title: Rapid reduction of central line infections in hospitalized pediatric oncology patients through simple quality improvement methods.
abstract: BACKGROUND
  Pediatric hematology-oncology (PHO) patients are at significant risk for developing central line-associated bloodstream infections (CLA-BSIs) due to their prolonged dependence on such catheters. Effective strategies to eliminate these preventable infections are urgently needed. In this study, we investigated the implementation of bundled central line maintenance practices and their effect on hospital-acquired CLA-BSIs.
  
  
  METHODS
  CLA-BSI rates were analyzed within a single-institution's PHO unit between January 2005 and June 2011. In May 2008, a multidisciplinary quality improvement team developed techniques to improve the PHO unit's safety culture and implemented the use of catheter maintenance practices tailored to PHO patients. Data analysis was performed using time-series methods to evaluate the pre- and post-intervention effect of the practice changes.
  
  
  RESULTS
  The pre-intervention CLA-BSI incidence was 2.92 per 1,000-patient days (PD) and coagulase-negative Staphylococcus was the most prevalent pathogen (29%). In the post-intervention period, the CLA-BSI rate decreased substantially (45%) to 1.61 per 1,000-PD (P < 0.004). Early on, blood and marrow transplant (BMT) patients had a threefold higher CLA-BSI rate compared to non-BMT patients (P < 0.033). With additional infection control countermeasures added to the bundled practices, BMT patients experienced a larger CLA-BSI rate reduction such that BMT and non-BMT CLA-BSI rates were not significantly different post-intervention.
  
  
  CONCLUSIONS
  By adopting and effectively implementing uniform maintenance catheter care practices, learning multidisciplinary teamwork, and promoting a culture of patient safety, the CLA-BSI incidence in our study population was significantly reduced and maintained.
authors.affiliation: Pediatric Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109-5942, USA. sungchoi@med.umich.edu
authors.forename: Sung W
authors.initials: SW
authors.lastname: Choi
authors.forename: Lawrence
authors.initials: L
authors.lastname: Chang
authors.forename: David A
authors.initials: DA
authors.lastname: Hanauer
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Shaffer-Hartman
authors.forename: Daniel
authors.initials: D
authors.lastname: Teitelbaum
authors.forename: Ian
authors.initials: I
authors.lastname: Lewis
authors.forename: Alex
authors.initials: A
authors.lastname: Blackwood
authors.forename: Nur
authors.initials: N
authors.lastname: Akcasu
authors.forename: Janell
authors.initials: J
authors.lastname: Steel
authors.forename: Joy
authors.initials: J
authors.lastname: Christensen
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Niedner
mesh_terms: D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D003428:Cross Infection / Q000517:prevention & control*; D019337:Hematologic Neoplasms / Q000628:therapy; D006801:Humans; D017053:Infection Control / Q000379:methods*; D015278:Intensive Care Units, Pediatric; D058996:Quality Improvement