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10. Decreasing PICU catheter-associated bloodstream infections: NACHRI's quality transformation efforts

Author

Miller, Marlene R., Griswold, Michael, Harris, J. Mitchell, II, Yenokyan, Gayane, Huskins, W. Charles, Moss, Michele, Rice, Tom B., Ridling, Debra, Campbell, Deborah, Margolis, Peter, Muething, Stephen, and Brilli, Richard J.

Subjects
National Association of Children's Hospitals and Related Institutions -- Quality management, Blood-borne diseases -- Prevention, Blood-borne diseases -- Research, Cross infection -- Prevention, Cross infection -- Research, Nosocomial infections -- Prevention, Nosocomial infections -- Research, Pediatric intensive care units -- Quality management, Pediatric intensive care units -- Research
Published
2010

11. Contributors

Author

Ackerman, Veda L., primary, Adelson, P. David, additional, Agbeko, Rachel S., additional, Almodovar, Melvin C., additional, Alonso, Estella M., additional, Aneja, Raj K., additional, Angus, Derek C., additional, Argent, Andrew C., additional, Aspesberro, Francois P., additional, Bakar, Adnan M., additional, Bambach, Barbara, additional, Bass, Lee M., additional, Bayir, Hülya, additional, Beaulieu, Pierre, additional, Bell, Michael J., additional, Bender, M.A., additional, Benson, Jeffrey C., additional, Benton, Wade W., additional, Berg, Robert A., additional, Berkowitz, Darryl H., additional, Bhutta, Omar J., additional, Biagas, Katherine C., additional, Blatt, Julie, additional, Blowey, Douglas L., additional, Blumer, Jeffrey L., additional, Bradley, John S, additional, Brandom, Barbara W., additional, Brodsky, Linda, additional, Brogan, Thomas V., additional, Brothers, Adam W., additional, Bunchman, Timothy E., additional, Burd, Randall S., additional, Burns, Jeffrey, additional, Bush, Sean P., additional, Bystrak, Louis L., additional, Campbell, Angela J.P., additional, Cannavino, Christopher R., additional, Carcillo, Joseph A., additional, Carrillo-Lopez, Hector, additional, Cassara, Antonio, additional, Caty, Michael G., additional, Charpie, John R., additional, Chavez, Adrian, additional, Christenson, John C., additional, Clark, Jonna D., additional, Clark, Robert S.B., additional, Clement, Katherine C., additional, Coalson, Jacqueline J., additional, Coopersmith, Craig M., additional, Coppola, Christopher P., additional, Corey, Seth J., additional, Cox, Peter N., additional, Cummings, James J., additional, Curley, Martha A.Q., additional, Czosnyka, Marek, additional, D’Angelis, Christopher A., additional, Dahmer, Mary K., additional, Dalton, Heidi J., additional, Davis, Peter J., additional, Morena, M. Theresa de la, additional, Oliveira, Cláudio Flauzino de, additional, Dhanani, Sonny, additional, Dobyns, Emily L., additional, Donner, Elizabeth J., additional, Doughty, Lesley, additional, Dreyfuss, Didier, additional, Duncan, Christine, additional, Durand, Philippe, additional, Duthie, Susan, additional, Eigen, Howard, additional, Maamoun El-Dawy, Waleed M., additional, Elliott, Steven, additional, Emery, Helen M., additional, Escobar, Mauricio A., additional, Evans, Jacqueline M., additional, Felmet, Kate, additional, Fineman, Jeffrey R., additional, Fink, Ericka L., additional, Fiser, Richard T., additional, Fish, Frank A., additional, Fletcher, James E., additional, Forbes, Michael J., additional, Fort, Amber E., additional, Fost, Norman, additional, Frader, Joel E., additional, Franzon, Deborah E., additional, Fricker, F. Jay, additional, Friess, Stuart, additional, Fuhrman, Bradley P., additional, Garcia-Casal, Xiomara, additional, Gauvin, France, additional, Gaynor, J. William, additional, Gilad, Eli, additional, Gilbert, James C., additional, Glaser, Nicole S., additional, Goldstein, Stuart L., additional, Goodman, Denise M., additional, Graciano, Ana Lía, additional, Gunnarsson, Björn, additional, Hahn, Cecil D., additional, Hall, Mark, additional, Hamilton, Melinda Fiedor, additional, Han, Yong Y., additional, Hanson, Cherissa, additional, Harding, Cary O., additional, Hartman, Mary E., additional, Hazelzet, Jan A., additional, Heard, Christopher M.B., additional, Heine, Ann Marie, additional, Hernan, Lynn J., additional, Hertzig, Jeremy S., additional, Heulitt, Mark J., additional, Hoffman, Julien I.E., additional, Huhta, James C., additional, Ichord, Rebecca, additional, Inglis, Andrew, additional, Linggi Irby, Gretchen A., additional, Jacobs, Brian, additional, Jardine, David, additional, Jarillo-Quijada, Alberto, additional, Javouey, Etienne, additional, Jefferis Kirk, Christa C., additional, Johns, James A., additional, Joshi, Prashant, additional, Kagan, Richard