Identifying high-risk central lines in critically ill children: A novel nurse-driven screening and mitigation intervention to reduce CLABSI

doi:10.1016/j.ajic.2024.10.029

. 2025 Mar;53(3):381-386.

doi: 10.1016/j.ajic.2024.10.029. Epub 2024 Nov 4.

Identifying high-risk central lines in critically ill children: A novel nurse-driven screening and mitigation intervention to reduce CLABSI

Affiliations

¹ Department of Pediatric Nursing, Johns Hopkins Hospital, Baltimore, MD. Electronic address: Smorgen2@jh.edu.
² Department of Pediatric Nursing, Johns Hopkins Hospital, Baltimore, MD.
³ Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MD.
⁴ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
⁵ Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
⁶ Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MD; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD; Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD.
⁷ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.

PMID: 39505114
PMCID: PMC11874062 (available on 2026-03-01)
DOI: 10.1016/j.ajic.2024.10.029

Identifying high-risk central lines in critically ill children: A novel nurse-driven screening and mitigation intervention to reduce CLABSI

Stephanie Morgenstern et al. Am J Infect Control. 2025 Mar.

. 2025 Mar;53(3):381-386.

doi: 10.1016/j.ajic.2024.10.029. Epub 2024 Nov 4.

Affiliations

¹ Department of Pediatric Nursing, Johns Hopkins Hospital, Baltimore, MD. Electronic address: Smorgen2@jh.edu.
² Department of Pediatric Nursing, Johns Hopkins Hospital, Baltimore, MD.
³ Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MD.
⁴ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
⁵ Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
⁶ Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MD; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD; Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD.
⁷ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.

PMID: 39505114
PMCID: PMC11874062 (available on 2026-03-01)
DOI: 10.1016/j.ajic.2024.10.029

Abstract

Background: Despite strong adherence to central line-associated bloodstream infection (CLABSI) infection prevention bundles, the CLABSI rate in our academic pediatric intensive care unit (PICU) and pediatric cardiac intensive unit (PCICU) remained high.

Methods: We developed a novel screening tool that stratified patients' risk for CLABSI and considered risk mitigation strategies.

Results: Of 1,583 screenings, 30% were classified as high-risk, 27% as moderate-risk, and 43% as low-risk. With accurate screening, the tool was 100% sensitive to patients who developed CLABSI, with a negative predictive value of 100% for low-risk screens. The CLABSI rate declined from 1.83 per 1,000 catheter-days to 0.98 and 1.02 in 2021 and 2022, respectively, with unprecedented consecutive months CLABSI-free. Device utilization was stable across both units, declining by 19% in the PICU and rising in the PCICU with increased cardiac surgeries. Clinicians expressed increased awareness of patient CLABSI risk factors and mitigation strategies in surveys.

Discussion: This novel screening tool effectively identified high-risk patients to target resources and promoted improvements in CLABSI prevention processes in the PICU and PCICU.

Conclusions: A novel nurse-driven CLABSI risk factor screening tool identified and focused resources on patients at high-risk for CLABSI, and increased awareness and proactive risk mitigation by clinicians.

Keywords: Central line; Infection; PICU; Pediatric; Pediatric intensive care; Risk factors.

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Conflict of interest statement

Conflict of interest disclosure: The authors have no conflicts of interest to disclose relevant to this article.

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Huo Z, Légeret C, Holland-Cunz SG, Gros SJ. Huo Z, et al. Front Pediatr. 2025 Jun 18;13:1421992. doi: 10.3389/fped.2025.1421992. eCollection 2025. Front Pediatr. 2025. PMID: 40606787 Free PMC article.

References

1. Woods-Hill CZ PK, Nelson E, et al. Harnessing implementation science to optimize harm prevention in critically ill children: A pilot study of bedside nurse CLABSI bundle performance in the pediatric intensive care unit. Am J Infect Control. 2021;49(3):345–351. doi:10.1016/j.ajic.2020.08.019 - DOI - PMC - PubMed
1. Woods-Hill CZ SL, Schriver E, Haj-Hassan T, Bezpalko O, Sammons JS. Novel risk factors for central-line associated bloodstream infections in critically ill children. Infect Control Hosp Epidemiol. 2020;41(1):67–72. doi:10.1017/ice.2019.302 - DOI - PubMed
1. Spelman T PD, Cheng AC, Bull AL, Richards MJ, Worth LJ. Central line-associated bloodstream infections in Australian ICUs: evaluating modifiable and non-modifiable risks in Victorian healthcare facilities. Epidemiol Infect. 2017;145(14):3047–3055. doi:10.1017/S095026881700187X - DOI - PMC - PubMed
1. Torre FPF BG, Troster EJ. Risk factors for vascular catheter-related bloodstream infections in pediatric intensive care units. Fatores de risco para infecções da corrente sanguínea relacionadas a cateter em unidades de terapia intensiva pediátrica. Rev Bras Ter Intensiva. 2018;30(4):436–442. doi:10.5935/0103-507X.20180066 - DOI - PMC - PubMed
1. Sanderson E YK, Wang AY, et al. Dwell time and risk of central-line-associated bloodstream infection in neonates. J Hosp Infect. 2017;97(3):267–274. doi:10.1016/j.jhin.2017.06.023 - DOI - PubMed

