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Pediatric Central Line Maintenance Bundle – Standardizing the Approach

Background. Hospital acquired infections (HAI) lead to increased morbidity and mortality with hospitalized patients. Implementing practices to decrease harm to the patient and reducing additional costs associated with HAI's is a healthcare focus. Hospital acquired central line associated blood stream infections (CLABSI) pose a challenge for hospitals. Proper insertion and appropriate maintenance of central lines are crucial in prevention of CLABSI's. Inconsistent practices towards central line maintenance place patients at risk for increased morbidity and mortality from CLABSI's.

Methods. Using the Centers for Disease Control and Prevention recommendations,a central line maintenance bundle was developed for use in the pediatric setting.

Five elements were chosen to become part of the updated maintenance bundle:

1. Documentation of central line dressing, tubing, and cap change

2. Daily CHG bath and linen change

3. Appropriate central line medication administration

4. Dressing is dated, current, clean, dry, and intact

5. All tubing is dated and current

Maintenance bundle education was disseminated to nursing staff. Clinical nursing specialists, unit managers, clinical educators, and infection preventionists were trained as super users. Principles of implementation science were used for the roll out. Bundle rounds were conducted and aggregated monthly to assess for bundle compliance. All elements were observed individually to assess for deficiencies in addition to total compliance for each patient. Total compliance was determined to be appropriate only when every element had been completed. Partial credit was not given.

Results. This study shows that high total bundle compliance reduces the rate of CLABSI. When the total bundle achieved a rate of 80% compliance, the CLABSI rate declined. During the first 4 months of this implementation, 4 CLABSI's were identified, with a rate of 2.34 and 66% bundle compliance. The last 4 months of this implementation, 0 CLABSI's were identified, a rate of 0.0 and 85% bundle compliance.

Conclusion. In conclusion, standard and consistent practices relating to appropriate central line maintenance contributes to reduction of CLABSI in pediatric patients.

Disclosures. All authors: No reported disclosures.

Author notes