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
Rinke and colleagues from Johns Hopkins Childrens
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
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
- Rinke ML. 4135.1. Presented at: 2012 PAS Annual Meeting; Boston.
- Dr. Rinke reports no relevant financial disclosures.