title: Central line-associated blood stream infections in pediatric intensive care units: Longitudinal trends and compliance with bundle strategies.
abstract: BACKGROUND
  Knowing the temporal trend central line-associated bloodstream infection (CLABSI) rates among U.S. pediatric intensive care units (PICUs), the current extent of central line bundle compliance, and the impact of compliance on rates is necessary to understand what has been accomplished and can be improved in CLABSI prevention.
  
  
  METHODS
  This is a longitudinal study of PICUs in National Healthcare Safety Network hospitals and a cross-sectional survey of directors and managers of infection prevention and control departments regarding PICU CLABSI prevention practices, including self-reported compliance with elements of central line bundles. Associations between 2011-2012 PICU CLABSI rates and infection prevention practices were examined.
  
  
  RESULTS
  Reported CLABSI rates decreased during the study period, from 5.8 per 1,000 line days in 2006 to 1.4 in 2011-2012 (P < .001). Although 73% of PICUs had policies for all central line prevention practices, only 35% of those with policies reported ≥95% compliance. PICUs with ≥95% compliance with central line infection prevention policies had lower reported CLABSI rates, but this association was statistically insignificant.
  
  
  CONCLUSIONS
  There was a nonsignificant trend in decreasing CLABSI rates as PICUs improved bundle policy compliance. Given that few PICUs reported full compliance with these policies, PICUs increasing their efforts to comply with these policies may help reduce CLABSI rates.
authors.affiliation: Division of Pediatric Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY. Electronic address: jde2134@columbia.edu.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Edwards
authors.affiliation: Center for Health Policy, Columbia University School of Nursing, New York, NY.
authors.forename: Carolyn T
authors.initials: CT
authors.lastname: Herzig
authors.affiliation: RAND Corporation, Boston, MA.
authors.forename: Hangsheng
authors.initials: H
authors.lastname: Liu
authors.affiliation: Jefferson School of Nursing, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Monika
authors.initials: M
authors.lastname: Pogorzelska-Maziarz
authors.affiliation: Division of Pediatric Infectious Diseases, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Philip
authors.initials: P
authors.lastname: Zachariah
authors.affiliation: RAND Corporation, Boston, MA.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Dick
authors.affiliation: Division of Pediatric Infectious Diseases, Columbia University College of Physicians and Surgeons, New York, NY; Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, NY.
authors.forename: Lisa
authors.initials: L
authors.lastname: Saiman
authors.affiliation: Center for Health Policy, Columbia University School of Nursing, New York, NY.
authors.forename: Patricia W
authors.initials: PW
authors.lastname: Stone
authors.affiliation: Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, NY; Division of Infectious Diseases, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: E Yoko
authors.initials: EY
authors.lastname: Furuya
mesh_terms: D000818:Animals; D001717:Birds; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D019983:Guideline Adherence; D006801:Humans; D017053:Infection Control / Q000379:methods; D015278:Intensive Care Units, Pediatric; D008137:Longitudinal Studies; D018805:Sepsis / Q000453:epidemiology* / Q000517:prevention & control*
keywords: Catheter-related infections; Intensive care units; Pediatric; Policy