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Bundle effectively reduced bacteremia in oncology patients with central lines
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BOSTON — The incidence of bloodstream infections among pediatric oncology patients with central lines can be reduced with a multidisciplinary approach, according to findings presented by Michael L. Rinke, MD, during the 2012 Pediatric Academic Societies Annual Meeting held here.
Rinke and colleagues from Johns Hopkins Children’s Center, Baltimore, reported that a multidisciplinary, best-practice central line maintenance care bundle reduced bacteremias by more than 50% in ambulatory pediatric oncology patients with central lines. Central line-associated blood stream infections (CLABSIs) decreased by nearly 40%, according to the study results.
More than 60% of pediatric oncology patients are managed as outpatients with central lines, and these lines increased the risk of morbidity and mortality. Therefore, Rinke and colleagues implemented a prospective, interrupted time series study of a best-practice bundle that involved all areas of central line care, including consolidation and elimination of line entries; aseptic entries into the line; aseptic procedures when changing components of the line; and regular site assessment.
Each of our three target groups (clinic staff, homecare agency nurses and patient families) received training on the bundle and its importance; had their practice audited; and were presented with public displays of CLABSIs rates through graphs, in-service training and bulletin boards.
The study team prospectively collected CLABSI and bacteremia rates for 23 months before and 11 months after the start of the intervention and compared the data utilizing a Poisson regression model. They found the average CLABSI rate decreased 38%, from 0.71 CLABSIs per 1,000 central-line days at baseline to 0.43 CLABSIs per 1,000 central-line days during the intervention period (rate ratio: 0.62, P=.079).
The average bacteremia rate decreased 55%, from 1.4 bacteremias per 1,000 central-line days at baseline to 0.64 bacteremias per 1,000 central-line days during the intervention period (rate ratio: 0.45, P<.001). The absolute difference in bacteremia counts after the intervention was 2.8 cases per month.
Further research is needed to determine if this reduction of health care-associated infections can be sustained, the researchers concluded.
References:
- Rinke ML. 4135.1. Presented at: 2012 PAS Annual Meeting; Boston.
Disclosures:
- Dr. Rinke reports no relevant financial disclosures.
Perspective
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David A. Kaufman, MD
The effectiveness of central line bundles for cancer patients when they are not in the hospital is critical. The rates of these infections are not captured by large reporting bodies, so they have not been the focus of much study to date. Dr. Miller who led the successful NACHRI PICU initiative to reduce CLABSIs, is right on target in working on central line bundles for cancer patients at home. So much goes into fighting cancer, preventing CLABSIs is key to these patients surviving, limiting the time they need to spend in the hospital for their cancer treatments, and adding quality to their lives.
This may also open up improvements to central line bundles in the hospital, but this may empower the patients who are able to be a key part of preventing these serious and often life-threatening infections.
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