Reducing central line-associated bloodstream infection in contaminated central venous catheters: case studies of a pediatric contamination guideline
Healthcare organizations have prioritized patient safety and quality improvement efforts to reduce central line-associated bloodstream infections (CLABSIs). Implementation of central venous catheter (CVC) insertion and maintenance bundles have significantly reduced infection rates. Nevertheless, CLABSIs continue to be a significant cause of mortality and morbidity in hospitals, and further efforts are necessary to improve CVC care practices. A hospital-wide committee at a tertiary care pediatric hospital identified gaps in our CVC maintenance practices resulting from CVC contamination events from a patient's body fluids. A lack of published literature on the topic resulted in the need to create an institutional clinical practice guideline (CPG) to develop guidance to mitigate potential CLASBIs from CVC contamination. Utilization of the CVC CPG in all inpatient units and other reduction strategies resulted in a steady decline in our CLABSI rates, particularly in those related to CVC contamination events. Case reports illustrate the effectiveness of the CPG.
Central line-associated bloodstream infections (CLABSIs) continue to be a significant cause of morbidity, mortality, and increased costs for hospitalized adult and pediatric patients. Approximately 5 million central vascular catheters (CVCs) are placed in adult and pediatric patients in the United States every year, impacting approximately 8% of hospitalized patients.1,2 Although CVCs are vital to deliver intravenous (IV) medications and provide medical therapies, CVCs' placement and use are associated with a risk for developing severe and life-threatening infections, which may increase the patient's risk of morbidity and mortality.3,4 In a systematic review, Umscheid et al.5 reported that the cost of a CLABSI in the United States ranged from $21,400 to $110,800 per infection.
Research over the last decade has demonstrated reduction of CLABSIs by introducing standardized line insertion and maintenance bundles.6,7,8,9 Implementing evidence-based bundles estimated prevention of 65% to 70% of CLABSIs.5 In addition to the use of standardized insertion and maintenance bundles described above, our hospital CLABSI Prevention Committee implemented additional practices aimed at ensuring the integrity of the CVC system, such as limiting the frequency of CVC access and limiting interruptions of the CVC system. However, further progress in reducing CLABSI rates has proved challenging, and our hospital's CLASBI reduction efforts mirrored the national trend.6,7 Along with published recommendations from the Centers for Disease Control and Prevention, the Children's Hospital Association collaborative identified aspects of CVC care that could reduce infection risk. Such aspects were creating standard bundles for CVC insertion and CVC maintenance and practices to protect the integrity of the CVC system, such as placing occlusive CVC dressings over the insertion site and limiting the frequency of CVC access.
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