Beyond the Bundle : CLABSI Reduction in the Home Setting for Pediatric Short Bowel Syndrome Patients

Background: Central line-associated bloodstream infections (CLABSIs) are significant sources of morbidity and mortality in pediatric patients with short bowel syndrome (SBS) who require central venous access. They increase hospitalizations, complications, and costs. This study evaluates the impact of quality improvement (QI) interventions on CLABSI rates among pediatric SBS patients receiving home health care.

Methods: A retrospective pre–post observational QI study compared monthly CLABSI rates before and after intervention implementation. The baseline period was January 2022–December 2023, with interventions initiated in January 2024 and rolled out and evaluated through October 2025. Staff-focused interventions included real-time competency assessments, standardized education, mentor visits, and collaboration with the gastroenterology outpatient team to align supplies and training. Patient-focused interventions incorporated chlorhexidine use, wrapping connections, supply totes, brochures, and welcome kits. An interrupted time series analysis using segmented Poisson regression modeled monthly CLABSI rates. A generalized linear model with Poisson distribution and log link included the natural log of monthly line-days as an offset. Predictors were baseline time, intervention, and post-intervention time. Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated with significance set at α = 0.05 in R using the glm() function.

Results: Across 46 monthly observations, 50 CLABSIs occurred over 11,521 line days. No significant pre-intervention trend was observed (IRR 1.03, 95% CI 0.97–1.10, p = 0.33), nor was there an immediate level change at implementation (IRR 1.12, 95% CI 0.42–2.98, p = 0.82). However, post-intervention rates declined steadily, with each month associated with an 11.4% reduction in incidence (IRR 0.89, 95% CI 0.81–0.97, p = 0.009), reflecting sustained reduction.

Conclusions: Designed and analyzed as a unified program with staggered rollout, findings suggest that comprehensive staff and patient-focused interventions can achieve ongoing reductions in CLABSI rates among pediatric SBS patients and highlight the importance of multidisciplinary collaboration in infection prevention.

Brittany Crumpacker

Infection Preventionist, IU Health

Brittany Crumpacker, BSN, RN, CIC has 18 years of Infection Prevention experience currently serving areas such as Home Health, Hospice, Urgent Cares, Sterile Compounding Pharmacies, Warehouse/Distribution, Sleep Labs, RT/DME, and Ambulatory Surgery Centers. She received her Bachelor of Science in Nursing from Indiana University. Brittany has served as a past and current APIC Indiana Board of Directors member. Prior to her work in Infection Prevention, Brittany was a pediatric and infusion Registered Nurse.

Ava Slowey

Infection Preventionist, Riley Hospital for Children

I am a new Infection Preventionist working at Riley Hospital for Children.

Kellie Rusin

Infection Preventionist, Children's Hospital Colorado

Kellie has been a member of the Association for Professionals in Infection Control and Epidemiology (APIC) since 2011. For the past 13 years she has worked at Children’s Hospital Colorado, the only dedicated Level 1 trauma center in a seven-state region. Kellie has served at the local chapter and national level. Local chapter engagement includes Treasurer and Election Committee of the Mille High APIC chapter. Nationally she is currently serving a three-year term as a member of the Annual Conference Committee. Kellie received her Bachelor of Science Degree in Biology from Mesa University and her Master of Public Health degree with a focus on Epidemiology from the University of Colorado Denver. In addition to being certified in Infection Prevention, she maintains a certification as a Medical Laboratory Scientist through the American Society for Clinical Pathology.