A Quality Improvement Initiative to Reduce Central Line associated Blood Stream Infection in PICU of a Tertiary Care Hospital in North India.

Abstract

Purpose: Central line-associated bloodstream infections (CLABSI) are common healthcare-associated complications, especially in low-middle-income countries. We aimed to study the impact of certain quality improvement (QI) initiatives in reducing these infections from baseline rate of 10.5 per 1000 central line days.

Methods: This prospective interventional study was conducted in phases over 14-month period in level 3, 15-beds Pediatric Intensive Care Unit. During Phase 1, existing practices were observed and documented as baseline data. In Phase 2, QI initiatives were formulated, infrastructure was ramped up and staff was trained followed by implementation in Phase 3. Data was compared in pre and post- QI phases.

Results: The insertion site changed from femoral to internal jugular vein in 7/21(33%) to 14/21(67%), which was statistically significant (p= 0.030). The days of Central Line (CL) in situ were reduced (p= 0.038). The availability of single-use alcohol swabs, use of peripheral cannula for intermittent medication, and self-reported 'scrub the hub' also improved (p<0.001). Central line associated blood stream infection rate decreased by 32% from a baseline rate of 10.5 to 7.1 per 1000 CL days. During the later three months, it further dropped by 74% to 2.7 per 1000 CL days, followed by 'CLABSI-free six months' post study period.

Conclusion: Implementation of Quality improvement interventions resulted in progressive decline in central line associated blood stream infection rates from baseline of 10.5 to 7.1 per 1000 CL days and further to 2.7, followed by 'CLABSI-free six months.The factors that promoted success included all stakeholder participation, providing necessary infrastructure, training, audit and feedback.