J., additional, Kannankeril, Prince J., additional, Kanter, Robert K., additional, Karam, Oliver, additional, Kasten, Kevin R., additional, Kelly, Michael, additional, Khanna, Paritosh C., additional, Kochanek, Patrick M., additional, Kocis, Keith C., additional, Kocoshis, Samuel A., additional, Koves, Ildiko H., additional, Kulik, Thomas J., additional, Kumar, Vasanth H., additional, Lacroix, Jacques, additional, Lakshminrusimha, Satyan, additional, Langley, Joanne M., additional, Laussen, Peter C., additional, Levin, Daniel L., additional, Lewis-Newby, Mithya, additional, Lieh-Lai, Mary W., additional, Lindsey, Daphne, additional, Litalien, Catherine, additional, Lynch, Robert E., additional, Makley, Amy T., additional, Marcin, James P., additional, Mariscalco, Mary Michele, additional, Markovitz, Barry, additional, Martin, Lynn D., additional, Maxvold, Norma J., additional, Mazur, Paula M., additional, McArthur, Jennifer A., additional, McLaughlin, Jerry, additional, McLaughlin, Gwenn E., additional, Redwine, Karen McNiece, additional, Mehta, Nilesh M., additional, Mehta, Renuka, additional, Melvin, Ann J., additional, Menon, Sharad, additional, Mian, Ayesa N., additional, Michelson, Kelly, additional, Michienzi, Kelly A., additional, Moloney-Harmon, Patricia A., additional, Monagle, Paul, additional, Moss, Michele M., additional, Mou, Steven S., additional, Muenzer, Jared T., additional, Nadkarni, Vinay, additional, Nakagawa, Thomas A., additional, Naran, Navyn, additional, Nguyen, Trung, additional, Nicholson, Carol E., additional, Nielsen, Katie R., additional, Northway, Tracie, additional, Norwood, Victoria F., additional, Notterman, Daniel A., additional, Nowak, Jeffrey E., additional, Oishi, Peter, additional, Orr, Richard A., additional, Ouellette, Yves, additional, Parakininkas, Daiva, additional, Parker, Margaret M., additional, Pearson-Shaver, Tony, additional, Pérez Fontán, J. Julio, additional, Peters, Mark, additional, Pihoker, Catherine, additional, Pinsk, Maury N., additional, Pollack, Murray M., additional, Pon, Steven, additional, Quasney, Michael, additional, Rajasekaran, Surender, additional, Rampersad, Sally E., additional, Ranjit, Suchitra, additional, Reade, Erin P., additional, Reese Jr., James J., additional, Relvas, Monica, additional, Remy, Kenneth E., additional, Ricard, Jean-Damien, additional, Rice, Tom B., additional, Ridling, Debra Ann, additional, Roberts, Joan S., additional, Ross, Ashley S., additional, Roth, Kimberly R., additional, Rotta, Alexandre T., additional, Rowin, Mark E., additional, Roy, John, additional, Rubino, Christopher M., additional, Ruppel, Randall A., additional, Rushton, Cynda H., additional, Ryan, Rita M., additional, Salonia, Rosanne, additional, Salvin, Joshua, additional, Sanders Jr., Ronald C., additional, Sarnaik, Ajit A., additional, Sarnaik, Ashok P., additional, Saumon, Georges, additional, Sawin, Robert, additional, Scanlon, Matthew C., additional, Schenkman, Kenneth A., additional, Schexnayder, Stephen M., additional, Schleien, Charles L., additional, Schwartz, George J., additional, Schwartz, Steven M., additional, Shann, Frank, additional, Shaw, Dennis W.W., additional, Shemie, Sam D., additional, Shoykhet, Mish, additional, Sivarajan, V. Ben, additional, Skippen, Peter W., additional, Slonim, Anthony D., additional, Smith, Laurie, additional, Smith, Lincoln S., additional, Standage, Stephen W., additional, Steinberg, Joel B., additional, Steinhorn, David M., additional, Stojanovski, Sasko D., additional, Storm, Elizabeth A., additional, Stroud, Michael H., additional, Sturgill, Marc G., additional, Sutton, Robert M., additional, Symons, Jordan M., additional, Tailounie, Muayyad, additional, Talano, Julie-An, additional, Tamburro Jr., Robert, additional, Tasker, Robert C., additional, Thompson, Ann E., additional, Tilton, Ann H., additional, Tinmouth, Alan, additional, Tobias, Joseph D., additional, Tobin, Nicole H., additional, Todres, I. David, additional, Tucci, Marisa, additional, Ulate, Kalia P., additional, Valentine, Kevin M., additional, Vaughan, David J., additional, Venkataraman, Shekhar T., additional, Visoiu, Mihaela, additional, von Saint André–von Arnim, Amélie, additional, Wainwright, Mark S., additional, Wakeham, Martin K., additional, Watson, R. Scott, additional, Webb, Ashley N., additional, Weigle, Carl, additional, Weimer, Maria B., additional, Wessel, David L., additional, Wetzel, Randall C., additional, Wong, Hector R., additional, Wood, Ellen G., additional, Woolf, Alan D., additional, Woytash, James J., additional, Yanay, Ofer, additional, Zaritsky, Arno, additional, Zerr, Danielle M., additional, and Zimmerman, Jerry J., additional

