Reducing bloodstream infections in pediatric rehabilitation patients receiving parenteral nutrition.
OBJECTIVE
To report our quality improvement efforts to reduce total parenteral nutrition (TPN)-associated bloodstream infections, and the results of those efforts, during the period including the first quarter of 2004 through the third quarter of 2010.


METHODS
A variant on failure modes and effect analysis and existing guidelines were used to develop and modify interventions. Effectiveness of the interventions was assessed by using a graphical depiction of interrupted time-series data on TPN-associated infections per 1000 TPN-days, aggregated across quarters within intervention periods.


RESULTS
Although initial interventions yielded limited reductions in infection rates, it was not until the implementation of a multifaceted "maintenance intervention bundle" that rates strongly responded. After this key intervention revision, the TPN-associated infection rate decreased between implementation in the first quarter of 2008 from 26.1 to 4.8 per 1000 TPN-days during the 8 quarters aggregated comprising the first quarter of 2008 through the fourth quarter of 2009. The final addition of an alcohol-swab cap resulted in a reduction of rates to 0 for the first three-quarters of 2010.


CONCLUSIONS
Our evidence suggests that iterative design/redesign of interventions using failure modes and effect analysis has directly reduced TPN-associated bloodstream infections.
Medical Department, Children's Specialized Hospital, New Brunswick, NJ 08901, USA. fcastello@childrens-specialized.org
Frank Vincent
FV
Castello
Anne
A
Maher
Gregory
G
Cable
D016470:Bacteremia / Q000209:etiology / Q000517:prevention & control*; D017848:Blood-Borne Pathogens; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003428:Cross Infection / Q000517:prevention & control*; D004866:Equipment Contamination / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D017053:Infection Control / Q000379:methods; D008297:Male; D010289:Parenteral Nutrition, Total / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D012778:Short Bowel Syndrome / Q000175:diagnosis / Q000534:rehabilitation*