Burden of bloodstream infections among ambulatory pediatric hematology/oncology patients with a central line.

262 Background: Pediatric hematology/oncology (PHO) patients are at high risk of bloodstream infections (BSI). The burden of BSI in PHO patients in the ambulatory setting has not been well documented. Methods: The Children’s Hospital Association leads the Childhood Cancer and Blood Disorders Network, a multicenter United States quality improvement collaborative, working to reduce the incidence of inpatient and ambulatory Central Line-Associated BSI (CLABSI) among PHO patients. Positive blood culture events (+BCE) were adjudicated as CLABSI, single positive blood cultures (SPBC) with potential commensals, or secondary BSI (attributed to source other than the central line) following standardized National Healthcare Safety Network definitions. Our study investigated the prevalence of +BCE among all centers with 90% complete monthly reporting of both +BCE and central line days (CLD) for at least one year (n=25) between January 2012 and September 2014. Ambulatory and inpatient BSI rates and 95% confidence intervals (CI) were calculated as the number of +BCE per 1,000 CLD per month. Results: A total of 1,747 +BCE and 4,883,413 CLD were reported among our target ambulatory population, whereas 1,095 +BCE and 353,259 CLD were reported among our corresponding inpatient population [Table]. While the CLABSI and SPBC rates were significantly lower in the ambulatory setting compared to inpatient (p<0.001), the total number of ambulatory CLABSI and SPBC events was 2.0 and 1.6 times higher than inpatient events, respectively. Conclusions: Our findings from a large multicenter collaborative demonstrate the burden of BSI among ambulatory PHO patients and identify benchmarks for future quality improvement work.Further investigation is necessary to develop effective infection reduction strategies for ambulatory PHO patients with central lines. [Table: see text]

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Quality Improvement to Reduce Neonatal CLABSI: The Journey to Zero

American Journal of Perinatology ◽

10.1055/s-0040-1713605 ◽

2020 ◽

Vol 37 (S 02) ◽

pp. S14-S17

Author(s):

Stephen A. Pearlman

Keyword(s):

Quality Improvement ◽

Central Venous Access ◽

Bloodstream Infections ◽

Venous Access ◽

Central Line ◽

Central Lines ◽

The Past ◽

Healthcare Improvement ◽

Key Points ◽

Innovative Techniques

Neonatal infections, including those associated with central lines, continue to be a major cause of morbidity and mortality despite many other improvements in neonatal outcomes. Over the past decades, significant advances have been made to reduce central line-associated bloodstream infections (CLABSIs) using quality improvement methodology. This article will review pertinent studies that used both the Institute for Healthcare Improvement Model for Improvement and other innovative techniques such as orchestrated testing and health care failure mode and effects analysis. These studies, by applying best practices, have demonstrated substantial and sustainable reductions in CLABSI. Some initiatives have been able to achieve rates of zero CLABSI for prolonged periods of time. While neonates often require prolonged central venous access and suffer from impaired immunity which increases the risk of CLABSI, this review demonstrates the journey to zero is feasible. Key Points

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Alcohol-impregnated caps and ambulatory central-line–associated bloodstream infections (CLABSIs): A randomized clinical trial

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.467 ◽

2020 ◽

pp. 1-9

Author(s):

Aaron M. Milstone ◽

Carol Rosenberg ◽

Gayane Yenokyan ◽

Danielle W. Koontz ◽

Marlene R. Miller ◽

...

Keyword(s):

Clinical Trial ◽

Isopropyl Alcohol ◽

Bloodstream Infections ◽

Venous Catheter ◽

Central Line ◽

Ambulatory Setting ◽

Oncology Patients ◽

Pediatric Hematology ◽

Standard Practices ◽

The Impact

Abstract Objective: To evaluate the effect of 70% isopropyl alcohol–impregnated central venous catheter caps on ambulatory central-line–associated bloodstream infections (CLABSIs) in pediatric hematology-oncology patients. Design: This study was a 24-month, cluster-randomized, 2 period, crossover clinical trial. Setting: The study was conducted in 15 pediatric healthcare institutions, including 16 pediatric hematology-oncology clinics. Participants: All patients with an external central line followed at 1 of the 16 hematology-oncology clinics. Intervention: Usual ambulatory central-line care per each institution using 70% isopropyl alcohol–impregnated caps at home compared to usual ambulatory central-line care in each institution without using 70% isopropyl alcohol–impregnated caps. Results: Of the 16 participating clinics, 15 clinics completed both assignment periods. As assigned, there was no reduction in CLABSI incidence in clinics using 70% isopropyl alcohol–impregnated caps (1.23 per 1,000 days) compared with standard practices (1.38 per 1,000 days; adjusted incidence rate ratio [aIRR], 0.83; 95% CI, 0.63–1.11). In the per-protocol population, there was a reduction in positive blood culture incidence in clinics using 70% isopropyl alcohol-impregnated caps (1.51 per 1,000 days) compared with standard practices (1.88 per 1,000 days; aIRR, 0.72; 95% CI, 0.52–0.99). No adverse events were reported. Conclusions: Isopropyl alcohol–impregnated central-line caps did not lead to a statistically significant reduction in CLABSI rates in ambulatory hematology-oncology patients. In the per-protocol analysis, there was a statistically significant decrease in positive blood cultures. Larger trials are needed to elucidate the impact of 70% isopropyl alcohol–impregnated caps in the ambulatory setting. Registration: ClinicalTrials.gov; NCT02351258

