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Rapid reduction of central line infections in hospitalized pediatric oncology patients through simple quality improvement methods.

TitleRapid reduction of central line infections in hospitalized pediatric oncology patients through simple quality improvement methods.
Publication TypeJournal Article
Year of Publication2013
AuthorsChoi, SW, Chang, L, Hanauer, DA, Shaffer-Hartman, J, Teitelbaum, D, Lewis, I, Blackwood, A, Akcasu, N, Steel, J, Christensen, J, Niedner, MF
JournalPediatr Blood Cancer
Volume60
Issue2
Pagination262-9
Date Published2013 Feb
ISSN1545-5017
KeywordsCatheter-Related Infections, Catheterization, Central Venous, Child, Cross Infection, Hematologic Neoplasms, Humans, Infection Control, Intensive Care Units, Pediatric, Quality Improvement
Abstract

BACKGROUND: Pediatric hematology-oncology (PHO) patients are at significant risk for developing central line-associated bloodstream infections (CLA-BSIs) due to their prolonged dependence on such catheters. Effective strategies to eliminate these preventable infections are urgently needed. In this study, we investigated the implementation of bundled central line maintenance practices and their effect on hospital-acquired CLA-BSIs.MATERIALS AND METHODS: CLA-BSI rates were analyzed within a single-institution's PHO unit between January 2005 and June 2011. In May 2008, a multidisciplinary quality improvement team developed techniques to improve the PHO unit's safety culture and implemented the use of catheter maintenance practices tailored to PHO patients. Data analysis was performed using time-series methods to evaluate the pre- and post-intervention effect of the practice changes.RESULTS: The pre-intervention CLA-BSI incidence was 2.92 per 1,000-patient days (PD) and coagulase-negative Staphylococcus was the most prevalent pathogen (29%). In the post-intervention period, the CLA-BSI rate decreased substantially (45%) to 1.61 per 1,000-PD (P < 0.004). Early on, blood and marrow transplant (BMT) patients had a threefold higher CLA-BSI rate compared to non-BMT patients (P < 0.033). With additional infection control countermeasures added to the bundled practices, BMT patients experienced a larger CLA-BSI rate reduction such that BMT and non-BMT CLA-BSI rates were not significantly different post-intervention.CONCLUSIONS: By adopting and effectively implementing uniform maintenance catheter care practices, learning multidisciplinary teamwork, and promoting a culture of patient safety, the CLA-BSI incidence in our study population was significantly reduced and maintained.

DOI10.1002/pbc.24187
Alternate JournalPediatr Blood Cancer
PubMed ID22522576
PubMed Central IDPMC3720122
Grant ListAI091623-01 / AI / NIAID NIH HHS / United States
K23 AI091623 / AI / NIAID NIH HHS / United States
P30 CA046592 / CA / NCI NIH HHS / United States
People: 
David Hanauer
University of Michigan Comprehensive Cancer Center at North Campus Reserach Complex
1600 Huron Parkway, Bldg 100, Rm 100 
Mailing Address: 2800 Plymouth Rd, NCRC 100-1004
Ann Arbor, MI 48109-2800 
Ph. (734) 764-8848 Fax. (734) 615-0517
Please acknowledge the Cancer Center Support Grant (P30 CA046592) when publishing manuscripts or abstracts that utilized the services of the University of Michigan's Comprehensive Cancer Center's Shared Resource: Cancer Informatics.
Suggested language: "Research reported in this [publication/press release] was supported by the National Cancer Institute of the National Institutes of Health under award number P30CA046592."

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