Implementation of central venous access device care bundles using a plan-do-study-act approach to reduce central line-associated bloodstream infection in children at a tertiary hospital in Indonesia

Abstract

Background: Sepsis is a major cause of morbidity and mortality worldwide, especially in low- and middle-income countries. Central line-associated bloodstream infection (CLABSI) contributes significantly to hospital-onset sepsis. However, data on CLABSI rates related to central venous catheter placement and bundle non-compliance in our hospital are limited. Aim: To evaluate a Plan-Do-Study-Act (PDSA) based CLABSI bundle in reducing CLABSI rates in children at Dr. Cipto Mangunkusumo Hospital. Methods: A quality improvement study using three sequential PDSA cycles was conducted between September and November 2022. Children aged 1 month to 18 years who underwent central venous access device (CVAD) insertion by the Pediatric Emergency and Intensive Care team between June and November 2022 were included. Interventions comprised education on the CLABSI bundle and CVAD insertion practices, increased nursing involvement through standardized bedside training, and reinforced documentation and monitoring of CVAD care. Results: A total of 280 patients were included, with 143 in the pre-intervention period and 137 during the intervention period. The mean CLABSI rate decreased from 12.7 to 8.6 per 1,000 central-line days within three months of PDSA implementation. The lowest CLABSI rate, 3.4 per 1,000 central-line days, was observed in November 2022. Process evaluation PDSA Cycle 3 identified persistent system-level barriers, including limited availability of essential supplies and suboptimal adherence to recommended insertion and dressing practices. Conclusion: PDSA-based CLABSI bundle implementation was feasible and associated with an early reduction in CLABSI rates; however, system-level and resource constraints limited sustained improvement.

Access to Document

Other files and links

• Link to publication in Scopus
• Open Access Version Available

Fingerprint