Published
2011
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13. Endotracheal suctioning with or without instillation of isotonic sodium chloride solution in critically ill children. (Pediatric Respiratory Critical Care)

Author

Ridling, Debra A., Martin, Lynn D., and Bratton, Susan L.

Subjects
Care and treatment, Evaluation, Materials, Dosage and administration, Methods, Saline solution -- Dosage and administration -- Evaluation, Suction -- Materials -- Methods, Critically ill children -- Care and treatment -- Methods, Otorhinolaryngologic surgery -- Methods, Suction (Medical care) -- Materials -- Methods, Physiologic salines -- Dosage and administration -- Evaluation
Abstract

* BACKGROUND Instillation of isotonic sodium chloride solution for endotracheal tube suctioning is controversial. Research has focused on the effect of such instillation in adults; no studies in children have [...]

Published
2003

17. Contributors

Author

Adelson, P. David, primary, Allen, David B., additional, Alonso, Estella M., additional, Alper, Gülay Pinar, additional, Angus, Derek C., additional, Anthone, Sidney, additional, Argent, Andrew, additional, Arnold, John H., additional, Bambach, Barbara, additional, Bayir, Hülya, additional, Beaulieu, Pierre, additional, Beitz, Laurie O., additional, Beltrán, Jorge R., additional, Benton, Wade W., additional, Berg, Robert A., additional, Bergman, Ira, additional, Blatt, Julie, additional, Blowey, Douglas L., additional, Blumer, Jeffrey L., additional, Bradley, John S., additional, Brandom, Barbara W., additional, Brecher, Martin L., additional, Brilli, Richard J., additional, Brisseau, Guy F., additional, Brogan, Thomas V., additional, Bunchman, Timothy E., additional, Bush, Sean P., additional, Carcillo, Joseph, additional, Carrel, Aaron L., additional, Carrillo-Lopez, Hector, additional, Cartwright, Victoria, additional, Carvajal, Hugo F., additional, Castillo, Leticia, additional, Caty, Michael G., additional, Cengiz, Pelin, additional, Chang, Anthony C., additional, Charpie, John R., additional, Chávez, Adrián, additional, Chesney, Russell W., additional, Cimino, Michael A., additional, Clark, Robert S.B., additional, Coalson, Jacqueline J., additional, Cook, D. Ryan, additional, Coopersmith, Craig M., additional, Coppola, Christopher P., additional, Corey, Seth J., additional, Cox, Peter N., additional, Culver, Kathleen, additional, Cummings, James J., additional, Curley, Martha A.Q., additional, Czosnyka, Marek, additional, Dalton, Heidi J., additional, Dauger, Stéphane, additional, Davis, Peter J., additional, Deshler, Jenina, additional, Dhanani, Sonny, additional, Dick, Rhonda M., additional, Dobyns, Emily L., additional, Donner, Elizabeth J., additional, Dreyfuss, Didier, additional, Durand, Philippe, additional, Duthie, Susan, additional, Ellenbogen, Richard G., additional, Evans, Jacqueline, additional, Fackler, James C., additional, Felmet, Kathryn, additional, Fineman, Jeffrey R., additional, Fiser, Debra H., additional, Fish, Frank A., additional, Fletcher, James E., additional, Fontán, J. Julio Pérez, additional, Forbes, Michael L., additional, Fost, Norman, additional, Frader, Joel E., additional, Franzon, Deborah, additional, Fricker, F. Jay, additional, Friedman, Aaron L., additional, Fuhrman, Bradley P., additional, Gauvin, France, additional, Gilad, Eli, additional, Gilbert, James C., additional, Giroir, Brett P., additional, Goldstein, Stuart L., additional, Graham, James, additional, Green, Jerril W., additional, Green, Thomas P., additional, Greene, Stephanie, additional, Griffith, James A., additional, Grossi, Mauro, additional, Gunnarsson, Björn, additional, Hagen, Scott A., additional, Hahn, Cecil D., additional, Hallstrom, Craig, additional, Han, Yong Y., additional, Harding, Cary O., additional, Harmon, William G., additional, Harry, Eric, additional, Hartman, Mary E., additional, Heard, Christopher, additional, Hernan, Lynn, additional, Heulitt, Mark J., additional, Hickey, Robert