ISR 58 - Central Line Associated Bloodstream Infection Reduction Efforts in a Pediatric Cardiac Intensive Care Unit: A Multifaceted Approach

Background: Central line-associated bloodstream infections (CLABSIs) represent a severe threat to patients that prolong length of stay and increase morbidity, mortality, and healthcare costs. Beginning in August 2021, our cardiac intensive care unit (CICU) experienced a sharp increase in CLABSI frequency, exceeding other areas in the hospital, despite high maintenance bundle compliance.

Methods: Infection Prevention and Control (IP&C) partnered with CICU medical and nursing leadership to address increased CLABSIs from multiple angles. Central line report forms were updated daily for discussion of line function and use during rounds. Weekly rounds led by local central line champions identified high level opportunities to decrease risk for infection beyond maintenance bundle elements. Enhanced cleaning of high touch surfaces, more frequent laundering of personal patient linen/belongings, increased frequency of room deep cleans for patients with prolonged stays, and use of UV light disinfection for mobile devices were implemented to reduce environmental bioburden. IP&C and nursing provided optimized and recurrent education, and updated protocols regarding basic practices including hand hygiene, separation of workspaces for clean and dirty tasks, and updated diapering protocols. CICU nursing performed central line maintenance audits with opportunities for improvement beyond standard institutional CLABSI prevention practices.

Results: Over a four- month period after implementation, the CICU experienced zero CLABSIs. During the 9-month periods before and after the intervention, the CICU CLABSI rate per 1,00 line days was 2.01 and 1.2, respectively. Observed hand hygiene compliance exceeded 85% compared to 70% in the preintervention period, sustained maintenance bundle compliance documentation at over 93%, and sustained observed bundle compliance practices above 91%.

Conclusions: Expanded and broad efforts to reduce CLABSIs in our CICU proved successful for a finite period. Resources related to staffing, time and money may be a limiting factor in sustaining efforts for prolonged periods of time. Future work will determine best strategies for sustained success.