Bloodstream Infections in Kids Significantly Reduced With Quality Improvement Initiatives

Bloodstream infections associated with catheters can be significantly reduced through quality improvement efforts, possibly leading to better health outcomes and lives saved, decreased stays at the hospital and related costs, according to a new study.

The Cincinnati Children’s Hospital Medical Center study shows that a project to reduce catheter-associated bloodstream infections in cardiac intensive care units reduced their incidence from a baseline of 3.3 per 1,000 central line days to 0.55 per 1,000 central line days at the end of the intervention period.

"We were able to reduce the incidence of bloodstream infections after implementing a central line insertion and maintenance bundle,” said Derek S. Wheeler, MD, a critical care physician at Cincinnati Children’s and the study’s lead author. "This bundle emphasizes full sterile barrier precautions and chlorhexidine skin preparation during insertion, as well as daily discussion of catheter necessity and meticulous site and tubing care.” Wheeler is also an assistant professor of clinical pediatrics at the University of Cincinnati College of Medicine.

The study will be presented at 7 p.m. ET Monday, May 3 at the annual Pediatric Academic Societies (PAS) meeting in Vancouver, Canada.

The study is one of two presented by Wheeler and colleagues this year at PAS that deal with catheter-associated bloodstream infections. The second study shows that a hospital-wide quality improvement collaborative resulted in a significant reduction in the incidence rate, from a baseline of 3.0 per 1,000 line days to less than 1.0 per 1,000 line days.

The collaborative approach included hospital-wide implementation of the same central line insertion and maintenance bundle on three critical care units, one oncology unit, one bone marrow transplant unit, and general medical/surgical units.

Catheter-associated bloodstream infections (CA-BSI) comprise the vast majority of hospital-acquired BSI in pediatric patients and are associated with increased length of stay (LOS), hospital costs and mortality.

Wheeler conducted the study in collaboration with researchers from Nationwide Children’s Hospital in Columbus, Ohio.