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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 (howard.jeffries@seattlechildrens.org)
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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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