Impact of Blood Culture Pathway on CLABSI Rates in a Pediatric Cardiac Intensive Care Unit

Abstract

<h3>Background</h3> Arterial lines, especially in Cardiac Intensive Care Units (CICU) are important in caring for patients. While not central lines, blood cultures are often drawn from them, potentially leading to contamination and over-diagnosis of central line-associated bloodstream infections (CLABSI). Diagnostic stewardship is needed to ensure that correct cultures are obtained, increase the identification of true-positive bacteremia, reduce contamination, and eliminate false-positive CLABSIs. <h3>Methods</h3> A retrospective review was performed to determine effects of a clinical work pathway (CWP) on blood culture practices and CLABSI rates in a 12-bed pediatric CICU from August 1st, 2019, to July 31, 2021. A multidisciplinary and multi-unit team developed a blood culture pathway in August 2020 discouraging culturing of often colonized arterial lines in favor of peripheral venous draws. The primary outcome was the total number of arterial line cultures collected per 100 patient-days. The secondary outcomes were the National Healthcare Safety Network standardized infection ratio (SIR) for the unit and the CLABSI rate per 1000 device-days. <h3>Results</h3> In the pre-intervention period, 763 blood culture were sent over 4316 patient days. For the post-intervention period, 632 cultures were sent over 5151 patient days. CICU had 981 additional device days in the post-period as compared to the pre-intervention period. Arterial line cultures decreased significantly from 3.99 arterial line cultures/100 patient days to 0.29 cultures/100 patient days (p< 0.001). The SIR went from 2.428 to 2.107 between the pre- and post-implementation period. The CLABSI rate decreased from 3.13 infections/1000 device days to 2.71 infections/1000 device days. <h3>Conclusions</h3> Standardization of blood cultures in the CICU decreased the number of arterial line cultures and contributed to a reduction in the SIR and CLABSI rate. The impact of the COVID-19 pandemic on blood culture practices is unclear although higher patient acuity was evident by the increase in device days post implementation of the CWP.