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Modified interventions reduced rate of central line-associated bloodstream infections

Castello FV. Pediatrics. 2011;doi:10.1542/peds.2010-3617.

Modified interventions, particularly a multifaceted “maintenance intervention bundle” reduced the central line-associated bloodstream infection rate in pediatric rehabilitation patients receiving parenteral nutrition.

Researchers from the medical department of Children’s Specialized Hospital in New Brunswick, N.J., evaluated whether new and modified interventions developed after failure modes and effect analysis improved the rates of infections. In the failure modes and effect analysis, members of a task force reviewed the process to identify “failure modes” or breakdown points, assigned risk priority numbers, prioritized failure modes for actions and identified actions to reduce or eliminate high-risk failure modes.

To identify breakdown points, the task force identified four related components: revision of hand washing procedures to require alcohol and gel before the manipulation of any total parenteral nutrition administration system; training in correct aseptic technique during priming of the total parenteral nutrition bag; education of all therapy disciplines regarding infection risk with total parenteral nutrition lines; and revision and training for use of antiseptics. The task force developed a maintenance intervention bundle that included priming of administration sets in the pharmacy sterile hood, use of sterile gloves and masks for line access and use of chlorhexidine for line disinfection.

They evaluated the effects of their intervention in an analysis of 27 patients. At baseline, there were 33.5 infections/1,000 patient-days of total parenteral nutrition. After the maintenance intervention bundle was introduced, the number of infections decreased to 4.8 infections/1,000 patient-days of total parenteral nutrition.

The maintenance interventional bundle was augmented with an alcohol-swab cap to disinfect the IV valve between medication administrations. After this was added, the number of infections decreased to zero/1,000 patient-days of total parenteral nutrition.

“The use of a maintenance intervention bundle and the continued monitoring of total parenteral nutrition-associated infections should help determine its efficacy in reducing infection rates,” the researchers wrote.

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