Best practices reduce CBSIs in children with cancer
Central-line-associated blood stream infections (CBSIs) were reduced in hospitalized pediatric oncology patients when a best-practice central-line maintenance care bundle was implemented. The research was conducted at Johns Hopkins Children's Center and published in Pediatrics.
This prospective, interrupted time series study used a best-practice bundle to address all areas of central-line care. The areas included reducing entries, having aseptic entries, and using aseptic procedures when changing components.
The best practices included improved disinfection and a daily assessment. The daily assessment determined if each central line was needed or if the lines could be consolidated or eliminated. The patients' family members received wallet cards that described the best care of central lines. Family members were encouraged to observe their child's care and to report any inconsistencies with the best practices.
A continuous quality improvement model was the basis for instituting targeted interventions that improved compliance with each of the bundle elements. The rates of CBSIs were collected for 10 months before the bundle was implemented and for 24 months after it was implemented.
The rate of CBSIs were reduced from 2.25 per 1000 central line days at baseline to 1.79 per 1000 central line days during the first 12 months of the intervention period (incidence rate ratio [IRR]: 0.80; P=.58). During the second 12 months of the intervention, the rate of CBSIs was reduced to 0.81 per 1000 central-line days (IRR: 0.36; P=.091).
The infections were analyzed, and 59% were from Gram-positive pathogens. Among the patients with a central-line-associated blood stream infection, 37% required that their central line be removed. Central-line-associated blood stream infections were more likely in patients with Hickman catheters than in patients with Infusaports (IRR: 4.62; P=.02).The researchers concluded that a best-practice central-line maintenance care bundle can be implemented among pediatric oncology patients who are hospitalized. They noted that long ramp-up times may be necessary before maximal benefits occur.