Systematic Intervention to Reduce Central Line–Associated Bloodstream Infection Rates in a Pediatric Cardiac Intensive Care Unit

Abstract

A multidisciplinary, evidence-based initiative resulted in a significant reduction in central line-associated bloodstream infections in our pediatric cardiac ICU.

Infection in pediatric interventional radiology

“…In central venous catheters (CVC), the incidence of infection varies depending on [40 The definition of a catheter-related bloodstream infection (CR-BSI) is a positive blood culture from a peripheral vein, clinical manifestations of infection and no apparent source except the catheter [41]. Overall infection rates are 2.3-7.8/ 1,000 catheter days, although this may be an overestimation as infection from another unknown source may be [41][42][43][44][45]. ICU LOS may increase 14.6 days and total hospital LOS 21.1 d [43].…”

“…Overall infection rates are 2.3-7.8/ 1,000 catheter days, although this may be an overestimation as infection from another unknown source may be [41][42][43][44][45]. ICU LOS may increase 14.6 days and total hospital LOS 21.1 d [43]. Attributed patient mortality is 12-25% for each line infection [41].…”

“…Attributed patient mortality is 12-25% for each line infection [41]. This increases patient cost with each CVC-related infection having an estimated cost of $35,000-$56,000 for ICU patients and $25,000 for all hospital patients [40,41,43].…”

“…This includes filling out an insertion bundle, a compliance checklist including tasks such as hand-washing, site preparation and proper draping [43], the use of appropriate disinfectant, the placement of a chlorhexidine-impregnated disc at the insertion site, and feedback on results [41,53]. In one study, this decreased infection rates from 7.8/1,000 catheter days to 2.3/1,000 catheter days with an overall bundle compliance of 94% [43].…”

“…This includes filling out an insertion bundle, a compliance checklist including tasks such as hand-washing, site preparation and proper draping [43], the use of appropriate disinfectant, the placement of a chlorhexidine-impregnated disc at the insertion site, and feedback on results [41,53]. In one study, this decreased infection rates from 7.8/1,000 catheter days to 2.3/1,000 catheter days with an overall bundle compliance of 94% [43]. In a study performed in a pediatric ICU, there was a similar decrease in infections from 5.4 to 3.1/1,000 catheter days [44]; however, they determined that more improvement was due to compliance in daily care than during insertion [44].…”