(1280) Bloodstream Infection Reduction After the Bright STAR PICU Diagnostic Stewardship Collaborative

Introduction: From 2018-2020, a 14-site quality improvement collaborative called BrighT STAR implemented a diagnostic stewardship program focusing on safe reduction of blood cultures in pediatric intensive care unit patients, and demonstrated a significant reduction in cultures, broad-spectrum antibiotics, and central-line associated bloodstream infection (CLABSI) rates. Blood culture rate reductions were sustained for 24 months after the formal program ended. Our objective was to evaluate the sustainability of CLABSI reduction in the participating sites. We hypothesized that CLABSI rates would remain lower than pre-implementation, similar to what was noted with total blood culture rates.

Methods: BrighT STAR sites assessed local practices, developed and implemented tools to guide new blood culture practices, and audited post-implementation cultures for compliance and safety for 18 months. Sites continued to collect data on blood culture and CLABSI rates for an additional 24 months (the sustainability period). Poisson regression was used to estimate and compare the CLABSI rates across three study periods (24 month pre-implementation, 18 month post-implementation, and 24 month sustainability).

Results: 14 sites provided monthly CLABSI data for the 66-month study period. CLABSI rates (95% confidence interval) for pre-implementation, post-implementation and sustainability period were 1.79 (1.33, 2.42), 1.12 (0.74, 1.71), and 1.28 (1.00, 1.64). The average rate was 14% higher (26% lower, 76% higher) in the sustainability period compared to the post-implementation period, but remained 28% lower (48% lower, 1% lower) than in the pre-implementation period.

Conclusions: After completion of the formal BrighT STAR blood culture QI program, CLABSI rates remained significantly below the pre-implementation baseline rate, similar to previously described sustained reduction in blood culture rates. Diagnostic stewardship has significant potential to augment efforts to reduce hospital-acquired harm, such as CLABSI, and warrants further study.