390. Focused Central Line and Urinary Catheter Rounds- A Multidisciplinary Approach to Reduce Device-Associated Infections
Session: Poster Abstract Session: HAI: Preventing Device-Associated Infections
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • ID Week 2016- IC Rounds FINAL.pdf (735.3 kB)
  • Background: Duration of catheterization is an important risk factor in the development of catheter-associated urinary tract infections (CAUTIs) and central line associated bloodstream infections (CLABSIs). Failure to review and remove catheters increases infection risk. Regular catheter necessity review is recommended by the CDC as one means to decrease hospital acquired infections.

    Methods: Children’s Memorial Hermann Hospital (CMHH) is a 240 bed tertiary care hospital with a 30 bed PICU. Multidisciplinary rounds were initiated in March 2014 to review urinary catheter (UC) and central vascular catheter (CVL) necessity. Rounding participants included an Infection Preventionist, nursing Quality Improvement Coordinator, and PICU physician. Participants met 3 times a week to review duration, necessity, alternatives, and removal plan for each UC and CVL on all PICU patients. UC alternatives included bladder scanning, intermittent catheterization or condom catheterization. When CVL removal was not possible, alternatives such as consolidation of access points or changing percutaneous CVLs to tunneled or peripherally-inserted CVLs were considered. Device utilization (DU) ratios and standardized infection ratios (SIR) were collected prospectively pre-intervention (Jan 2013-Feb 2014) and post-intervention (Mar 2014-Feb 2016). National Healthcare Safety Network definitions were utilized.

    Results: Rounding resulted in removal of 38% of UCs and removal or alternative for 6% of CVLs. UC DU ratio decreased from mean of 0.36 to 0.30 (p= 0.007), 95% CI [0.019, 0.109], and CAUTI SIR decreased from mean of 1.11 to 0.69 (p= 0.002), 95% CI [0.163, 0.671]. CVL DU ratio did not change significantly [0.77 to 0.78 (p= 0.656)], but CLABSI SIR decreased from mean of 0.49 to 0.37 (p= 0.000), 95% CI [0.070, 0.185].

    Conclusion: Multidisciplinary rounds on device necessity can significantly decrease DU and reduce hospital acquired infections. While CVL DU did not decrease, interventions associated with rounds may have contributed to decreased incidence of CLABSI.

    Andrea Leblanc, MPH, Quality, Patient Safety, and Infection Control, Memorial Hermann- Texas Medical Center, Houston, TX, Danielle Salley, BSN, RN, Pediatric Critical Care, Children's Memorial Hermann Hospital, Houston, TX, Jamie Causey, MD, The University of Texas Health Science Center at Houston, Houston, TX, Neal Patel, MBA/MHA, Pedi Quality and Safety, Children's Memorial Hermann Hospital, Houston, TX and Galit Holzmann-Pazgal, MD, FSHEA, University of Texas Health Sciences Center at Houston, Houston, TX

    Disclosures:

    A. Leblanc, None

    D. Salley, None

    J. Causey, None

    N. Patel, None

    G. Holzmann-Pazgal, None

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