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[1] Woods-Hill CZ PK, Nelson E, et al. Harnessing implementation science to optimize harm prevention in critically ill children: A pilot study of bedside nurse CLABSI bundle performance in the pediatric intensive care unit. Am J Infect Control. 2021;49(3):345–351. doi:10.1016/j.ajic.2020.08.019 - DOI - PMC - PubMed

[2] Woods-Hill CZ PK, Nelson E, et al. Harnessing implementation science to optimize harm prevention in critically ill children: A pilot study of bedside nurse CLABSI bundle performance in the pediatric intensive care unit. Am J Infect Control. 2021;49(3):345–351. doi:10.1016/j.ajic.2020.08.019 - DOI - PMC - PubMed

[3] Woods-Hill CZ SL, Schriver E, Haj-Hassan T, Bezpalko O, Sammons JS. Novel risk factors for central-line associated bloodstream infections in critically ill children. Infect Control Hosp Epidemiol. 2020;41(1):67–72. doi:10.1017/ice.2019.302 - DOI - PubMed

[4] Woods-Hill CZ SL, Schriver E, Haj-Hassan T, Bezpalko O, Sammons JS. Novel risk factors for central-line associated bloodstream infections in critically ill children. Infect Control Hosp Epidemiol. 2020;41(1):67–72. doi:10.1017/ice.2019.302 - DOI - PubMed

[5] Spelman T PD, Cheng AC, Bull AL, Richards MJ, Worth LJ. Central line-associated bloodstream infections in Australian ICUs: evaluating modifiable and non-modifiable risks in Victorian healthcare facilities. Epidemiol Infect. 2017;145(14):3047–3055. doi:10.1017/S095026881700187X - DOI - PMC - PubMed

[6] Spelman T PD, Cheng AC, Bull AL, Richards MJ, Worth LJ. Central line-associated bloodstream infections in Australian ICUs: evaluating modifiable and non-modifiable risks in Victorian healthcare facilities. Epidemiol Infect. 2017;145(14):3047–3055. doi:10.1017/S095026881700187X - DOI - PMC - PubMed

[7] Torre FPF BG, Troster EJ. Risk factors for vascular catheter-related bloodstream infections in pediatric intensive care units. Fatores de risco para infecções da corrente sanguínea relacionadas a cateter em unidades de terapia intensiva pediátrica. Rev Bras Ter Intensiva. 2018;30(4):436–442. doi:10.5935/0103-507X.20180066 - DOI - PMC - PubMed

[8] Torre FPF BG, Troster EJ. Risk factors for vascular catheter-related bloodstream infections in pediatric intensive care units. Fatores de risco para infecções da corrente sanguínea relacionadas a cateter em unidades de terapia intensiva pediátrica. Rev Bras Ter Intensiva. 2018;30(4):436–442. doi:10.5935/0103-507X.20180066 - DOI - PMC - PubMed

[9] Sanderson E YK, Wang AY, et al. Dwell time and risk of central-line-associated bloodstream infection in neonates. J Hosp Infect. 2017;97(3):267–274. doi:10.1016/j.jhin.2017.06.023 - DOI - PubMed

[10] Sanderson E YK, Wang AY, et al. Dwell time and risk of central-line-associated bloodstream infection in neonates. J Hosp Infect. 2017;97(3):267–274. doi:10.1016/j.jhin.2017.06.023 - DOI - PubMed

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Identifying high-risk central lines in critically ill children: A novel nurse-driven screening and mitigation intervention to reduce CLABSI

Affiliations

Identifying high-risk central lines in critically ill children: A novel nurse-driven screening and mitigation intervention to reduce CLABSI

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Abstract

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