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Enhanced central venous catheter bundle for pediatric parenteral-dependent intestinal failure

Authors :
Grace M. Lee
Jennifer Ormsby
Jane Carpenter
Kierrah Leger
Judy Mahoney
Bola Bukoye
Debra Lajoie
Lisa J. Martin
Gail Potter-Bynoe
Herminia Shermont
Al Ozonoff
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.

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