Preventing central-line-associated bloodstream infections in pediatric specialized care units: A case study of successful quality improvement

Central line associated bloodstream infections in pediatric intensive care units extend the intensive care unit length of stay and increase the cost of hospitalization. These infections, once thought to be an accepted complication of central vascular access, are now known to be preventable. Despite using hand hygiene, full barrier protection, and proper skin disinfection with 70% isopropyl alcohol/20% chlorhexidine gluconate for pediatric central venous catheter insertion, our catheter associated bloodstream infection rate remained high. We instituted a new practice involving scrubbing the catheter hub and performing dressing changes with 70% isopropyl alcohol/20% chlorhexidine gluconate in a combined pediatric intensive care and pediatric cardiac intensive care unit. We removed alternative products from the bedside thereby making it easier for the staff to follow procedure and reducing the need for training and monitoring. This change reduced our catheter associated bloodstream infection rate from 7.1 episodes per 1000 line days to 1.5 episodes per 1000 line days. We describe the barriers we encountered in instituting this practice change, evaluating the impact of the change with limited resources, and in eventually implementing the change in other units system-wide. The most commonly encountered obstacle to change was not a lack of resources, but the insistence by the medical staff that the incidence of these infections was a result of differences in patient populations and not differences in compliance with standardized procedure.