Rapid reduction of central line infections in hospitalized pediatric oncology patients through simple quality improvement methods

Abstract

Background Pediatric hematology-oncology (PHO) patients are at significant risk for developing central line-associated bloodstream infections (CLA-BSIs) due to their prolonged dependence on such catheters. Effective strategies to eliminate these preventable infections are urgently needed. In this study, we investigated the implementation of bundled central line maintenance practices and their effect on hospital-acquired CLA-BSIs. Materials and Methods CLA-BSI rates were analyzed within a single-institution’s PHO unit between January 2005 and June 2011. In May 2008, a multidisciplinary quality improvement team developed techniques to improve the PHO unit’s safety culture and implemented the use of catheter maintenance practices tailored to PHO patients. Data analysis was performed using time-series methods to evaluate the pre- and post-intervention effect of the practice changes. Results The pre-intervention CLA-BSI incidence was 2.92 per 1000-patient days (PD) and coagulase-negative Staphylococcus was the most prevalent pathogen (29%). In the post-intervention period, the CLA-BSI rate decreased substantially (45%) to 1.61 per 1000-PD (p<0.004). Early on, blood and marrow transplant (BMT) patients had a three-fold higher CLA-BSI rate compared to non-BMT patients (p<0.033). With additional infection control countermeasures added to the bundled practices, BMT patients experienced a larger CLA-BSI rate reduction such that BMT and non-BMT CLA-BSI rates were not significantly different post-intervention. Conclusions By adopting and effectively implementing uniform maintenance catheter care practices, learning multidisciplinary teamwork, and promoting a culture of patient safety, the CLA-BSI incidence in our study population was significantly reduced and maintained.

Central Line Maintenance Bundles and CLABSIs in Ambulatory Oncology Patients

“…4 Central line maintenance care bundles, based on Centers for Disease Control and Prevention (CDC) CLABSI prevention guidelines, reduced CLABSIs in PICUs, NICUs, pediatric stem cell transplant recipients, and hospitalized pediatric oncology patients. [5][6][7][8][9][10][11][12] Less attention has been paid to CLABSIs in the ambulatory setting, 7,13 despite the fact that most oncology patients are discharged with central lines. [13][14][15][16][17][18][19] Additionally, no work has been done evaluating whether maintenance care bundles reduce positive blood cultures in ambulatory patients, an important cause for pediatric oncology patient admission.…”

“…[5][6][7][8][9][10][11] Ambulatory central line care interventions are complicated because multiple caregiver groups access ambulatory central lines and each group must be targeted in interventions. This study suggests that interventions involving clinic staff, homecare nurses, and home caregivers can reduce CLABSI and bacteremia incidence rates.…”

Bacterial bloodstream infections in the allogeneic hematopoietic cell transplant patient: new considerations for a persistent nemesis

“…Standardization of bundle elements coupled with systematic implementation and compliance has been shown to effectively and significantly reduce CLABSI rates across multiple studies involving pediatric oncology and HCT patients in the inpatient setting. [86][87][88][89][90] Best practice bundle implementation with particular focus on maintenance strategies also reduces CLABSI rates in the ambulatory setting. 86,91 As part of a multicenter quality improvement initiative, 32 pediatric hematology/oncology and HCT centers across the United States implemented a standardized CVC care bundle.…”

Preventing CLABSIs Among Pediatric Hematology/Oncology Inpatients: National Collaborative Results

“…Recent reports describe single-center successes with reducing CLABSIs in PHO inpatients with the use of standardized implementation of CL care and CL access practices. [8][9][10] Whether CL maintenance care practices can be standardized for PHO inpatients across a diverse group of hospitals nationwide and similar gains in CLABSI reduction achieved in this patient population, which has other competing sources of bacteremia (eg, compromised skin and mucosal membranes), is unknown.As part of a multicenter quality improvement (QI) initiative, PHO centers across the United States implemented and monitored adherence to a standardized CL maintenance care bundle and tracked CLABSIs by using standardized definitions for health care-associated infections. 11 The present article describes the feasibility of such a multicenter effort and its impact on CLABSI rates in PHO inpatients.…”