Abstract
OBJECTIVES: To evaluate the impact of a phased, multifaceted intervention on reducing central line-associated bloodstream infection (CLABSI) rates in a large pediatric referral hospital in Vietnam.
METHODS: A multi-year quality improvement study conducted in six intensive care units at the Vietnam National Children's Hospital. The intervention was implemented in three phases: baseline surveillance (2018-2019), CLABSI prevention bundle implementation (2020-2021), and compliance monitoring with data-driven quality improvement (2021-2024). Primary outcome was CLABSI incidence per 1,000 central line-days. Bundle compliance was assessed using structured checklists. Descriptive methods were used to examine trends in CLABSI and compliance rates. Associations between bundle compliance and CLABSI rates were explored.
RESULTS: The pooled CLABSI rate declined from 5.8 per 1,000 central line-days at baseline to 0.9 per 1,000 in 2024, representing an 84.5% reduction. Among 12,189 observed central line insertions, compliance with all prevention bundle elements was 89.7%, increasing from 84.6% in 2021 to 93.1% in 2024 (p<0.001). Higher quarterly compliance correlated with lower quarterly CLABSI rates (r=-0.555; p=0.039).
CONCLUSIONS: A sustained reduction in CLABSI rates was achieved through a multifaceted approach integrating standardized surveillance, evidence-based bundles, and continuous audit-and-feedback. This study demonstrates the feasibility of adapting and sustaining infection prevention strategies in a pediatric low- and middle-income country setting.