289. Central line-associated blood stream infection rates and compliance with bundle strategies in Pediatric ICUs
Session: Poster Abstract Session: HAIs in Children
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDweek PICU poster.pdf (756.8 kB)
  • Background:

    Bundle strategies for insertion can decrease central line-associated blood stream infection (CLABSI) rates.  The association between reported compliance with specific bundle elements and CLABSI rates in pediatric intensive care units (PICU) has not been studied.

    Methods:

    A nationwide survey of infection control departments, which included hospitals with PICUs, was performed in the fall of 2011.  The survey assessed CLABSI prevention policies in PICUs and reported compliance with 6 insertion practices—insertion bundle checklist, selecting optimal catheter site, chlorhexidine skin disinfection, maximal barrier precautions, monitoring hand hygiene, and checking line necessity daily.  In addition, respondents provided access to CLABSI data from 2011 through mid-2012 reported to the CDC’s National Healthcare Safety Network.  Weighted mean and standard deviation (SD) CLABSI rates were calculated.  Bivariate analyses were performed to compare differences in rates by PICU characteristic and bundle practice compliance using negative binomial regression.

    Results:

    Eighty-eight hospitals with 99 PICUs were studied; 16 (18%) were stand-alone children’s hospitals; 77 (88%) were affiliated with an medical school; and 30 (30%) PICUs had >=16 beds.  The proportion of PICUs with written policies for each of the 6 specific bundle elements ranged from 86-95%.  Among PICUs with policies, >=95% compliance with specific bundle practices ranged from 47-61%, and 25 (35%) PICUs with all policies had >=95% compliance in all practices. The weighted mean CLABSI rate for all PICUs was 1.42 (SD 1.07) per 1000 CL days.  There were no statistical differences in CLABSI rates by PICU characteristics.  Similarly, there were no statistical differences in rates between PICUs that had >=95% vs. <95% compliance with all practices (1.3 vs. 1.41, P=0.59) or with specific practices. 

    Conclusion:

    In this cohort of PICUs, most had CL insertion policies, and CLABSI rates were relatively low.  While reported >=95% compliance with these practices was not associated with lower CLABSI rates, strict compliance was low.  Future work should focus on increasing compliance with bundle practices and studying the impact on CLABSI rates.

    Jeffrey Edwards, MD, MA, MAS1, Hangsheng Liu, PhD, MS, B.Med2, Carolyn Herzig, MS3, Monika Pogorzelska-Maziarz, PhD, MPH3, Philip Zachariah, MD1, E. Yoko Furuya, MD, MS4, Andrew Dick, PhD2, Patricia Stone, PhD, MPH, RN, FAAN3 and Lisa Saiman, MD, MPH, FSHEA1, (1)Columbia University College of Physicians & Surgeons, New York, NY, (2)RAND Corporation, Boston, MA, (3)Columbia University School of Nursing, New York, NY, (4)Columbia University, New York, NY

    Disclosures:

    J. Edwards, None

    H. Liu, None

    C. Herzig, None

    M. Pogorzelska-Maziarz, None

    P. Zachariah, None

    E. Y. Furuya, None

    A. Dick, None

    P. Stone, None

    L. Saiman, None

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