Formative Evaluation of CLABSI Adoption and Sustainment Interventions in a Pediatric Intensive Care Unit

Abstract

Background: Pediatric patients require central venous catheters to maintain adequate hydration, nutritional status, and delivery of life-saving medications in the pediatric intensive care unit. Although central venous catheters provide critical medical therapies, their use increases the risk of severe infection, morbidity, and mortality. Adopting an evidence-based central line-associated bloodstream infection (CLABSI) bundle to guide nursing practice can decrease and sustain low CLABSI rates, but reliable and consistent implementation is challenging. This study aimed to conduct a mixed-methods formative evaluation to explore CLABSI bundle implementation strategies in a PICU.

Methods: The team used The Consolidated Framework for Implementation Research to develop the interview guide and data analysis plan.

Results: Facilitators and barriers for the CLABSI bundle occurred in four domains: inner setting, process, characteristics of individuals, and innovation characteristics in each cycle that led to recommended implementation strategy opportunities. The champion role was a major implementation strategy that facilitated the adoption and sustainment of the CLABSI bundle.

Conclusions: Implementation Science Frameworks, such as Consolidated Framework for Implementation Research (CFIR), can be a beneficial framework to guide quality improvement efforts for evidence-based practices such as the CLABSI bundle. Using a champion role in the critical care setting may be an important implementation strategy for CLABSI bundle adoption and sustainment efforts.

Fig. 1.

CFIR: interview guide domains. This figure demonstrates how the qualitative interview guide was developed utilizing the CFIR domains and constructs.

Fig. 2.

CFIR domains and constructs. This figure outlines the three CFIR domains and 14 constructs that resulted from this study.

Fig. 3.

PICU central-line-associated blood stream infection rates U-chart. The solid line represents (in black) CLABSI rates. Rates are calculated as number of CLABSI events divided by 1000 catheter days. The central dashed line represents the mean CLABSI rate. The upper dashed line is the upper control limit (UCL), and the lower dashed line is the lower control limit (LCL), set at zero. Each study cycle is also displayed.

Fig. 4.

PICU central-line-associated blood stream infection bundle compliance rates U-chart. This figure displays overall CLABSI bundle compliance each month (solid black line). The central dashed line represents the mean CLABSI bundle compliance rate. The upper dashed line is the upper control limit (UCL), and the lower dashed line is the lower control limit (LCL). Each study cycle is also displayed. There are missing data from July ’21 to Jan ’22 due to insufficient staff to collect the data.