Pediatricians at Children's Hospitals Identify New Practices Reducing the Rate of CLABSIs

A study published in the online edition of Pediatrics, the official journal of the American Academy of Pediatrics, identified additional best practices for the care and maintenance of central venous catheters (CVC) leading to a reduction of central line-associated bloodstream infections (CLABSIs) rates by 19 percent among 17 children’s hospitals participating in the study. These CVC catheters are essential for the administration of fluids, nutrition and medications to critically ill NICU patients. There are evidence-based and widely accepted practices to improve central line infection rates which include hand hygiene, central line insertion techniques, dressing changes and root cause analysis. However, there are some central line care practices that have variability and limited published evidence. In particular, central line care practices including tubing change technique, hub care monitoring, CVC access limitation and CVC removal monitoring were noted to have wide variation among Children’s Hospitals Neonatal Database (CHND) member NICUs. Of these practices, the combination of sterile tube-change technique with hub scrub monitoring lowered CLABSI rates by 1.25 per 1,000 line days.

“Our results support a recommendation to incorporate sterile tubing change along with hub care compliance monitoring for further reduction in CLABSI rates in NICUs and perhaps could be effective in other units where central venous catheters are commonly used,” says Beverly Brozanski, MD, neonatologist and NICU medical director of Children’s Hospital of Pittsburgh of UPMC.

CLABSIs are healthcare-acquired infections that can result in longer hospitalizations, ongoing sickness and even death. While it is estimated that 50 percent of healthcare-acquired infections are preventable, 33,000 of the nearly 1.7 million infection that were reported in 2002 were among infants in NICUs. The estimated annual cost of healthcare-acquired infections ranges from $35.7 billion to $45 billion for inpatient hospital care.

“While several studies have shown that the implementation of evidence-based guidelines or care bundles can reduce CLABSI across a wide range of settings, CLABSIs remain a major health care expense averaging $69,000 per infection and can lead to long-term neurodevelopmental impairment,” says Anthony J. Piazza, MD, neonatologist and NICU medical director of Children’s Healthcare of Atlanta at Egleston.

The 17 hospitals participating in this CLABSI prevention improvement project are part of the CHND’s Collaborative Initiatives for Quality Improvement, established to improve care and clinical outcomes for NICU patients. A benchmarking survey, a systematic literature review and expert opinion were the basis for the development of clinical practice recommendations for the reduction of CLABSIs in the children’s hospital NICUs. The collaborative utilized a new approach for conducting a multicenter quality improvement collaborative known as orchestrated testing. Key components of orchestrated testing include clear definition of practice variation; engagement of teams including a system for data monitoring and feedback; statistical analysis and replication of important results.

“We’ve made progress over the years in reducing the rate of these dangerous and costly infections, but we knew we could do better,” says Eugenia Pallotto, MD, neonatologist and NICU medical director at Children’s Mercy Kansas City. “With our novel research collaboration we identified additional best practices that significantly decreased the infection rate.”

More information on the orchestrated testing and the work of CHND Collaborative Initiatives for Quality Improvement can be found in the Oct. 19, 2015 online issue of the American Journal of Medical Quality.

Source: Children’s Hospital Association