Central Line-Associated Bloodstream Infection Surveillance and Reduction Strategies across the Continuum of Care of a Tertiary-Care Pediatric Institution

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BACKGROUND: Central line–associated bloodstream infections (CBSIs) are the most common type of device-related, healthcare-associated infection across the care continuum at Columbus Children's Hospital (CCH). CBSIs result in prolongation of hospitalization, morbidity, and mortality at CCH and nationally. OBJECTIVE: To demonstrate the value of CBSI surveillance across the care continuum and of interdisciplinary collaboration to identify and implement interventions to reduce the risk of occurrence. METHODS: In 1990, CCH became a member of the Centers for Disease Control and Prevention's (CDC) National Nosocomial Infection Surveillance System (NNIS). Surveillance began in the pediatric intensive care unit (PICU) and the neonatal intensive care unit (NICU). The other inpatient units and Home Parenteral Nutritional (HPN) Program were added in 1994, followed by CCH's Homecare (HC) in 2000. Infection control practitioners (ICPs) conduct surveillance in all inpatient units utilizing NNIS criteria. Nutritional Support Services collects HPN data; HC collects data based upon Infection Control Committee (ICC)–approved criteria. Epidemiology assists with interpretation, analysis, and recommendations for these areas. Meetings occur regularly to identify opportunities for improvement and to ensure consistent practice in all settings. RESULTS: Rates are expressed as the number of CBSI/1000 central line days. The following are a comparison of rates from 2000 and 2003 year to day by site or service: Hospital-wide (6.5 versus 4.9, p = 0.015); PICU (7.8 versus 5.5, p = 0.150); NICU (10.5 versus 6.3, p = 0.006); HC Private Duty Nursing (4.0 versus 1.9, p = 0.273); HC Pharmacy Only (2.0 versus 1.7, p = 0.360); HPN patients served by CCH HC (9.0 versus 5.6, p = 0.093), and those served by other HCs (3.8 to 8.0, p = 0.178). CONCLUSIONS: 1) CBSI surveillance across the care continuum is essential. 2) Interdisciplinary collaboration maximizes identification of opportunities to improve. 3) Direct observation of healthcare workers' practice with feedback and standardized policy/practice is essential. 4) Feedback to other HC companies caring for our patients is necessary. 5) Administrative, Medical Staff, and ICC support is critical. 6) An organizational culture of patient safety is required. 7) In 2003, an IV Access Taskforce identified interventions including a budget-approved IV Access Team.