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A Prospective, Holistic, Multicenter Approach to Tracking and Understanding Bloodstream Infections in Pediatric Hematology-Oncology Patients

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2017.57 ◽

2017 ◽

Vol 38 (06) ◽

pp. 690-696 ◽

Cited By ~ 12

Author(s):

Aditya H. Gaur ◽

David G. Bundy ◽

Eric J. Werner ◽

Jeffrey D. Hord ◽

Marlene R. Miller ◽

...

Keyword(s):

Healthcare Providers ◽

Bloodstream Infections ◽

The United States ◽

Central Line ◽

Mucosal Barrier ◽

Care Bundle ◽

Patient Centered ◽

Pediatric Hematology ◽

Single Positive ◽

Definition Of

OBJECTIVE To assess the burden of bloodstream infections (BSIs) among pediatric hematology-oncology (PHO) inpatients, to propose a comprehensive, all-BSI tracking approach, and to discuss how such an approach helps better inform within-center and across-center differences in CLABSI rate DESIGN Prospective cohort study SETTING US multicenter, quality-improvement, BSI prevention network PARTICIPANTS PHO centers across the United States who agreed to follow a standardized central-line–maintenance care bundle and track all BSI events and central-line days every month. METHODS Infections were categorized as CLABSI (stratified by mucosal barrier injury–related, laboratory-confirmed BSI [MBI-LCBI] versus non–MBI-LCBI) and secondary BSI, using National Healthcare Safety Network (NHSN) definitions. Single positive blood cultures (SPBCs) with NHSN defined common commensals were also tracked. RESULTS Between 2013 and 2015, 34 PHO centers reported 1,110 BSIs. Among them, 708 (63.8%) were CLABSIs, 170 (15.3%) were secondary BSIs, and 232 (20.9%) were SPBCs. Most SPBCs (75%) occurred in patients with profound neutropenia; 22% of SPBCs were viridans group streptococci. Among the CLABSIs, 51% were MBI-LCBI. Excluding SPBCs, CLABSI rates were higher (88% vs 77%) and secondary BSI rates were lower (12% vs 23%) after the NHSN updated the definition of secondary BSI (P<.001). Preliminary analyses showed across-center differences in CLABSI versus secondary BSI and between SPBC and CLABSI versus non-CLABSI rates. CONCLUSIONS Tracking all BSIs, not just CLABSIs in PHO patients, is a patient-centered, clinically relevant approach that could help better assess across-center and within-center differences in infection rates, including CLABSI. This approach enables informed decision making by healthcare providers, payors, and the public. Infect Control Hosp Epidemiol 2017;38:690–696

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Reduction of Central-Line–Associated Bloodstream Infections in a Spinal Cord Injury Unit

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.998 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s370-s370

Author(s):

Stephanie L. Baer ◽

Amy Halcyon Larsh ◽

Annalise Prunier ◽

Victoria Thurmond ◽

Donna Goins ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Patient Population ◽

