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Quality improvement efforts reduced pediatric CLABSI rates
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Implementing a collaborative quality improvement program yielded significant reductions in the rate of central line-associated bloodstream infections among pediatric hematology-oncology inpatients, according to recent study data.
“Bloodstream infections are the most common health care–associated infections in pediatric hematology-oncology patients and are often associated with central lines, such as central line–associated bloodstream infections (CLABSIs),” David G. Bundy, MD, MPH, division of general pediatrics at the Medical University of South Carolina, and colleagues wrote. “In addition to directly attributable morbidity, CLABSIs may introduce deleterious delays in the management of underlying malignancies.”
David G. Bundy
To gauge a multicenter effort to standardize central line care and CLABSI tracking, researchers introduced a program developed by the Children’s Hospital Association and designed to prevent CLABSIs. The program was implemented at 32 sites and conducted by a team of pediatric hematology/oncology physicians and nurses, infectious disease and infection prevention experts, quality improvement experts and Children’s Hospital Association-based staff.
Teams met semiannually to address quality improvement, data review, and general discussion. The care bundle included CDC recommendations, best practice guidelines taken from previous CLABSI prevention initiatives, and expert opinions. The teams provided data on baseline CLABSI rates from January 2006 to October 2009, before introducing the prevention collaborative. They compared those data with intervention rates from November 2009 to August 2012. Each location also provided self-reported data on timelines for adoption of and compliance to the central line care bundle
The mean pre-collaborative rate was 2.85 CLABSIs per 1,000 central line-days, while researchers said there was a rapid overall adoption of the central line care bundle, with an average 80% compliance rate by the end of the program’s first year and exceeding 80% after this time.
Data reported as of August 2012 showed a mean rate of 2.04 CLABSIs per 1,000 central line-days during the intervention, reflecting a 28% decrease (RR=0.71; 95% CI, 0.55-0.92). No statistical association was observed between changes in central line care bundle compliance and changes in CLABSI rates.
“Substantial future work remains, both to better understand the definitional and epidemiologic challenges of CLABSI reduction in this population, and also to extend the gains by the most successful of our teams to all centers,” the researchers wrote. “Maximizing the outcomes of children with cancer will require not only continued increases in cure rates from new therapies, but also steadfast focus on reducing the complications associated with treatment.”
Disclosure: The researchers report employment relationships with the Children’s Hospital Association.
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