Infection Prevention & Control, Boston Children's Hospital, Boston, MA.
Surgical Programs, Boston Children's Hospital, Boston, MA.
Am J Infect Control. 2018 Nov;46(11):1284-1289. doi: 10.1016/j.ajic.2018.04.209. Epub 2018 May 31.
Central line-associated bloodstream infections (CLABSIs) cause substantial morbidity and increase antimicrobial use and length of stay among hospitalized children in the United States. CLABSI occurs more frequently among high-risk pediatric patients, such as those with intestinal failure (IF) who are parenteral nutrition (PN) dependent. Following an increase in CLABSI rates, a quality improvement (QI) initiative was implemented.
Using QI methodology, an enhanced central venous catheter (CVC) maintenance bundle was developed and implemented on 2 units for pediatric PN-dependent patients with IF. CLABSI rates were prospectively monitored pre- and postimplementation, and bundle element adherence was monitored. Enhanced bundle elements included chlorhexidine-impregnated patch, daily bathing, ethanol locks, 2 nurses for CVC care in a distraction-free zone, peripheral laboratory draws, bundling routine laboratory tests, and PN administration set changes every 24 hours.
Adherence to enhanced bundle elements increased to >90% over 3 months. CLABSI rates averaged 1.41 per 1,000 central line days preimplementation compared with 0.40 per 1,000 device days postimplementation (P = .003), an 85% absolute reduction in CLABSI rates over 12 months.
Patients with IF are at an increased risk for CLABSI. Enhanced CVC maintenance bundles that specifically target prevention practices in this population may be beneficial.
中心静脉相关血流感染（CLABSIs）会导致大量发病，并增加美国住院儿童的抗菌药物使用和住院时间。CLABSI 在肠衰竭（IF）且依赖肠外营养（PN）的高危儿科患者中更为常见。在 CLABSI 发生率增加后，实施了一项质量改进（QI）计划。
使用 QI 方法，为接受 PN 依赖 IF 的儿科 PN 依赖患者的 2 个单位制定并实施了增强型中心静脉导管（CVC）维护套件。在实施前后，前瞻性监测 CLABSI 发生率，并监测捆绑元素的依从性。增强型捆绑元素包括氯己定浸渍贴剂、每日沐浴、乙醇锁、在无干扰区由 2 名护士进行 CVC 护理、外周实验室采血、常规实验室检测捆绑、PN 输注套件每 24 小时更换 1 次。
增强型捆绑元素的依从性在 3 个月内增加到>90%。在实施前，每 1000 个中心静脉导管日的 CLABSI 发生率平均为 1.41，而实施后每 1000 个设备日的 CLABSI 发生率为 0.40（P=0.003），12 个月内 CLABSI 发生率绝对降低 85%。
IF 患者发生 CLABSI 的风险增加。针对该人群的预防实践的增强型 CVC 维护套件可能是有益的。
