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Enhanced central venous catheter bundle for pediatric parenteral-dependent intestinal failure
- Source :
- American Journal of Infection Control. 46:1284-1289
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- Background Central line–associated bloodstream infections (CLABSIs) cause substantial morbidity and increase antimicrobial use and length of stay among hospitalized children in the United States. CLABSI occurs more frequently among high-risk pediatric patients, such as those with intestinal failure (IF) who are parenteral nutrition (PN) dependent. Following an increase in CLABSI rates, a quality improvement (QI) initiative was implemented. Methods Using QI methodology, an enhanced central venous catheter (CVC) maintenance bundle was developed and implemented on 2 units for pediatric PN-dependent patients with IF. CLABSI rates were prospectively monitored pre- and postimplementation, and bundle element adherence was monitored. Enhanced bundle elements included chlorhexidine-impregnated patch, daily bathing, ethanol locks, 2 nurses for CVC care in a distraction-free zone, peripheral laboratory draws, bundling routine laboratory tests, and PN administration set changes every 24 hours. Results Adherence to enhanced bundle elements increased to >90% over 3 months. CLABSI rates averaged 1.41 per 1,000 central line days preimplementation compared with 0.40 per 1,000 device days postimplementation (P = .003), an 85% absolute reduction in CLABSI rates over 12 months. Conclusions Patients with IF are at an increased risk for CLABSI. Enhanced CVC maintenance bundles that specifically target prevention practices in this population may be beneficial.
- Subjects :
- Male
Catheterization, Central Venous
Parenteral Nutrition
medicine.medical_specialty
Adolescent
Organ Dysfunction Scores
Epidemiology
medicine.medical_treatment
Population
03 medical and health sciences
0302 clinical medicine
030225 pediatrics
Intestinal failure
medicine
Central Venous Catheters
Humans
030212 general & internal medicine
Child
education
education.field_of_study
Antiinfective agent
Central line
business.industry
Health Policy
Public Health, Environmental and Occupational Health
Infant
Quality Improvement
Intestinal Diseases
Infectious Diseases
Parenteral nutrition
Increased risk
Catheter-Related Infections
Child, Preschool
Bundle
Emergency medicine
Female
business
Patient Care Bundles
Central venous catheter
Subjects
Details
- ISSN :
- 01966553
- Volume :
- 46
- Database :
- OpenAIRE
- Journal :
- American Journal of Infection Control
- Accession number :
- edsair.doi.dedup.....b20511ab02bfd608d691d63e729c3bf2
- Full Text :
- https://doi.org/10.1016/j.ajic.2018.04.209