Hospitals can substantially reduce the number of life-threatening central line infections in pediatric cancer patients by following a set of basic precautions, encouraging families to speak up when they observe noncompliance with the protocol and conducting an honest analysis of the root cause behind every infection, according to a study.
Researchers with Johns Hopkins Children’s Center said the triple-threat approach has prevented one in five infections over two years. They said the study, scheduled for publication in the October issue of Pediatrics, is the first to focus on pediatric patients undergoing cancer treatment and bone marrow transplants.
Because nurses and physicians access a central venous catheter several times a day — and as often as 10 to 30 times daily in oncology patients — proper handling of the device is critical, the researchers said.
“Children receiving cancer treatment are uniquely prone to invasive bloodstream infections because of their weakened immunity and because their central lines are accessed multiple times a day, with each entry posing a risk for infection,” Michael Rinke, MD, the studys lead investigator and a pediatrician and patient safety expert at the Johns Hopkins Children’s Center, said in a news release.
The study was carried out by pediatric oncology nurses, physicians and safety experts at the Johns Hopkins pediatric inpatient cancer unit. To keep bacteria and other pathogens at bay, the nurses deployed strict device-handling precautions that included frequent and regular changing of the dressing covering the central line; regular changing of the tubes and caps attached to central line; cleaning of the line before and after each use; use of facial mask and gloves when handling the device; and hand-washing before and after handling the line.
In a twist, the investigators asked parents to provide additional oversight, equipping them with wallet flash cards on the “dos” and “donts” of central line care.
“Parents can act as an invaluable second set of eyes, and we urged them to be vigilant about the way their childs central line was handled,” said study co-investigator Kim Drucis, RN, MSN, a pediatric oncology nurse. “We also encouraged them to ask questions and to speak up every time they noticed something different.”
The oncology nurses also held monthly briefings to discuss every infection that occurred during the study. Such root-cause analysis is already a staple of error reduction in other industries including airline, nuclear and military, the researchers noted.
“Honest discussion of ones practice is neither easy nor pleasant but is absolutely critical to illuminate areas for improvement,” said co-investigator Stephanie Panton, RN, MSN, CPON.
The approach reduced infections by 20% over two years. The infection rate remained unchanged during the first year but plummeted by 64% during the second year. “Real change rarely occurs overnight,” Rinke said. “It requires sustained effort and unwavering focus day after day, month after month, year after year. Its a slow, arduous process, but the payoff can be dramatic.”
Each year, 250,000 central line infections occur in the United States and up to a quarter are fatal, according to the Centers for Disease Control and Prevention. Each infection carries a price tag of up to $25,000.
The study abstract is available at http://pediatrics.aappublications.org/content/early/2012/08/28/peds.2012-0295.abstract.