Preventing CLABSIs among pediatric hematology/oncology inpatients: national collaborative results

• Published in: Pediatrics (Evanston) Vol. 134; no. 6; pp. e1678 - e1685
• Main Authors: Bundy, David G, Gaur, Aditya H, Billett, Amy L, He, Bing, Colantuoni, Elizabeth A, Miller, Marlene R
• Format: Journal Article
• Language: English
• Published: United States American Academy of Pediatrics 01-12-2014
• Subjects: Bacteremia - prevention & control; Bacteremia - transmission; Catheter-Related Infections - prevention & control; Catheterization, Central Venous - standards; Child; Children & youth; Compliance; Cooperative Behavior; Cross Infection - prevention & control; Cross Infection - transmission; Disease prevention; Hematologic Diseases - therapy; Hematology; Hospitals, Pediatric - organization & administration; Hospitals, Pediatric - standards; Humans; Inservice Training - organization & administration; Inservice Training - standards; Interdisciplinary Communication; Neoplasms - therapy; Nosocomial infections; Oncology Service, Hospital - organization & administration; Oncology Service, Hospital - standards; Patients; Pediatrics; Quality Assurance, Health Care - organization & administration; Quality Assurance, Health Care - standards; Quality Improvement - organization & administration; Quality Improvement - standards; Risk Factors; United States; United States; hospital oncology service; cross infection; quality improvement; catheter-related infections; bacteremia
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2014-0582

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.
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.
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.
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.