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Prevention of Central Venous Catheter-Associated Bloodstream Infections in Pediatric Intensive Care Units A Performance Improvement Collaborative

Published online by Cambridge University Press:  02 January 2015

Howard E. Jeffries ,
Wilbert Mason ,
Melanie Brewer ,
Katie L. Oakes ,
Esther I. Mufioz ,
Wendi Gornick ,
Lee D. Flowers ,
Jodi E. Mullen ,
Craig Harris Gilliam  and
Stana Fustar
...Show all authors
Howard E. Jeffries*
Affiliation:
University of Washington School of Medicine, Seattle, Washington Division of Pediatric Critical Care, Seattle Children's Hospital, Seattle, Washington
Wilbert Mason
Affiliation:
Department of Pediatrics, Keck School of Medicine, Children's Hospital, Los Angeles Division of Infectious Diseases, Children's Hospital, Los Angeles
Melanie Brewer
Affiliation:
Arizona State University, Phoenix, Arizona Phoenix Children's Hospital, Phoenix, Arizona
Katie L. Oakes
Affiliation:
Prevision Improvement Advisors, Leawood
Esther I. Mufioz
Affiliation:
Infection Control Department, Phoenix, Arizona
Wendi Gornick
Affiliation:
Department of Infection Control and Epidemiology, Children's Hospital of Orange County, California
Lee D. Flowers
Affiliation:
Convergent HRS, Weston, Florida
Jodi E. Mullen
Affiliation:
Children's Medical Center of Dayton, Dayton, Ohio
Craig Harris Gilliam
Affiliation:
Arkansas Children's Hospital, Little Rock, Arkansas
Stana Fustar
Affiliation:
Surgical Oncology Unit, Children's Hospital, Los Angeles
Cary W. Thurm
Affiliation:
Child Health Corporation of America, Shawnee
Tina Logsdon
Affiliation:
Child Health Corporation of America, Shawnee
William R. Jarvis
Affiliation:
Kansas; and Jason and Jarvis Associates, Port Orford, Oregon
*
University of Washington School of Medicine, Division of Pediatric Critical Care, Seattle Children's Hospital, 4800 Sandpoint Way NE, MS: W-8866, Seattle, WA 98105 ([email protected])
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Abstract

Objective.

The goal of this effort was to reduce central venous catheter (CVC)-associated bloodstream infections (BSIs) in pediatric intensive care unit (ICU) patients by means of a multicenter evidence-based intervention.

Methods.

An observational study was conducted in 26 freestanding children's hospitals with pediatric or cardiac ICUs that joined a Child Health Corporation of America collaborative. CVC-associated BSI protocols were implemented using a collaborative process that included catheter insertion and maintenance bundles, daily review of CVC necessity, and daily goals. The primary goal was either a 50% reduction in the CVC-associated BSI rate or a rate of 1.5 CVC-associated BSIs per 1,000 CVC-days in each ICU at the end of a 9-month improvement period. A 12-month sustain period followed the initial improvement period, with the primary goal of maintaining the improvements achieved.

Results.

The collaborative median CVC-associated BSI rate decreased from 6.3 CVC-associated BSIs per 1,000 CVC-days at the start of the collaborative to 4.3 CVC-associated BSIs per 1,000 CVC-days at the end of the collaborative. Sixty-five percent of all participants documented a decrease in their CVC-associated BSI rate. Sixty-nine CVC-associated BSIs were prevented across all teams, with an estimated cost avoidance of $2.9 million. Hospitals were able to sustain their improvements during a 12-month sustain period and prevent another 198 infections.

Conclusions.

We conclude that our collaborative quality improvement project demonstrated that significant reduction in CVC-associated BSI rates and related costs can be realized by means of evidence-based prevention interventions, enhanced communication among caregivers, standardization of CVC insertion and maintenance processes, enhanced measurement, and empowerment of team members to enforce adherence to best practices.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 7 , July 2009 , pp. 645 - 651
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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References

