Implementation of a central line maintenance care bundle in hospitalized pediatric oncology patients

Michael L. Rinke, Allen R. Chen, David G. Bundy, Elizabeth Colantuoni, Lisa Fratino, Kim M. Drucis, Stephanie Y. Panton, Michelle Kokoszka, Alicia P. Budd, Aaron M. Milstone, Marlene R. Miller

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

OBJECTIVE: To investigate whether a multidisciplinary, best-practice central line maintenance care bundle reduces central line-associated blood stream infection (CLABSI) rates in hospitalized pediatric oncology patients and to further delineate the epidemiology of CLABSIs in this population. METHODS: We performed a prospective, interrupted time series study of a best-practice bundle addressing all areas of central line care: reduction of entries, aseptic entries, and aseptic procedures when changing components. Based on a continuous quality improvement model, targeted interventions were instituted to improve compliance with each of the bundle elements. CLABSI rates and epidemiological data were collected for 10 months before and 24 months after implementation of the bundle and compared in a Poisson regression model. RESULTS: CLABSI rates decreased from 2.25 CLABSIs per 1000 central line days at baseline to 1.79 CLABSIs per 1000 central line days during the intervention period (incidence rate ratio [IRR]: 0.80, P = .58). Secondary analyses indicated CLABSI rates were reduced to 0.81 CLABSIs per 1000 central line days in the second 12 months of the intervention (IRR: 0.36, P = .091). Fifty-nine percent of infections resulted from Gram-positive pathogens, 37% of patients with a CLABSI required central line removal, and patients with Hickman catheters were more likely to have a CLABSI than patients with Infusaports (IRR: 4.62, P = .02). CONCLUSIONS: A best-practice central line maintenance care bundle can be implemented in hospitalized pediatric oncology patients, although long ramp-up times may be necessary to reap maximal benefits. Further research is needed to determine if this CLABSI rate reduction can be sustained and spread.

Original languageEnglish (US)
JournalPediatrics
Volume130
Issue number4
DOIs
StatePublished - Oct 2012
Externally publishedYes

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Patient Care Bundles
Maintenance
Pediatrics
Infection
Practice Guidelines
Incidence
Architectural Accessibility
Bundle
Oncology
Quality Improvement
Blood
Epidemiology
Catheters

Keywords

  • Central line-associated blood stream infection
  • Central venous catheter/access device
  • Epidemiology
  • Oncology
  • Pediatric
  • Quality improvement

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Arts and Humanities (miscellaneous)

Cite this

Rinke, M. L., Chen, A. R., Bundy, D. G., Colantuoni, E., Fratino, L., Drucis, K. M., ... Miller, M. R. (2012). Implementation of a central line maintenance care bundle in hospitalized pediatric oncology patients. Pediatrics, 130(4). https://doi.org/10.1542/peds.2012-0295

Implementation of a central line maintenance care bundle in hospitalized pediatric oncology patients. / Rinke, Michael L.; Chen, Allen R.; Bundy, David G.; Colantuoni, Elizabeth; Fratino, Lisa; Drucis, Kim M.; Panton, Stephanie Y.; Kokoszka, Michelle; Budd, Alicia P.; Milstone, Aaron M.; Miller, Marlene R.

In: Pediatrics, Vol. 130, No. 4, 10.2012.

Research output: Contribution to journalArticle

Rinke, ML, Chen, AR, Bundy, DG, Colantuoni, E, Fratino, L, Drucis, KM, Panton, SY, Kokoszka, M, Budd, AP, Milstone, AM & Miller, MR 2012, 'Implementation of a central line maintenance care bundle in hospitalized pediatric oncology patients', Pediatrics, vol. 130, no. 4. https://doi.org/10.1542/peds.2012-0295
Rinke, Michael L. ; Chen, Allen R. ; Bundy, David G. ; Colantuoni, Elizabeth ; Fratino, Lisa ; Drucis, Kim M. ; Panton, Stephanie Y. ; Kokoszka, Michelle ; Budd, Alicia P. ; Milstone, Aaron M. ; Miller, Marlene R. / Implementation of a central line maintenance care bundle in hospitalized pediatric oncology patients. In: Pediatrics. 2012 ; Vol. 130, No. 4.
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