Reducing Inpatient Pediatric Central Line-associated Bloodstream Infections by Proactive Risk Assessment and Escalation.

Abstract

Introduction: Central line-associated bloodstream infections (CLABSIs), despite the application of best practices, are still prevalent and cause significant morbidity and mortality in pediatric patients. We describe a quality improvement project with an aim to reduce inpatient CLABSIs focused on standardization and proactive risk assessment.

Methods: The aim was to reduce inpatient CLABSI rates by 30% within 3 years beginning in January 2021. An apparent cause analysis in 2018 suggested that the lack of escalation of concerns was a potential focus area. We used Plan-Do-Study-Act cycles starting with a pilot in 2019 to roll out a CLABSI Watcher Program. After a CLABSI prevention summit in 2020, a reorganization of drivers reidentified the need for a standardized escalation process for central line (CL) concerns. A CL nurse program was then scaled across the hospital, focusing on timely proactive huddling. Hospital-wide standardization of practices occurred from 2021 to 2023. We used statistical process control charts to assess changes in CLABSI rates.

Results: Special cause variation, with a downward shift in the CLABSI rate process mean compared with baseline (0.97 per 1,000 CL days), was observed starting June 2021 (0.13 per 1,000 CL days). A second shift occurred from August 2023 through December 2024 (0.00 per 1,000 CL days). The CLABSI rate decreased by 65% (0.34 per 1,000 CL days) through December 2023.

Conclusions: Significant reductions in hospital CLABSI rates can be achieved by using additional measures beyond focusing on CL maintenance and insertion bundles, and particularly through developing proactive risk assessment and escalation processes.