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Central line maintenance care bundle reduced infections, bacteremia
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Use of a multidisciplinary central line maintenance care bundle significantly reduced central line–associated bloodstream infections and bacteremias in an ambulatory pediatric cancer patients, according to study results.
Central line maintenance care bundles have been shown to reduce central line–associated bloodstream infections in pediatric stem cell transplant recipients and hospitalized pediatric cancer patients. Less consideration has been given to infections in the ambulatory setting.
Michael L. Rinke
“Pediatric hematology/oncology patients and pediatric bone marrow transplant patients have higher central line–associated bloodstream infections rates than almost all subsets of comparable adult oncology patients,” Michael L. Rinke, MD, PhD, of the department of pediatrics at The Children’s Hospital of Montefiore, and colleagues wrote.
Rinke and colleagues conducted an interrupted time-series study of a maintenance bundle concerning all areas of central line care.
Three target groups — clinic staff, home care agency nurses and patient families — underwent training on the bundle and its significance. They were shown central line–associated bloodstream infection rates through graphs, in-service training and bulletin boards, and clinicians also had their practices audited.
Researchers compiled central line–associated bloodstream infections and bacteremia person-time incidence rates for 23 months before the intervention and 24 months after. They used a Poisson regression model to make comparisons.
The mean rate of central line–associated bloodstream infections decreased by 48%, from 0.63 infections per 1,000 central line days at baseline to 0.32 infections per 1,000 central line days during the intervention period (P=.005). The mean bacteremia rate decreased by 54%, from 1.27 bacteremias per 1,000 central line days at baseline to 0.59 bacteremias per 1,000 central line days during the intervention period (P<.001).
“The ability of a maintenance care bundle to reduce bacteremias in the ambulatory setting suggests that bacteremias could serve as a more feasible and objective surrogate marker for central line–associated bloodstream infections in outpatients,” Rinke and colleagues wrote. “Additional studies should investigate whether bacteremias can effectively provide a marker for ambulatory central line–associated bloodstream infections in other outpatient settings.”
Disclosure: The researchers report grant support from Sage Products Inc.
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