Reducing PICU central line - Associated bloodstream infections: 3-Year results

Marlene R. Miller, Matthew F. Niedner, W Charles Huskins, Elizabeth Colantuoni, Gayane Yenokyan, Michele Moss, Tom B. Rice, Debra Ridling, Deborah Campbell, Richard J. Brilli

Research output: Contribution to journalArticle

115 Citations (Scopus)

Abstract

OBJECTIVES: To evaluate the long-term impact of pediatric central line care practices in reducing PICU central line - associated bloodstream infection (CLA-BSI) rates and to evaluate the added impact of chlorhexidine scrub and chlorhexidine-impregnated sponges. METHODS: A 3-year, multi-institutional, interrupted time-series design (October 2006 to September 2009), with historical control data, was used. A nested, 18-month, nonrandomized, factorial design was used to evaluate 2 additional interventions. Twenty-nine PICUs were included. Two central line care bundles (insertion and maintenance bundles) and 2 additional interventions (chlorhexidine scrub and chlorhexidine-impregnated sponges) were used. CLA-BSI rates (January 2004 to September 2009), insertion and maintenance bundle compliance rates (October 2006 to September 2009), and chlorhexidine scrub and chlorhexidine-impregnated sponge compliance rates (January 2008 to June 2009) were assessed. RESULTS: The average aggregate baseline PICU CLA-BSI rate decreased 56% over 36 months from 5.2 CLA-BSIs per 1000 line-days (95% confidence interval [CI]: 4.4-6.2 CLA-BSIs per 1000 line-days) to 2.3 CLA-BSIs per 1000 line-days (95% CI: 1.9-2.9 CLA-BSIs per 1000 linedays) (rate ratio: 0.44 [95% CI: 0.37-0.53]; P < .0001). No statistically significant differences in CLA-BSI rate decreases between PICUs using or not using either of the 2 additional interventions were found. CONCLUSIONS: Focused attention on consistent adherence to the use of pediatrics-specific central line insertion and maintenance bundles produced sustained, continually decreasing PICU CLA-BSI rates. Additional use of either chlorhexidine for central line entry scrub or chlorhexidine-impregnated sponges did not produce any statistically significant additional reduction in PICU CLA-BSI rates.

Original languageEnglish (US)
JournalPediatrics
Volume128
Issue number5
DOIs
StatePublished - Nov 2011

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Chlorhexidine
Porifera
Infection
Maintenance
Confidence Intervals
Patient Care Bundles
Pediatrics
Bundle

Keywords

  • Bloodstream infections
  • Children
  • Nosocomial infections
  • Pediatric intensive care unit

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Arts and Humanities (miscellaneous)

Cite this

Miller, M. R., Niedner, M. F., Huskins, W. C., Colantuoni, E., Yenokyan, G., Moss, M., ... Brilli, R. J. (2011). Reducing PICU central line - Associated bloodstream infections: 3-Year results. Pediatrics, 128(5). https://doi.org/10.1542/peds.2010-3675

Reducing PICU central line - Associated bloodstream infections : 3-Year results. / Miller, Marlene R.; Niedner, Matthew F.; Huskins, W Charles; Colantuoni, Elizabeth; Yenokyan, Gayane; Moss, Michele; Rice, Tom B.; Ridling, Debra; Campbell, Deborah; Brilli, Richard J.

In: Pediatrics, Vol. 128, No. 5, 11.2011.

Research output: Contribution to journalArticle

Miller, MR, Niedner, MF, Huskins, WC, Colantuoni, E, Yenokyan, G, Moss, M, Rice, TB, Ridling, D, Campbell, D & Brilli, RJ 2011, 'Reducing PICU central line - Associated bloodstream infections: 3-Year results', Pediatrics, vol. 128, no. 5. https://doi.org/10.1542/peds.2010-3675
Miller, Marlene R. ; Niedner, Matthew F. ; Huskins, W Charles ; Colantuoni, Elizabeth ; Yenokyan, Gayane ; Moss, Michele ; Rice, Tom B. ; Ridling, Debra ; Campbell, Deborah ; Brilli, Richard J. / Reducing PICU central line - Associated bloodstream infections : 3-Year results. In: Pediatrics. 2011 ; Vol. 128, No. 5.
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abstract = "OBJECTIVES: To evaluate the long-term impact of pediatric central line care practices in reducing PICU central line - associated bloodstream infection (CLA-BSI) rates and to evaluate the added impact of chlorhexidine scrub and chlorhexidine-impregnated sponges. METHODS: A 3-year, multi-institutional, interrupted time-series design (October 2006 to September 2009), with historical control data, was used. A nested, 18-month, nonrandomized, factorial design was used to evaluate 2 additional interventions. Twenty-nine PICUs were included. Two central line care bundles (insertion and maintenance bundles) and 2 additional interventions (chlorhexidine scrub and chlorhexidine-impregnated sponges) were used. CLA-BSI rates (January 2004 to September 2009), insertion and maintenance bundle compliance rates (October 2006 to September 2009), and chlorhexidine scrub and chlorhexidine-impregnated sponge compliance rates (January 2008 to June 2009) were assessed. RESULTS: The average aggregate baseline PICU CLA-BSI rate decreased 56{\%} over 36 months from 5.2 CLA-BSIs per 1000 line-days (95{\%} confidence interval [CI]: 4.4-6.2 CLA-BSIs per 1000 line-days) to 2.3 CLA-BSIs per 1000 line-days (95{\%} CI: 1.9-2.9 CLA-BSIs per 1000 linedays) (rate ratio: 0.44 [95{\%} CI: 0.37-0.53]; P < .0001). No statistically significant differences in CLA-BSI rate decreases between PICUs using or not using either of the 2 additional interventions were found. CONCLUSIONS: Focused attention on consistent adherence to the use of pediatrics-specific central line insertion and maintenance bundles produced sustained, continually decreasing PICU CLA-BSI rates. Additional use of either chlorhexidine for central line entry scrub or chlorhexidine-impregnated sponges did not produce any statistically significant additional reduction in PICU CLA-BSI rates.",
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AU - Miller, Marlene R.

