Reducing Central Line Associated Blood Stream Infections in a Tertiary Care Paediatric Oncology Unit: A Quality Improvement Study

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Abstract Background The Pediatric Oncology unit of a tertiary care teaching hospital in India found that central line-associated bloodstream infections (CLABSIs) appeared to cause delays in chemotherapy, increased intensive care admissions, higher treatment costs, increased morbidity, and mortality among children on cancer chemotherapy. However, accurate data on CLABSI rates in the unit were not available. Hence, a quality improvement (QI) project was undertaken with the aim of estimating the burden of CLABSI in the unit and decreasing CLABSI rates among children with cancers by 85% over a period of 6 months (24 weeks). Methods This QI study was conducted in the pediatric oncology unit of a teaching hospital in Southern India between January 2021 and December 2022. All children between 1 month and 18 years of age with a diagnosis of cancer and receiving chemotherapy or supportive care in the unit were included in the study. This study was conducted in three phases: Observation phase (8 months): QI team formation, baseline data collection, and root cause analysisIntervention phase (6 months): QI interventionsSustenance phase (10 months): Sustain changes proposed Process indicators included hand hygiene adherence and central line insertion/maintenance bundle adherence, and outcome measures included CLABSI rates and mortality Results During the study period, a total of 480 children were on cancer chemotherapy at our centre, contributing to a total of 14,873 central line days. A QI team comprising doctors, medical trainees, and nurses was formed. In the baseline period, CLABSI rates were found to be 18.5 per 1000 central line days, leading to 3 deaths. Root cause analysis identified several risk factors for increased CLABSI rates. The QI team proposed several interventions to address the risk factors identified (Table 1). The interventions were prioritised using a prioritisation matrix and executed using four Plan-Do-Study-Act cycles, each lasting 6 weeks (Fig 1). A significant improvement in hand hygiene adherence and central line bundle adherence from 22.4% to 82% and 12.6% to 73.8% respectively, was achieved, translating to >85% reduction in CLABSI rates from 18.5% to 1.7% during the intervention period (Table 2). These gains were sustained over a period of 3.5 years, with a CLABSI rate of 1.37% contributing to 2 deaths. Conclusion QI measures were effective in reducing CLABSI rates by 93%. Along with hand hygiene and central line bundle care adherence, patient cohorting, limiting caretaker movement, and aseptic non-touch technique can help reduce CLABSI rates.