Bloodstream Infections ◽

Central Line ◽

Fiscal Year ◽

Improvement Project ◽

Central Lines ◽

Cord Injury ◽

Bundle Compliance

Background: Central-line–associated bloodstream infections (CLABSIs) are a complication of indwelling central venous catheters, which increase morbidity, mortality, and cost to patients. Objective: Due to increased rates in a spinal cord injury unit (SCIU), a performance improvement project was started to reduce CLABSI in the patient population. Methods: To reduce the incidence of CLABSI, a prevention bundle was adopted, and a peer-surveillance tool was developed to monitor compliance with the bundle. Staff were trained to monitor their peers and submit weekly surveillance. Audits were conducted by the clinical nurse leader with accuracy feedback. Bundle peer-surveillance was implemented in February of 2018 with data being fed back to leadership, peer monitors, and stakeholders. Gaps in compliance were addressed with peer-to-peer education, changes in documentation requirements, and meetings to improve communication and reduce line days. In addition, the use of an antiseptic-impregnated disc for vascular accesses was implemented for dressing changes. Further quality improvement cycles during the first 2 quarters of fiscal year 2019 included service-wide education reinforcement, identification in variance of practice, and reporting to staff and stakeholders. Results: CLABSI bundle compliance increased from 67% to 98% between February and October 2018. The weekly audit reporting accuracy improved from 33% to 100% during the same period. Bundle compliance was sustained through the fourth quarter of 2019 at 98%, and audit accuracy was 99%. The initial CLABSI rates the quarter prior to the intervention were 6.10 infections per 1,000 line days for 1 of the 3 SCIUs and 2.68 infections per 1,000 line days for the service overall. After the action plan was initiated, no CLABSIs occurred for the next 3 quarters in all SCIUs despite unchanged use of central lines (5,726 line days in 2018). The improvement was sustained, and the line days decreased slightly for 2019, with a fiscal year rate of 0.61 per 1,000 line days (ie, 3 CLABSIs in 4,927 central-line days). Conclusions: The incidence of CLABSI in the SCIU was reduced by an intensive surveillance intervention to perform accurate peer monitoring of bundle compliance with weekly feedback, communication, and education strategies, improvement of the documentation, and the use of antiseptic-impregnated discs for dressings. Despite the complexity of the patient population requiring long-term central lines, the CLABSI rate was greatly impacted by evidence-based interventions coupled with reinforcement of adherence to the bundle.Funding: NoneDisclosures: None

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Central Line-associated Bloodstream Infections: A Critical Look at the Role and Research of Quality Improvement Interventions and Strategies

Annual Update in Intensive Care and Emergency Medicine - Annual Update in Intensive Care and Emergency Medicine 2015 ◽

10.1007/978-3-319-13761-2_2 ◽

2015 ◽

pp. 15-24 ◽

Cited By ~ 1

Author(s):

K. Blot ◽

D. Vogelaers ◽

S. Blot

Keyword(s):

Quality Improvement ◽

Bloodstream Infections ◽

Central Line ◽

Improvement Interventions ◽

Quality Improvement Interventions

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Analysis of Central Line–Associated Bloodstream Infections in the Intensive Care Unit after Implementation of Central Line Bundles

Infection Control and Hospital Epidemiology ◽

10.1086/652157 ◽

2010 ◽

Vol 31 (05) ◽

pp. 551-553 ◽

Cited By ~ 29

Author(s):

Emily K. Shuman ◽

Laraine L. Washer ◽

Jennifer L. Arndt ◽

Christy A. Zalewski ◽

Robert C. Hyzy ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Units ◽

Bloodstream Infections ◽

Central Line ◽

Line Bundles ◽

Blood Samples ◽

Central Lines ◽

Definition Of ◽

Contaminated Blood

Central line-associated bloodstream infections (CLABSIs) have been reduced in number but not eliminated in our intensive care units with use of central line bundles. We performed an analysis of remaining CLABSIs. Many bloodstream infections that met the definition of CLABSI had sources other than central lines or represented contaminated blood samples.

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Central Line Associated Blood Stream Infections in Pediatric Hematology/Oncology Patients With Different Types of Central Lines

Pediatric Blood & Cancer ◽

10.1002/pbc.26053 ◽

2016 ◽

Vol 63 (9) ◽

pp. 1603-1607 ◽

Cited By ~ 21

Author(s):

Jeffrey D. Hord ◽

John Lawlor ◽

Eric Werner ◽

Amy L. Billett ◽

David G. Bundy ◽

...

Keyword(s):

Blood Stream ◽

Central Line ◽

Oncology Patients ◽

Blood Stream Infections ◽

Central Lines ◽

Pediatric Hematology ◽

Different Types

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Reducing Central Line-Associated Bloodstream Infection in Contaminated Central Venous Catheters: Case Studies of a Pediatric Contamination Guideline

Journal of the Association for Vascular Access ◽

10.2309/java-d-20-00038 ◽

2021 ◽

Author(s):

Tracy B. Chamblee ◽

Lindsey J. Patton ◽

Virginia B. Young ◽

Jennifer Marusich ◽

Cindy D. Bowens ◽

...

Keyword(s):

Case Reports ◽

Tertiary Care ◽

Bloodstream Infections ◽

Venous Catheter ◽

Central Line ◽

Healthcare Organizations ◽

Central Venous ◽

Mortality And Morbidity ◽

Reduction Strategies ◽

Contamination Events

Highlights Abstract 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.

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