413. Mucosal Barrier Injury Central Line Associated Bloodstream Infections: What is the Impact of Standard Prevention Bundles?
Session: Poster Abstract Session: HAI: Preventing Device-Associated Infections
Thursday, October 27, 2016
Room: Poster Hall

Background: Central line associated bloodstream infections (CLABSI) remain a significant problem for hospitalized children, particularly among hematology-oncology populations. Recognizing the unique challenges posed by neutropenia and impaired gut integrity, the CDC’s National Healthcare Safety Network (NHSN) introduced a revised surveillance protocol for CLABSI in January 2013 that included a new classification for mucosal-barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI). We sought to determine the impact of standard catheter insertion and maintenance bundles on the rates of both MBI and non-MBI CLABSI.

Methods: A retrospective observational study compared the monthly rate of MBI and non-MBI CLABSI (per 1000 central line days) among oncology patients at a tertiary care children’s hospital from January 2013-March 2016. All CLABSIs were prospectively identified using NHSN criteria as part of ongoing active surveillance. Standard catheter insertion and maintenance bundles were implemented through iterative improvement cycles (Plan-Do-Study-Act) throughout the study period. Differences in rates of change between MBI and non-MBI CLABSI were determined by fitting a Poisson model.

Results: During the study period, rates of MBI and non-MBI CLABSI both decreased. There was no significant difference in the rate of change between MBI and non-MBI infections (p=0.873).

Conclusion: Implementation of standard catheter insertion and maintenance bundles was associated with similar reductions in the rates of MBI and non-MBI CLABSI.  These findings suggest the pathogenesis of some MBI CLABSI events might be related to breeches in the insertion and care of catheters.

Julia Shaklee Sammons, MD, MSCE1, Rachael Ross, MPH2, Susan Ditaranto, RN, MHA, NEA-BC3, Margaret Gilman, CIC4, Anne Reilly, MD, MPH5, Leslie Kersun, MD, MSCE6, Amanda Shanahan, RN, BSN6 and Susan Coffin, MD, MPH, FSHEA, FPIDS2, (1)Perelman School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Department of Infection Prevention and Control, The Children's Hospital of Philadelphia, Philadelphia, PA, (2)Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, (3)Department of Medical/Medical Subspecialty Nursing, The Children's Hospital of Philadelphia, Philadelphia, PA, (4)Department of Infection Prevention and Control, The Children's Hospital of Philadelphia, Philadelphia, PA, (5)Department of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, (6)Department of Inpatient Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA

Disclosures:

J. S. Sammons, None

R. Ross, None

S. Ditaranto, None

M. Gilman, None

A. Reilly, None

L. Kersun, None

A. Shanahan, None

S. Coffin, None

Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.