Reducing ambulatory central line-associated bloodstream infections: A family-centered approach.

Autor: Wong CI; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.; Division of Pediatric Hematology-Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.; Department of Quality and Patient Safety, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.; Division of Pediatric Hematology-Oncology, University Hospitals Rainbow Babies and Children's Hospital and Division of Hematology-Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio, USA., Ilowite M; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.; Division of Pediatric Hematology-Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.; Department of Quality and Patient Safety, Dana-Farber Cancer Institute, Boston, Massachusetts, USA., Yan A; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.; Division of Pediatric Hematology-Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.; Division of Pediatric Hematology-Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada., Mahan RM; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.; Department of Quality and Patient Safety, Dana-Farber Cancer Institute, Boston, Massachusetts, USA., Desrochers MD; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA., Conway M; Division of Pediatric Hematology-Oncology, Boston Children's Hospital, Boston, Massachusetts, USA., Billett AL; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.; Division of Pediatric Hematology-Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.
Jazyk: angličtina
Zdroj: Pediatric blood & cancer [Pediatr Blood Cancer] 2024 Aug; Vol. 71 (8), pp. e31064. Date of Electronic Publication: 2024 May 18.
DOI: 10.1002/pbc.31064
Abstrakt: Background: Ambulatory central line-associated bloodstream infections (CLABSIs) cause significant morbidity and mortality, especially in pediatric oncology. Few studies have had interventions directed toward caregivers managing central lines (CL) at home to reduce ambulatory CLABSI rates. We aimed to reduce and sustain our ambulatory CLABSI rate by 25% within 3 years of the start of a quality improvement intervention.
Procedure: Plan-do-study-act cycles were implemented beginning April 2016. The main intervention was a family-centered CL care skill development curriculum for external CLs. Training began upon hospital CL insertion, followed by an ambulatory teach-back program to achieve home caregiver CL care independence. Other changes included: standardizing ambulatory nurse CL care practice (audits, a train the nurse trainer process, and workshops for independent home care agencies); developing aids for trainers and caregivers; providing supplies for clean surfaces; wide dissemination of the program; and minimizing opportunities of CLABSI (e.g., standardizing timing of CL removal). The outcome measure was the ambulatory CLABSI rate (excluding mucosal barrier injury laboratory-confirmed bloodstream infection), compared pre intervention (January 2015 to March 2016) to post intervention, including 2 years of sustainability (April 2016 to June 2023), using statistical process control charts. We estimated the total number of CLABSI and associated healthcare charges prevented.
Results: The ambulatory CLABSI rate decreased by 52% from 0.25 to 0.12 per 1000 CL days post intervention, achieved within 27 months; 117 CLABSI were prevented, with $4.2 million hospital charges and 702 hospital days avoided.
Conclusions: Focusing efforts on home caregivers CL care may lead to reduction in pediatric oncology ambulatory CLABSI rates.
(© 2024 Wiley Periodicals LLC.)
Databáze: MEDLINE
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