrating high-quality PICC care into routine practice, offering a potential reference model for other high-risk populations.
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