1.Richards, MJ, Edwards, JR, Culver, DH, et al.Nosocomial infections in pediatric intensive care units in the United States: National Nosocomial Infections Surveillance System. Pediatrics 1999;103:e39.Google Scholar
2.Raad, I. Intravascular-catheter-related infections. Lancet 1998;351:893–898.Google Scholar
3.Singh-Naz, N, Sprague, BM, Patel, KM, Pollack, MM. Risk factors for nosocomial infection in critically ill children: a prospective cohort study. Crit Care Med 1996;24:875–878.Google Scholar
4.Stockwell, J. Nosocomial infections in the PICU: affecting the impact on safety and outcome. Pediatr Crit Care Med 2007;8:S21–S37.CrossRefGoogle Scholar
5.National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance System (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.CrossRefGoogle Scholar
6.Slonim, AD, Kurtines, HC, Sprague, BM, Singh, N. The costs associated with nosocomial bloodstream infections in the pediatric intensive care unit. Pediatr Crit Care Med 2001;2:170–174.CrossRefGoogle ScholarPubMed
7.Warren, DK, Zack, JE, Cox, MJ, Cohen, MM, Fraser, VJ. An educational intervention to prevent catheter-associated bloodstream infections in a nonteaching, community medical center. Crit Care Med 2003;31:1959–1963.Google Scholar
8.Higuera, F, Rosenthal, VD, Duarte, P, Ruiz, J, Franco, G, Safdar, N. The effect of process control on the incidence of central venous catheter-associated bloodstream infections and mortality in intensive care units in Mexico. Crit Care Med 2005;33:2022–2027.CrossRefGoogle ScholarPubMed
9.Lobo, RD, Levin, AS, Brasileiro Gomes, LM, et al. Impact of an educational program and policy changes on decreasing catheter-associated bloodstream infections in a medical intensive care unit in Brazil. Am J Infect Control 2005;33:83–87.CrossRefGoogle Scholar
10.Berenholtz, SM, Pronovost, PJ, Lipsett, PA, et al.Eliminating catheter-related bloodstream infections in the intensive care unit. Crif Care Med 2004;32:2014–2020.CrossRefGoogle ScholarPubMed
11.Bhutta, A, Gilliam, C, Honeycutt, M, et al.Reduction of bloodstream infections associated with catheters in pediatric intensive care unit: stepwise approach. BMJ 2007;334:362–365.CrossRefGoogle ScholarPubMed
12.Warren, DK, Cosgrove, SE, Diekema, DJ, et al.A multicenter intervention to prevent catheter-associated bloodstream infections. Infect Control Hosp Epidemiol 2006;27:662–669.CrossRefGoogle ScholarPubMed
13.Pronovost, P, Needham, D, Berenholtz, S, et al.An intervention to decrease catheter-related bloodstream infections in the ICU (published correction appears in N Engl J Med 2007;356:2660). N Engl J Med 2006;355:2725–2732.Google Scholar
14.O'Grady, NP, Alexander, M, Dellinger, EP, et al.Guidelines for the prevention of intravascular catheter-related infections. Pediatrics 2002;110:e51.CrossRefGoogle ScholarPubMed
15.Elward, AM, Hollenbeak, CS, Warren, DK, Fraser, VJ. Attributable cost of nosocomial primary bloodstream infection in pediatric intensive care unit patients. Pediatrics 2005;115:868–872.Google Scholar
16.Little, RA, Rubin, DB. Statistical Analysis With Missing Data. New York: Wiley; 1987.Google Scholar
17.Trautner, BW, Darouiche, RO. Catheter-associated infections: pathogenesis affects prevention. Arch Intern Med 2004;164:842–850.CrossRefGoogle ScholarPubMed
18.Crnich, C, Maki, D. The promise of novel technology for the prevention of intravascular device-related bloodstream infection. I. Pathogenesis and short-term devices. Clin Infect Dis 2002;34:1232–1242.Google Scholar
19.Pittet, D, Hugonnet, S, Harbath, S, et al.Effectiveness of a hospital-wide programme to improve compliance with hand hygiene: Infection Control Programme. Lancet 2000;356:1307–1312.Google Scholar
20.Larson, EL. APIC guideline for hand washing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251–269.CrossRefGoogle ScholarPubMed
21.Raad, I, Hohn, D, Gilbreath, B, et al.Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion. Infect Control Hosp Epidemiol 1994;15:231–238.Google Scholar
22.Maki, DG, Ringer, M, Alvarado, CJ. Prospective randomized trial of pov-idone-iodine, alcohol, and Chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet 1991;338:339–343.CrossRefGoogle ScholarPubMed
23.Chayiakunapruk, N, Veenstra, DL, Lipsky, BA, Saint, SJ. Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: a meta-analysis. Ann Intern Med 2002;136:792–801.CrossRefGoogle Scholar
24.Lederle, FA, Parenti, CM, Berskow, LC, Ellingson, KJ. The idle intravenous catheter. Ann Intern Med 1992;116:737–738.Google Scholar
25.Costello, JM, Forbes Morrow, D, Graham, DA, Potter-Bynoe, G, Sandora, TJ, Laussen, PC. Systematic intervention to reduce central line-associated bloodstream infection rates in a pediatric cardiac intensive care unit. Pediatrics 2008;121:915–923.CrossRefGoogle Scholar
26.Pronovost, PJ, Angus, DC, Dorman, T, et al.Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA 2002;288:2151–2162.Google Scholar