AU - Niedner, Matthew F.

AU - Huskins, W Charles

AU - Colantuoni, Elizabeth

AU - Yenokyan, Gayane

AU - Moss, Michele

AU - Rice, Tom B.

AU - Ridling, Debra

AU - Campbell, Deborah

AU - Brilli, Richard J.

PY - 2011/11

Y1 - 2011/11

N2 - OBJECTIVES: To evaluate the long-term impact of pediatric central line care practices in reducing PICU central line - associated bloodstream infection (CLA-BSI) rates and to evaluate the added impact of chlorhexidine scrub and chlorhexidine-impregnated sponges. METHODS: A 3-year, multi-institutional, interrupted time-series design (October 2006 to September 2009), with historical control data, was used. A nested, 18-month, nonrandomized, factorial design was used to evaluate 2 additional interventions. Twenty-nine PICUs were included. Two central line care bundles (insertion and maintenance bundles) and 2 additional interventions (chlorhexidine scrub and chlorhexidine-impregnated sponges) were used. CLA-BSI rates (January 2004 to September 2009), insertion and maintenance bundle compliance rates (October 2006 to September 2009), and chlorhexidine scrub and chlorhexidine-impregnated sponge compliance rates (January 2008 to June 2009) were assessed. RESULTS: The average aggregate baseline PICU CLA-BSI rate decreased 56% over 36 months from 5.2 CLA-BSIs per 1000 line-days (95% confidence interval [CI]: 4.4-6.2 CLA-BSIs per 1000 line-days) to 2.3 CLA-BSIs per 1000 line-days (95% CI: 1.9-2.9 CLA-BSIs per 1000 linedays) (rate ratio: 0.44 [95% CI: 0.37-0.53]; P < .0001). No statistically significant differences in CLA-BSI rate decreases between PICUs using or not using either of the 2 additional interventions were found. CONCLUSIONS: Focused attention on consistent adherence to the use of pediatrics-specific central line insertion and maintenance bundles produced sustained, continually decreasing PICU CLA-BSI rates. Additional use of either chlorhexidine for central line entry scrub or chlorhexidine-impregnated sponges did not produce any statistically significant additional reduction in PICU CLA-BSI rates.

AB - OBJECTIVES: To evaluate the long-term impact of pediatric central line care practices in reducing PICU central line - associated bloodstream infection (CLA-BSI) rates and to evaluate the added impact of chlorhexidine scrub and chlorhexidine-impregnated sponges. METHODS: A 3-year, multi-institutional, interrupted time-series design (October 2006 to September 2009), with historical control data, was used. A nested, 18-month, nonrandomized, factorial design was used to evaluate 2 additional interventions. Twenty-nine PICUs were included. Two central line care bundles (insertion and maintenance bundles) and 2 additional interventions (chlorhexidine scrub and chlorhexidine-impregnated sponges) were used. CLA-BSI rates (January 2004 to September 2009), insertion and maintenance bundle compliance rates (October 2006 to September 2009), and chlorhexidine scrub and chlorhexidine-impregnated sponge compliance rates (January 2008 to June 2009) were assessed. RESULTS: The average aggregate baseline PICU CLA-BSI rate decreased 56% over 36 months from 5.2 CLA-BSIs per 1000 line-days (95% confidence interval [CI]: 4.4-6.2 CLA-BSIs per 1000 line-days) to 2.3 CLA-BSIs per 1000 line-days (95% CI: 1.9-2.9 CLA-BSIs per 1000 linedays) (rate ratio: 0.44 [95% CI: 0.37-0.53]; P < .0001). No statistically significant differences in CLA-BSI rate decreases between PICUs using or not using either of the 2 additional interventions were found. CONCLUSIONS: Focused attention on consistent adherence to the use of pediatrics-specific central line insertion and maintenance bundles produced sustained, continually decreasing PICU CLA-BSI rates. Additional use of either chlorhexidine for central line entry scrub or chlorhexidine-impregnated sponges did not produce any statistically significant additional reduction in PICU CLA-BSI rates.

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KW - Children

KW - Nosocomial infections

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