Infection-prevention protocols showed significant reductions in central line-associated blood stream infections (CLABSIs) and bacteria in the blood of ambulatory pediatric oncology patients. Increasingly, central lines are used to administer chemotherapy directly into blood vessels in the outpatient setting, where infections can increase chances of morbidity in this immune-compromised population. The study found infection-prevention protocols reduce CLABSIs by 48 percent and bacteria in the blood by 54 percent. These data were published today in the journal Pediatrics.
Research has shown children with cancer getting chemotherapy on an outpatient basis develop three times as many dangerous bloodstream infections from their central lines than their hospitalized counterparts. Common causes of infection are thought to be mishandling the central line or handling too frequently. Not only can the infections lead to serious complications, including organ damage and even death, research has shown that each infection can cost up to $45,000 in additional treatment.
"Allowing outpatient chemotherapy treatment is beneficial because patients aren't exposed to harmful hospital-acquired infections and they experience better quality of life at home; however there are concerns about safety and high numbers of infections in central lines used outside of the hospital," said Michael L. Rinke, M.D., Ph.D., assistant medical director of pediatric quality at The Children's Hospital at Montefiore (CHAM) and assistant professor of Pediatrics at Albert Einstein College of Medicine of Yeshiva University. "These data show that implementing the CDC central line maintenance practices, which are standard in the hospital setting, on an outpatient basis are an effective tool in reducing harmful infections in a vulnerable population."
This study featured a multidisciplinary team led by nurses who worked with Dr. Rinke to educate clinic nurses, homecare nurses and patient families on how to safely and reliably manage central lines with the goal of reducing infection rates. Infection rates of 330 patients who received the intervention were compared to 339 patients who received ambulatory care before the intervention started. Assessments were completed pre- and post-intervention to compare CLABSI rates and positive blood culture rates. Researchers suggest that the intervention may have prevented more than 70 hospital admissions for children with cancer and saved hundreds of thousands of dollars in health care costs.
As part of the intervention clinical staff, homecare nurses and families received additional training in hand hygiene, tube changing and the use of needles, gloves, masks and dressings. Teams held regular meetings, webinars and learning sessions to discuss quality improvement practices as part of the Children's Hospital Association Quality Transformation efforts and to identify lessons learned from every infection. Families also received education on central line safety, were asked to monitor provider compliance and regularly were asked to demonstrate their own abilities to care for their child's central line.
"Clinical staff plays a key role, but parents and families are vital partners in reducing infection rates. We found improved compliance in each of these groups during the intervention period and believe this significantly contributed to the reduction," Dr. Rinke said. "Using continuous quality improvement practices and applying these as the standard of care in the ambulatory space could help to reduce rates of infection for kids with cancer throughout the country, as well as reduce the significant costs associated with treating such infections."
- M. L. Rinke, D. G. Bundy, A. R. Chen, A. M. Milstone, E. Colantuoni, M. Pehar, C. Herpst, L. Fratino, M. R. Miller. Central Line Maintenance Bundles and CLABSIs in Ambulatory Oncology Patients. PEDIATRICS, 2013; DOI: 10.1542/peds.2013-0302
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