Major articleCentral line-associated blood stream infections in pediatric intensive care units: Longitudinal trends and compliance with bundle strategies

•A longitudinal study of pediatric intensive care unit central line-associated bloodstream infection rates and a survey of their prevention practices.•Central line-associated bloodstream infection rates fell significantly from 5.8 per 1,000 line days in 2006 to 1.4 in 2011-2012.•Compliance with optimal site and hand hygiene were associated with lower central line-associated bloodstream infection rates.•Compliance with other policies or practices were not associated with less central line-associated bloodstream infections.•Only 25% of pediatric intensive care units had ≥95% compliance with all studied prevention policies.

BackgroundKnowing the temporal trend central line-associated bloodstream infection (CLABSI) rates among U.S. pediatric intensive care units (PICUs), the current extent of central line bundle compliance, and the impact of compliance on rates is necessary to understand what has been accomplished and can be improved in CLABSI prevention.MethodsThis is a longitudinal study of PICUs in National Healthcare Safety Network hospitals and a cross-sectional survey of directors and managers of infection prevention and control departments regarding PICU CLABSI prevention practices, including self-reported compliance with elements of central line bundles. Associations between 2011-2012 PICU CLABSI rates and infection prevention practices were examined.ResultsReported CLABSI rates decreased during the study period, from 5.8 per 1,000 line days in 2006 to 1.4 in 2011-2012 (P < .001). Although 73% of PICUs had policies for all central line prevention practices, only 35% of those with policies reported ≥95% compliance. PICUs with ≥95% compliance with central line infection prevention policies had lower reported CLABSI rates, but this association was statistically insignificant.ConclusionThere was a nonsignificant trend in decreasing CLABSI rates as PICUs improved bundle policy compliance. Given that few PICUs reported full compliance with these policies, PICUs increasing their efforts to comply with these policies may help reduce CLABSI rates.