Preventing CLABSIs among pediatric hematology/oncology inpatients: national collaborative results
Central lines (CLs) are essential for the delivery of modern cancer care to children. Nonetheless, CLs are subject to potentially life-threatening complications, including central line-associated bloodstream infections (CLABSIs). The objective of this study was to assess the feasibility of a multice...
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| Published in: | Pediatrics (Evanston) Vol. 134; no. 6; p. e1678 |
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| Main Authors: | , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
United States
01.12.2014
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| Subjects: | |
| ISSN: | 1098-4275, 1098-4275 |
| Online Access: | Get more information |
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| Abstract | Central lines (CLs) are essential for the delivery of modern cancer care to children. Nonetheless, CLs are subject to potentially life-threatening complications, including central line-associated bloodstream infections (CLABSIs). The objective of this study was to assess the feasibility of a multicenter effort to standardize CL care and CLABSI tracking, and to quantify the impact of standardizing these processes on CLABSI rates among pediatric hematology/oncology inpatients.
We conducted a multicenter quality improvement collaborative starting in November 2009. Multidisciplinary teams at participating sites implemented a standardized bundle of CL care practices and adopted a common approach to CLABSI surveillance.
Thirty-two units participated in the collaborative and reported a mean, precollaborative CLABSI rate of 2.85 CLABSIs per 1000 CL-days. Self-reported adoption of the CL care bundle was brisk, with average compliance approaching 80% by the end of the first year of the collaborative and exceeding 80% thereafter. As of August 2012, the mean CLABSI rate during the collaborative was 2.04 CLABSIs per 1000 CL-days, a reduction of 28% (relative risk: 0.71 [95% confidence interval: 0.55-0.92]). Changes in self-reported CL care bundle compliance were not statistically associated with changes in CLABSI rates, although there was little variability in bundle compliance rates after the first year of the collaborative.
A multicenter quality improvement collaborative found significant reductions in observed CLABSI rates in pediatric hematology/oncology inpatients. Additional interventions will likely be required to bring and sustain CLABSI rates closer to zero for this high-risk population. |
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| AbstractList | Central lines (CLs) are essential for the delivery of modern cancer care to children. Nonetheless, CLs are subject to potentially life-threatening complications, including central line-associated bloodstream infections (CLABSIs). The objective of this study was to assess the feasibility of a multicenter effort to standardize CL care and CLABSI tracking, and to quantify the impact of standardizing these processes on CLABSI rates among pediatric hematology/oncology inpatients.OBJECTIVESCentral lines (CLs) are essential for the delivery of modern cancer care to children. Nonetheless, CLs are subject to potentially life-threatening complications, including central line-associated bloodstream infections (CLABSIs). The objective of this study was to assess the feasibility of a multicenter effort to standardize CL care and CLABSI tracking, and to quantify the impact of standardizing these processes on CLABSI rates among pediatric hematology/oncology inpatients.We conducted a multicenter quality improvement collaborative starting in November 2009. Multidisciplinary teams at participating sites implemented a standardized bundle of CL care practices and adopted a common approach to CLABSI surveillance.METHODSWe conducted a multicenter quality improvement collaborative starting in November 2009. Multidisciplinary teams at participating sites implemented a standardized bundle of CL care practices and adopted a common approach to CLABSI surveillance.Thirty-two units participated in the collaborative and reported a mean, precollaborative CLABSI rate of 2.85 CLABSIs per 1000 CL-days. Self-reported adoption of the CL care bundle was brisk, with average compliance approaching 80% by the end of the first year of the collaborative and exceeding 80% thereafter. As of August 2012, the mean CLABSI rate during the collaborative was 2.04 CLABSIs per 1000 CL-days, a reduction of 28% (relative risk: 0.71 [95% confidence interval: 0.55-0.92]). Changes in self-reported CL care bundle compliance were not statistically associated with changes in CLABSI rates, although there was little variability in bundle compliance rates after the first year of the collaborative.RESULTSThirty-two units participated in the collaborative and reported a mean, precollaborative CLABSI rate of 2.85 CLABSIs per 1000 CL-days. Self-reported adoption of the CL care bundle was brisk, with average compliance approaching 80% by the end of the first year of the collaborative and exceeding 80% thereafter. As