This goal of this project, Eliminating CLABSI in Ambulatory Patients, is to determine whether use of 70% isopropyl alcohol embedded protective caps on central lines, layered on top of reliable use of best practice Maintenance Care for central lines, is associated with reduction in ambulatory central line- associated bloodstream infections in a high-risk population of pediatric hematology/oncology patients. The Children's Hospital Association, a 200+ member, not-for-profit organization of children's hospitals, has developed, sustained and spread quality transformation efforts focused on CLABSI elimination in hospital settings. The Association's CLABSI work is supported by an Agency for Healthcare Research and Quality (AHRQ) grant (R18 HS019590 Eliminating CLABSIs in Chronic Central Lines) to reduce CLABSI in hospitalized, non-intensive care unit (ICU) children. Preliminary analyses show a roughly 30% decrease in CLABSI rates in this high risk, hospitalized, but non-ICU population. The Association's Pediatric ICU CLABSI effort, involving over 70 PICUs, has resulted in CLABSI rates dropping dramatically from 5.5 infections per 1,000 central line days to approximately 1 infection per 1,000 central line days. Despite these successes, it remains unknown what generalizable best practices should be with chronic central lines in the home setting and how effective involving patients and caregivers across multiple institutions in CLABSI reduction efforts will be. Our proposal will build on ongoing AHRQ-funded work with 24 children's hospitals. We will use a cluster-randomized, cross over design, clinical trial to evaluate a promising new intervention to reduce CLABSI among children with chronic central lines in the home setting.
The overall goal of this proposal, entitled 'Eliminating CLABSI in Ambulatory Patients', is to determine whether use of 70% isopropyl alcohol embedded protective caps on central lines, layered on top of reliable use of best practice Maintenance Care for central lines, in the home setting is associated with a reduction in ambulatory central line-associated bloodstream infections in a high-risk population of pediatric hematology/oncology patients. Our proposal will accomplish this by partnering with 24 children's hospitals in a cluster-randomized, cross over design, clinical trial. Successful completion of this project will provide the Agency for Healthcare Research and Quality, providers, patients, payers, and policymakers with effective tools for spreading CLABSI eradication efforts to the ambulatory setting.
