Identifying high-risk central lines in critically ill children: A novel nurse-driven screening and mitigation intervention to reduce CLABSI

Background: Despite strong adherence to central line-associated bloodstream infection (CLABSI) infection prevention bundles, the CLABSI rate in our academic pediatric intensive care unit (PICU) and pediatric cardiac intensive unit (PCICU) remained high.

Methods: We developed a novel screening tool that stratified patients' risk for CLABSI and considered risk mitigation strategies.

Results: Of 1,583 screenings, 30% were classified as high-risk, 27% as moderate-risk, and 43% as low-risk. With accurate screening, the tool was 100% sensitive to patients who developed CLABSI, with a negative predictive value of 100% for low-risk screens. The CLABSI rate declined from 1.83 per 1,000 catheter-days to 0.98 and 1.02 in 2021 and 2022, respectively, with unprecedented consecutive months CLABSI-free. Device utilization was stable across both units, declining by 19% in the PICU and rising in the PCICU with increased cardiac surgeries. Clinicians expressed increased awareness of patient CLABSI risk factors and mitigation strategies in surveys.

Discussion: This novel screening tool effectively identified high-risk patients to target resources and promoted improvements in CLABSI prevention processes in the PICU and PCICU.

Conclusions: A novel nurse-driven CLABSI risk factor screening tool identified and focused resources on patients at high-risk for CLABSI, and increased awareness and proactive risk mitigation by clinicians.