Standardized central line care practices reduce bloodstream infections

1. From November 2009 to August 2012, 32 institutions participated in a multicenter collaborative utilizing a standardized central line (CL) maintenance care bundle for pediatric hematology/oncology patients. Compliance rates reached 79% by the end of the first year and ranged from 81-86% for the remainder of the study.

2. CL-associated bloodstream infection rates decreased by 28% at 34 months of implementing the standardized CL maintenance care bundle.

Evidence Rating Level: 1 (Excellent) 

Study Rundown: Pediatric cancer treatment often utilizes CLs for the delivery of treatment. However, CLs also increase the risk of CL-associated bloodstream infections (CLABSIs), which can delay treatment and increase morbidity and mortality. This multicenter study examined the effect of a standardized CL maintenance care bundle on CLABSI rates in pediatric hematology/oncology inpatients. Thirty-two institutions participated in the study with a compliance of 79% by the end of the first year and 81-86% during the remainder of the intervention period. When compared to baseline rates during the precollaborative period, CLABSI rates decreased by 28% after 34 months of implementation of the standardized bundle. This was equivalent to preventing approximately 290 CLABSIs. Though limited by variability among participating institutions regarding non-CLABSI focused care strategies and trialing of other CLABSI reduction strategies that may have confounded results, this study highlights important strategies that physicians can use to reduce CLABSI rates among patients.

Click to read the study, published today in Pediatrics

Relevant Reading: Attributable cost of nosocomial primary bloodstream infection in pediatric intensive care unit patients

In-Depth [quality improvement collaborative]: Thirty-two institutions participated in this multicenter collaborative through the Children’s Hospital Association from November 2009 to August 2012. Units varied in size from 8 to 48 beds, 1/3 used chlorhexidine gluconate baths, and none used antimicrobial-impregnated catheters. The standardized CL maintenance care bundle was developed by collaborative faculty and combined Centers for Disease Control and Prevention recommendations and standards, evidence-based best practices, and expert opinions. The CL maintenance care bundle included reduction of CL entries, sterile CL entry, and standardized CL care practices. Baseline CLABSI data from January 2006 to October 2009 revealed a mean precollaborative CLABSI rate of 2.85 CLABSIs per 1000 CL-days across all centers. After 34 months of the collaborative, the CLABSI rate had reduced to 2.04 CLABSIs per 1000 CL-days, with a relative risk of 0.71 (95% CI 0.55-0.92). The odds of a “no CLABSI event” in a given unit per given month increased to 2.59 compared to the precollaborative period (95% CI 1.26-5.33).

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