Proper daily care and maintenance of central lines might reduce infection rate in PICUs

By following a few basic rules for handling central venous catheters, nurses and doctors at a group of children's hospitals have, in three years, prevented nearly a thousand infections and saved more than a hundred children's lives and millions of dollars, according to a study by investigators at Johns Hopkins Children's Center and elsewhere.

The results of the program, spearheaded by the National Association of Children's Hospitals and Related Institutions (NACHRI) and led by Marlene Miller, M.D., M.Sc., director of Pediatric Quality and Safety at Johns Hopkins, are published online in the November issue of Pediatrics.

The research involved 29 pediatric intensive-care units (PICUs) and examined whether and how low-tech steps involving proper daily care and maintenance of central lines might reduce infection rates.

Researchers found that proper daily care of the central line slashed the number of infections by more than half (56 percent) over three years.

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 portal for medication, fluids or blood draws in patients who need them frequently. Because central lines also provide quick direct access into a patient's bloodstream in emergencies, children in the PICU often have them for weeks or months. Inserted incorrectly or mishandled after insertion, the central line can become a gateway for bacteria or other germs to enter the patient's bloodstream, causing invasive disease and organ damage in these already vulnerable patients.

Because the catheter is often accessed multiple times a day after insertion, proper handling is critical, the investigators say. Basic precautions, such as daily assessment of the actual need for a central line and prompt removal if no longer needed; regularly changing the dressing covering the central line; changing the tubes and caps attached to it; cleaning the line before and after each use; and hand washing before handling the line can go a long way to keep bacteria and other bugs at bay.

The results, the investigators say, are impressive because they showed sustained and continuous reduction in infections over a long period of time and across PICUs with varying staffing, sizes and protocols.

"The drastic reduction in infections sustained over time and across many different hospitals shows that proper catheter care, when practiced rigorously and systematically, can be a game-changer in the battle against catheter-related infections," says Miller, the study's lead investigator and vice president for quality transformation at NACHRI.

Sustaining the success long term and curbing infection rates further will require the continuing education of medical staff, Miller says, adding that constant reminders to follow catheter protocol should be a mainstay in every PICU.

"The lessons learned can be applied beyond the PICU floor and, if made a national priority for all pediatric hospitals, these basic steps could lead to many more saved lives and reduce healthcare costs even further," added Miller.

In an 18-month-long sub-study, researchers examined two more steps:

additional scrubbing of the device's cap with antiseptic solution before each access and placing antiseptic-soaked sponges at the catheter insertion site. Neither strategy reduced infection rates further, they found.