Abstract :
A Reduction of Bloodstream Infections in a Pediatric Oncology Unit following Electronic Surveillance and Targeted Interventions
Page E120
B. Vason
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AbstractAbstract
Abstract
BACKGROUND: The Childrenʹs Hospital of Alabama (CHAL), a 250-bed pediatric facility in Birmingham, was alerted to an unsuspected pattern of hospital blood isolates from patients the Oncology Unit (OU).
OBJECTIVES: Confirm clinical significance of detected pattern, investigate causal factors, and implement interventions.
METHODS: Data-mining services are provided to CHAL. Monthly reports are generated to detect unrecognized patterns of infection. In July 2003, CHAL received an alert describing four patients from June 2003 with initial blood isolates obtained late in the hospital stay among patients on the OU, representing a 16-fold increase from the previous 4-month baseline (p=0.009). Culturing practices were unchanged, during, and after pattern identification.
RESULTS: Investigation of factors that led to the increase of bloodstream infections in June 2003 revealed: 1) a lack of compliance to updated CVL policies, 2) the need for an effective skin disinfectant prior to and following IV line insertion; 3) inconsistent techniques for care of CVLs throughout hospital. Interventions directed at bloodstream infection prevention were implemented. Guidelines for the insertion and care of were revised to reflect current CDC recommendations. Efforts were made to involve the unit staff in the improvement process and were supported with weekly meetings to review outcome data generated by our electronic surveillance system. In the 12 weeks following full implementation, only one hospital-associated isolate was obtained, a reduction of 90% (p = 0.014).
CONCLUSIONS: Early identification of unusual numbers of hospital-associated blood isolates led to the implementation of focused interventions thus reducing nosocomial bloodstream infections.
