Sustained decline in central line-associated bloodstream infections following a multifaceted intervention in a pediatric referral hospital in Vietnam.

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 1000 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 1000 central line-days at baseline to 0.9 per 1000 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).

CONCLUSION

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.