W., additional, Hoffman, Julien I.E., additional, Hofmann, Karen T., additional, Hollman, Gregory A., additional, Huhta, James C., additional, James, Hector E., additional, Jardine, David, additional, Jarillo, Alberto, additional, Javouey, Etienne, additional, Johns, James A., additional, Johnson, Kristin K., additional, Johnston, Michael V., additional, Jones, Deborah P., additional, Joshi, Prashant, additional, Kannankeril, Prince J., additional, Kanter, Robert K., additional, Kellum, John A., additional, Kelly, Michael, additional, Kochanek, Patrick M., additional, Kocoshis, Samuel A., additional, Kulik, Thomas J., additional, Kumar, Vasanth H., additional, Lacroix, Jacques, additional, Lai, Yichen, additional, Langley, Joanne M., additional, Lau, Stanley T., additional, Laussen, Peter, additional, Lee, Yi-Horng, additional, Lieh-Lai, Mary W., additional, Lindsay, D. Michael, additional, Litalien, Catherine, additional, Luban, Naomi L.C., additional, Lynch, Robert E., additional, Maffei, Frank, additional, Marcin, James P., additional, Mariscalco, Mary Michele, additional, Markovitz, Barry P., additional, Martin, Lynn D., additional, Matlow, Anne G., additional, Mayer, John E., additional, Mazur, Paula, additional, McKenzie, E. Dean, additional, McLaughlin, Gwenn E., additional, Mehta, Nilesh, additional, Mehta, Renuka, additional, Melvin, Ann J., additional, Mercier, Jean-Christophe, additional, Michelson, Kelly, additional, Michienzi, Kelly A., additional, Moloney-Harmon, Patricia A., additional, Morin, Frederick C., additional, Moss, Michele, additional, Nadkarni, Vinay, additional, Nicholson, Carol E., additional, Norwood, Victoria F., additional, Notterman, Daniel, additional, Nugent, Alan, additional, Oishi, Peter, additional, Olivar, Victor, additional, Orr, Richard A., additional, Ouellette, Yves, additional, Parakininkas, Daiva, additional, Parker, Margaret M., additional, Pearson-Shaver, Anthony L., additional, Petruzzi, Mary Jane F., additional, Pinsk, Maury N., additional, Pollack, Murray M., additional, Pon, Steven, additional, Pong, Alice, additional, Primak, Lara, additional, Prince, Audra, additional, Ricard, Jean-Damien, additional, Rice, Tom B., additional, Richards, Gail E., additional, Ridling, Debra Ann, additional, Roberts, Joan, additional, Roth, Kimberly, additional, Rotta, Alexandre T., additional, Rubens, Daniel, additional, Rubenstein, Jeffrey S., additional, Rubino, Christopher M., additional, Ruppel, Randall, additional, Safar, Peter J., additional, Sarnaik, Ashok P., additional, Sarner, Joel B., additional, Saumon, Georges, additional, Scanlon, Matthew C., additional, Schenkman, Kenneth, additional, Schexnayder, Stephen M., additional, Schleien, Charles L., additional, Sentongo, Timothy A., additional, Shanley, Thomas P., additional, Shann, Frank, additional, Shaw, Dennis W.W., additional, Shemie, Sam D., additional, Skippen, Peter, additional, Slonim, Anthony D., additional, Smith, Laurie, additional, Smith, Lincoln, additional, Steinhorn, David M., additional, Storm, Waldemar E., additional, Sturgill, Marc, additional, Sweetser, Marianne T., additional, Symons, Jordan M., additional, Tasker, Robert C., additional, Thompson, Ann E., additional, Tilton, Ann Henderson, additional, Tobin, Nicole H., additional, Todres, I. David, additional, Trinkaus, Peter, additional, Vaughan, David J., additional, Venkataraman, Shekhar T., additional, Villanueva, Rapheus C.Q., additional, Wankum, Patricia C., additional, Watson, R. Scott, additional, Waz, Wayne R., additional, Weigle, Carl G.M., additional, Weimer, Maria B., additional, Weinberger, Ed, additional, Wessel, David L., additional, West, William T., additional, Wetzel, Randall C., additional, Whitby, Dale, additional, Wong, Hector R., additional, Wood, Ellen G., additional, Woolf, Alan D., additional, Woytash, James, additional, Yanay, Ofer, additional, Zaritsky, Arno, additional, Zerr, Danielle M., additional, and Zimmerman, Jerry J., additional

