An Interprofessional Quality Improvement Project to Reduce Community-Acquired Central Line-Associated Bloodstream Infections in the Pediatric Intestinal Failure Population

Samantha W. Neumeister, Megan E Gabel, Jeffrey M. Meyers, Brenda Tesini, Julie Albright Gottfried, Acadia Fairchild, Jan Schriefer
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Abstract

Central line-associated bloodstream infections (CLABSIs) result in significant morbidity but are largely preventable. Methods to reduce hospital-acquired CLABSIs are well described, but few recommendations exist for how these practices might translate to patients with central lines in the ambulatory setting. This team sought to reduce the mean monthly community-acquired CLABSI rate by 25% from 11.7 to 8.8 per 1000 community line-days in children with intestinal failure who require home parenteral nutrition within 12 months. First, an interprofessional quality improvement team was formed. After baseline data collection, plan-do-study-act cycles began. Tests of change consisted of a central venous catheter (CVC) maintenance bundle. This bundle included a CVC care tote with additional supplies, improved educational materials, and ethanol lock prophylaxis. A control chart was used to display the monthly community-acquired CLABSI rate and observe for special cause variation. At baseline, the average monthly community-acquired CLABSI rate was 11.7 per 1000 community catheter-days. The home CVC maintenance bundle was implemented, after which there were 5 consecutive months with no infections. After enhancements to the care bundle and tote, special cause variation was noted, and the average monthly community-acquired CLABSI rate declined by 66% to 4 per 1000 community catheter-days. Special cause variation was noted at 2 other time points without an identifiable cause. A lower community-acquired CLABSI rate has been sustained for 24 months and reflects approximately 12 fewer infections per year in this at-risk population.
减少小儿肠道功能衰竭人群社区获得性中心静脉相关血流感染的跨专业质量改进项目
中心管路相关血流感染(CLABSIs)会导致严重的发病率,但在很大程度上是可以预防的。减少医院获得性 CLABSI 的方法已经有了很好的描述,但对于如何将这些方法应用于非住院环境中的中心静脉置管患者却鲜有建议。该团队试图将 12 个月内需要居家肠外营养的肠功能衰竭患儿的平均每月社区获得性 CLABSI 感染率降低 25%,从每 1000 个社区管路日 11.7 例降至 8.8 例。 首先,成立了一个跨专业质量改进小组。在收集基线数据后,开始了 "计划-实施-研究-行动 "的循环。变革测试包括中心静脉导管 (CVC) 维护捆绑包。该护理包包括一个装有额外用品的 CVC 护理手提袋、经过改进的教育材料和乙醇锁预防措施。对照表用于显示每月社区获得性 CLABSI 感染率,并观察特殊原因的变化。 基线时,平均每月社区获得性 CLABSI 感染率为每 1000 个社区导管日 11.7 例。家庭 CVC 维护包实施后,连续 5 个月未发生感染。在对护理捆绑包和手提箱进行改进后,发现了特殊原因引起的变异,平均每月社区获得性 CLABSI 感染率下降了 66%,降至每 1000 个社区导管日 4 例。在其他两个时间点也发现了特殊原因的变化,但无法确定原因。 社区获得性 CLABSI 感染率的降低已持续了 24 个月,反映出这一高危人群中的感染病例每年减少了约 12 例。
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