Elimination of hospital-acquired central line-associated bloodstream infection on a mixed-service pediatric unit.

Abstract

INTRODUCTION\nHospital-acquired central line-associated bloodstream infections (CLABSI) are never events in U.S. healthcare. Efforts to eliminate CLABSI are critically important to children with intestinal failure (IF) who depend on long-term, daily use of a central venous catheter (CVC) and often undergo extended hospitalizations. They are also vital to the safety of any patient with a CVC. We sought to describe long-term outcomes of a multidisciplinary CLABSI elimination effort on a 24-bed medical-surgical unit caring for children with IF.\n\n\nMETHODS\nUnit CLABSI events from 1/9/2012 to 4/16/2020 were evaluated in the context of multiple interventions aimed at preventing CLABSI; leveraging prospectively maintained clinical registries and National Healthcare Safety Network (NHSN) reporting data, patient and unit demographics, ethanol lock utilization, and unit CVC days. Interventions, including zinc oxide-based adhesive barriers, environmental cleaning, and simulation as part of staff education were developed utilizing consensus of hospital experts and Centers for Disease Control and Prevention guidelines with staff engagement. Descriptive statistics and tests of non-parametric data were employed for analysis.\n\n\nRESULTS\nNinety-five patients with IF and 862 non-IF patients experienced a total of 1,629 admissions with 20,372 CVC days during the study period. Twelve hospital-acquired CLABSI events occurred, including 7 following NHSN definition change on 1/1/2015 (0.56 per 1,000 CVC days). Following the last unit CLABSI on 12/5/2016, there were 7,117 CVC days without CLABSI through study conclusion.\n\n\nCONCLUSIONS\nUse of described interventions in the context of an enhanced culture of collaborative care and ownership is associated with hospital-acquired CLABSI elimination. Success in a specific population translated to all other unit patients with a CVC. Findings suggest that CLABSI elimination is not the result of a single new product or practice but rather an approach that supports and empowers those most closely responsible for care of the patient and their CVC is key. This article is protected by copyright. All rights reserved.