Central Line Care Research Articles

372. Attributable Mortality of Candidemia After Introduction of Echinocandins

BackgroundCandidemia is among the most frequent nosocomial blood stream infections and associated with considerable morbidity and mortality. Landmark case–control studies estimated an attributable mortality of 38% and 49%. After introduction of echinocandins, attributable mortality may have decreased.MethodsIn a case–control design, 100 consecutive, hospitalized patients with candidemia were enrolled at the University Hospital of Cologne. These cases had at least one blood culture positive for Candida spp. >48 hours post admission. We enrolled patients from January 2017 backwards until February 2014. Controls were patients without candidemia matched for age, sex, calendar year, duration of hospitalization, main admission diagnosis, and Patient Clinical Complexity Level. Risk factors for candidemia captured were malignancy, diabetes, infection other than candidemia, liver cirrhosis, hemodialysis, congestive heart failure, coronary artery disease, chronic lung disease, intensive care, mechanical ventilation, and presence of central lines. For each control patient, we considered the day of candidemia of its matched case to compare post diagnosis length of stay. We estimated attributable mortality until day 30 post candidemia diagnosis. We performed χ2-test for categorical and Student’s t-test for continuous variables, and defined a two-tailed P-value of <0.05 statistically significant.ResultsCases and controls were 68% males. Median age was 62 and 63 years, and 25th and 75th percentile 55 and 74 years in both groups. Candidemia occurred a median 18 days post admission. For cases and controls, median length of stay post diagnosis was 17 and 15.5 days (P = 0.13), for those controls who died 12 and 19 days (P = 0.21), and for survivors 24 and 13 days (P = 0.006). Day 30 mortality rates were 38% and 11% for cases and controls (P = 0.03); thus attributable mortality was 27% (95% CI, 16%–28%).ConclusionAttributable mortality of nosocomial candidemia is still substantial, but was lower in our study when compared with literature from before introduction of echinocandins.Disclosures O. Cornely, Actelion, Amplyx, Arsanis, Astellas, AstraZeneca, Basilea, Bayer, Cidara, F2G, Gilead, GSK, Leeds University, Matinas, MedPace, Melinta, Merck/MSD, Miltenyi, Pfizer, Rempex, Roche, sanofi pasteur, Scynexis, Seres, Medicines Company: Research Contractor, Research grant and Research support. Allecra Therapeutics, Amplyx, Actelion, Astellas, Basilea, Cidara, Da Volterra, F2G, Gilead, IQVIA, Janssen, Matinas, Menarini, Merck/MSD, Paratek, PSI, Scynexis, Seres, Summit, Tetraphase, Vical: Consultant, Consulting fee. Astellas, Basilea, Gilead, Merck/MSD, Pfizer: Speaker’s Bureau, Speaker honorarium.

Insights into medical management of pediatric intestinal failure

Medical management of children with Intestinal failure continues to evolve. The development of specialized teams focused on the management of these children has made the most significant impact in improving outcomes. Medical management strategies are centered on the provision of adequate fluid electrolytes and calories to allow for appropriate growth and neurological development. Enteral therapy and drugs are required to enhance bowel adaptation while parenteral nutrition is the main source of nutrients, electrolytes and fluid. Modification in parenteral nutrition with the availability of lipid alternatives are contributing to decreasing incidence of Intestinal failure associated liver disease. Utilization of patient centered central line care bundles has also significantly contributed to the decrease in morbidity and mortality. This review provides insight into the current medical therapy available for managing intestinal failure in children.

The compliance coach: A bedside observer, auditor, and educator as part of an infection prevention department's team approach for improving central line care and reducing central line-associated bloodstream infection risk

A compliance coach who audits central line maintenance and provides feedback and education to bedside nurses through timely, nonpunitive conversation is an effective addition to busy infection prevention departments. Staff nurses and nurse managers reported receiving clearly communicated and actionable information from the coach and compliance improved over time in multiple areas of central line maintenance.

Sustained Reduction and Prevention of Neonatal and Pediatric Central Line-Associated Bloodstream Infection Following a Nurse-Driven Quality Improvement Initiative in a Pediatric Facility

PurposeHospitals devote significant resources developing protocols to minimize the incidence of central line-associated bloodstream infections (CLABSIs), a source of increased patient morbidity and health care costs; however, few of these protocols, especially centralized protocols, are reported in the literature. This study characterizes the development and effectiveness of a pediatric hospital's centralized CLABSI prevention bundle. Design and MethodsThe study was designed as a retrospective interrupted time series to quantify the effectiveness of the prevention bundle that was developed and implemented by nursing leadership in infection control, and both the neonatal and pediatric intensive care units between 2006 and 2014. The study period was subdivided into pre-, peri-, post-, and second peri-intervention periods based on the implementation status of the bundle. Segmented linear regression was used to model and compare the CLABSI rates for each intervention period overall as well as the 5 individual hospital units. ResultsThe hospital's modeled CLABSI rate during the preintervention period was 3.80 out of 1000 line days and was significantly reduced to 0.45 (P < 0.001). Clear decreases in unit CLABSI rates were observed and all units were below corresponding National Healthcare Safety Network CLABSI rates after the study. ConclusionsThe centralized CLABSI prevention bundle reduced and sustained low CLABSI rates overall and within each hospital unit demonstrating the success of the bundle. Practice ImplicationsA centralized CLABSI prevention bundle can universalize central line care, simplify infection control, and improve quality of care to help sustain low CLABSI rates throughout the hospital.

Caregiver Education Reduces the Incidence of Community-Acquired CLABSIs in the Pediatric Patient With Intestinal Failure.

Pediatric patients with intestinal failure often require central venous catheters for extended periods of time for parenteral nutrition, blood sampling, and medication administration, increasing morbidity, mortality, and costs. In 2007, we reported a central line-associated bloodstream infection rate of 7.0 per 1,000 catheter line-days in our pediatric patients with intestinal failure. On the basis of this high rate of catheter-associated infections, we developed and implemented a central line care curriculum for patients/family caregivers and home health nurses. We aim to show with the implementation of patient/family caregiver and home health nurse standardized education, the central line-associated bloodstream infection rate can be significantly reduced and that this is sustainable. A retrospective review of 80 pediatric outpatients with intestinal failure and long-term central venous access was performed between January 1, 2009, and December 31, 2014. During this time period, the nursing department at Children's Medical Center of Dallas implemented a systematic central line care education program for patients and/or caregivers. The number of community-acquired central line-associated bloodstream infections during this time period was collected and compared with our previously reported data from 2005 to 2007 prior to the implementation of education program. With the implementation of standardized care guidelines and a central venous catheter care curriculum, the community-acquired rate decreased from 4.8 to 2.9 per 1,000 catheter-days in 80 patients with intestinal failure between January 1, 2009, and December 31, 2014 (p < .001). This was also a significant decrease compared with the initial central line-associated bloodstream infection rate of 7.0 per 1,000 central line days in 2007 (p < .001) prior to the development of the central venous catheter care curriculum. We have shown that the incidence of community-acquired central line-associated bloodstream infections in children with intestinal failure can be reduced through formal education of central venous catheter care to family members.

The epidemiology, antibiograms and predictors of mortality among critically-ill patients with central line-associated bloodstream infections.

For high risk of central line-associated bloodstream infections (CLABSIs) in patients of intensive care units (ICUs) and scarcely epidemiology and therapeutic recommendations in Asia, we aimed to evaluate the annual change in epidemiology, antibiogram, and risk factors for 14-day mortality. A retrospective study of ICUs patients with CLABSIs at a medical center in Taiwan (2010-2016), where central line care bundle implemented since 2014, by reviewing clinical data, pathogens, and the antibiogram. Gram-negative bacteria (59.3%) were main microorganisms of CLABSIs, and 9.0% of all GNB were MDROs. Acinetobacter spp., Enterobacter spp., and Stenotrophomonas maltophilia were the most frequently isolated. In multivariate analysis, malignancy, inadequate empirical antimicrobial therapy, inadequate definite antimicrobial therapy, and infection by fungi or multidrug-resistant organisms (MDROs) were associated with 14-day mortality (all p<0.05). The CLABSI incidence rate decreased from 5.54 to 2.18 per 1000 catheter-day (from 2014 to 2015) with improved compliance to care bundle. Carbapenem and aminoglycoside were suitable empirical drugs in the hospital setting when GNB is predominant for CLABSI. Significant decreasing susceptibility of ampicillin/sulbactam in Enterobacter spp. (36.7%-0.0%), and ampicillin/sulbactam (12.5%-0.0%), ceftazidime (100.0%-52.9%), and tigecycline (87.5%-35.3%) in Serratia marcescens. We identified Gram-negative bacteria as leading pathogens of CLABSIs in a Taiwan medical center, and good compliance to care bundle is associated with reduced CLABSI incidence rate. Malignancy, infection by MDROs or fungi, inadequate empirical or definite antimicrobial therapy are significant factors for 14-day mortality.

Low Incidence of Fungal Infections Following Intestinal Transplantation

Background: Pediatric intestinal transplant (ITx) patients are at high risk of invasive fungal infections because of multiple predisposing risk factors. Aim: To report on a single center experience with fungal infections following ITx. Material/methods: Data on fungal infections in ITx patients were obtained from the Liver unit database and hospital laboratory systems (ICE and Telepath). Our local protocol is to use prophylactic i.v. antifungal for 2 weeks, followed by oral non-absorbable antifungal for 6 months following transplant for selective decontamination of digestive tract. If medical or surgical complications occur, duration of i.v. and oral prophylactic antifungal was extended. Any patient with unexplained fever despite antibiotic use for 48 hrs was discussed with microbiology team, and a comprehensive sepsis work-up (including blood cultures, urine cultures, drain cultures, stool MC and S), change of central lines, radiological imaging was performed. Results: 93 patients in our cohort of p-SBT since the start of the SBT program in 1993 until August 2016 were included in the study. 49/93 (52%) patients had candida grown from any body site at some point after ITx and 4/93 (4.3%) patients had grown Aspergillus, both were sterile sites. Of the 49/93 growing candida from any body site, 12/49 (24%) had non-albican candida. Only 4/12 were further identified to species level. Two were C. parapsilosis, 1 was C glabrata and was 1 C.lucitaniae. 10/49 had grown Candida from a normally sterile body site (urine was excluded from ‘normally sterile body site’ analysis). 1/10 grew from bile (C. albicans) and 6/10 (2 C. albicans, 3 non-albican candida, 1 C lusitaniae from peritoneal fluid, 3/10 children had candida grown from blood cultures (2 -non candia albicans and 1- candida albicans). Only one of the three candidemia was within first 12 months of SBT procedure. The other two grew at 46 and 36 months after their transplant. There was no mortality related directly to candidemia, but there was one mortality directly related to aspergillus infection. Discussion: The incidence of fungal infections is low in our ITx patients from sterile body sites as compared to other reports in the literature. This is most likely due to a combination of factors: prolonged use of appropriate antifungal prophylaxis, meticulous central venous line care and judicious use of antimicrobial drugs. 1/4 children with candida from ‘any body’ site had ‘non-albican’ candida, which influences the choice of empirical antifungal treatment of infection. Conclusion: Fungal infections can be prevented following intestinal transplantation with a high index of suspicion and an appropriate prophylactic regime. Multidisciplinary intestinal transplant team at Birmingham Children's Hospital.

Across the Continuum: Central Line Care From Hospital to Home

BACKGROUND: Central line associated bloodstream infections (CLABSI) in children at home with central lines is a common cause of hospitalization and a major cause of morbidity. Little is known about the rates and impact of CLABSI acquired in the ambulatory setting. We set out to identify those children discharged from the hospital with a central line and determine their rate of CLABSI. We developed tools for tracking line days and investigating blood stream infections.

The Impact of a Team Approach to Central Line Care in Preventing Central Line-Associated Bloodstream Infections

The Impact of a Team Approach to Central Line Care in Preventing Central Line-Associated Bloodstream Infections

Becoming Parent and Nurse: High-Fidelity Simulation in Teaching Ambulatory Central Line Infection Prevention to Parents of Children with Cancer

Ambulatory central-line infections in children with cancer are life-threatening. Infections are two to three times more frequent in outpatients than inpatients, for whom evidence-based bundles have decreased morbidity. Most cancer care now takes place at home, where parents perform many of the same tasks as nurses. However, parents often feel stressed and unprepared. To address this, high-fidelity simulation, which has been effective for teaching novice nurses, was evaluated for parent central-line education. In a feasibility study using a pretest/posttest design, after completion of usual central-line education, parents participated in a high-fidelity simulation practice session. Parents were assessed in three domains: (1) knowledge of infection prevention; (2) psychomotor skill competence; and (3) ability to recognize health care provider nonadherence to best practices. Parents also completed a 5-point Likert simulation experience survey. A convenience sample of 17 parents participated between December 2015 and March 2016. Knowledge median scores increased from pre- to posttest from 10 to 15 of 16 points possible (p ≤ 0.001; Wilcoxon signed rank test). Median skills scores increased from pre- to posttest from 8 to 12 points of 12 possible (p ≤ 0.001). Following simulation, median recognition scores increased from 3 to 6 with 6 points possible (p ≤ 0.001). For the parent experience survey, 100% of participants strongly agreed or agreed that simulation was meaningful for learning central-line care. As an adjunct to usual care central-line education, translation of high-fidelity simulation to parent education is a novel approach that shows promise for improving central-line care at home in children with cancer.

Central line associated sepsis in children receiving parenteral nutrition in Oman.

Parenteral Nutrition (PN) is used when gut fails to provide complete nutrition. Central line Associate Blood Stream Infection (CLABSI) a major complication of this therapy. The objective of the study was to report the incidence of CLABSI and associated mortality in children receiving PN in the Royal Hospital and study the indication and duration of PN use. All children from the age of 0-48 months who received TPN outside NICU from the period between 1/1/2011 till 31/12/2014 were included. Data were retrieved from the hospital electronic data base. There were 42 children 27 males and 15 females who used PN through a central line for a total duration of 569 days. The incidence of CLABSI was 14 days per 1000 days catheter and mortality of 556 per 10000. The average duration of TPN was 14.5 days. Most of the patient had CLABSI in the PICU and cardiac related illness or surgery was the most common indication of PN use. The average duration of use was 14 days. Inspite of that short duration use of PN, there is a very high incidence of CLABSI and its related mortality. Bundle policy for central line care is not used in the Royal Hospital and this study calls for urgent implementation of central line care bundle policy in the Royal Hospital.

Value of central line care teaching for families of pediatric oncology patients.

60 Background: Pediatric oncology care depends on central lines (CLs) in both outpatient and inpatient settings. Although inpatient implementation of CL maintenance bundles has been achieved, little attention has focused on families who care for CLs at home. Families are expected to follow best practice, but most have no prior experience or medical background. We sought to understand the comfort level and knowledge of families caring for external CLs at home and the value of our program’s existing teaching strategies, prior to an improvement initiative. Methods: Families caring for children with new and existing external CLs at home from May 2015-May 2016 were eligible for a survey and approached during outpatient visits if their primary team agreed. Using Likert scales, families were asked to assess their current comfort level with CL care, evaluate existing teaching strategies (instructional sheets; hands-on teaching by program nurses, and by home health nurses), and comment on other potentially helpful strategies. Five content questions regarding CL care were included to evaluate knowledge. Results: 80 of 82 (97.6%) families approached completed the survey. 70% had a CL in place for &gt; 60 days. 46.3% felt "very comfortable" performing CL care, 42.5% were "comfortable", and 11.2% were "sort of or not comfortable". Only 17.5% of families found instruction sheets indispensable. Hands-on teaching was indispensable for 51.3% of families; 1.3% responded that teaching was not performed. 27.5% of families found hands-on teaching by home health nurses indispensable, but 22.5% had not received this. 98% of content questions were answered correctly. Other helpful strategies concentrated on 3 themes: standardization of educational content, increased opportunity for hands-on practice, and cognitive aids (e.g. a checklist) for CL care. Conclusions: A minority of families feel the highest level of comfort with CL care at home even after months of experience. Improvement opportunities and gaps in CL care teaching strategies are prevalent. To help support families caring for CLs at home and ensure adherence to best practice, programs should engage families to better understand their needs and develop solutions to meet them.

Feasibility of a clinic-based central line care teach-back program for pediatric oncology families.

183 Background: Pediatric oncology (PO) patients with central lines (CLs) are at high risk for CL associated bloodstream infections (CLABSI), which increase morbidity, mortality, and costs. A large portion of ambulatory CL care in the home is provided by families who often have limited opportunities to develop the needed skills and adhere to best practice line care. Methods: A pilot quality improvement initiative was undertaken from 5/2015-6/2016 to develop a coaching program for families to demonstrate external CL care with a nurse during a routine clinic visit (teach-back), either on a simulation model or the patient. Tests of change were implemented to add teach-backs during routine clinic visits and ensure teach-back documentation in the medical record. Initial steps included assessing family interest in teach-backs by conducting surveys about CL care at home and unstructured incorporation into routine care by existing clinic nursing staff. After assessment of the pilot phase, targeted interventions started April 2016 including dedicated staff for scheduling, tracking, and performing teach-backs during routine clinic visits; culture change including an expectation that all families would participate and on-going staff education about the program; language change to increase participation by avoiding family perception of being tested; and incentives (gift-card raffle) for nurses to provide coaching. Results: Before April 2016, less than 25% of families participated due to a combination of family refusal; lack of nursing availability, space, or time; and inability to approach prior to line removal. In April 2016, 52% of families participated, reaching 90% by June 2016. Informal feedback from both staff and patient/family participants suggested increased job satisfaction by nurses and wide acceptance by all. In addition, many families participated in multiple teach-back sessions to improve line care skills. Conclusions: A CL teach-back program in a busy ambulatory PO clinic is feasible, but requires dedicated resources and culture change. Ongoing improvements are in place to ensure sustainability of the program and measure the impact on ambulatory CLABSI rate and family distress and line care skills.

Efficacy of Reducing Alteplase Dose to Restore Patency in Nonhemodialysis Central Vascular Access Devices.

Central line-associated bloodstream infections (CLABSIs) are preventable through vigilant and thorough care. When CLABSIs occurred at a facility in Southwest Arizona, the root cause analysis discovered that declotting agents, such as alteplase, were not given routinely when nonhemodialysis (non-HD) central vascular access devices (CVADs) lacked blood return. A PICO question was developed that guided the review of literature and central line care standards of practice: In the adult patients with non-HD central lines, what medications are currently recommended to restore patency? As a result of this project, our facility instituted a new protocol using a reduced dose of alteplase to restore patency to non-HD CVADs.

A Methodological Study to Develop a Standard Operational Protocol for Nurses on Central Line Catheter Care of Patients in Selected Intensive Care Units.

Aim:This study aims to develop a standard operational protocol (SOP) for central line catheter care for nurses.Materials and Methods:A preliminary draft of protocol based on extensive review of the literature was developed. The current practices of the nurses regarding central line catheter care were observed. Focus group discussions (FGD) were conducted with the nurses to identify the problems encountered by them during care of central line. Four rounds of Delphi were conducted to validate the protocol. The protocol was found to be feasible in terms of understanding, clarity and easy implementation after conducting a pilot study. An observation checklist was developed from the final draft of the protocol. The nurses were taught regarding the central line catheter care as per the protocol. 30 nurses were observed during central line catheter care by the researcher. After implementation of the protocol, feedback of the nurses was taken by conducting FGDs.Results:Content validity index of each item in the protocol was acceptable. The overall Cronbach's alpha value of the checklist was 0.75. It was concluded that the checklist is reliable and each item has a contribution in the checklist.Conclusion:This protocol addresses interventions to enable staff to provide proper care of the central line catheter to prevent CLABSI.

Effect of education program on nurses’ knowledge and practice regarding care of central venous line in pediatric hemodialysis: evidence-based practice guidelines

Introduction Catheter-related blood stream infections (CRBSIs) are the main cause of hemodialysis (HD) failure in infants and children. Active prevention of CRBSIs required multiple interventions and adherence to evidence-based practice guidelines. Aim The aim of this study was to investigate the effect of education program on nurses’ knowledge and practice in pediatric HD unit evidence-based practice (EBP) guidelines. Participants and methods A quasiexperimental design was utilized. The study was conducted in the Pediatric Hemodialysis Unit at Benha University Hospital and the Hemodialysis Unit at Benha Fever Hospital. A convenient sample of 40 nurses from the previously mentioned setting was included in the study. Two tools were used: a questionnaire sheet for assessing nurses’ personal data and knowledge about CRBSIs and EBP guidelines, and an observational checklist to assess nurses’ practice toward care of pediatric HD catheter. Results The study results showed that there was a highly statistically significant improvement in total knowledge level of nurses immediately after implementation and 6 months after implementation of education program guidelines. Moreover, there was a highly statistically significant relation in nurses’ practice and their educational level, occupation, years of experience, and attendance of training course, before implementation/immediately after implementation and 6 months after implementation. Conclusion The current study concluded that the nurses who received evidence-based guidelines educational program as regards central vascular catheter maintenance and care showed high score level in nurses’ knowledge and practice after implementation of the program than that before recommendation. The study recommended that training and continuing education of the EBP guidelines for staff nurses are important to improve care provided in the pediatric hemodialysis units.

Diagnostics, monitoring and outpatient care in children with suspected pulmonary hypertension/paediatric pulmonary hypertensive vascular disease. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK

Pulmonary hypertension (PH) is a condition of multiple aetiologies with underestimated prevalence and incidence. Indeed, despite access to modern therapies, pulmonary hypertensive vascular disease (PHVD) remains a progressive, usually life-limiting...

Providing Care Beyond the Hospital: Perspective of a Tertiary Care Hospital from a Developing Country

Neurorehabilitation is an important aspect of continuing care for neurosurgical patients with functional disability. In developing countries, where formal home nursing frequently is unavailable, ensuring care after discharge is a difficult task. Training attendants to provide nursing care is an alternate option. In this study, we compared the outcomes of patients nursed by family members versus those looked after by a professional nurse. This was a retrospective observational study conducted at the Aga Khan University Hospital Karachi. The study consisted of 2 groups. Group 1 (consisting of patients cared for by a professional nurse) included 94 patients and group 2 (patients cared for by family members) included 102. All these patients had activity of daily living score of ≥3. Glasgow Outcomes Scale score, time to decannulation, development/worsening of bedsores, and mortality were recorded and compared between the groups at follow-up. The study included 196 patients. Traumatic brain injury was the most common diagnosis. Nursing requirements were similar between the 2 groups and included tracheostomy care, percutaneous endoscopic gastrostomy tube care, peripherally inserted central catheter line care, care of patients with no bone flap, and log-rolling. The outcomes of the 2 groups were comparable and included bedsore development/worsening of grade, Glasgow Outcomes Scale score at follow-up, time to decannulation, and 30-day mortality. There was no statistically significant difference in outcomes of patients nursed by family members compared with the patients looked after by professional nurses.

SLUG Bug: Quality Improvement With Orchestrated Testing Leads to NICU CLABSI Reduction.

Reduce central line-associated bloodstream infection (CLABSI) rates 15% over 12 months in children's hospital NICUs. Use orchestrated testing as an approach to identify important CLABSI prevention practices. Literature review, expert opinion, and benchmarking were used to develop clinical practice recommendations for central line care. Four existing CLABSI prevention strategies (tubing change technique, hub care monitoring, central venous catheter access limitation, and central venous catheter removal monitoring) were identified for study. We compared the change in CLABSI rates from baseline throughout the study period in 17 participating centers. Using orchestrated testing, centers were then placed into 1 of 8 test groups to identify which prevention practices had the greatest impact on CLABSI reduction. CLABSI rates decreased by 19.28% from 1.333 to 1.076 per 1000 line-days. Six of the 8 test groups and 14 of the 17 centers had decreased infection rates; 16 of the 17 centers achieved >75% compliance with process measures. Hub scrub compliance monitoring, when used in combination with sterile tubing change, decreased CLABSI rates by 1.25 per 1000 line-days. This multicenter improvement collaborative achieved a decrease in CLABSI rates. Orchestrated testing identified infection prevention practices that contribute to reductions in infection rates. Sterile tubing change in combination with hub scrub compliance monitoring should be considered in CLABSI reduction efforts.