Published
2006
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18. Implementation of the m-lSHAPED Tool for Nursing Interdepartmental Handoffs.

Author

Stimpson, Megan, Carlin, Kristen, and Ridling, Debra

Subjects
AUDITING, CHI-squared test, CONFIDENCE intervals, FISHER exact test, JOB satisfaction, NURSING, QUALITY assurance, HUMAN services programs, DISEASE incidence, DATA analysis software, DESCRIPTIVE statistics
Abstract

Background: Handoffs can pose risks to patients. Local Problem: Nurses throughout a children's hospital understood patient handoffs differently, resulting in handoff errors (failures) across departments. Methods: Lean principles were used to modify and implement the ISHAPED (Introduction, Story, History, Assessment, Plan, Error Prevention, and Dialogue) tool. Interventions: The team implemented a modified ISHAPED (m-ISHAPED) tool to align the content shared and the expectations for interdepartmental handoff. Results: Improvements were seen in reported patient safety events from 6.84 to 1.57 per 100 patient days (P < .001) and nurse satisfaction from 81.1% to 90.6% (P < .001). Conclusions: A standardized process for interdepartmental nursing handoff was successfully implemented. [ABSTRACT FROM AUTHOR]

Published
2020
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22. Implementation Science: Describing Implementation Methods Used by Pediatric Intensive Care Units in a National Collaborative.

Author

Ridling, Debra A. and Magyary, Diane

Abstract

In 2001, the Committee on Quality in Health Care in America found it took 17 years for evidence from randomized controlled trials to be applied to practice, with little improvement over the last decade. Even abbreviated and summarized evidence fails to be consistently implemented at the bedside. More emphasis needs to be placed on understanding which Implementation Methods are most effective in successfully implementing evidence-based practice at the bedside.~Background~Background~The purpose of the study was to explore the use of 20 Implementation Methods by 57 Pediatric Intensive Care Units (PICUs) participating in the National Association of Children's Hospitals and Related Institutions (NACHRI, 2011) collaborative to eliminate central line associated blood stream infections (CLABSI) in critically ill children.~Purpose~Objective~This descriptive research study was conducted using a Likert survey to determine the intensity of use of 20 Implementation Methods by PICUs. PICUs were also asked to identify any additional Implementation Methods that were used, but not included in the survey.~Methods~Methods~Most Implementation Methods had high or very high use across the 57 PICUs.~Results~Results~The 20 Implementation Methods identified as part of this study, represented the vast majority of Implementation Methods used by PICUs.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

Published
2015
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24. Contributors

