Pediatric hospitals can significantly decrease the number of bloodstream infections from central venous catheters by following some low-tech rules: Insert the catheter correctly and, above all, keep everything squeaky clean after that.
Yearlong research by Marlene Miller, M.D. Ms.C., of the Johns Hopkins Children's Center and colleagues from other hospitals saw a 43-percent drop in the rate of bloodstream infections from catheters in 29 pediatric intensive care units (PICUs) that focused on careful placement and basic daily cleaning of the devices.
Results are to be published in the February issue of the journal Pediatrics.
Each year, 250,000 central line infections occur in the United States, researchers estimate, and up to one-fourth of patients die from them. Between 10 and 20 percent of children who get such infections die from them, researchers believe, and each infection carries a cost of $50, 000.
"If every single pediatric intensive care unit applies this approach rigorously and systematically, I'd be surprised if it didn't translate into hundreds of lives and millions of dollars saved," says Miller, the lead investigator, who also serves as vice president for quality transformation at the National Association of Children's Hospitals and Related Institutions (NACHRI), which spearheaded the initiative.
A central venous catheter, or central line, is a tube inserted into a major blood vessel in the neck, chest or groin to serve as a temporary portal for injected medications and fluids, or blood sampling in patients who need them frequently. Because central lines also provide quick access in emergencies, children in the PICU often have them for weeks or longer. But if inserted incorrectly and, more importantly, mishandled after that, the central line can become a contaminated gateway for bacteria to enter directly into the patient's bloodstream.
Therefore, investigators say, simple precautions like regularly changing the dressing covering the central line, changing the tubes and caps attached to it, cleaning the line before and after use, and rigorous hand washing before handling the line are essential to keeping bacteria away.