Reducing Catheter-Associated Bloodstream Infections in Children

Compliance with special policies for insertion and maintenance of central venous catheters was associated with a 43% reduction in the infection rate.

In recent years, the rate of catheter-associated bloodstream infections (CA-BSIs) has dropped considerably in adult intensive care units (ICUs) as a result of widespread changes in catheter-care practices. Might such changes have a similar effect in pediatric ICUs (PICUs), where the rate of infection has historically been higher? To find out, the National Association of Children's Hospitals and Related Institutions sponsored a study in 29 such units across the U.S.

Each unit developed teams consisting of a physician PICU leader and two or three additional members (e.g., quality-improvement personnel, infectious disease physicians, PICU nurses, infection-control professionals). From October 2006 through September 2007, the teams implemented two central line–care bundles: one involving insertion practices and the other focused on maintenance care. These bundles included individual procedures shown to be effective in reducing adult CA-BSIs.

At baseline, the PICUs averaged 5.4 CA-BSIs per 1000 central line–days. The rate dropped to 4.3 during the "ramp-up" period, when units were beginning to implement the bundles, and then decreased to a steady state of 3.1 — a 43% reduction. The only significant predictor of this decrease was use of the two bundles. Additional analysis to determine the importance of specific factors revealed that maintenance-bundle compliance was largely responsible for the reduction.


Citation(s):

Miller MR et al. Decreasing PICU catheter-associated bloodstream infections: NACHRI's quality transformation efforts. Pediatrics 2010 Feb; 125:206.