Implementation of a Central Line Maintenance Care Bundle in Hospitalized Pediatric Oncology Patients

Johns Hopkins University School of Medicine, Department of Pediatrics, 2091 Rubenstein Child Health Building, 200 N. Wolfe St, Baltimore MD, 21287. .
PEDIATRICS (Impact Factor: 5.47). 09/2012; 130(4):e996-e1004. DOI: 10.1542/peds.2012-0295
Source: PubMed


To investigate whether a multidisciplinary, best-practice central line maintenance care bundle reduces central line-associated blood stream infection (CLABSI) rates in hospitalized pediatric oncology patients and to further delineate the epidemiology of CLABSIs in this population.
We performed a prospective, interrupted time series study of a best-practice bundle addressing all areas of central line care: reduction of entries, aseptic entries, and aseptic procedures when changing components. Based on a continuous quality improvement model, targeted interventions were instituted to improve compliance with each of the bundle elements. CLABSI rates and epidemiological data were collected for 10 months before and 24 months after implementation of the bundle and compared in a Poisson regression model.
CLABSI rates decreased from 2.25 CLABSIs per 1000 central line days at baseline to 1.79 CLABSIs per 1000 central line days during the intervention period (incidence rate ratio [IRR]: 0.80, P = .58). Secondary analyses indicated CLABSI rates were reduced to 0.81 CLABSIs per 1000 central line days in the second 12 months of the intervention (IRR: 0.36, P = .091). Fifty-nine percent of infections resulted from Gram-positive pathogens, 37% of patients with a CLABSI required central line removal, and patients with Hickman catheters were more likely to have a CLABSI than patients with Infusaports (IRR: 4.62, P = .02).
A best-practice central line maintenance care bundle can be implemented in hospitalized pediatric oncology patients, although long ramp-up times may be necessary to reap maximal benefits. Further research is needed to determine if this CLABSI rate reduction can be sustained and spread.

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    • "CLABSIs are serious but preventable infections, which usually occur when a bacteria or virus enters the bloodstream through the central line (Centers for Disease Control and Prevention, 2011). CLABSIs develop at a rate of 0.7 to 7.4 infections per 1000 catheter days and can cost up to $85 000 per infection (Rinke et al., 2012; Weber & Rutala, 2011). In a study of neonates, data show the onset of CLABSIs occurred around 11 days after "
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    ABSTRACT: Young children with cancer often have central lines. When ambulating during an intravenous infusion, their tubing drags on the hospital floor resulting in contamination of the exterior of the tubing. The tubing can then contaminate the children's linens, where central line procedures occur, increasing the risk of a central lineassociated blood stream infection. The purpose of this project was to evaluate the IV Line Lifter as a device to decrease contamination of the exterior of IV tubing. Baseline adenosine triphosphate bioluminescence testing was used on the exterior IV tubing to quantify organic matter as relative light units. The bioluminescence tests were performed on ambulatory, inpatient children with cancer ages 2 to 10 years, preimplementation (n = 29) and postimplementation (n = 18) of the IV Line Lifter. Relative light unit levels significantly decreased postimplementation (P < .001). Users of the device reported ease of ambulation when using the device and a willingness to use again. Results support the need for an IV Line Lifter to keep IV tubing off of the hospital floor, to ease ambulation, and decrease the risk of central line-associated blood stream infection. © 2015 by Association of Pediatric Hematology/Oncology Nurses.
    Journal of Pediatric Oncology Nursing 07/2015; DOI:10.1177/1043454215589922 · 0.90 Impact Factor
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    • "Interventions focusing primarily on central-line insertion procedures, emphasized staff education, compliance to basic hygiene, and timely removal of CVC have been associated with substantial reductions in CLABSI rates [3-9]. Few studies have included the evaluation of post-insertion care [10-13]. "
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    ABSTRACT: We analyzed the impact associated with an intervention based on process control and performance feedback to decrease central line-associated bloodstream infection (CLABSI) rates.This study was conducted from March 2011 to September 2012 in five adult intensive care units (ICU) located in two Belgian tertiary hospitals A and B, with a total of 53 beds. This study was divided in three phases: P1 (baseline), P2 (intervention) and P3 (post intervention).During P2, external monitoring of five central venous catheters (CVC) care critical processes and monthly reporting (meetings and feedbacks reports posted) of performance indicators (CLABSI rate, CVC utilization ratio, compliance rate with each care process, and insertion site) to ICU workers were performed. The external monitoring of process measures was assessed by the same trained research nurse.A Poisson regression analysis was used to compare CLABSI incidence density rate per phase. Statistical significance was achieved with 2-sided p-value of <0.05. For the analysis, we separated the five ICU in hospital A and B when appropriate. Significantly improved total mean compliance was achieved for hand hygiene, CVC handling and CVC dressing. CLABSI rate declined from 4.00 (95% confidence interval (CI): 1.94-6.06) to 1.81 (0.46-3.17) per 1,000 CVC-days in P2 with an incidence rate ratio (IRR) of 0.49 (0.24-0.98, p = 0.043). A better response was observed in hospital A where the nurse participation at the monthly meeting was significantly higher than in hospital B (p < 0.001) as the percentage of feedbacks reports posted in ICU (p < 0.001). The decline in the CLABSI rate observed during P2 in comparison with P1 was independent of the insertion site (femoral or non-femoral; p = 0.054). The overall CLABSI rate increased to 2.73 (1.17-4.29) per 1,000 CVC-days with IRR of 0.67 (0.36-1.26, p = 0.212) in P3 compared to P1, but a high nursing turnover was observed in both hospitals. Our intervention focused on external auditing and performance feedback resulted in significant reduction in rates of CLABSI. Investigation continues regarding the most effective way to sustain CLABSI prevention practices and to improve the culture of safety in healthcare.
    12/2013; 2(1):33. DOI:10.1186/2047-2994-2-33
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    ABSTRACT: Objective: Research suggests a median central line associated bacteraemia rate of zero is achievable. This paper outlines the effectiveness of using a combined nursing and medical approach in reducing central line associated bacteraemia in a New Zealand critical care unit. Method: The study used a before and after audit design. Data collected between October 2007 and December 2008 prior to introducing a central line associated bacteraemia insertion bundle were compared to data collected between January 2009 and April 2011 when insertion, maintenance and high risk patient bundles were sequentially introduced. Results: Data collected between October 2007 and December 2008 identified a mean central line associated bacteraemia rate of 6.43 per 1000 catheter days (range=0-12.30, Mdn=6.3, SD 3.34). Introducing the insertion bundle significantly decreased the mean central line associated bacteraemia rate to 1.50 (range=0-10.5, Mdn=0, SD=3.97, p=.02). Introducing a maintenance and high risk patient bundle sustained a median central line associated bacteraemia rate of zero over the following 12-month period. Conclusion: The study demonstrated a combined nursing and medical approach using central line bundles was effective in reducing the central line associated bacteraemia rate per 1000 line days and sustaining a median central line associated bacteraemia rate of zero.
    Intensive & critical care nursing: the official journal of the British Association of Critical Care Nurses 01/2013; 29(3). DOI:10.1016/j.iccn.2012.11.004
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