OBJECTIVE: Few data exist on successes at reducing pediatric catheter-associated bloodstream infections (CA-BSI). The objective was to eradicate CA-BSI with a multifaceted pediatric-relevant intervention proven effective in adult patients. DESIGN: Prospective cohort of pediatric intensive care (PICU) patients with historical controls. SETTING: Multidisciplinary PICU. PATIENTS/PARTICIPANTS: PICU patients with intervention targeting PICU providers. INTERVENTIONS: Multifaceted intervention involving preintervention staff surveys, provider educational program, creation of central catheter procedure cart, guideline-supported central catheter insertion checklist, nursing staff empowerment to stop procedures that breached guidelines, and real-time data feedback to PICU leadership. MEASUREMENTS AND MAIN RESULTS: We measured rate of CA-BSI per 1000 catheter days from August 2001 through September 2006. Reliable use of evidence-based best practices for insertion of central catheters in our PICU was associated with a statistically and clinically significant decrease in our CA-BSI rate for 24 months postintervention (p < .05). During a portion of this postintervention period, we experienced a dramatic increase in our CA-BSI rate that was ultimately found to be due to the introduction of a new positive displacement mechanical valve intravenous port in April 2004. After removal of this positive displacement mechanical valve, our CA-BSI rate dropped from 5.2 +/- 4.5 CA-BSI per 1000 central catheter days to a rate of 3.0 +/- 1.9 CA-BSI per 1000 central catheter days. Chart review of postintervention CA-BSI cases revealed that these patients acquired CA-BSI weeks after both PICU admission and after insertion of the most recent central catheter. CONCLUSIONS: Our data show that improving practices for insertion of central catheters leads to a reduction of CA-BSI among pediatric patients but not elimination of CA-BSI. More research is needed to identify best practices for maintenance of central catheters for children. In addition, our experience shows that even despite good interventions to control CA-BSI, institutions must remain vigilant to factors such as new technology with apparent advantages but short track records of use.
OBJECTIVE: Few data exist on successes at reducing pediatric catheter-associated bloodstream infections (CA-BSI). The objective was to eradicate CA-BSI with a multifaceted pediatric-relevant intervention proven effective in adult patients. DESIGN: Prospective cohort of pediatric intensive care (PICU) patients with historical controls. SETTING: Multidisciplinary PICU. PATIENTS/PARTICIPANTS: PICU patients with intervention targeting PICU providers. INTERVENTIONS: Multifaceted intervention involving preintervention staff surveys, provider educational program, creation of central catheter procedure cart, guideline-supported central catheter insertion checklist, nursing staff empowerment to stop procedures that breached guidelines, and real-time data feedback to PICU leadership. MEASUREMENTS AND MAIN RESULTS: We measured rate of CA-BSI per 1000 catheter days from August 2001 through September 2006. Reliable use of evidence-based best practices for insertion of central catheters in our PICU was associated with a statistically and clinically significant decrease in our CA-BSI rate for 24 months postintervention (p < .05). During a portion of this postintervention period, we experienced a dramatic increase in our CA-BSI rate that was ultimately found to be due to the introduction of a new positive displacement mechanical valve intravenous port in April 2004. After removal of this positive displacement mechanical valve, our CA-BSI rate dropped from 5.2 +/- 4.5 CA-BSI per 1000 central catheter days to a rate of 3.0 +/- 1.9 CA-BSI per 1000 central catheter days. Chart review of postintervention CA-BSI cases revealed that these patients acquired CA-BSI weeks after both PICU admission and after insertion of the most recent central catheter. CONCLUSIONS: Our data show that improving practices for insertion of central catheters leads to a reduction of CA-BSI among pediatric patients but not elimination of CA-BSI. More research is needed to identify best practices for maintenance of central catheters for children. In addition, our experience shows that even despite good interventions to control CA-BSI, institutions must remain vigilant to factors such as new technology with apparent advantages but short track records of use.
Authors: Corsino Rey; Francisco Alvarez; Victoria De-La-Rua; Andrés Concha; Alberto Medina; Juan-José Díaz; Sergio Menéndez; Marta Los-Arcos; Juan Mayordomo-Colunga Journal: Intensive Care Med Date: 2011-01-27 Impact factor: 17.440
Authors: Michael L Rinke; David G Bundy; Aaron M Milstone; Kristin Deuber; Allen R Chen; Elizabeth Colantuoni; Marlene R Miller Journal: Jt Comm J Qual Patient Saf Date: 2013-08
Authors: Naomi P O'Grady; Mary Alexander; Lillian A Burns; E Patchen Dellinger; Jeffrey Garland; Stephen O Heard; Pamela A Lipsett; Henry Masur; Leonard A Mermel; Michele L Pearson; Issam I Raad; Adrienne G Randolph; Mark E Rupp; Sanjay Saint Journal: Clin Infect Dis Date: 2011-05 Impact factor: 9.079
Authors: Naomi P O'Grady; Mary Alexander; Lillian A Burns; E Patchen Dellinger; Jeffrey Garland; Stephen O Heard; Pamela A Lipsett; Henry Masur; Leonard A Mermel; Michele L Pearson; Issam I Raad; Adrienne G Randolph; Mark E Rupp; Sanjay Saint Journal: Clin Infect Dis Date: 2011-04-01 Impact factor: 9.079
Authors: Ryan P Fagan; Jonathan R Edwards; Benjamin J Park; Scott K Fridkin; Shelley S Magill Journal: Infect Control Hosp Epidemiol Date: 2013-07-16 Impact factor: 3.254