290. Beyond the Bundle: Decreasing Central Line Associated Bloodstream Infections in a Pediatric Cardiac Intensive Care Unit
Session: Poster Abstract Session: HAIs in Children
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • IDSA 2013 PK final 9.25_1for uploading.JPG (511.7 kB)
  • Background:

    Central line associated bloodstream infection (CLABSI) rates in critically ill children are associated with increased morbidity and mortality. Decreasing the risk of CLABSI through successful implementation of central line (CL) insertion and maintenance bundles has been well documented. Given the proximity of the CL insertion site and intravascular (IV) tubing connections to the oropharyngeal and genitourinary regions, maintaining dry and intact CL dressings in children is problematic.  By creating a dedicated CL dressing change team and increasing involvement of leadership in the details of CL care, a sustained decrease in the cardiac intensive care unit (CICU) CLABSI was seen.


    Creation and deployment of a CL dressing change team began July 2011. The CL dressing change team consisted of a group of experienced CICU staff nurses. The team members were responsible for changing all CL dressings following recommended maintenance guidelines. The bedside nurses were present during each dressing change which enhanced awareness and provided “just in time” education. The CICU utilized pictures of appropriate and inappropriate CL dressings as visual aids. The CICU medical director and nursing leadership began joint weekly rounds in June 2012 which reinforced and validated their commitment to decreasing CLABSI rates. Rounds included assessing the need for all IV lines, careful evaluation of the CL dressing, repositioning of the IV tubing away from the potential contamination sites, and separation of the tubing and stopcocks from these areas if change in position was not possible. If umbilical lines were present, the umbilical stump was evaluated for omphalitis.


    (See Table 1) While not statistically significant (p = .065), CLABSI rates decreased 69.2% from 2010-2012. The median days between CLABSI increased from 32 in 2010 to 79 in 2012 (p=0.16) and year to date 2013 is 138.


    Table 1: 2010-2012 CICU CLABSI Data


    # CLABSI

    Device Days

    CLABSI Rate

    Device Utilization Ratio (DUR)

    NHSN Pooled mean
























    Using dedicated staff members to manage CL dressing changes paired with consistent high level leadership involvement in CLABSI prevention can positively impact outcomes and decrease CLABSI rates.

    Patricia Kieffer, RN, BSN, CIC1, Alexis Elward, MD, MPH2, Avihu Z. Gazit, M.D.3,4, Kym Galbraith, RN, BSN5, Kathleen Gase, MPH, CIC1, Hilary M. Babcock, MD, MPH6,7 and Raya Khoury, MPH8, (1)BJC Healthcare, St. Louis, MO, (2)Washington University School of Medicine, St Louis, MO, (3)Cardiac Intensive Care Unit, St. Louis Childrens Hospital, St. Louis, MO, (4)Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, (5)Cicu, St. Louis Children's Hospital, St. Louis, MO, (6)Bjc Healthcare, St. Louis, MO, (7)Division Of Infectious Diseases, Washington University in St.Louis School of Medicine, St. Louis, MO, (8)Center for Clinical Excellence, Bjc Healthcare, St. Louis, MO


    P. Kieffer, None

    A. Elward, None

    A. Z. Gazit, None

    K. Galbraith, None

    K. Gase, None

    H. M. Babcock, None

    R. Khoury, None

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