Hospitals can dramatically reduce the number of life-threatening central line infections in pediatric cancer patients by following a set of basic precautions, by encouraging families to speak up when they observe noncompliance with the protocol and by honest analysis of the root cause behind every single infection, according to a new Johns Hopkins Children's Center study.
In a report in the October issue of Pediatrics, published online Sept. 3, the researchers say this triple-threat approach has prevented one in five infections over two years.
Previous studies from Johns Hopkins and other institutions have demonstrated that meticulous daily care of the central line can cut the number of bloodstream infections in critically ill patients, but this is the first study, the researchers say, to focus on the most vulnerable of pediatric patients - those undergoing cancer treatment and bone marrow transplants.
A central venous catheter, or central line, is a tube inserted into a major blood vessel in the neck, chest or groin as a portal for medication, fluids or blood draws.
Inserted incorrectly or mishandled after insertion, the central line can become a gateway for bacteria and other germs into the patient's bloodstream, causing invasive disease and organ damage. Because nurses and doctors access the catheter several times a day -- as much as 10 to 30 times daily in oncology patients, researchers say -- proper handling of the device is critical.
"Children receiving cancer treatment are uniquely prone to invasive bloodstream infections because of their weakened immunity and because their central lines are accessed multiple times a day, with each entry posing a risk for infection," says lead investigator Michael Rinke, M.D., a pediatrician and a patient safety expert at the Johns Hopkins Children's Center.
The current study was carried out by pediatric oncology nurses, physicians and safety experts at the Johns Hopkins pediatric inpatient cancer unit. To keep bacteria and other pathogens at bay, the nurses deployed strict device-handling precautions that included -- among other things -- frequent and regular changing of the dressing covering the central line; regular changing of the tubes and caps attached to central line; cleaning of the line before and after each use; use of facial mask and gloves when handling the device; and hand-washing before and after handling the line.
In a novel twist, the Johns Hopkins investigators asked parents to provide additional oversight, equipping them with wallet flash cards on the "do's" and "don'ts" of central line care.