title: Preventing CLABSIs among pediatric hematology/oncology inpatients: national collaborative results.
abstract: OBJECTIVE
  Central lines (CLs) are essential for the delivery of modern cancer care to children. Nonetheless, CLs are subject to potentially life-threatening complications, including central line-associated bloodstream infections (CLABSIs). The objective of this study was to assess the feasibility of a multicenter effort to standardize CL care and CLABSI tracking, and to quantify the impact of standardizing these processes on CLABSI rates among pediatric hematology/oncology inpatients.
  
  
  METHODS
  We conducted a multicenter quality improvement collaborative starting in November 2009. Multidisciplinary teams at participating sites implemented a standardized bundle of CL care practices and adopted a common approach to CLABSI surveillance.
  
  
  RESULTS
  Thirty-two units participated in the collaborative and reported a mean, precollaborative CLABSI rate of 2.85 CLABSIs per 1000 CL-days. Self-reported adoption of the CL care bundle was brisk, with average compliance approaching 80% by the end of the first year of the collaborative and exceeding 80% thereafter. As of August 2012, the mean CLABSI rate during the collaborative was 2.04 CLABSIs per 1000 CL-days, a reduction of 28% (relative risk: 0.71 [95% confidence interval: 0.55-0.92]). Changes in self-reported CL care bundle compliance were not statistically associated with changes in CLABSI rates, although there was little variability in bundle compliance rates after the first year of the collaborative.
  
  
  CONCLUSIONS
  A multicenter quality improvement collaborative found significant reductions in observed CLABSI rates in pediatric hematology/oncology inpatients. Additional interventions will likely be required to bring and sustain CLABSI rates closer to zero for this high-risk population.
authors.affiliation: Division of General Pediatrics, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina; dbundy@musc.edu.
authors.forename: David G
authors.initials: DG
authors.lastname: Bundy
authors.affiliation: Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee;
authors.forename: Aditya H
authors.initials: AH
authors.lastname: Gaur
authors.affiliation: Division of Hematology/Oncology, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;
authors.forename: Amy L
authors.initials: AL
authors.lastname: Billett
authors.affiliation: Departments of Biostatistics and.
authors.forename: Bing
authors.initials: B
authors.lastname: He
authors.affiliation: Departments of Biostatistics and.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Colantuoni
authors.affiliation: Division of Quality and Safety, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; and Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Children's Hospital Association, Alexandria, Virginia.
authors.forename: Marlene R
authors.initials: MR
authors.lastname: Miller
mesh_terms: D016470:Bacteremia / Q000517:prevention & control* / Q000635:transmission; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000592:standards*; D002648:Child; D003299:Cooperative Behavior; D003428:Cross Infection / Q000517:prevention & control* / Q000635:transmission; D006402:Hematologic Diseases / Q000628:therapy*; D006776:Hospitals, Pediatric / Q000458:organization & administration / Q000592:standards; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration / Q000592:standards; D033183:Interdisciplinary Communication; D009369:Neoplasms / Q000628:therapy*; D016522:Oncology Service, Hospital / Q000458:organization & administration / Q000592:standards; D011785:Quality Assurance, Health Care / Q000458:organization & administration / Q000592:standards; D058996:Quality Improvement / Q000458:organization & administration / Q000592:standards; D012307:Risk Factors; D014481:United States
keywords: bacteremia; catheter-related infections; cross infection; hospital oncology service; quality improvement