P2.105: Fine Lines: Reduction in Central Line Blood Stream Infections in the Pediatric Intensive Care Unit Through Implementation of Multidisciplinary, Unit-Based Rounding

Purpose/Objectives: Central Line-Associated Blood Stream Infections (CLABSIs) are common, preventable complications of central lines that lead to significant morbidity and mortality in critically ill children. In addition, CLABSIs prolong hospital stays, increase hospitalization costs, and cause added stress to patients and their families. We aimed to reduce CLABSI rates in our Pediatric Intensive Care Unit (PICU) through a weekly, team-based, multidisciplinary rounding process that minimally impacted provider workflow.

Design/Methods: In January 2023, we instituted weekly multidisciplinary rounding with a dedicated team consisting of a nurse leader, infection preventionist, quality improvement specialist nurse, and a physician. The team reviewed the age, indication and necessity for all central lines, evaluated the central line dressing, and audited adherence to the hospital protocol CLABSI bundle including alcohol-impregnated caps on all ports. The team particularly focused on high-risk central lines (femoral, internal jugular, and umbilical lines). Team members were not directly involved in patient care at the time to ensure objectivity and adequate resource allocation. For bedside nurses, immediate feedback and additional resources were provided. The physician rounder provided feedback and recommendations to the on-service physician, either in person or via an Epic message when appropriate. In addition, during the week, a physician provided personal reminder messages to the on-service providers when high-risk central lines were five, seven and ten days old, with a goal of removing these lines by seven days, if possible.

The number of CLABSIs and device days were used to calculate the CLABSI rate (per 1000 device days). The Poisson rate hypothesis test, comparing the rates of infection before and after the intervention was used.

Results: In the 42 months prior to the study intervention (June 2019-December 2022), our 20-bed mixed cardiac/surgical/medical PICU had a CLABSI rate of 2.84 infections per 1,000 device days. Following the institution of multidisciplinary rounding for 24 months, (January 2023-December 2024), the CLABSI rate decreased to 1.33 infections per device days (p= 0.028). Poisson regression that adjusted for utilization rate and patient days was conducted to investigate whether the intervention had a statistically significant effect on CLABSI rate. The intervention has a coefficient estimate of -0.96 with a p-value of 0.0137. The coefficient estimate corresponds to a rate ratio of approximately 0.38, which suggests a 62% reduction in infection rates after intervention, even with a shorter time interval for measurement. Compliance with rounding over 18 months was 97%.

Conclusion/Discussion: Our PICU achieved a significant decrease in CLABSI rates after implementing a dedicated central line rounding team and prompts for line removal sent to on-service clinicians. Further analysis is needed to determine if this intervention alone was responsible for the decrease in CLABSI rate as well as next steps in the CLABSI reduction bundle.