An unexpected increase in catheter-associated bloodstream infections at a children's hospital following introduction of the Spiros closed male connector.

BACKGROUND: Catheter-associated bloodstream infections (CA-BSIs) are associated with increased morbidity and mortality. Previous investigations have reported outbreaks of CA-BSI temporally associated with the use of needleless connector valves or similar devices. METHODS: We observed an unexpected increase in the rate of CA-BSI at our institution during August 2009. We used statistical process control and quality improvement methodology to identify the factor(s) associated with this increased rate of CA-BSI. RESULTS: We reviewed the overall hospital Shewhart U chart for CA-BSI, which indicated special cause variation with an unexpected cluster (6/9; 67%) of CA-BSIs localized to the oncology ward and the bone marrow transplant unit. An event-cause analysis review showed that 5 of these 9 infections were caused by Staphylococcus aureus. We discovered that the Spiros Closed Male Connector (ICU Medical, San Clemente, CA) had been introduced in these 2 units around the same time as the cluster of infections occurred. Based on this information, we discontinued the use of this device, and the CA-BSI rate and distribution of causative microorganisms returned to previous baseline values. CONCLUSION: This case study highlights the utility of statistical process control in the surveillance and investigation of CA-BSI.

A hospital-wide quality-improvement collaborative to reduce catheter-associated bloodstream infections.

BACKGROUND: Catheter-associated bloodstream infections (CA BSIs) are associated with increased hospital length of stay, total hospital costs, and mortality. Quality-improvement collaboratives (QICs) are frequently used to improve health care quality. Our PICU was previously involved in a successful national QIC to reduce the incidence of CA BSI in critically ill children. OBJECTIVE: We hypothesized that the formation of a hospital-wide QIC would reduce the incidence of CA BSI throughout our institution. METHODS: We retrospectively reviewed the incidence of CA BSI from March 2006 to March 2010. The collaborative approach included hospital-wide implementation of central-line insertion and maintenance bundles that emphasized full sterile barrier precautions and chlorhexidine skin preparation during line insertion, daily discussion of catheter necessity, and meticulous site and tubing care. The hospital units involved were our 3 critical care units, the oncology unit, the bone marrow transplant unit, and wards. Each individual unit was responsible for collecting unit-specific data and performing event-cause analysis within 48 hours of identifying a CA BSI. These results were shared with the other hospital units during monthly meetings. Compliance with the insertion and maintenance bundles was monitored and reported to each unit monthly. RESULTS: The hospital-wide CA-BSI rate decreased from a baseline of 3.0 to <1.0 CA BSI per 1000 line-days after implementation of the QIC. CONCLUSIONS: Our hospital-wide QIC resulted in a significant reduction in the incidence of CA BSI at our children's hospital. A collaborative model based on improvement science methodology is both feasible and effective in reducing the incidence of CA BSI.