| Primary Author: | Ralph D. Cade, RRT-NPS |
| Co-Principal Investigators/Collaborators: | Tracy Chamblee, PhD, RN, Marita Thompson, MD |
| Organization | Children’s Medical Center Dallas |
Abstract
Purpose
To determine the incidence of bloodstream infections among neonatal and pediatric patients while on ECMO and to determine the efficacy of a practice change on our CLA-BSI rate over a 10 year period (2002-2011).
Background
Extracorporeal membrane oxygenation (ECMO) is a clinical therapy that allows for prolonged cardiopulmonary support for patients with reversible cardiac or pulmonary disease. Central Line-Associated Blood Stream Infections (CLA-BSI) in pediatric intensive care unit (PICU) patients are a significant source of morbidity, mortality, and increased healthcare costs. There is little published research available on the risk of CLA-BSI in pediatric patients undergoing ECMO therapy. An increase in the number of blood stream infections associated with ECMO therapy prompted our team to investigate and implement a change in clinical practice.
Practice Change
The ECMO team consists of 10 core ECMO specialist, a combination of Registered Nurses and Respiratory Therapist. The core team underwent extensive education and training on proper sterile technique. Subsequently, the use of sterile technique for assembling ECMO circuits was implemented.
Evaluation
This practice change accomplished 2 primary objectives, it: 1) provided a standardized process for ECMO circuit assembly, using sterile technique, and 2) minimized the number of staff involved in ECMO circuit assembly. To determine the efficacy of the practice change, a retrospective, descriptive study design was used. Sources of data collection included the ECMO database and electronic medical record. These were reviewed to obtain patient demographics, indications for ECMO support, type of ECMO support, (VA vs VV), presence of infection during ECMO support, organism type, time to positivity, source of infection, duration of ECMO, and survival to hospital discharge.
Results
Final results are pending. However, preliminary results suggest that the practice change contributed to a reduction in the number of CLA-BSI acquired during ECMO therapy. If selected, final results will be available for presentation at the conference.
Biblipgraphy
Niedner, M., et al., (2011). Epidemiology of central line-associated bloodstream infections in the pediatric intensive care unit. Infection Control and Hospital Epidemiology, 32 (12), 0000-0000.
Odetola, F., et al., (2003). Nosocomial catheter-related bloodstream infections in a pediatric intensive care unit, risk and rates associated with various intravascular technologies. Pediatric Critical Care Medicine, 4, 432-436
Yogaraj, J., Elward, A., & Fraser, V. (2002). Rate, risk factors, and outcomes of nosocomial primary bloodstream infection in pediatric intensive care unit patients. Pediatrics, 110 (3), 481-485.
© Improvement Science Research Network, 2012
The ISRN published this as received and with permission from the author(s).