title: Central catheter-associated bloodstream infection reduction with ethanol lock prophylaxis in pediatric intestinal failure: broadening quality improvement initiatives from hospital to home.
abstract: OBJECTIVE
  Children with intestinal failure are at high risk for developing central catheter-associated bloodstream infections (CCABSIs) owing to children's chronic dependence on central venous catheters for parenteral nutrition.
  
  
  OBJECTIVE
  To evaluate the effectiveness and safety of the addition of ethanol lock prophylaxis to a best-practice CCABSI prevention bundle on hospital and ambulatory CCABSI rates in children with intestinal failure.
  
  
  METHODS
  Quality improvement and statistical process control analysis that took place at a tertiary care pediatric hospital and patient homes. Participants included children who were 18 years or younger with intestinal failure requiring a central venous catheter.
  
  
  METHODS
  Central catheter-associated bloodstream infection prevention bundle that included daily ethanol lock prophylaxis.
  
  
  METHODS
  Central catheter-associated bloodstream infection rates and safety outcomes (central catheter insertions, repairs, and hospitalizations) before (January 1, 2011-January 31, 2012) and after (February 1, 2012-December 31, 2013) ethanol lock prophylaxis bundle implementation.
  
  
  RESULTS
  Twenty-four children with intestinal failure received the ethanol lock prophylaxis CCABSI prevention bundle for a median of 266 days (range, 12-635 days). Rates of CCABSI decreased from 6.99 CCABSIs per 1000 catheter days at baseline to 0.42 CCABSI per 1000 catheter days after ethanol lock prophylaxis bundle implementation, despite an increase in the total number of catheter days. A subset of 14 children who received prolonged ethanol lock prophylaxis (≥3 months) had fewer median (range) central catheter insertions 0 (0-2) vs 3 (0-6); P = .001. The pre-ELP intervention CCABSI rates in this subset was 7.01 per 1000 catheter days vs 0.64 per 1000 catheter days for post-ELP intervention (P = .004). There were no significant differences in the total number of hospital admissions; however, there were fewer hospitalizations for fever and CCABSI (P = .003).
  
  
  CONCLUSIONS
  A best-practice CCABSI prevention bundle that included ethanol lock prophylaxis in both the hospital and home was successfully implemented, well tolerated, and demonstrated a significant and sustained reduction in preventable harm in the form of CCABSIs in children with intestinal failure.
authors: Department of Pediatrics, Division of Infectious Diseases and Immunology, Nationwide Children's Hospital and The Ohio State University, Columbus.
authors: Monica I
authors: MI
authors: Ardura
authors: Quality Improvement Services, Nationwide Children's Hospital and The Ohio State University, Columbus.
authors: Jeffrey
authors: J
authors: Lewis
authors: Department of Pharmacy, Nationwide Children's Hospital and The Ohio State University, Columbus.
authors: Jessica L
authors: JL
authors: Tansmore
authors: Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital and The Ohio State University, Columbus.
authors: Patricia L
authors: PL
authors: Harp
authors: Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital and The Ohio State University, Columbus.
authors: Molly C
authors: MC
authors: Dienhart
authors: Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital and The Ohio State University, Columbus.
authors: Jane P
authors: JP
authors: Balint
mesh_terms: D000293:Adolescent; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D016470:Bacteremia / Q000209:etiology / Q000517:prevention & control*; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002408:Catheters, Indwelling / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D005769:Gastrointestinal Motility; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007410:Intestinal Diseases / Q000628:therapy*; D008286:Malabsorption Syndromes / Q000628:therapy; D008297:Male; D010288:Parenteral Nutrition; D058996:Quality Improvement; D012778:Short Bowel Syndrome / Q000628:therapy
chemical_list: D000891:Anti-Infective Agents, Local; D000431:Ethanol