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.
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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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