of August 2012, the mean CLABSI rate during the collaborative was 2.04 CLABSIs per 1000 CL-days, a reduction of 28% (relative risk: 0.71 [95% confidence interval: 0.55-0.92]). Changes in self-reported CL care bundle compliance were not statistically associated with changes in CLABSI rates, although there was little variability in bundle compliance rates after the first year of the collaborative.A multicenter quality improvement collaborative found significant reductions in observed CLABSI rates in pediatric hematology/oncology inpatients. Additional interventions will likely be required to bring and sustain CLABSI rates closer to zero for this high-risk population.CONCLUSIONSA multicenter quality improvement collaborative found significant reductions in observed CLABSI rates in pediatric hematology/oncology inpatients. Additional interventions will likely be required to bring and sustain CLABSI rates closer to zero for this high-risk population. Central lines (CLs) are essential for the delivery of modern cancer care to children. Nonetheless, CLs are subject to potentially life-threatening complications, including central line-associated bloodstream infections (CLABSIs). The objective of this study was to assess the feasibility of a multicenter effort to standardize CL care and CLABSI tracking, and to quantify the impact of standardizing these processes on CLABSI rates among pediatric hematology/oncology inpatients. We conducted a multicenter quality improvement collaborative starting in November 2009. Multidisciplinary teams at participating sites implemented a standardized bundle of CL care practices and adopted a common approach to CLABSI surveillance. Thirty-two units participated in the collaborative and reported a mean, precollaborative CLABSI rate of 2.85 CLABSIs per 1000 CL-days. Self-reported adoption of the CL care bundle was brisk, with average compliance approaching 80% by the end of the first year of the collaborative and exceeding 80% thereafter. As of August 2012, the mean CLABSI rate during the collaborative was 2.04 CLABSIs per 1000 CL-days, a reduction of 28% (relative risk: 0.71 [95% confidence interval: 0.55-0.92]). Changes in self-reported CL care bundle compliance were not statistically associated with changes in CLABSI rates, although there was little variability in bundle compliance rates after the first year of the collaborative. A multicenter quality improvement collaborative found significant reductions in observed CLABSI rates in pediatric hematology/oncology inpatients. Additional interventions will likely be required to bring and sustain CLABSI rates closer to zero for this high-risk population. |
| Author | Bundy, David G He, Bing Miller, Marlene R Gaur, Aditya H Colantuoni, Elizabeth A Billett, Amy L |
| Author_xml | – sequence: 1 givenname: David G surname: Bundy fullname: Bundy, David G email: dbundy@musc.edu organization: Division of General Pediatrics, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina; dbundy@musc.edu – sequence: 2 givenname: Aditya H surname: Gaur fullname: Gaur, Aditya H organization: Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee – sequence: 3 givenname: Amy L surname: Billett fullname: Billett, Amy L organization: Division of Hematology/Oncology, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts – sequence: 4 givenname: Bing surname: He fullname: He, Bing organization: Departments of Biostatistics and – sequence: 5 givenname: Elizabeth A surname: Colantuoni fullname: Colantuoni, Elizabeth A organization: Departments of Biostatistics and – sequence: 6 givenname: Marlene R surname: Miller fullname: Miller, Marlene R organization: Division of Quality and Safety, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; and Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Children's Hospital Association, Alexandria, Virginia |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/25404721$$D View this record in MEDLINE/PubMed |
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| Copyright | Copyright © 2014 by the American Academy of Pediatrics. |
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| SubjectTerms | Bacteremia - prevention & control Bacteremia - transmission Catheter-Related Infections - prevention & control Catheterization, Central Venous - standards Child Cooperative Behavior Cross Infection - prevention & control Cross Infection - transmission Hematologic Diseases - therapy Hospitals, Pediatric - organization & administration Hospitals, Pediatric - standards Humans Inservice Training - organization & administration Inservice Training - standards Interdisciplinary Communication Neoplasms - therapy Oncology Service, Hospital - organization & administration Oncology Service, Hospital - standards Quality Assurance, Health Care - organization & administration Quality Assurance, Health Care - standards Quality Improvement - organization & administration Quality Improvement - standards Risk Factors United States |
| Title | Preventing CLABSIs among pediatric hematology/oncology inpatients: national collaborative results |
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