title: Implementation of a children's hospital-wide central venous catheter insertion and maintenance bundle.
abstract: BACKGROUND
  Central venous catheter-associated bloodstream infections in children are an increasingly recognized serious safety problem worldwide, but are often preventable. Central venous catheter bundles have proved effective to prevent such infections. Successful implementation requires changes in the hospital system as well as in healthcare professionals' behaviour. The aim of the study is to evaluate process and outcome of implementation of a state-of-the-art central venous catheter insertion and maintenance bundle in a large university children's hospital.
  
  
  METHODS
  An interrupted time series design will be used; the study will encompass all children who need a central venous catheter. New state-of-the-art central venous catheter bundles will be developed. The Pronovost-model will guide the implementation process. We developed a tailored multifaceted implementation strategy consisting of reminders, feedback, management support, local opinion leaders, and education. Primary outcome measure is the number of catheter-associated infections per 1000 line-days. The process outcome is degree of adherence to use of these central venous catheter bundles is the secondary outcome. A cost-effectiveness analysis is part of the study. Outcomes will be monitored during three periods: baseline, pre-intervention, and post-intervention for over 48 months.
  
  
  CONCLUSIONS
  This model-based implementation strategy will reveal the challenges of implementing a hospital-wide safety program. This work will add to the body of knowledge in the field of implementation. We postulate that healthcare workers' willingness to shift from providing habitual care to state-of-the-art care may reflect the need for consistent care improvement. Trial registration: Dutch trials registry, trial # 3635.
  
  
  BACKGROUND
  Dutch trials registry (http://www.trialregister.nl), trial # 3635.
authors.affiliation: Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands. o.helder@erasmusmc.nl.
authors.forename: Onno
authors.initials: O
authors.lastname: Helder
authors.forename: René
authors.initials: R
authors.lastname: Kornelisse
authors.forename: Cynthia
authors.initials: C
authors.lastname: van der Starre
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
authors.forename: Caspar
authors.initials: C
authors.lastname: Looman
authors.forename: René
authors.initials: R
authors.lastname: Wijnen
authors.forename: Marten
authors.initials: M
authors.lastname: Poley
authors.forename: Erwin
authors.initials: E
authors.lastname: Ista
mesh_terms: D055499:Catheter-Related Infections / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000191:economics / Q000379:methods* / Q000592:standards; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D006776:Hospitals, Pediatric / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D064872:Patient Care Bundles / Q000191:economics / Q000379:methods* / Q000592:standards; D016730:Program Development