Prevention of central venous catheter-associated bloodstream infections in pediatric intensive care units: a performance improvement collaborative.
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.
Jeffries
Howard E
HE
University of Washington School of Medicine, Division of Pediatric Critical Care, Seattle Children's Hospital, Seattle, WA 98105, USA. howard.jeffries@seattlechildrens.org
Mason
Wilbert
W
Brewer
Melanie
M
Oakes
Katie L
KL
Muñoz
Esther I
EI
Gornick
Wendi
W
Flowers
Lee D
LD
Mullen
Jodi E
JE
Gilliam
Craig Harris
CH
Fustar
Stana
S
Thurm
Cary W
CW
Logsdon
Tina
T
Jarvis
William R
WR
D016470:Bacteremia / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D055499:Catheter-Related Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003299:Cooperative Behavior; D004866:Equipment Contamination / Q000517:prevention & control; D006776:Hospitals, Pediatric; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D015397:Program Evaluation