Reduction of catheter-associated bloodstream infections in pediatric patients: Experimentation and reality

Christopher McKee, Ivor Berkowitz, Sara E. Cosgrove, Karen Bradley, Claire Beers, Trish M. Perl, Laura Winner, Peter J. Pronovost, Marlene R. Miller

Research output: Contribution to journalArticle

69 Scopus citations

Abstract

OBJECTIVE: Few data exist on successes at reducing pediatric catheter-associated bloodstream infections (CA-BSI). The objective was to eradicate CA-BSI with a multifaceted pediatric-relevant intervention proven effective in adult patients. DESIGN: Prospective cohort of pediatric intensive care (PICU) patients with historical controls. SETTING: Multidisciplinary PICU. PATIENTS/PARTICIPANTS: PICU patients with intervention targeting PICU providers. INTERVENTIONS: Multifaceted intervention involving preintervention staff surveys, provider educational program, creation of central catheter procedure cart, guideline-supported central catheter insertion checklist, nursing staff empowerment to stop procedures that breached guidelines, and real-time data feedback to PICU leadership. MEASUREMENTS AND MAIN RESULTS: We measured rate of CA-BSI per 1000 catheter days from August 2001 through September 2006. Reliable use of evidence-based best practices for insertion of central catheters in our PICU was associated with a statistically and clinically significant decrease in our CA-BSI rate for 24 months postintervention (p < .05). During a portion of this postintervention period, we experienced a dramatic increase in our CA-BSI rate that was ultimately found to be due to the introduction of a new positive displacement mechanical valve intravenous port in April 2004. After removal of this positive displacement mechanical valve, our CA-BSI rate dropped from 5.2 ± 4.5 CA-BSI per 1000 central catheter days to a rate of 3.0 ± 1.9 CA-BSI per 1000 central catheter days. Chart review of postintervention CA-BSI cases revealed that these patients acquired CA-BSI weeks after both PICU admission and after insertion of the most recent central catheter. CONCLUSIONS: Our data show that improving practices for insertion of central catheters leads to a reduction of CA-BSI among pediatric patients but not elimination of CA-BSI. More research is needed to identify best practices for maintenance of central catheters for children. In addition, our experience shows that even despite good interventions to control CA-BSI, institutions must remain vigilant to factors such as new technology with apparent advantages but short track records of use.

Original languageEnglish (US)
Pages (from-to)40-46
Number of pages7
JournalPediatric Critical Care Medicine
Volume9
Issue number1
DOIs
StatePublished - Jan 2008

Keywords

  • Adolescent
  • Child
  • Hospitals
  • Infant
  • Inpatients
  • Nosocomial infections
  • Quality of health care

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

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    McKee, C., Berkowitz, I., Cosgrove, S. E., Bradley, K., Beers, C., Perl, T. M., Winner, L., Pronovost, P. J., & Miller, M. R. (2008). Reduction of catheter-associated bloodstream infections in pediatric patients: Experimentation and reality. Pediatric Critical Care Medicine, 9(1), 40-46. https://doi.org/10.1097/01.PCC.0000299821.46193.A3