TY - JOUR
T1 - Central line maintenance bundles and clabsis in ambulatory oncology patients
AU - Rinke, Michael L.
AU - Bundy, David G.
AU - Chen, R.
AU - Milstone, Aaron M.
AU - Colantuoni, Elizabeth
AU - Pehar, Miriana
AU - Herpst, Cynthia
AU - Fratino, Lisa
AU - Miller, Marlene R.
PY - 2013/11/1
Y1 - 2013/11/1
N2 - OBJECTIVE: Pediatric oncology patients are frequently managed with central lines as outpatients, and these lines confer significant morbidity in this immune-compromised population. We aimed to investigate whether a multidisciplinary, central line maintenance care bundle reduces central line-associated bloodstream infections (CLABSIs) and bacteremias in ambulatory pediatric oncology patients. METHODS: We conducted an interrupted time-series study of a maintenance bundle concerning all areas of central line care. Each of 3 target groups (clinic staff, homecare agency nurses, and patient families) (1) received training on the bundle and its importance, (2) had their practice audited, and (3) were shown CLABSI rates through graphs, inservice training, and bulletin boards. CLABSI and bacteremia persontime incidence rates were collected for 23 months before and 24 months after beginning the intervention and were compared by using a Poisson regression model. RESULTS: The mean CLABSI rate decreased by 48% from 0.63 CLABSIs per 1000 central line days at baseline to 0.32 CLABSIs per 1000 central line days during the intervention period (P = .005). The mean bacteremia rate decreased by 54% from 1.27 bacteremias per 1000 central line days at baseline to 0.59 bacteremias per 1000 central line days during the intervention period (P , .001). CONCLUSIONS: Implementation of a multidisciplinary, central line maintenance care bundle significantly reduced CLABSI and bacteremia person-time incidence rates in ambulatory pediatric oncology patients with central lines. Further research is needed to determine if maintenance care bundles reduce ambulatory CLABSIs and bacteremia in other adult and pediatric populations. Pediatrics 2013;132:e1403- e1412.
AB - OBJECTIVE: Pediatric oncology patients are frequently managed with central lines as outpatients, and these lines confer significant morbidity in this immune-compromised population. We aimed to investigate whether a multidisciplinary, central line maintenance care bundle reduces central line-associated bloodstream infections (CLABSIs) and bacteremias in ambulatory pediatric oncology patients. METHODS: We conducted an interrupted time-series study of a maintenance bundle concerning all areas of central line care. Each of 3 target groups (clinic staff, homecare agency nurses, and patient families) (1) received training on the bundle and its importance, (2) had their practice audited, and (3) were shown CLABSI rates through graphs, inservice training, and bulletin boards. CLABSI and bacteremia persontime incidence rates were collected for 23 months before and 24 months after beginning the intervention and were compared by using a Poisson regression model. RESULTS: The mean CLABSI rate decreased by 48% from 0.63 CLABSIs per 1000 central line days at baseline to 0.32 CLABSIs per 1000 central line days during the intervention period (P = .005). The mean bacteremia rate decreased by 54% from 1.27 bacteremias per 1000 central line days at baseline to 0.59 bacteremias per 1000 central line days during the intervention period (P , .001). CONCLUSIONS: Implementation of a multidisciplinary, central line maintenance care bundle significantly reduced CLABSI and bacteremia person-time incidence rates in ambulatory pediatric oncology patients with central lines. Further research is needed to determine if maintenance care bundles reduce ambulatory CLABSIs and bacteremia in other adult and pediatric populations. Pediatrics 2013;132:e1403- e1412.
KW - Central line-associated bloodstream infection
KW - Central venous catheter/ access device
KW - Epidemiology
KW - Oncology
KW - Outpatient management
KW - Pediatric
KW - Quality improvement
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UR - http://www.scopus.com/inward/citedby.url?scp=84887088044&partnerID=8YFLogxK
U2 - 10.1542/peds.2013-0302
DO - 10.1542/peds.2013-0302
M3 - Article
C2 - 24101764
AN - SCOPUS:84887088044
SN - 0031-4005
VL - 132
SP - e1403-e1412
JO - Pediatrics
JF - Pediatrics
IS - 5
ER -