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 CDCs 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 childrens 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.
J. S. Sammons,
S. Ditaranto, None
M. Gilman, None
A. Reilly, None
L. Kersun, None
A. Shanahan, None
S. Coffin, None