Beyond the Bundle: Reducing Central Line–Associated Bloodstream Infections on a Pediatric Hematology, Oncology, and Bone Marrow Transplant Unit.

This article focuses on a quality improvement (QI) project aimed at reducing central line–associated bloodstream infections (CLABSIs) in pediatric patients with cancer or undergoing hematopoietic stem cell transplantation (HSCT) in a combined pediatric hematology/oncology/bone marrow transplant (PHOB) unit. The project implemented four interventions— in situ simulation training for nurses, interdisciplinary proactive safety huddles, use of Prevantics® Device Swabs (a combination of isopropyl alcohol and chlorhexidine gluconate) for catheter hub disinfection, and expanded levofloxacin prophylaxis for high-risk patients—using the Plan-Do-Study-Act model. Over 30 months, these interventions reduced the non-mucosal barrier injury (non-MBI) CLABSI rate from 2.19 to 0.52 infections per 1,000 catheter days, while mucosal barrier injury (MBI) CLABSI rates remained unchanged. The study highlights that traditional prevention bundles alone may be insufficient for this population and that targeted, multifaceted strategies involving nursing education, patient-specific risk assessment, and antimicrobial prophylaxis can effectively reduce non-MBI CLABSI rates in similar pediatric oncology settings.