Beyond the Bundle: Reducing Central Line-Associated Bloodstream Infections on a Pediatric Hematology, Oncology, and Bone Marrow Transplant Unit

Abstract

BackgroundPediatric patients with cancer or undergoing hematopoietic stem cell transplantation (HSCT) are at an increased risk for central line-associated bloodstream infections (CLABSIs). Previous reports show that while primary prevention bundle elements have resulted in clinically important reductions in CLABSI events, they have not eliminated events in this patient population.MethodThe quality improvement (QI) project team implemented four interventions to reduce CLABSI in a pediatric inpatient combined hematology/oncology/bone marrow transplant (PHOB) unit, using the Plan-Do-Study-Act improvement model. (a) In situ simulation provided a practical application to bedside nurses to practice skills and critical thinking without disrupting care. (b) Interdisciplinary proactive safety huddles provided an opportunity to generate patient-specific strategies for patients with unique risks. (c) Prevantics^® Device swabs for catheter hub disinfection, replacing single agent isopropyl alcohol. (d) Levofloxacin prophylaxis was expanded to a broader scope of patients.ResultsDuring the 30-month project period, the inpatient PHOB unit experienced a reduced nonmucosal barrier injury (non-MBI) CLABSI rate from a baseline of 2.19 infections per 1,000 catheter days to 0.52 infections per 1,000 catheter days. MBI CLABSI rates remained unchanged.DiscussionWhile traditional prevention bundle elements play an essential role in CLABSI prevention efforts, pediatric patients with cancer or undergoing HSCT may require additional targeted strategies to achieve desired results. Our QI project, implemented at a large, freestanding pediatric academic center effectively reduced CLABSI rates during a 30-month project. We believe the interventions may be effective in other PHOB programs.

Keywords: CLABSI; pediatric oncology nursing; quality improvement.