Author

Adelson, P. David, Allen, David B., Alonso, Estella M., Alper, Gülay Pinar, Angus, Derek C., Anthone, Sidney, Argent, Andrew, Arnold, John H., Bambach, Barbara, Bayir, Hülya, Beaulieu, Pierre, Beitz, Laurie O., Beltrán, Jorge R., Benton, Wade W., Berg, Robert A., Bergman, Ira, Blatt, Julie, Blowey, Douglas L., Blumer, Jeffrey L., Bradley, John S., Brandom, Barbara W., Brecher, Martin L., Brilli, Richard J., Brisseau, Guy F., Brogan, Thomas V., Bunchman, Timothy E., Bush, Sean P., Carcillo, Joseph, Carrel, Aaron L., Carrillo-Lopez, Hector, Cartwright, Victoria, Carvajal, Hugo F., Castillo, Leticia, Caty, Michael G., Cengiz, Pelin, Chang, Anthony C., Charpie, John R., Chávez, Adrián, Chesney, Russell W., Cimino, Michael A., Clark, Robert S.B., Coalson, Jacqueline J., Cook, D. Ryan, Coopersmith, Craig M., Coppola, Christopher P., Corey, Seth J., Cox, Peter N., Culver, Kathleen, Cummings, James J., Curley, Martha A.Q., Czosnyka, Marek, Dalton, Heidi J., Dauger, Stéphane, Davis, Peter J., Deshler, Jenina, Dhanani, Sonny, Dick, Rhonda M., Dobyns, Emily L., Donner, Elizabeth J., Dreyfuss, Didier, Durand, Philippe, Duthie, Susan, Ellenbogen, Richard G., Evans, Jacqueline, Fackler, James C., Felmet, Kathryn, Fineman, Jeffrey R., Fiser, Debra H., Fish, Frank A., Fletcher, James E., Fontán, J. Julio Pérez, Forbes, Michael L., Fost, Norman, Frader, Joel E., Franzon, Deborah, Fricker, F. Jay, Friedman, Aaron L., Fuhrman, Bradley P., Gauvin, France, Gilad, Eli, Gilbert, James C., Giroir, Brett P., Goldstein, Stuart L., Graham, James, Green, Jerril W., Green, Thomas P., Greene, Stephanie, Griffith, James A., Grossi, Mauro, Gunnarsson, Björn, Hagen, Scott A., Hahn, Cecil D., Hallstrom, Craig, Han, Yong Y., Harding, Cary O., Harmon, William G., Harry, Eric, Hartman, Mary E., Heard, Christopher, Hernan, Lynn, Heulitt, Mark J., Hickey, Robert W., Hoffman, Julien I.E., Hofmann, Karen T., Hollman, Gregory A., Huhta, James C., James, Hector E., Jardine, David, Jarillo, Alberto, Javouey, Etienne, Johns, James A., Johnson, Kristin K., Johnston, Michael V., Jones, Deborah P., Joshi, Prashant, Kannankeril, Prince J., Kanter, Robert K., Kellum, John A., Kelly, Michael, Kochanek, Patrick M., Kocoshis, Samuel A., Kulik, Thomas J., Kumar, Vasanth H., Lacroix, Jacques, Lai, Yichen, Langley, Joanne M., Lau, Stanley T., Laussen, Peter, Lee, Yi-Horng, Lieh-Lai, Mary W., Lindsay, D. Michael, Litalien, Catherine, Luban, Naomi L.C., Lynch, Robert E., Maffei, Frank, Marcin, James P., Mariscalco, Mary Michele, Markovitz, Barry P., Martin, Lynn D., Matlow, Anne G., Mayer, John E., Jr., Mazur, Paula, McKenzie, E. Dean, McLaughlin, Gwenn E., Mehta, Nilesh, Mehta, Renuka, Melvin, Ann J., Mercier, Jean-Christophe, Michelson, Kelly, Michienzi, Kelly A., Moloney-Harmon, Patricia A., Morin, Frederick C., III, Moss, Michele, Nadkarni, Vinay, Nicholson, Carol E., Norwood, Victoria F., Notterman, Daniel, Nugent, Alan, Oishi, Peter, Olivar, Victor, Orr, Richard A., Ouellette, Yves, Parakininkas, Daiva, Parker, Margaret M., Pearson-Shaver, Anthony L., Petruzzi, Mary Jane F., Pinsk, Maury N., Pollack, Murray M., Pon, Steven, Pong, Alice, Primak, Lara, Prince, Audra, Ricard, Jean-Damien, Rice, Tom B., Richards, Gail E., Ridling, Debra Ann, Roberts, Joan, Roth, Kimberly, Rotta, Alexandre T., Rubens, Daniel, Rubenstein, Jeffrey S., Rubino, Christopher M., Ruppel, Randall, Safar, Peter J., Sarnaik, Ashok P., Sarner, Joel B., Saumon, Georges, Scanlon, Matthew C., Schenkman, Kenneth, Schexnayder, Stephen M., Schleien, Charles L., Sentongo, Timothy A., Shanley, Thomas P., Shann, Frank, Shaw, Dennis W.W., Shemie, Sam D., Skippen, Peter, Slonim, Anthony D., Smith, Laurie, Smith, Lincoln, Steinhorn, David M., Storm, Waldemar E., Sturgill, Marc, Sweetser, Marianne T., Symons, Jordan M., Tasker, Robert C., Thompson, Ann E., Tilton, Ann Henderson, Tobin, Nicole H., Todres, I. David, Trinkaus, Peter, Vaughan, David J., Venkataraman, Shekhar T., Villanueva, Rapheus C.Q., Wankum, Patricia C., Watson, R. Scott, Waz, Wayne R., Weigle, Carl G.M., Weimer, Maria B., Weinberger, Ed, Wessel, David L., West, William T., Wetzel, Randall C., Whitby, Dale, Wong, Hector R., Wood, Ellen G., Woolf, Alan D., Woytash, James, Yanay, Ofer, Zaritsky, Arno, Zerr, Danielle M., and Zimmerman, Jerry J.

