Reducing PICU central line-associated bloodstream infections: 3-year results.
OBJECTIVE
To evaluate the long-term impact of pediatric central line care practices in reducing PICU central line-associated bloodstream infection (CLA-BSI) rates and to evaluate the added impact of chlorhexidine scrub and chlorhexidine-impregnated sponges.


METHODS
A 3-year, multi-institutional, interrupted time-series design (October 2006 to September 2009), with historical control data, was used. A nested, 18-month, nonrandomized, factorial design was used to evaluate 2 additional interventions. Twenty-nine PICUs were included. Two central line care bundles (insertion and maintenance bundles) and 2 additional interventions (chlorhexidine scrub and chlorhexidine-impregnated sponges) were used. CLA-BSI rates (January 2004 to September 2009), insertion and maintenance bundle compliance rates (October 2006 to September 2009), and chlorhexidine scrub and chlorhexidine-impregnated sponge compliance rates (January 2008 to June 2009) were assessed.


RESULTS
The average aggregate baseline PICU CLA-BSI rate decreased 56% over 36 months from 5.2 CLA-BSIs per 1000 line-days (95% confidence interval [CI]: 4.4-6.2 CLA-BSIs per 1000 line-days) to 2.3 CLA-BSIs per 1000 line-days (95% CI: 1.9-2.9 CLA-BSIs per 1000 line-days) (rate ratio: 0.44 [95% CI: 0.37-0.53]; P < .0001). No statistically significant differences in CLA-BSI rate decreases between PICUs using or not using either of the 2 additional interventions were found.


CONCLUSIONS
Focused attention on consistent adherence to the use of pediatrics-specific central line insertion and maintenance bundles produced sustained, continually decreasing PICU CLA-BSI rates. Additional use of either chlorhexidine for central line entry scrub or chlorhexidine-impregnated sponges did not produce any statistically significant additional reduction in PICU CLA-BSI rates.
Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA. mmille21@jhmi.edu
Marlene R
MR
Miller
Matthew F
MF
Niedner
W Charles
WC
Huskins
Elizabeth
E
Colantuoni
Gayane
G
Yenokyan
Michele
M
Moss
Tom B
TB
Rice
Debra
D
Ridling
Deborah
D
Campbell
Richard J
RJ
Brilli
D000891:Anti-Infective Agents, Local / Q000494:pharmacology*; D016470:Bacteremia / Q000209:etiology / Q000517:prevention & control*; D017848:Blood-Borne Pathogens / Q000302:isolation & purification*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D002710:Chlorhexidine / Q000494:pharmacology*; D016001:Confidence Intervals; D003428:Cross Infection / Q000517:prevention & control; D004866:Equipment Contamination / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D011322:Primary Prevention / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D014481:United States
D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine