Central Line Maintenance Bundles Research Articles

The evaluation of Candida-related central line-related bloodstream infections in pediatric cancer patients: A pre- and post-intervention study.

The purpose of this study was to assess the efficacy of a central line maintenance bundle in preventing catheter-related (implanted venous access devices, port) Candida bloodstream infections. The study encompassed two distinct time periods, namely, pre-bundle and bundle. The number of catheter-related bloodstream infections (CRBSI) episodes per catheter days for each timeframe was determined. Upon implementation of the central line bundle, the rate of CRBSI reduced significantly from 4.27 per 1000 central line days in the pre-bundle period to 1.0 per 1000 central line days in the bundle period (p < .001). Using a central line bundle to avoid CRBSIs in pediatric cancer patients with ports led to a significant decrease in Candida species-related CRBSIs.

Compliance With Central Line Maintenance Bundle and Infection Rates.

Reliable bundle performance is the mainstay of central line-associated bloodstream infections (CLABSI) prevention despite an unclear relationship between bundle reliability and outcomes. Our primary objective was to evaluate the correlation between reported bundle compliance and CLABSI rate in the Solutions for Patient Safety network. The secondary objective was to identify which hospital and process factors impact this correlation. We examined data on bundle compliance and monthly CLABSI rates from January 11 to December 21 in 159 hospitals. The correlation (adjusting for temporal trend) between CLABSI rates and bundle compliance was done at the network level. Negative binomial regression was done to detect the impact of hospital type, central line audit rate, and adoption of a comprehensive safety culture program on the association between bundle compliance and CLABSI rates. During the study, hospitals reported 27 196 CLABSI on 20 274 565 line days (1.34 CLABSI/1000 line days). Out of 2 460 133 observed bundle opportunities, 2 085 700 (84%) were compliant. There was a negative correlation between the monthly bundle reliability and monthly CLABSI rate (-0.35, P <.001). After adjusting for the temporal trend, the partial correlation was -0.25 (P = .004). On negative binomial regression, significant positive interaction was only noted for the hospital type, with Hospital Within Hospital (but not freestanding children's hospitals) revealing a significant association between compliance ≥95% and lower CLABSI rates. Adherence to best practice guidelines is associated with a reduction in CLABSI rate. Hospital-level factors (hospitals within hospitals vs freestanding), but not process-related (central line audit rate and safety culture training), impact this association.

Increasing Compliance with the Central Line Maintenance Bundle via Nurse Led Observations

Increasing Compliance with the Central Line Maintenance Bundle via Nurse Led Observations

Strength in numbers: Utilization of an innovative electronic audit to enhance the completion of central line maintenance audits

Healthcare systems use auditing processes to monitor compliance with evidence-based practices. The auditing process for a bundle targeting central line-associated bloodstream infectionprevention at a large children's hospital was suboptimal. The purpose of this project was to implement a revised audit and feedback data collection process. The specific aims of the project were to evaluate(1) the number of completed audits and, (2) central line maintenance bundle compliance rates before and after implementing a new process. An innovative, electronic audit process was developed to allow data entry in real-time as central line-associated bloodstream infection prevention champions conducted audits. Data were fed into a robust electronic dashboard, allowing units to readily visualize their performance. Data was analyzed over a 52-month period (26 months pre- and post-implementation). The number of central line maintenance bundle audits significantly increased post-implementation from an average of 36 to 64 per month, P=.001. Central line maintenance bundle compliance scores also increased from an average compliance score of 76.3% to 89.3%, P=.001. Special cause variation was also noted in the statistical process control charts. This project demonstrated the effectiveness of using an electronic process to capture audit data to assist with quality improvement efforts. Other institutions may consider implementing a similar electronic audit process to capture infection prevention compliance data.

Nurses' Perceptions of Adherence to the Central Line Maintenance Bundle: Linkages to Thoughts, Emotions, and Behavior.

The U.S. Centers for Disease Control established the central line maintenance care bundle in 2011, yet nurses' adherence to all seven components remains challenging. The specific aim of this study was to explore and understand intensive care nurses' perceptions and beliefs regarding central line maintenance, bundle care elements, and associated adherence. This qualitative study used a phenomenological approach. Three main themes emerged as follows: (1) thoughts about the ability to adhere to the central line bundle created feelings about central line maintenance care, (2) feelings about the nurses' ability to adhere to the central line bundle influenced behaviors, and (3) behaviors for central line bundle adherence reinforced thoughts. Each theme had several subthemes. Organizations must assess and mitigate the unique cognitive and behavioral factors that affect nurses' adherence to the central line-associated bloodstream infection (CLABSI) maintenance bundle. In addition, nursing adherence requires knowledge of CLABSI rates and direct care nurse involvement in identifying solutions.

Impact of Training on Central Line Associated Blood Stream Infection Maintenance Bundle on Central Line Associated Blood Stream Infection Rates - A Retro-prospective Study in a Selected Hospital, Hyderabad

Background: Central line-associated bloodstream infections (CLABSI) are a very common cause of healthcare-associated infections (HAI). CLABSIs will not only increase mortality and morbidity but also increases length of stay (LOS) and financial burden to ICU patients. Infection control practices play a major role in preventing CLABSI. Research indicates that quality improvement initiatives have helped in reducing CLABSI rates. CLABSI rates have been successfully reduced in ICU settings however, there is still significant variability in practice due to poor adherence to evidence-based CLABSI maintenance bundle components. However, nurses frequently struggle to follow evidence-based preventive practices, thus it is necessary to understand better the behavioral influences on implementing CLABSI prevention measures. Additionally, it has been emphasized that implementation studies must consider or quantify the potential impact on CLABSI rates. Before taking up the study, we have noticed increase in CLABSI rates for 1month Period, for which the Retrospective data was collected and analyzed to understand the gaps to implement CLABSI maintenance bundle components. Therefore, this study helped us identifying gaps in maintenance bundle and observed infections rates before and after study Aim: To evaluate the effect of central line (CL) bundle compliance on central line-associated bloodstream infections (CLABSIs) To evaluate the knowledge and practices of physicians and nurses working in all ICUs and wards regarding the components of central line maintenance bundles (ref table I) Design: Used a retro prospective study, to reduce the CLABSI rates and to increase awareness on maintenance bundle components in intensive care units (ICU) and wards. we have initiated a structured training program to all nurses and doctors. Two tools were prepared. one is to assess the knowledge of nurses and doctors working in ICUs and wards on CLABSI. The second tool consists of components related to central line maintenance bundle to evaluate the effectiveness in reducing incidence of CLABSI. A total 489 Registered nurses and 10 intensivists and 15 ward doctors were included in the current study. Phase I was the pre-interventional period during this period audits were conducted, we observed lacunae in implementing CLABSI Maintenance bundle. Phase II was the intervention period lasting for 2 month, during this period, the entire nursing staff and doctors working in ICUs and Wards underwent a continuous teaching and training. Phase III was the post-intervention period- In this period questionnaire was given in September and again in December. This was to check for the impact of training on knowledge and awareness level which will further lead better implementation of the practices. Observed CLABSI rate reduced from17.2. to 6.8 per 1000 central line days. Result: Knowledge assessment- Comparison data between June 2021 and September 2021 mean knowledge score significantly higher in September (9.1) than June (6.4) .similarly, December (9.9) score significantly higher than June and September to determine the difference between the mean of various observations in the pre and post intervention period with 95% confidence interval, the difference in the knowledge level and CLABSI rate in the pre and post intervention period was found significant(p&lt;0.001) .During this 6 months period(July 2021 to December 2021) there were a total of 1120 patients on central lines, for all the patients line care was observed after implementation of structured training programme. The rate of CLABSI significantly declined from 17.2 per 1000 catheter days to 6.8 per 1000 catheter days. Conclusion: This study clearly indicated that the educational interventions in structured formats are imperative when imparting trainings in Infection control practices and should be implemented frequently to bridge the gap between knowledge and practice. With the dynamics of infection control and the challenges faced in its implementation continuing this type of trainings will ensure all use evidence-based interventions. Recommendations: Continues Training program should be carried out for nurses and doctors related to implementation of CLABSI Bundle. Keywords: CLABSI, Catheter hub care, Hand hygiene, Training, Maintenance bundle, Teaching, Implementing, Structured program.

Implementation of Evidence-based Maintenance Bundles to Reduce Central Line-Associated Bloodstream Infection (CLABSI) and Catheter-Associated Urinary Tract Infection (CAUTI) Rates

Background In 2021, an increase in central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) rates was observed at an academic medical center. CLABSI and CAUTI have a significant impact on patient outcomes including mortality, length of stay, and healthcare costs. Reduction of CLABSI and CAUTI incidence can be achieved through implementation of standardized, evidence-based maintenance bundles for central lines and foley catheters. Methods A multidisciplinary team began meeting weekly in July 2021 to review CLABSI and CAUTI rates, insertion and maintenance practices, product utilization, and education initiatives. Standardized central line and foley catheter maintenance bundles were developed based on current infection prevention evidence-based guidelines. In August 2021, the maintenance bundles were implemented on every unit and education was provided to nursing unit leaders and staff by the infection prevention department. The maintenance bundles are maintained through daily audits by nursing unit leaders and weekly validation audits by the infection prevention department. Observations from the weekly validation audits are documented and reviewed on a weekly basis by the multidisciplinary team and influence ongoing education topics. Results Between August and November 2021, a 4% reduction in CLABSI rate (2.2 per 1,000 device days) and a 19% reduction in CAUTI rate (2.9 per 1,000 device days) was observed compared to the baseline period. The central line maintenance bundle compliance increased by 21% from August to November with a maximum monthly compliance of 84%. The foley catheter maintenance bundle compliance increased by 23% with a maximum monthly compliance of 79% during the same time period. Conclusions A standardized, evidence-based maintenance bundle for central lines and foley catheters contributes to the reduction of CLABSI and CAUTI rates. Continuous monitoring and validation of the maintenance bundles provides guidance, accountability, and feedback for staff and highlights issues and trends that can be addressed through education. In 2021, an increase in central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) rates was observed at an academic medical center. CLABSI and CAUTI have a significant impact on patient outcomes including mortality, length of stay, and healthcare costs. Reduction of CLABSI and CAUTI incidence can be achieved through implementation of standardized, evidence-based maintenance bundles for central lines and foley catheters. A multidisciplinary team began meeting weekly in July 2021 to review CLABSI and CAUTI rates, insertion and maintenance practices, product utilization, and education initiatives. Standardized central line and foley catheter maintenance bundles were developed based on current infection prevention evidence-based guidelines. In August 2021, the maintenance bundles were implemented on every unit and education was provided to nursing unit leaders and staff by the infection prevention department. The maintenance bundles are maintained through daily audits by nursing unit leaders and weekly validation audits by the infection prevention department. Observations from the weekly validation audits are documented and reviewed on a weekly basis by the multidisciplinary team and influence ongoing education topics. Between August and November 2021, a 4% reduction in CLABSI rate (2.2 per 1,000 device days) and a 19% reduction in CAUTI rate (2.9 per 1,000 device days) was observed compared to the baseline period. The central line maintenance bundle compliance increased by 21% from August to November with a maximum monthly compliance of 84%. The foley catheter maintenance bundle compliance increased by 23% with a maximum monthly compliance of 79% during the same time period. A standardized, evidence-based maintenance bundle for central lines and foley catheters contributes to the reduction of CLABSI and CAUTI rates. Continuous monitoring and validation of the maintenance bundles provides guidance, accountability, and feedback for staff and highlights issues and trends that can be addressed through education.

A Quality Improvement Initiative to Increase Central Line Maintenance Bundle Compliance through Nursing-led Rounds

Introduction:Improvements in maintenance bundle compliance around central line-associated bloodstream infections (CLABSIs) lack standardization. The objective was to implement a formalized nursing-led rounding process, Rounds for Influence, with a goal of 12 rounds/wk on each inpatient unit and Ambulatory Infusion Center, achieving > 90% maintenance bundle compliance.Methods:Nurses served as peer “influencers” to perform rounds. The CLABSI prevention team created three comprehensive rounding tools (line access, dressing change/port needle insertion, and cap change) on a digital platform. The team designed these tools to assess clinical competence for maintenance bundle components and implemented nine plan-do-study-act cycles throughout the study period.Results:Influencers completed 191 rounds after the first month of implementation, resulting in a 264.2% increase from the baseline of 52.5 rounds per month. Over the 2.5 years postimplementation, rounds resulted in 7836 total observations. Maintenance bundle compliance decreased from 86.9% (centerline value from November 2017 to September 2018) to 40.8% after the first month of implementation. Compliance increased iteratively (two separate centerline shifts) to a current centerline value of 87.1%. The CLABSI 12-month cumulative standardized infection ratio (SIR) was 0.9 in November 2017 and dropped to 0.53 in June 2021.Conclusion:Implementing a formalized nursing-led rounding process led to increased maintenance bundle compliance, decreased CLABSI SIR, and is an integral part of nursing practice. Given this success, there is interest from other hospital-acquired condition improvement teams in applying this rounding practice to their improvement work.

The Compliance of Healthcare Providers to Care Bundles in a Tertiary Hospital in Riyadh Region

This study aimed to describe the compliance rate of healthcare providers to care bundles in a tertiary hospital in Riyadh Region. The overall compliance rate of hand hygiene was low (less than 80%). The overall compliance rates of urinary catheter bundle, central line insertion bundle, and central line maintenance bundle were high (more than 95 %). The compliance rate to SSI bundle, ventilator bundle, safe injection practice, and using personal protective equipment was high. It is important to increase the compliance rate of the care bundles elements to 95 percent or greater, particularly the compliance to hand hygiene to improve patient care.

505. Use of CLABSI Prevention Bundle Audits to Decrease CLABSI Rates in COVID Positive ICU Patients in an Acute Care Hospital in New York City During the COVID-19 Epidemic

BackgroundMount Sinai Beth Israel (MSBI) is a 220 bed acute care hospital located in the Manhattan borough of Manhattan in New York City. Prior to COVID-19, the hospital had one 16-bed Medical/Surgical ICU. When the COVID epidemic struck New York City, the MSBI ED was flooded with critically ill patients requiring ICU care. Seven other ICUs were opened, all of which were filled with COVID patients. The majority of these patients required central lines for the multiple antibiotics, steroids, and vasopressors they needed to survive. Agency RNs were brought in to care for ICU patients. In April, the MSBI Infection Prevention (IP) department received several CLABSI notifications through its data mining system. The IPs were alarmed at the number of CLABSIs occurring in ICU COVID patients with central lines.ICU CLABSI Rates in an Acute Care Hospital During the COVID-19 Epidemic in New York City MethodsA baseline assessment, using the central line maintenance bundle, was conducted on all COVID patients with central lines. This assessment revealed issues with central line maintenance, including: undated, bloody, and non-intact dressings, poorly placed CHG impregnated disks; blood in end-caps, and missing alcohol impregnated caps on ports. The decision was made to bring in infusion RNs from an outpatient system site to perform daily rounds on central lines. These RNs performed daily intensive maintenance bundle rounds for a month during the COVID epidemic. During their rounds, ICU nurses and managers were notified of central line dressing and cap issues and educated on how to correct them. These RNs also e-mailed daily reports of their findings to Nursing Leadership for their review.Central Line Audit Team: RNs Who Monitored Central Lines in COVID ICUs in An Acute Care Hospital in NYC Central Line Audit Team: RNs Who Monitored Central Lines in COVID ICUs in An Acute Care Hospital in NYCResultsCentral line rounds performed after the intervention showed a great improvement in compliance with the central line maintenance bundle, from 13% during the first rounds performed in April, to 88% in May, less than a month after these rounds started. Since this intervention, the ICU CLABSI rate has decreased from a rate of 3.3 per 1,000 central line days in April and May to a current rate of 0.ConclusionThe timely identification and root cause analysis of a problem must be followed by timely, intensive, and repeated interventions that are designed to attack the causes of problems at their source. After the crisis period is over, the interventions must be maintained to ensure that gains made can be sustained.Disclosures All Authors: No reported disclosures

Effects of a Care Package on the Shelf Life and Incidence of the Infection of Central Peripheral Venous Catheter in the Premature Infants Admitted to the NICU

Background: Neonates require continuous and reliable intravenous routes to receive fluids, intravenous nutrition, and medications; accordingly, repeated interventions are essential to implant these routes. Percutaneous catheterization is a technology used for this purpose. Considering that central line infections are a major concern in neonatal intensive care units (NICUs), the present study aimed to assess the effects of using a care package on the incidence of infections and shelf life of peripheral central catheterization in the premature infants admitted to the NICU. Methods: This quasi-experimental study was a process assessment research conducted on 131 premature catheterized infants who were admitted to the NICU of Mofid Children’s Hospital affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran, in 2019. The study sample included 131 neonates who met the inclusion criteria. The neonates were enrolled in the study at two levels, including 53 subjects in the first four months before the intervention, and 78 in the second four months after application of the care package. The infants were selected via the convenience sampling method. Data were collected using the central line maintenance bundle and central line maintenance bundle daily checklists. The catheter insertion method and the degree of catheter tip infection were evaluated before and after the protocol training program for the nurses. The results of catheter tip culture after removal were considered as the training outcomes. Data analysis was performed in SPSS V. 16, using descriptive statistics, independent t test, the Fisher exact test, and the chi-squared test. Results: The results of the catheter tip culture confirmed the presence of pathogens in the catheter and culture of 18 samples (34%), before the intervention, while a reduction was denoted in 14 samples (17.9%) after the intervention; the reduction was statistically significant (P=0.036). Furthermore, the shelf life of the catheter increased after the intervention, however, the difference was not significant. Conclusion: According to the results, applying the care package reduces the incidence of central peripheral venous catheter infection in neonates admitted to the NICU. Therefore, it is suggested to incorporate this package into the care instructions of neonatal wards.

Does Nursing Shift Influence Adherence to Central-Line Maintenance Bundles?

Background: Proper care and maintenance of central lines is essential to prevent central-line–associated bloodstream infections (CLABSI). Our facility implemented a hospital-wide central-line maintenance bundle based on CLABSI prevention guidelines. The objective of this study was to determine whether maintenance bundle adherence was influenced by nursing shift or the day of week. Methods: A central-line maintenance bundle was implemented in April 2018 at a 1,266-bed academic medical center. The maintenance bundle components included alcohol-impregnated disinfection caps on all ports and infusion tubing, infusion tubing dated, dressings, not damp or soiled, no oozing at insertion site greater than the size of a quarter, dressings occlusive with all edges intact, transparent dressing change recorded within 7 days, and no gauze dressings in place for &gt;48 hours. To monitor bundle compliance, 4 non–unit-based nurse observers were trained to audit central lines. Observations were collected between August 2018 and October 2019. Observations were performed during all shifts and 7 days per week. Just-in-time feedback was provided for noncompliant central lines. Nursing shifts were defined as day (7:00 a.m. to 3:00 p.m.), evening (3:00 p.m. to 11:00 p.m.), and night (11:00 p.m. to 7:00 a.m.). Central-line bundle compliance between shifts were compared using multinomial logistic regression. Bundle compliance between week day and weekend were compared using Mantel-Haenszel 2 analysis. Results: Of the 25,902 observations collected, 11,135 (42.9%) were day-shift observations, 11,559 (44.6%) occurred on evening shift, and 3,208 (12.4%) occurred on the night shift. Overall, 22,114 (85.9%) observations occurred on a week day versus 3,788 (14.6%) on a Saturday or Sunday (median observations per day of the week, 2,570; range, 1,680–6,800). In total, 4,599 CLs (17.8%) were noncompliant with &gt;1 bundle component. The most common reasons for noncompliance were dressing not dated (n = 1,577; 44.0%) and dressings not occlusive with all edges intact (n = 1340; 37.4%). The noncompliant rates for central-line observations by shift were 12.8% (1,430 of 1,1,135) on day shift, 20.4% (2,361 of 11,559) on evening shift, and 25.2% (808 of 3,208) on night shift. Compared to day shift, evening shift (OR, 1.74; 95% CI, 1.62–1.87; P &lt; .001) and night shift (OR, 2.29; 95% CI, 2.07–2.52; P &lt; .001) were more likely to have a noncompliant central lines. Compared to a weekday, observations on weekend days were more likely to find a noncompliant central line: 914 of 3,788 (24.4%) weekend days versus 3,685 of 22,114 (16.7%) week days (P &lt; .001). Conclusions: Noncompliance with central-line maintenance bundle was more likely on evening and night shifts and during the weekends.Funding: NoneDisclosures: None

Compliant or Biased? Comparing Central Line Maintenance Bundle Compliance Data Between Unit-based and Non-unit Based Observers in an Academic Hospital

<h3>Background</h3> Appropriate maintenance of central lines (CL) is important to prevent central line-associated bloodstream infections (CLABSI). Daily assessment of CL maintenance with feedback was instituted as a CLABSI prevention effort. The objective of this study was to determine if observer bias influenced CL maintenance bundle observation compliance data. <h3>Methods</h3> We developed and implemented a maintenance bundle based on CLABSI prevention guidelines at a 1266-bed academic hospital. Observers were trained to audit CL for compliance with maintenance bundle components, including: alcohol-impregnated disinfection caps on unused CL ports and infusion tubing, dressings clean and dry, no oozing at insertion site greater than the size of a quarter, dressings occlusive and intact, transparent dressing change recorded within 7-day timeframe, and within 48 hours for gauze dressings. Observations were performed by unit based observers and non-unit based nurse observers house-wide. Bundle compliance between unit based observer and non-unit based observer was compared using Mantel-Haenszel chi-square analysis. <h3>Results</h3> Between 8/1/2018 and 11/1/2019 there were 91,068 CL observations [63,945 (70.2%) by unit-based and 27,123 (29.8%) by non-unit based observers]. Overall, 9,455 (10.4%) CL observations were non-compliant with 1 or more bundle components. 3,019 (3.3%) (14.11%)]. Unit-based observers were less likely to report CL observations that were non-compliant with 1 or more bundle components compared to non-unit based observers [3,808 (6%) vs. 5,647 (20.8%), p < 0.001]. Unit-based observers were less likely to document dressing non-compliance [2,163 (3.4%) vs. 3,586 (13.3%), p < 0.001] or alcohol-impregnated disinfection cap non-compliance [943 (1.6%) vs. 2,076 (8.5%), p < 0.001] compared to non-unit based observers. <h3>Conclusions</h3> Observer bias may impact reported compliance from unit-based observations, compared to trained external observer data. Unit-based observers may be less likely to report non-compliance with bundle components. The use of external observers should be considered to reduce potential bias, and increase confidence in the accuracy of compliance data.

From kamishibai card to key card: a family-targeted quality improvement initiative to reduce paediatric central line-associated bloodstream infections

BackgroundCentral line-associated bloodstream infections (CLABSIs) are major contributors to preventable harm in the inpatient paediatric setting. Despite multiple guidelines to reduce CLABSI, sustaining reliable central line maintenance bundle compliance remains...

Implementation of a Central Line Maintenance Bundle for Dislodgement and Infection Prevention in the NICU.

Infants in the newborn intensive care unit (NICU) often receive medications or nutritional support for extended periods. Due to the fragility of veins, central lines are often used. Adverse outcomes from central lines such as infections and line dislodgements, where the line terminates in a peripheral vessel rather than centrally, can drastically increase infant morbidity and mortality. Although evidence exists addressing the specialized needs of premature or smaller infants, there is far less evidence regarding infants that are larger, more physiologically complex, and have longer stays. Using evidence-based practice strategies, we examined the literature for central line maintenance practices specific to the NICU population and created a care maintenance bundle to reduce infection and line dislodgement rates. Furthermore, we examined implementation of this bundle. A systematic search of PubMed, Cochrane Library, and CINAHL provided evidence for a practice change for central line maintenance for our nontunneled central lines. During project implementation, infection and dislodgement rates for both tunneled and nontunneled lines were examined in order have a control and intervention group. Prior to central line maintenance bundle implementation, there were 19 total incidences of central line dislodgements and 5 central line infections (14 dislodgements and 4 infections were from nontunneled lines, 5 dislodgements and 1 infection from a tunneled line). Postintervention there were 1 total dislodgement and 4 central line infections (the dislodgement was from a nontunneled line and all infections were from tunneled lines). Although research has shown frequent, scheduled dressing changes using the chlorhexidine patch decreases infection rates, the risk of dislodgement and skin breakdown for NICU infants outweighs the potential benefit of decreased infection. Further research is needed to determine whether this central line maintenance bundle would be beneficial for tunneled central lines.

The Association of Central-Line-Associated Bloodstream Infections With Central-Line Utilization Rate and Maintenance Bundle Compliance Among Types of PICUs.

Central-line-associated bloodstream infections comprise 25% of device-associated infections. Compared with other units, PICUs demonstrate a higher central-line-associated bloodstream infections prevalence. Prior studies have not investigated the association of central-line-associated bloodstream infections prevalence, central-line utilization, or maintenance bundle compliance between specific types of PICUs. This study analyzed monthly aggregate data regarding central-line-associated bloodstream infections prevalence, central-line utilization, and maintenance bundle compliance between three types of PICUs: 1) PICUs that do not care for cardiac patients (PICU); 2) PICUs that provide care for cardiac and noncardiac patients (C/PICU); or 3) designated cardiac ICUs (CICU). The included units submitted data as part of The Children's Hospital Association PICU central-line-associated bloodstream infections collaborative from January 1, 2011, to December 31, 2013. Patients admitted to PICUs in collaborative institutions. None. The overall central-line-associated bloodstream infections prevalence was low (1.37 central-line-associated bloodstream infections events/1,000 central-line days) and decreased over the time of the study. Central-line-associated bloodstream infections prevalence was not related to the type of PICU although C/PICU tended to have a higher central-line-associated bloodstream infections prevalence (p = 0.055). CICU demonstrated a significantly higher central-line utilization ratio (p < 0.001). However, when examined on a unit level, central-line utilization was not related to the central-line-associated bloodstream infections prevalence. The central-line maintenance bundle compliance rate was not associated with central line-associated bloodstream infections prevalence in this unit-level investigation. Neither utilization rate nor compliance rate changed significantly over time in any of the types of units. Although this unit-level analysis did not demonstrate an association between central-line-associated bloodstream infections prevalence and central-line utilization and maintenance bundle compliance, optimization of both should continue, further decreasing central-line-associated bloodstream infections prevalence. In addition, investigation of patient-specific factors may aid in further central-line-associated bloodstream infections eradication.

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.

Central Line Maintenance Bundles and CLABSIs in Ambulatory Oncology Patients

Pediatric oncology patients are frequently managed with central lines as outpatients, and these lines confer significant morbidity in this immune-compromised population. We aimed to investigate whether a multidisciplinary, central line maintenance care bundle reduces central line-associated bloodstream infections (CLABSIs) and bacteremias in ambulatory pediatric oncology patients. We conducted an interrupted time-series study of a maintenance bundle concerning all areas of central line care. Each of 3 target groups (clinic staff, homecare agency nurses, and patient families) (1) received training on the bundle and its importance, (2) had their practice audited, and (3) were shown CLABSI rates through graphs, in-service training, and bulletin boards. CLABSI and bacteremia person-time incidence rates were collected for 23 months before and 24 months after beginning the intervention and were compared by using a Poisson regression model. The mean CLABSI rate decreased by 48% from 0.63 CLABSIs per 1000 central line days at baseline to 0.32 CLABSIs per 1000 central line days during the intervention period (P = .005). The mean bacteremia rate decreased by 54% from 1.27 bacteremias per 1000 central line days at baseline to 0.59 bacteremias per 1000 central line days during the intervention period (P < .001). Implementation of a multidisciplinary, central line maintenance care bundle significantly reduced CLABSI and bacteremia person-time incidence rates in ambulatory pediatric oncology patients with central lines. Further research is needed to determine if maintenance care bundles reduce ambulatory CLABSIs and bacteremia in other adult and pediatric populations.