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25. Reducing PICU central line-associated bloodstream infections: 3-year results.

Author

Miller MR, Niedner MF, Huskins WC, Colantuoni E, Yenokyan G, Moss M, Rice TB, Ridling D, Campbell D, and Brilli RJ

Subjects
Bacteremia etiology, Catheterization, Central Venous methods, Child, Child, Preschool, Confidence Intervals, Cross Infection prevention & control, Equipment Contamination prevention & control, Female, Follow-Up Studies, Humans, Incidence, Infant, Male, Primary Prevention methods, Retrospective Studies, Risk Assessment, Time Factors, United States, Anti-Infective Agents, Local pharmacology, Bacteremia prevention & control, Blood-Borne Pathogens isolation & purification, Catheterization, Central Venous adverse effects, Chlorhexidine pharmacology, Intensive Care Units, Pediatric
Abstract

Objectives: To evaluate the long-term impact of pediatric central line care practices in reducing PICU central line-associated bloodstream infection (CLA-BSI) rates and to evaluate the added impact of chlorhexidine scrub and chlorhexidine-impregnated sponges., Methods: A 3-year, multi-institutional, interrupted time-series design (October 2006 to September 2009), with historical control data, was used. A nested, 18-month, nonrandomized, factorial design was used to evaluate 2 additional interventions. Twenty-nine PICUs were included. Two central line care bundles (insertion and maintenance bundles) and 2 additional interventions (chlorhexidine scrub and chlorhexidine-impregnated sponges) were used. CLA-BSI rates (January 2004 to September 2009), insertion and maintenance bundle compliance rates (October 2006 to September 2009), and chlorhexidine scrub and chlorhexidine-impregnated sponge compliance rates (January 2008 to June 2009) were assessed., Results: The average aggregate baseline PICU CLA-BSI rate decreased 56% over 36 months from 5.2 CLA-BSIs per 1000 line-days (95% confidence interval [CI]: 4.4-6.2 CLA-BSIs per 1000 line-days) to 2.3 CLA-BSIs per 1000 line-days (95% CI: 1.9-2.9 CLA-BSIs per 1000 line-days) (rate ratio: 0.44 [95% CI: 0.37-0.53]; P < .0001). No statistically significant differences in CLA-BSI rate decreases between PICUs using or not using either of the 2 additional interventions were found., Conclusions: Focused attention on consistent adherence to the use of pediatrics-specific central line insertion and maintenance bundles produced sustained, continually decreasing PICU CLA-BSI rates. Additional use of either chlorhexidine for central line entry scrub or chlorhexidine-impregnated sponges did not produce any statistically significant additional reduction in PICU CLA-BSI rates.

Published
2011
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