Intervention leads to reduction in central venous catheter-associated blood stream infections for pediatric patients
Research Activities, November 2009
Severely ill children in pediatric intensive care units (ICUs) often have central venous catheters (CVCs), thin flexible tubes inserted into the chest or arm to deliver medicine, fluids, nutrients, or blood products to aid recovery. Many caregivers in pediatric ICUs view CVC-associated blood stream infections (BSIs) as unavoidable byproducts of providing care to critically ill or injured children. However, a new study conducted at a collaborative of 26 hospitals found a 32 percent reduction in CVC-associated BSIs when care providers followed evidence-based guidelines for inserting and maintaining CVCs in pediatric ICUs. These guidelines include having care providers prepare the patient's skin with antiseptic, washing their hands thoroughly, and donning protective barriers, such as gloves, gowns, and masks to prevent infections.
After implementing the guidelines for 9 months, the hospitals saw a median reduction in CVC-associated BSIs from 6.3 to 4.3 per 1,000 CVC days. Further, researchers estimated that taking these measures prevented 69 CVC-associated BSIs for a cost savings of nearly $3 million in hospital and health care costs. For the 20 hospitals that completed an additional 12-month sustainment period, the median reduction dipped to 3.5 CVC-associated BSIs per 1,000 CVC days. Additionally, the measures prevented 198 infections for a cost savings of nearly $8.5 million. While other studies have shown that CVC-associated BSIs may be preventable in adult populations when evidence-based guidelines are deployed, this is the first study to show significant and sustained reductions of these infections for children in ICUs.
The authors also noted that a culture change may have occurred as a result of this study's success in that some hospital teams shifted toward a zero tolerance of these infections instead of viewing them as inescapable realities in ICUs. This study was funded in part by the Agency for Healthcare Research and Quality (HS13698). See “Prevention of central venous catheter-associated bloodstream infections in pediatric intensive care units: A performance improvement collective,” by Howard E. Jeffries, M.D., M.B.A., M.P.H., Wilbert Mason, M.D., M.P.H., Melanie Brewer, D.N.Sc., and others in the July 2009 Infection Control and Hospital Epidemiology 30(7), pp. 645-651.