Pediatric central line infections reduced by ‘best practice’ guidelines

By Helen Albert, Senior medwireNews Reporter

The number of central line-associated bloodstream infections sustained by hospitalized children with cancer can be substantially reduced by encouraging staff to follow simple "best practice" regulations, say researchers.

If the central line of hospitalized patients is poorly inserted or mishandled following insertion it can become a breeding ground for bacteria and other germs, potentially causing sepsis, invasive disease, or organ damage.

"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," explained lead author Michael Rinke (Johns Hopkins University School of Medicine, Baltimore, Maryland, USA) in a press statement.

To try and reduce the number of these infections, Rinke and colleagues instituted a Children's Hospital Association (CHA) best practice central line care bundle in an 18-bed oncology ward in Johns Hopkins Children's Center in the USA.

The bundle consisted of six components designed to guide staff on the best and most aseptic methods of reducing central line infection risk. These included daily assessment of central line necessity and daily dressing/site assessment; rigorous aseptic technique when inserting catheters or changing the cap, tubing, dressing, or needle; and good knowledge of how often dressings and catheter components should be changed to minimize infection risk.

To assess the efficacy of the bundle, Rinke and co-workers collected data on the number of pediatric central line-associated bloodstream infections in the cancer ward in the 10 months before and 24 months after it was implemented.

As reported in Pediatrics, they found that the number of infections was reduced from 2.25 per 1000 central line days at baseline to 1.79 per 1000 central line days on average during the intervention period.

When the researchers looked at the second 12 months of the follow-up period only, they found that the number of central line infections had dropped still further to 0.81 per 1000 central line days.

"Real change rarely occurs overnight. It requires sustained effort and unwavering focus, day after day, month after month, year after year," Rinke commented. "It's a slow, arduous process, but the payoff can be dramatic."

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