Identifying high-risk central lines in critically ill children: a novel nurse-driven screening and mitigation intervention to reduce CLABSI.

IF 3.8 3区 医学 Q2 INFECTIOUS DISEASES American journal of infection control Pub Date : 2024-11-04 DOI:10.1016/j.ajic.2024.10.029
Stephanie Morgenstern, Katie Thompson, Stephanie Panton, Vivian Donnelly, Sara Pau, Kat Nelson, Lauren Booth, Taylor McIlquham, Jessica Kitlas, Christina Schumacher, Aaron M Milstone, Meghan Bernier, Anna C Sick-Samuels
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Abstract

Background: Despite strong adherence to central line associated bloodstream infection (CLABSI) infection prevention bundles, the CLABSI rate in our academic pediatric intensive care unit (PICU) and pediatric cardiac intensive unit (PCICU) remained high.

Methods: We developed a novel screening tool that stratified patients' risk for CLABSI and considered risk-mitigation strategies.

Results: Of 1583 screenings, 30% were classified as high-risk, 27% as moderate-risk, and 43% as low-risk. With accurate screening, the tool was 100% sensitive to patients who developed CLABSI, with a negative predictive value of 100% for low-risk screens. The CLABSI rate declined from 1.83 per 1000 catheter-days to 0.98 and 1.02 in 2021 and 2022, respectively, with unprecedented consecutive months CLABSI free. Device utilization was stable across both units, declining by 22% in the PICU and rising in the PCICU with increased cardiac surgeries. Clinicians expressed increased awareness of patient CLABSI risk factors and mitigation strategies in surveys.

Discussions: This novel screening tool effectively identified high-risk patients to target resources and promoted improvements in CLABSI-prevention processes in the PICU and PCICU.

Conclusions: A novel nurse-driven CLABSI risk factor screening tool identified and focused resources on patients at high-risk for CLABSI, and increased awareness and proactive risk mitigation by clinicians.

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识别重症患儿的高风险中心静脉置管:以护士为主导的新型筛查和缓解干预措施,以减少 CLABSI。
背景:尽管我们严格遵守了中心管路相关血流感染(CLABSI)的感染预防措施,但我们的儿科重症监护病房(PICU)和儿科心脏重症监护病房(PCICU)的CLABSI感染率仍然很高:方法:我们开发了一种新型筛查工具,对患者的 CLABSI 风险进行分层,并考虑风险缓解策略:结果:在 1583 次筛查中,30% 的患者被归类为高风险,27% 的患者被归类为中度风险,43% 的患者被归类为低风险。通过准确筛查,该工具对发生 CLABSI 的患者敏感度为 100%,对低风险筛查的阴性预测值为 100%。2021 年和 2022 年,CLABSI 感染率分别从每 1000 个导管日 1.83 例和 1.02 例下降到 0.98 例和 1.02 例,前所未有地实现了连续数月无 CLABSI 感染。两个病房的设备使用率保持稳定,PICU 下降了 22%,PCICU 则随着心脏手术的增加而上升。临床医生在调查中表示对患者 CLABSI 风险因素和缓解策略的认识有所提高:讨论:这一新型筛查工具有效识别了高风险患者,为其提供了针对性资源,并促进了 PICU 和 PCICU CLABSI 预防流程的改进:由护士驱动的新型 CLABSI 风险因素筛查工具可识别 CLABSI 高危患者并将资源集中用于这些患者,还可提高临床医生的意识并主动降低风险。
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来源期刊
CiteScore
7.40
自引率
4.10%
发文量
479
审稿时长
24 days
期刊介绍: AJIC covers key topics and issues in infection control and epidemiology. Infection control professionals, including physicians, nurses, and epidemiologists, rely on AJIC for peer-reviewed articles covering clinical topics as well as original research. As the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC)
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