Implementation of a children’s hospital-wide central venous catheter insertion and maintenance bundle

Abstract

BackgroundCentral venous catheter-associated bloodstream infections in children are an increasingly recognized serious safety problem worldwide, but are often preventable. Central venous catheter bundles have proved effective to prevent such infections. Successful implementation requires changes in the hospital system as well as in healthcare professionals’ behaviour. The aim of the study is to evaluate process and outcome of implementation of a state-of-the-art central venous catheter insertion and maintenance bundle in a large university children’s hospital.Methods/designAn interrupted time series design will be used; the study will encompass all children who need a central venous catheter. New state-of-the-art central venous catheter bundles will be developed. The Pronovost-model will guide the implementation process. We developed a tailored multifaceted implementation strategy consisting of reminders, feedback, management support, local opinion leaders, and education. Primary outcome measure is the number of catheter-associated infections per 1000 line-days. The process outcome is degree of adherence to use of these central venous catheter bundles is the secondary outcome. A cost-effectiveness analysis is part of the study. Outcomes will be monitored during three periods: baseline, pre-intervention, and post-intervention for over 48 months.DiscussionThis model-based implementation strategy will reveal the challenges of implementing a hospital-wide safety program. This work will add to the body of knowledge in the field of implementation. We postulate that healthcare workers’ willingness to shift from providing habitual care to state-of-the-art care may reflect the need for consistent care improvement. Trial registration: Dutch trials registry, trial # 3635.Trial registrationDutch trials registry (http://www.trialregister.nl), trial # 3635

Interventions to Decrease Catheter-Associated Bloodstream Infections in Newborns: An Integrative Review

“…Fourteen of the 15 papers selected were written in English [9][10][11][19][20][21][22][23][24][25][26][27][28][29] (93.3%); only one was in Spanish; 30 none were written in Portuguese. In regard to the year of publication, the papers were mainly published in 2011, 9,[19][20]24,[26][27] 40% of the total, followed by 26.6% of the papers published in 2009.…”

“…In regard to the year of publication, the papers were mainly published in 2011, 9,[19][20]24,[26][27] 40% of the total, followed by 26.6% of the papers published in 2009. [22][23]28,30 In regard to the papers' specific fields, three (20%) addressed catheters both in pediatric and neonatal populations, 11,20,30 and the other 12 9-10,19,21-27-29 (80%) papers included only neonatal populations. Papers that only included pediatric populations were excluded in the final selection.…”

“…In terms of design, before and after interventions 19,24,29-30 (26.6%) and reviews [21][22][23]28 (26.6%) predominated, representing 53.2% of the sample. There were also three cohort studies, [9][10]27 two timeseries studies, 11,26 one retrospective intervention study, 20 and one exploratory study. 25 The main information extracted from the studies is distributed between: 1) measures adopted to prevent CVC-BSI according to level of evidence (Tables 1 and 2); and 2) strategies used to implement evidence into care practice (Table 3).…”

“…The Institute for Healthcare Improvement developed the concept of care bundles, a package composed of a small set of practices that arguably improved the outcomes of healthcare, considering that, these practices lead to better outcomes when concomitantly implemented than when implemented individually. 4 Even though the efficacy of care bundles is increasingly supported by various studies [4][5][6][7][8][9][10][11][12][13][14][15][16][17] and by the Centers for Disease Control and Prevention (CDC), 2 it is important to stress that the involvement of the entire multi-disciplinary team is key for successful actions and improved quality of care delivery. In this sense, the successful implementation of these actions, as well as the process of quality improvement as a whole, requires the entire staff to be engaged.…”

Using the knowledge translation framework to change practical care of central catheters in a Brazilian neonatal unit

“…For example, whereas insertion practices were much closer to the recommendations in the preimplementation period, all targets were established at 100%, all of which were met. Other studies that used bundles [5,6,[17][18][19] also reported setting up goals to motivate teams, but they did not describe the process to develop the goals and the values involved.…”