Published August 2016
BMJ Journals

Children with compromised immune systems are among the most challenging to treat because they face a minute-to-minute risk of developing potentially fatal central line-associated bloodstream infections (CLABSI).

Preventing CLABSI depends on highly reliable care and attention to the little details underpinning treatment, according to a time-series analysis published by researchers at Cincinnati Children’s that demonstrated how multifactorial interventions achieved sustained reductions in CLABSI.

The team found a strong association between CLABSI rates and microsystem stress within the hospital, including increased census, active phase-1 patients and relapsed refractory patients. New intervention strategies reduced CLABSI rates from 2.03 per 1,000 line days in May 2014 to 0.39 in May 2015.

Several key processes became more reliable, including identifying high-risk patients daily; completing all dressing changes according to a two-person standard; and increasing daily hygiene adherence nearly three-fold to 70 percent.

The team involved researchers from the James M. Anderson Center for Health Systems Excellence and the divisions of Bone Marrow Transplant and Immune Deficiency, Patient Services, Oncology, and Hospital Medicine.

“It is essential to have a team of leaders, providers, scientists, nurses, patient care assistants, and ancillary services who are all focused on research,” says first author Christopher Dandoy, MD, MSc, of Bone Marrow Transplant and Immune Deficiency. “The work we are doing as a team to identify these advances together is exhilarating.”

In fiscal 2017, system-wide improvements produced a better-than 25 percent reduction in CLABSI. That translates to 30 fewer children experiencing CLABSI, says senior author Jeffrey Simmons, MD, MSc, of Hospital Medicine.

Since publishing the study, the team has expanded its work to include all bloodstream infections in high-risk patient populations.