Sustained Reduction and Prevention of Neonatal and Pediatric Central Line-Associated Bloodstream Infection Following a Nurse-Driven Quality Improvement Initiative in a Pediatric Facility

Tracie Savage; Darci E. Hodge; Kary Pickard; Pam Myers; Kristen Powell; Jonathan M. Cayce

doi:10.1016/j.java.2017.11.002

journal article Open Access Mar 01, 2018

Sustained Reduction and Prevention of Neonatal and Pediatric Central Line-Associated Bloodstream Infection Following a Nurse-Driven Quality Improvement Initiative in a Pediatric Facility

Tracie Savage Darci E. Hodge Kary Pickard Pam Myers Kristen Powell Jonathan M. Cayce

Journal of the Association for Vascular Access Vol. 23 No. 1 pp. 30-41 · Association for Vascular Access

View at Publisher Save 10.1016/j.java.2017.11.002

Abstract

Abstract
Purpose: Hospitals devote significant resources developing protocols to minimize the incidence of central line-associated bloodstream infections (CLABSIs), a source of increased patient morbidity and health care costs; however, few of these protocols, especially centralized protocols, are reported in the literature. This study characterizes the development and effectiveness of a pediatric hospital's centralized CLABSI prevention bundle.
Design and Methods: The study was designed as a retrospective interrupted time series to quantify the effectiveness of the prevention bundle that was developed and implemented by nursing leadership in infection control, and both the neonatal and pediatric intensive care units between 2006 and 2014. The study period was subdivided into pre-, peri-, post-, and second peri-intervention periods based on the implementation status of the bundle. Segmented linear regression was used to model and compare the CLABSI rates for each intervention period overall as well as the 5 individual hospital units.
Results: The hospital's modeled CLABSI rate during the preintervention period was 3.80 out of 1000 line days and was significantly reduced to 0.45 (P &lt; 0.001). Clear decreases in unit CLABSI rates were observed and all units were below corresponding National Healthcare Safety Network CLABSI rates after the study.
Conclusions: The centralized CLABSI prevention bundle reduced and sustained low CLABSI rates overall and within each hospital unit demonstrating the success of the bundle.
Practice Implications: A centralized CLABSI prevention bundle can universalize central line care, simplify infection control, and improve quality of care to help sustain low CLABSI rates throughout the hospital.

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References

48

[1]

Son "Central line-associated bloodstream infection surveillance outside the intensive care unit: a multicenter survey" Infect Control Hosp Epidemiol (2012) 10.1086/667378

[2]

Pronovost "Sustaining reductions in catheter-related bloodstream infections in Michigan intensive care units: observational study" BMJ (2010) 10.1136/bmj.c309

[3]

Lee "Effect of nonpayment for preventable infections in U.S. hospitals" N Engl J Med (2012) 10.1056/nejmsa1202419

[4]

Health Care-Associated Infections Among Critically Ill Children in the US, 2007–2012

Stephen W. Patrick, Alison Tse Kawai, Ken Kleinman et al.

Pediatrics 2014 10.1542/peds.2014-0613

[5]

Edwards "Central line-associated blood stream infections in pediatric intensive care units: longitudinal trends and compliance with bundle strategies" Am J Infect Control (2015) 10.1016/j.ajic.2015.01.006

[6]

National Healthcare Safety Network report, data summary for 2013, Device-associated Module

Margaret A. Dudeck, Jonathan R. Edwards, Katherine Allen-Bridson et al.

American Journal of Infection Control 2015 10.1016/j.ajic.2014.11.014

[7]

Ista "Effectiveness of insertion and maintenance bundles to prevent central-line-associated bloodstream infections in critically ill patients of all ages: a systematic review and meta-analysis" Lancet Infect Dis (2016) 10.1016/s1473-3099(15)00409-0

[8]

Guerin "Reduction in central line-associated bloodstream infections by implementation of a postinsertion care bundle" Am J Infect Control (2010) 10.1016/j.ajic.2010.03.007

[9]

Dumyati "Sustained reduction of central line-associated bloodstream infections outside the intensive care unit with a multimodal intervention focusing on central line maintenance" Am J Infect Control (2014) 10.1016/j.ajic.2014.03.353

[10]

Advani "Central line-associated bloodstream infection in hospitalized children with peripherally inserted central venous catheters: extending risk analyses outside the intensive care unit" Clin Infect Dis (2011) 10.1093/cid/cir145

[11]

Wheeler "A hospital-wide quality-improvement collaborative to reduce catheter-associated bloodstream infections" Pediatrics (2011) 10.1542/peds.2010-2601

[12]

Costello "Systematic intervention to reduce central line-associated bloodstream infection rates in a pediatric cardiac intensive care unit" Pediatrics (2008) 10.1542/peds.2007-1577

[13]

Marra "Impact of a program to prevent central line-associated bloodstream infection in the zero tolerance era" Am J Infect Control (2010) 10.1016/j.ajic.2009.11.012

[14]

Miller "Reducing PICU central line-associated bloodstream infections: 3-year results" Pediatrics (2011) 10.1542/peds.2010-3675

[15]

Galpern "Effectiveness of a central line bundle campaign on line-associated infections in the intensive care unit" Surgery (2008) 10.1016/j.surg.2008.06.004

[16]

A Quality Improvement Initiative to Reduce Central Line–Associated Bloodstream Infections in a Neonatal Intensive Care Unit

Matthew J. Bizzarro, Barbara Sabo, Melanie Noonan et al.

