Published online May 1, 2008
PEDIATRICS Vol. 121 No. 5 May 2008, pp. 915-923 (doi:10.1542/peds.2007-1577)
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ARTICLE

Systematic Intervention to Reduce Central Line–Associated Bloodstream Infection Rates in a Pediatric Cardiac Intensive Care Unit

John M. Costello, MDa, Debra Forbes Morrow, RNb, Dionne A. Graham, PhDa,c, Gail Potter-Bynoe, BSd, Thomas J. Sandora, MD, MPHd,e and Peter C. Laussen, MBBSa

Departments of a Cardiology
b Nursing
c Clinical Research Program
d Infection Control Program
e Division of Infectious Diseases, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts

OBJECTIVE. Our goal was to determine whether an intervention involving staff education, increased awareness, and practice changes would decrease central line–associated bloodstream infection rates in a pediatric cardiac ICU.

METHODS. A retrospective, interventional study using an interrupted time-series design was conducted to compare central line–associated bloodstream infection rates during 3 time periods for all patients admitted to our pediatric cardiac ICU between April 1, 2004, and December 31, 2006. During the preintervention period (April 2004 to December 2004), a committee was convened to track and prevent nosocomial infections. Pretesting demonstrated knowledge deficits regarding nosocomial infection prevention, and educational tools were developed. During the partial intervention period (January 2005 to March 2006), a comprehensive central line–associated bloodstream infection prevention initiative was implemented, including establishment of a unit-based infection control nurse position, education for physicians and nurses, real-time feedback on central line–associated bloodstream infection data, implementation of central venous line insertion, access, and maintenance bundles, and introduction of daily goal sheets on rounds that emphasized timely central venous line removal. Central line–associated bloodstream infection rates in the preintervention, partial intervention, and full intervention (April 2006 to December 2006) periods were compared.

RESULTS. The estimated mean preintervention central line–associated bloodstream infection rate was 7.8 infections per 1000 catheter-days, which decreased to 4.7 infections per 1000 catheter-days in the partial intervention period and 2.3 infections per 1000 catheter-days in the full intervention period. The preintervention central line–associated bloodstream infection rate was significantly higher than the median rate of 3.5 infections per 1000 catheter-days for multidisciplinary PICUs reporting to the National Healthcare Safety Network. During the full intervention period, our central line–associated bloodstream infection rate was lower than this pediatric benchmark, although statistical significance was not achieved.

CONCLUSIONS. A multidisciplinary, evidence-based initiative resulted in a significant reduction in central line–associated bloodstream infections in our pediatric cardiac ICU.

Key Words: nosocomial infection • pediatric intensive care units • bacterial infection • congenital heart defect • infection control • catheter

Abbreviations: BCBS-MA—BlueCross BlueShield of Massachusetts • CLAB—central line–associated bloodstream infection • BSI—bloodstream infetion • CVL—central venous line • CICU—cardiac ICU • NHSN—National Healthcare Safety Network

Accepted Sep 14, 2007.


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