N4. Device-related HAIs (CLABSI, CAUTI, VAP)
Oral Abstract Submission
Clinicians obtain endotracheal aspirate (ETA) cultures from mechanically ventilated patients in the pediatric intensive care unit (PICU) for the evaluation of ventilator-associated infection (i.e. tracheitis or pneumonia). Positive cultures prompt clinicians to treat with antibiotics even though ETA cultures cannot distinguish bacterial colonization from infection. We undertook a quality improvement initiative to standardize the use of endotracheal cultures in the evaluation of ventilator-associated infections among hospitalized children.
A multidisciplinary team developed a clinical decision support algorithm to guide when to obtain ETA cultures from patients admitted to the PICU and ventilated for > 1 day. We disseminated the algorithm to all bedside providers in the PICU in April 2018 and compared the rate of cultures one year before and after the intervention using Poisson regression and a quasi-experimental interrupted time-series models. Charge savings were estimated based on $220 average charge for one ETA culture.
In the pre-intervention period, there was an average of 46 ETA cultures per month, a total of 557 cultures over 5092 ventilator-days; after introduction of the algorithm, there were 19 cultures obtained per month, a total of 231 cultures over 3554 ventilator-days (incident rate 10.9 vs. 6.5 per 100 ventilator-days, Figure 1). There was a 43% decrease in the monthly rate of cultures (IRR 0.57, 95%CI 0.50-0.67, P < 0.001). The ITSA revealed a pre-existing 2% decline in the monthly culture rate (IRR 0.98, 95%CI 0.97-1.00, P=0.01), an immediate 44% drop (IRR 0.56, 95%CI 0.45-0.69, p=0.02) and a stable rate in the post-intervention period (IRR 1.03, 95%CI 0.99-1.07, p=0.09). The intervention led to an estimated $6000 in monthly charge savings.