Infection Control & Hospital Epidemiology 2010 10.1086/650448

[17]

O'Neil "A central line care maintenance bundle for the prevention of central line–associated bloodstream infection in non–intensive care unit settings" Infect Control Hosp Epidemiol (2016) 10.1017/ice.2016.32

[18]

Wirtschafter "A statewide quality improvement collaborative to reduce neonatal central line-associated blood stream infections" J Perinatol (2010) 10.1038/jp.2009.172

[19]

Payne "Sustained reduction in neonatal nosocomial infections through quality improvement efforts" Pediatrics (2012) 10.1542/peds.2011-0566

[20]

Ceballos "Nurse-driven quality improvement interventions to reduce hospital-acquired infection in the NICU" Adv Neonatal Care (2013) 10.1097/anc.0b013e318285fe70

[21]

National Healthcare Safety Network "Patient safety component" (2017)

[22]

O'Grady "Guidelines for the prevention of intravascular catheter-related infections" Morb Mortal Wkly Rep Recomm Rep (2002)

[23]

Levy "Chlorhexidine-impregnated dressing for prevention of colonization of central venous catheters in infants and children: a randomized controlled study" Pediatr Infect Dis J (2005) 10.1097/01.inf.0000172934.98865.14

[24]

Yébenes "Efficacy of three different valve systems of needle-free closed connectors in avoiding access of microorganisms to endovascular catheters after incorrect handling" Crit Care Med (2008) 10.1097/ccm.0b013e318183effb

[25]

Smith "Peripheral intravenous catheter dwell times: a comparison of 3 securement methods for implementation of a 96-hour scheduled change protocol" J Infus Nurs (2006) 10.1097/00129804-200601000-00004

[26]

Kaler "Successful disinfection of needleless access ports: a matter of time and friction" J Assoc Vasc Access (2007) 10.2309/java.12-3-9

[27]

Maki "Prospective randomized trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters" Lancet (1991) 10.1016/0140-6736(91)90479-9

[28]

Hill "A silver–alginate-coated dressing to reduce peripherally inserted central catheter (PICC) infections in NICU patients: a pilot randomized controlled trial" J Perinatol (2010) 10.1038/jp.2009.190

[29]

Khattak "A randomized controlled evaluation of absorption of silver with the use of silver alginate (Algidex) patches in very low birth weight (VLBW) infants with central lines" J Perinatol (2010) 10.1038/jp.2009.169

[30]

Chlorhexidine Use in the Neonatal Intensive Care Unit: Results from a National Survey

Pranita D. Tamma, Susan W. Aucott, Aaron M. Milstone

Infection Control & Hospital Epidemiology 2010 10.1086/655017

[31]

Jebb "Time series analysis for psychological research: examining and forecasting change" Front Psychol (2015) 10.3389/fpsyg.2015.00727

[32]

Edwards "National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009" Am J Infect Control (2009) 10.1016/j.ajic.2009.10.001

[33]

Dudeck "National Healthcare Safety Network (NHSN) report, data summary for 2010, device-associated module" Am J Infect Control (2011) 10.1016/j.ajic.2011.10.001

[34]

Dudeck "National Healthcare Safety Network (NHSN) report, data summary for 2012, device-associated module" Am J Infect Control (2013) 10.1016/j.ajic.2013.09.002

[35]

Sacks "Reducing the rate of catheter-associated bloodstream infections in a surgical intensive care unit using the institute for healthcare improvement central line bundle" Am J Surg (2014) 10.1016/j.amjsurg.2013.08.041

[36]

Visscher "Effect of chlorhexidine gluconate on the skin integrity at PICC line sites" J Perinatol (2009) 10.1038/jp.2009.116

[37]

Silvestri "Chlorhexidine: uses and adverse reactions" Dermat Contact Atopic Occup Drug (2013)

[38]

Weitz "Chlorhexidine gluconate-impregnated central access catheter dressings as a cause of erosive contact dermatitis: a report of 7 cases" JAMA Dermatol (2013) 10.1001/jamadermatol.2013.903

[39]

Hemani "Skin preparation for the prevention of surgical site infection: which agent is best?" Rev Urol (2009)

[40]

Chaiyakunapruk "Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care" Ann Intern Med (2002) 10.7326/0003-4819-136-11-200206040-00007

[41]

Karki "Impact of non-rinse skin cleansing with chlorhexidine gluconate on prevention of healthcare-associated infections and colonization with multi-resistant organisms: a systematic review" J Hosp Infect (2012) 10.1016/j.jhin.2012.07.005

[42]

Analyses Comparing the Antimicrobial Activity and Safety of Current Antiseptic Agents

John S. Hibbard

Journal of Infusion Nursing 2005 10.1097/00129804-200505000-00008

[43]

Silla "Use of chlorhexidine varnishes in preventing and treating periodontal disease. A review of the literature" Med Oral Patol Oral Cir Bucal (2008)

[44]

Lansdown "Silver: its antibacterial properties and mechanism of action" J Wound Care (2002) 10.12968/jowc.2002.11.4.26389

[45]

Castellano "Comparative evaluation of silver-containing antimicrobial dressings and drugs" Int Wound J (2007) 10.1111/j.1742-481x.2007.00316.x

[46]

Antiseptics and Disinfectants: Activity, Action, and Resistance

Gerald McDonnell, A. Denver Russell

Clinical Microbiology Reviews 1999 10.1128/cmr.12.1.147

[47]

Schulman "Statewide NICU central-line-associated bloodstream infection rates decline after bundles and checklists" Pediatrics (2011) 10.1542/peds.2010-2873

[48]

Brecher "Bacterial contamination of blood components" Clin Microbiol Rev (2005) 10.1128/cmr.18.1.195-204.2005

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Details

Published: Mar 01, 2018
Vol/Issue: 23(1)
Pages: 30-41
License: View

Authors

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Tracie Savage