title: Prevention of central venous catheter-associated bloodstream infections in pediatric intensive care units: a performance improvement collaborative.
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.
authors.affiliation: University of Washington School of Medicine, Division of Pediatric Critical Care, Seattle Children's Hospital, Seattle, WA 98105, USA. howard.jeffries@seattlechildrens.org
authors.forename: Howard E
authors.initials: HE
authors.lastname: Jeffries
authors.forename: Wilbert
authors.initials: W
authors.lastname: Mason
authors.forename: Melanie
authors.initials: M
authors.lastname: Brewer
authors.forename: Katie L
authors.initials: KL
authors.lastname: Oakes
authors.forename: Esther I
authors.initials: EI
authors.lastname: Muñoz
authors.forename: Wendi
authors.initials: W
authors.lastname: Gornick
authors.forename: Lee D
authors.initials: LD
authors.lastname: Flowers
authors.forename: Jodi E
authors.initials: JE
authors.lastname: Mullen
authors.forename: Craig Harris
authors.initials: CH
authors.lastname: Gilliam
authors.forename: Stana
authors.initials: S
authors.lastname: Fustar
authors.forename: Cary W
authors.initials: CW
authors.lastname: Thurm
authors.forename: Tina
authors.initials: T
authors.lastname: Logsdon
authors.forename: William R
authors.initials: WR
authors.lastname: Jarvis
mesh_terms: 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