Program Schedule

1287
Reduction in Central Line-Associated Bloodstream Infections in Children with Intestinal Failure through Implementation of a Central Line Prevention Bundle: Broadening Quality Improvement Initiatives from the Hospital to the Home

Session: Oral Abstract Session: CLABSI: Surveillance and Prevention
Saturday, October 11, 2014: 9:15 AM
Room: The Pennsylvania Convention Center: 107-AB

Background: Children with intestinal failure (IF) are at high risk for developing central-line associated bloodstream infections (CLABSI) owing to their chronic dependence on central venous catheters for parenteral nutrition. CLABSI prevention remains a continued challenge to optimizing outcomes in children with IF.

Methods: We performed a QI initiative using a prospective, interrupted time series design to evaluate the safety and efficacy of a best-practice CLABSI prevention bundle that included ethanol lock prophylaxis (ELP) in both the hospital and home settings, on the primary outcome measure of CLABSI/1,000 catheter days.  Data on CLABSI rates and microbiology, central line insertions, repairs, and hospitalizations were collected before (1/1/2011-2/1/12) and after (2/1/12-12/31/13) bundle implementation.

Results: Twenty four children were eligible to receive the prevention bundle with ELP for a median of 266 days [range 12-635]:  median age of 3 yrs [range 0.25-18], 18 males with IF (with a median residual small bowel length of 48 cm [20-150]).   CLABSI rates decreased from 6.99 CLABSI/1,000 catheter days at baseline to 0.42 CLABSI/1,000 catheter days after bundle implementation, despite an increase in total number of catheter days.  Before bundle implementation, CLABSIs were primarily community-acquired and 35% were polymicrobial.  Fourteen children received prolonged ELP (median 415 days [range 104-635]) and required fewer central line insertions (p=0.001) and hospitalizations for fever and CLABSI (p=0.003) compared with pre-intervention.  There were no significant differences in central-line associated complications pre and post bundle implementation.

Conclusion: A best-practice CLABSI prevention bundle that included ELP in both the hospital and home was successfully implemented, well tolerated, and demonstrated a significant and sustained reduction in preventable harm in the form of CLABSI in children with IF.

Figure 1.  Shewhart U chart of CLABSI rates in 24 children with IF demonstrating sustained reduction in CLABSI rates after best-practice CLABSI prevention bundle with ELP was implemented

Description: https://idsa.confex.com/data/abstract/idsa/2014/Paper_46607_abstract_41731_0.jpg

CLABSI prevention bundle with ELP offered to (A) eligible patients with history of ≥ 2 CLABSI and (B) all eligible patients

Monica I. Ardura, DO, MSCS, Pediatrics, Infectious Diseases and Immunology, The Ohio State University and Nationwide Children’s Hospital, Columbus, OH, Jeff Lewis, RN, MBOE, LSSBB, Quality Improvement Services, Nationwide Children's Hospital, Columbus, OH, Jessica Tansmore, PharmD, Pharmacy, Nationwide Children's Hospital, Columbus, OH, Patricia Harp, RN, Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH, Molly Dienhart, MD, Pediatrics, Gastroenterology, Hepatology, and Nutrition, The Ohio State University and Nationwide Children’s Hospital, Columbus, OH and Jane Balint, MD, Pediatrics, Gastroenterology, Hepatology, and Nutrition, The Ohio State University and Nationwide Children's Hospital, Columbus, OH

Disclosures:

M. I. Ardura, None

J. Lewis, None

J. Tansmore, None

P. Harp, None

M. Dienhart, None

J. Balint, None

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