Decreasing PICU catheter-associated bloodstream infections: NACHRI's quality transformation efforts

Marlene R. Miller, Michael Griswold, J. Mitchell Harris, Gayane Yenokyan, W Charles Huskins, Michele Moss, Tom B. Rice, Debra Ridling, Deborah Campbell, Peter Margolis, Stephen Muething, Richard J. Brilli

Research output: Contribution to journalArticle

244 Citations (Scopus)

Abstract

OBJECTIVE: Despite the magnitude of the problem of catheter-associated bloodstream infections (CA-BSIs) in children, relatively little research has been performed to identify effective strategies to reduce these complications. In this study, we aimed to develop and evaluate effective catheter-care practices to reduce pediatric CA-BSIs. STUDY DESIGN AND METHODS: Our study was a multi-institutional, interrupted time-series design with historical control data and was conducted in 29 PICUs across the United States. Two central venous catheter-care practice bundles comprised our intervention: the insertion bundle of pediatric-tailored care elements derived from adult efforts and the maintenance bundle derived from the Centers for Disease Control and Prevention recommendations and expert pediatric clinician consensus. The bundles were deployed with quality-improvement teaching and methods to support their adoption by teams at the participating PICUs. The main outcome measures were the rate of CA-BSIs from January 2004 to September 2007 and compliance with each element of the insertion and maintenance bundles from October 2006 to September 2007. RESULTS: Average CA-BSI rates were reduced by 43% across 29 PICUs (5.4 vs 3.1 CA-BSIs per 1000 central-line-days; P < .0001). By September 2007, insertion-bundle compliance was 84% and maintenance-bundle compliance was 82%. Hierarchical regression modeling showed that the only significant predictor of an observed decrease in infection rates was the collective use of the insertion andmaintenance bundles, as demonstrated by the relative rate (RR) and confidence intervals (CIs) (RR: 0.57 [95% CI: 0.45-0.74]; P < .0001). We used comparable modeling to assess the relative importance of the insertion versus maintenance bundles; the results showed that the only significant predictor of an infection-rate decrease was maintenance-bundle compliance (RR: 0.41 [95% CI: 0.20-0.85]; P < .017). CONCLUSIONS: In contrast with adult ICU care, maximizing insertion-bundle compliance alone cannot help PICUs to eliminate CA-BSIs. The main drivers for additional reductions in pediatric CA-BSI rates are issues that surround daily maintenance care for central lines, as defined in our maintenance bundle. Additional research is needed to define the optimal maintenance bundle that will facilitate elimination of CA-BSIs for children.

Original languageEnglish (US)
Pages (from-to)206-213
Number of pages8
JournalPediatrics
Volume125
Issue number2
DOIs
StatePublished - Feb 2010

Fingerprint

Catheter-Related Infections
Maintenance
Compliance
Pediatrics
Confidence Intervals
Patient Care Bundles
Central Venous Catheters
Centers for Disease Control and Prevention (U.S.)
Quality Improvement
Infection
Research
Teaching
Catheters
Outcome Assessment (Health Care)

Keywords

  • Bloodstream infections
  • Catheter-associated bloodstream infections
  • Children
  • Hospital-acquired infections
  • Nosocomial infections
  • Pediatric intensive care unit

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Miller, M. R., Griswold, M., Harris, J. M., Yenokyan, G., Huskins, W. C., Moss, M., ... Brilli, R. J. (2010). Decreasing PICU catheter-associated bloodstream infections: NACHRI's quality transformation efforts. Pediatrics, 125(2), 206-213. https://doi.org/10.1542/peds.2009-1382

Decreasing PICU catheter-associated bloodstream infections : NACHRI's quality transformation efforts. / Miller, Marlene R.; Griswold, Michael; Harris, J. Mitchell; Yenokyan, Gayane; Huskins, W Charles; Moss, Michele; Rice, Tom B.; Ridling, Debra; Campbell, Deborah; Margolis, Peter; Muething, Stephen; Brilli, Richard J.

In: Pediatrics, Vol. 125, No. 2, 02.2010, p. 206-213.

Research output: Contribution to journalArticle

Miller, MR, Griswold, M, Harris, JM, Yenokyan, G, Huskins, WC, Moss, M, Rice, TB, Ridling, D, Campbell, D, Margolis, P, Muething, S & Brilli, RJ 2010, 'Decreasing PICU catheter-associated bloodstream infections: NACHRI's quality transformation efforts', Pediatrics, vol. 125, no. 2, pp. 206-213. https://doi.org/10.1542/peds.2009-1382
Miller, Marlene R. ; Griswold, Michael ; Harris, J. Mitchell ; Yenokyan, Gayane ; Huskins, W Charles ; Moss, Michele ; Rice, Tom B. ; Ridling, Debra ; Campbell, Deborah ; Margolis, Peter ; Muething, Stephen ; Brilli, Richard J. / Decreasing PICU catheter-associated bloodstream infections : NACHRI's quality transformation efforts. In: Pediatrics. 2010 ; Vol. 125, No. 2. pp. 206-213.
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AU - Harris, J. Mitchell

AU - Yenokyan, Gayane

AU - Huskins, W Charles

AU - Moss, Michele

AU - Rice, Tom B.

AU - Ridling, Debra

AU - Campbell, Deborah

AU - Margolis, Peter

AU - Muething, Stephen

AU - Brilli, Richard J.

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N2 - OBJECTIVE: Despite the magnitude of the problem of catheter-associated bloodstream infections (CA-BSIs) in children, relatively little research has been performed to identify effective strategies to reduce these complications. In this study, we aimed to develop and evaluate effective catheter-care practices to reduce pediatric CA-BSIs. STUDY DESIGN AND METHODS: Our study was a multi-institutional, interrupted time-series design with historical control data and was conducted in 29 PICUs across the United States. Two central venous catheter-care practice bundles comprised our intervention: the insertion bundle of pediatric-tailored care elements derived from adult efforts and the maintenance bundle derived from the Centers for Disease Control and Prevention recommendations and expert pediatric clinician consensus. The bundles were deployed with quality-improvement teaching and methods to support their adoption by teams at the participating PICUs. The main outcome measures were the rate of CA-BSIs from January 2004 to September 2007 and compliance with each element of the insertion and maintenance bundles from October 2006 to September 2007. RESULTS: Average CA-BSI rates were reduced by 43% across 29 PICUs (5.4 vs 3.1 CA-BSIs per 1000 central-line-days; P < .0001). By September 2007, insertion-bundle compliance was 84% and maintenance-bundle compliance was 82%. Hierarchical regression modeling showed that the only significant predictor of an observed decrease in infection rates was the collective use of the insertion andmaintenance bundles, as demonstrated by the relative rate (RR) and confidence intervals (CIs) (RR: 0.57 [95% CI: 0.45-0.74]; P < .0001). We used comparable modeling to assess the relative importance of the insertion versus maintenance bundles; the results showed that the only significant predictor of an infection-rate decrease was maintenance-bundle compliance (RR: 0.41 [95% CI: 0.20-0.85]; P < .017). CONCLUSIONS: In contrast with adult ICU care, maximizing insertion-bundle compliance alone cannot help PICUs to eliminate CA-BSIs. The main drivers for additional reductions in pediatric CA-BSI rates are issues that surround daily maintenance care for central lines, as defined in our maintenance bundle. Additional research is needed to define the optimal maintenance bundle that will facilitate elimination of CA-BSIs for children.

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