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Prevention of Central Venous Catheter–Associated Bloodstream Infections in Pediatric Intensive Care Units: A Performance Improvement Collaborative

Howard E. Jeffries , MD, MBA, MPH, Wilbert Mason , MD, MPH, Melanie Brewer , DNSc, Katie L. Oakes , MPA, Esther I. Muñoz , RN, BSN, CIC, Wendi Gornick , MS, CIC, Lee D. Flowers, Jodi E. Mullen , BC, CCRN, CCNS, Craig Harris Gilliam , CIC, BS, Stana Fustar , CRNI, Cary W. Thurm , PhD, Tina Logsdon , MS and William R. Jarvis , MD
Infection Control and Hospital Epidemiology
Vol. 30, No. 7 (July 2009), pp. 645-651
DOI: 10.1086/598341
Stable URL: http://www.jstor.org/stable/10.1086/598341
Page Count: 7
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Prevention of Central Venous Catheter–Associated Bloodstream Infections in Pediatric Intensive Care Units: A Performance Improvement Collaborative
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Abstract

Objective.  The goal of this effort was to reduce central venous catheter (CVC)–associated bloodstream infections (BSIs) in pediatric intensive care unit (ICU) patients by means of a multicenter evidence‐based intervention. Methods.  An observational study was conducted in 26 freestanding children’s hospitals with pediatric or cardiac ICUs that joined a Child Health Corporation of America collaborative. CVC‐associated BSI protocols were implemented using a collaborative process that included catheter insertion and maintenance bundles, daily review of CVC necessity, and daily goals. The primary goal was either a 50% reduction in the CVC‐associated BSI rate or a rate of 1.5 CVC‐associated BSIs per 1,000 CVC‐days in each ICU at the end of a 9‐month improvement period. A 12‐month sustain period followed the initial improvement period, with the primary goal of maintaining the improvements achieved. Results.  The collaborative median CVC‐associated BSI rate decreased from 6.3 CVC‐associated BSIs per 1,000 CVC‐days at the start of the collaborative to 4.3 CVC‐associated BSIs per 1,000 CVC‐days at the end of the collaborative. Sixty‐five percent of all participants documented a decrease in their CVC‐associated BSI rate. Sixty‐nine CVC‐associated BSIs were prevented across all teams, with an estimated cost avoidance of $2.9 million. Hospitals were able to sustain their improvements during a 12‐month sustain period and prevent another 198 infections. Conclusions.  We conclude that our collaborative quality improvement project demonstrated that significant reduction in CVC‐associated BSI rates and related costs can be realized by means of evidence‐based prevention interventions, enhanced communication among caregivers, standardization of CVC insertion and maintenance processes, enhanced measurement, and empowerment of team members to enforce adherence to best practices.

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