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Pediatric cancer patients vulnerable to CLABSIs at home

Thursday July 25, 2013
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Pediatric cancer patients whose central lines are used to treat them at home develop nearly three times as many dangerous bloodstream infections from their devices as their hospitalized counterparts, according to a study.

Findings of the research, reported July 23 on the website of the journal Pediatric Blood & Cancer, provide insight into the safety of central line uses outside the hospital and underscore the need to carefully evaluate the benefits and risk of sending a child home with one, said investigators with Johns Hopkins Children’s Center.

Furthermore, the results highlight the importance of better understanding the risks of at-home central line care and designing infection-prevention strategies.

"The healthcare system as a whole has spent a lot of time and energy studying hospital-acquired bloodstream infections and has made serious progress in reducing their burden as a result," Michael Rinke, MD, PhD, a pediatrician and safety expert at Johns Hopkins Children’s Center, said in a news release. "It is now time that we did the same for central line infections acquired outside the hospital."

If inserted incorrectly, mishandled or simply handled too frequently, central lines can become a gateway for bacteria into the bloodstream, which can lead to serious complications, including organ damage and even death. Beyond the human toll, each infection can cost up to $45,000 in additional treatment, the researchers said, citing previous research.

The new study followed 319 children with cancer treated at Johns Hopkins who had central lines and received treatment between 2009 and 2010. Nearly all children were treated in the hospital at some point and sent home thereafter.

In hospitalized children, there were 19 bloodstream infections over 8,682 days spent with a central line, compared with 55 such episodes over 84,705 days in the at-home group.

"Some children with central lines do well at home and will have no complications," Rinke said, "but based on our findings, we feel clinicians should remain vigilant when sending home certain special categories of pediatric cancer patients who face higher infection risk by virtue of their condition, device type or a combination of the two."

Rinke and colleagues said several potent risk factors for infection emerged among children treated at home. Patients with recently placed central lines, those with recent bone marrow transplants and those with past infections were at highest risk, the researchers found.

In addition, children with a type of central line tunneled under the skin that remains open, rather than implanted, in the chest were found to be at greatest risk for infection. But because this type of central line is handled more frequently, whether the increased risk stems from the frequency of access or from the anatomic positioning of the device itself remains unclear, the researchers said.

The investigators emphasized that central line care, even in the hospital, requires experienced clinicians and trained family members familiar with infection-prevention protocols — a level of care that is not always taught to families before the patient is discharged home.

"Teaching family members the 101 of central line cleaning and care can go a long way toward reducing infection risk and is something that should become part of the formal discharge routine in each and every hospital," Rinke said.

Study abstract: http://onlinelibrary.wiley.com/doi/10.1002/pbc.24677/abstract


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