Blood Stream Infections
Overview
The National Association of Children's Hospital and Related Institutions (NACHRI) are working with faculty and teams from across the United States will launch a learning collaborative to eliminate catheter-related blood stream infections in the pediatric intensive care unit.
Catheter-associated bloodstream infections (CA-BSI) are a significant source of morbidity, mortality and added medical costs to hospitalized adult and pediatric patients every year. According to the National Nosocomial Infection Surveillance System (NNIS) established by the Centers for Disease Control and Prevention, the pooled mean among the 54 pediatric intensive care units (PICUs) was 6.6 CA-BSI per 1,000 catheter days, higher than many adult intensive care units (9). Despite the magnitude of this problem in pediatrics, there has been limited effort to develop strategies to reduce the impact of CA-BSI for children.
Researchers at Johns Hopkins University have nearly eliminated CA-BSI in adult intensive care unit patients by applying a multifaceted intervention focused on insertion of central lines and based on safety theory and the 2002 Guidelines for the Prevention of Intravascular Catheter-Related Infection. These insertion-related interventions are now used broadly throughout the country and the world with dissemination promoted via the Institute for Healthcare Improvement 100,000 Lives effort. CA-BSI has now become one of The Joint Commission core measures for quality in intensive care units.
While some previous work has produced results in PICUs to reduce infections associated with catheter insertion, data from John Hopkins and Cincinnati Children's Hospital Medical Center suggest that even after reliable implementation of sterile insertion practices, PICU patients may continue to experience CA-BSI. Despite these experiences, there are no pediatric specific evidence-based strategies related to catheter maintenance practices which focus upon reducing CA-BSI.
This initiative has three areas of focus:
- Develop and test strategies to reduce the rate of CA-BSI in children hospitalized in the PICU and to spread improvements that are shown to be effective throughout the pediatric critical care community
- Enable critical care pediatricians, via this multi-institutional collaborative work, an opportunity to fulfill Part IV of the Program of Maintenance of Certification (PMCP)
- Develop a model for national collaborative research across PICUs. The remainder of this document will focus on #1 and the improvement collaborative for PICUs
The long-term goal of the initiative is to build the foundation of a sustainable collaborative network to improve the outcomes of children cared for in the over 300 critical care units in the US.
In Phase 1, participating PICUs, NACHRI, clinical faculty with the support of the CHCQ and the ABP, will work together to improve the care of children in the PICU by elimination of CA-BSI. This collaborative improvement effort will have two areas of emphasis:
- Reliable performance of best practices for insertion of central lines
- Testing and identifying best practices for maintenance of central lines
More Information
For more information, contact:
Amy Borgert
3333 Burnet Ave.
MLC 7014
Cincinnati, OH 45229
513-636-0161
