Reducing Catheter-Associated Blood Stream Infections in a Pediatric Intensive Care Unit: A Collaborative Effort

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Abstract

Objective:

The objectives of our study were to determine the incidence of catheter-associated blood stream infection (CA-BSI) pre- and postintroduction of our CA-BSI bundle.

Design:

Retrospective chart review for 2004 and prospective descriptive study for 2005.

Setting:

A tertiary referral, university affiliated, medical-surgical pediatric intensive care unit with 22 beds and approximately 1100 admissions per year.

Patients:

All patients who were admitted to our unit who had any documented CA-BSI according to the Centre for Disease Control criteria between January 2004 and December 2005.

Interventions:

Education and institution of a bundle for decreasing CA-BSI. The CA-BSI bundle was adapted for pediatrics and included components for catheter insertion and ongoing catheter maintenance.

Measurements and Main Results:

Cases of CA-BSI were collected and rates per 1000 line days and per 1000 admissions were calculated pre institution of bundle (January to September 2004), during institution (October 2004 to May 2005) and postinstitution (June 2005 to December 2005). Infection rates per 1000 line days decreased from pre 8.8 (17/1934; 95% confidence interval [CI], 5.2-14) to during 1.8 (3/1665; 95% CI, 0.4-5.3) and post 2.2 (3/1367; 55% CI, 0.4-6.4). Decreases per 1000 admissions were also seen: pre 18.3 (17/928; 95% CI, 10.7-29), during 4.3 (3/691; 95% CI, 0.9-12.3) and post 5.1 (3/583; 95% CI, 1-15).

Conclusion:

Strategies aimed at reducing CA-BSI appear to be effective.

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