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Protocol lowers CLABSI rates in ambulatory pediatric chemotherapy

Monday October 14, 2013
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Infection-prevention protocols showed significant reductions in central line-associated bloodstream infections and bacteremia of ambulatory pediatric oncology patients, according to a new study.

Central lines increasingly are used to administer chemotherapy in the outpatient setting; however, research has shown children receiving chemo as outpatients develop three times as many CLABSIs as children treated in the hospital. Each infection can cost as much as $45,000 in additional treatment, according to a news release.

“Allowing outpatient chemotherapy treatment is beneficial because patients aren’t exposed to harmful hospital-acquired infections and they experience better quality of life at home; however there are concerns about safety and high numbers of infections in central lines used outside of the hospital,” Michael L. Rinke, MD, PhD, assistant medical director of pediatric quality at The Children’s Hospital at Montefiore, New York City, said in the release. “These data show that implementing the CDC central line maintenance practices, which are standard in the hospital setting, on an outpatient basis are an effective tool in reducing harmful infections in a vulnerable population.”

The study, published Oct. 8 as an online-first article in the journal Pediatrics, featured a multidisciplinary team led by nurses who worked with Rinke to educate clinic nurses, homecare nurses and patient families on safely and reliably managing central lines. This included training in hand hygiene, tube changing and the use of needles, gloves, masks and dressings.

The researchers compared infection rates of 330 patients who received the intervention with 339 patients who had received ambulatory care before the intervention began. Data were collected before and after the intervention to compare CLABSI and bacteremia incidence rates. The findings showed the protocols reduced the occurrence of CLABSIs by 48%, lowering the rate from 0.63 CLABSIs per 1,000 central-line days to 0.32 CLABSIs per 1,000 central-line days during the intervention period. The protocols also reduced the average bacteremia rate by 54%, from 1.27 bacteremias per 1,000 central-line days to 0.59 bacteremias per 1,000 central-line days.

The intervention may have prevented at least 70 hospital admissions for children with cancer and saved hundreds of thousands of dollars in healthcare costs, according to the release.

During the study period, families also received education on central-line safety, were asked to monitor provider compliance and regularly were asked to demonstrate their own abilities to care for their child’s central line.

“Clinical staff plays a key role, but parents and families are vital partners in reducing infection rates,” Rinke said in the news release. “We found improved compliance in each of these groups during the intervention period and believe this significantly contributed to the reduction. Using continuous quality improvement practices and applying these as the standard of care in the ambulatory space could help to reduce rates of infection for kids with cancer throughout the country, as well as reduce the significant costs associated with treating such infections.”

Rinke’s research is funded by the Agency for Healthcare Research and Quality.

Study abstract: http://bit.ly/1c9vw47


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