Reduction in Inpatient Central Line Associated Blood Stream Infection Post Implementation of Bundled Care Measures in Patients with Benign and Malignant Hematological Conditions in a Single Pediatric Institution

Background:Central line associated blood stream infections (CLABSIs) are a significant source of morbidity, mortality and cost for pediatric hematology/oncology patients. In response to increasing CLABSI rates, the Hematology/Oncology division at Primary Children's Hospital (PCH) initiated a quality improvement project to reduce CLABSIs in January 2011. This effort included participation in the Children's Hospital Association (CHA) quality improvement initiative targeted at reducing CLABSIs in hematology/oncology patients from 2011 through 2015, implementation of best practice central line maintenance bundles, and ongoing monitoring of staff adherence to the maintenance care bundles.Objective:The objective of this study was to study the relationship and impact of implementation of a comprehensive central line care quality improvement program on CLABSI rates and bloodstream pathogens in children admitted to our hospital with benign and malignant hematological conditions.Methods:We retrospectively identified CLABSIs in children with a hematology/oncology diagnosis admitted to the 32 bed immunocompromised unit at Primary Children's Hospital from January 2006 through July 2015. We used the National Health Safety Network and Center for Disease Control's definition for CLABSI. The pre-intervention period was from January 2006 through December 2010. The post-intervention period was from January 2011 through July 2015. We calculated CLABSI events per 1000 line days for both the pre- and post-intervention groups. In January 2011, our hospital implemented a central line quality improvement initiative, which includedCDC-based guidelines on: daily central line assessment, hand hygiene, sterile/non-sterile gloves and mask depending on procedure, specific central line site care protocols with scrub and dressing change schedule, specific hub/cap/tubing care and parental fluid/medication administration.Results:More than 75% of CLABSIs in hospitalized children with a hematology/oncology diagnosis, in both the pre- and post-intervention periods occurred in patients with benign and malignant hematological conditions. From 2006-2010, there were 156 infections [4.84/1,000 line days (32,229 line days)] documented in hospitalized hematology/oncology patients of which 123 infections were in patients with any hematological condition. This decreased to 80 infections [2.86/1,000 line days (28,003 line days)] in all hospitalized hematology/oncology patients, and to 65 in patients with any hematological conditions from 2010-2015 (Fig 1). Viridans group Streptococci was the leading cause of CLABSIs in both pre- and post-intervention periods (27% and 20%, respectively), but we observed post-intervention notable decreases among Viridans group Streptococci, coagulase-negative Staphylococci, and Candida species. Gram negative and Enterococcus spp. infections appeared to remain similar in the pre- and post-intervention period (Fig 2).Conclusion:In both pre- and post-implementation periods, patients with benign and malignant hematological conditions comprise the majority (75%) of all hematology/oncology patients who experience CLABSI events.After implementation of a central line care quality improvement initiative in 2011, CLABSI events decreased among all hematology/oncology patients, with apparent decreases noted in infections involving Viridans group Streptococci, coagulase-negative Staphylococci and Candida spp. It appears as though CLABSIs due to organisms common to the lower gastrointestinal tract, i.e. gram negative organisms and Enterococcus spp., were similar in both study periods. This may indicate that infections involving these organisms may be less amenable to reduction with current best practice central line maintenance care bundles. Continuing to evaluate these data will not only further our understanding of CLABSIs in patients with benign and malignant hematological conditions but also bloodstream infections (BSI) in general in the hematology/oncology population. This information will guide ongoing refinements of interventions to reduce BSI in this population. [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.