O2090: Use of Clinical Decision Support to Mitigate Central Line-Associated Blood Stream Infection Risk in High-Risk Patients

Purpose/Objectives: Central line-associated blood stream infections (CLABSI) are an inherent risk for all pediatric ICU (PICU) patients with a central line. Despite efforts focused on CLABSI prevention, CLABSIs remain a source of morbidity and mortality. In the Cincinnati Children’s Hospital Medical Center (CCHMC) PICU, the CLABSI Risk Tool is a clinical decision support (CDS) tool that stratifies a patient’s CLABSI risk based on evidence-based risk factors. For patients categorized as high-risk, an automated best practice alert (BPA) is triggered in the electronic health record for filing of a progress note with targeted, evidence-based prevention strategies to improve situational awareness and allow for immediate action to aid in CLABSI prevention.

The objective of this study was to assess the saliency of a CDS tool for PICU patients identified to be at high-risk for CLABSI.

Design/Methods: Retrospective review of 151 CLABSI Risk Tool progress notes filed on CCHMC PICU patients with a high-risk CLABSI score from December 2023 to December 2024. Saliency was defined as the proportion of notes containing plans to reduce lab frequency and line access; adhere to predetermined blood culture criteria; consult infectious disease; or remove the central line.

Results: 151 BPA episodes were captured during the study period which represented 44 unique patients. 48 BPA episodes were excluded from analysis as they represented a single patient. There was 50% saliency across the study period. 20% noted an effort to reduce lab frequency and line access with 24% of those leading to actual reductions. 35% of BPA episodes had blood cultures drawn with 50% compliance to the outlined culture criteria. Two episodes documented plans for infectious disease consultation with one consultation being placed. Additionally, three episodes discussed line removal with two instances of lines being removed. Finally, CLABSI rates per 1000 line days in the CCHMC PICU was 2.5 in 2023 prior to launch of the tool compared to 1.2 in 2024 after the tool was live.

Conclusion/Discussion: This analysis demonstrates that an evidence-based CLABSI risk CDS tool has effective saliency when it comes to adopting prevention measures for mitigating CLABSI risk in high-risk PICU patients. Additionally, there was a decrease in CLABSI rates after implementation of the CLABSI risk CDS.