Implementation of a Central Line Maintenance Care Bundle in Hospitalized Pediatric Oncology Patients

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

doi:10.1542/peds.2012-0295

Cited by 100 publications

(127 citation statements)

References 30 publications

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“…4 Central line maintenance care bundles, based on Centers for Disease Control and Prevention (CDC) CLABSI prevention guidelines, reduced CLABSIs in PICUs, NICUs, pediatric stem cell transplant recipients, and hospitalized pediatric oncology patients. [5][6][7][8][9][10][11][12] Less attention has been paid to CLABSIs in the ambulatory setting, 7,13 despite the fact that most oncology patients are discharged with central lines. [13][14][15][16][17][18][19] Additionally, no work has been done evaluating whether maintenance care bundles reduce positive blood cultures in ambulatory patients, an important cause for pediatric oncology patient admission.…”

Section: Resultsmentioning

confidence: 99%

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Central Line Maintenance Bundles and CLABSIs in Ambulatory Oncology Patients

Rinke

Bundy

Chen³

et al. 2013

Pediatrics

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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 AUTHORS:

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Section: Resultsmentioning

confidence: 99%

“…As described previously, 10,20 positive blood cultures were identified by front-line nurses and case managers, and via active surveillance from infection preventionists (IPs). Ambulatory bacteremias were defined as any positive blood culture occurring .48 hours after discharge and until 48 hours after admission.…”

Section: Definitions and Data Sourcesmentioning

confidence: 99%

Central Line Maintenance Bundles and CLABSIs in Ambulatory Oncology Patients

Rinke

Bundy

Chen³

et al. 2013

Pediatrics

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“…Standardization of bundle elements coupled with systematic implementation and compliance has been shown to effectively and significantly reduce CLABSI rates across multiple studies involving pediatric oncology and HCT patients in the inpatient setting. [86][87][88][89][90] Best practice bundle implementation with particular focus on maintenance strategies also reduces CLABSI rates in the ambulatory setting. 86,91 As part of a multicenter quality improvement initiative, 32 pediatric hematology/oncology and HCT centers across the United States implemented a standardized CVC care bundle.…”

Section: Bloodstream Infection Preventionmentioning

confidence: 99%

Bacterial bloodstream infections in the allogeneic hematopoietic cell transplant patient: new considerations for a persistent nemesis

Dandoy

Ardura

Papanicolaou

et al. 2017

Bone Marrow Transplant

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Bacterial bloodstream infections (BSI) cause significant transplant-related morbidity and mortality following allogeneic hematopoietic cell transplantation (allo-HCT). This manuscript reviews the risk factors for and the bacterial pathogens causing BSIs in allo-HCT recipients in the contemporary transplant period. In addition, it offers insight into emerging resistant pathogens and reviews clinical management considerations to treat and strategies to prevent BSIs in allo-HCT patients.

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“…7 Central venous catheter insertion and daily maintenance care bundles have been used to reduce CLABSI in pediatric intensive care units, neonatal intensive care units, pediatric cardiothoracic units, pediatric stem cell transplant recipients, and inpatient pediatric oncology patients. 17,18 Central venous catheter insertion bundles focus on care practices during insertion of the CVC, and maintenance care bundles address specific procedures for access, dressing changes, intravenous line care, and patient hygiene.…”

Section: Utilization Of Care Bundles In Quality Improvementmentioning

confidence: 99%

Pediatric central venous access devices: nursing interventions

Duffy¹,

Nelson²

2017

NRR

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A central venous catheter (CVC) is an indwelling catheter that provides permanent or temporary stable venous access for both acute and chronically ill pediatric patients. These catheters provide stable venous access that can be used for a variety of medical purposes including drawing blood, hemodynamic monitoring, infusion of intravenous medications, infusion of intravenous fluids, chemotherapy, blood products, and parenteral nutrition. Each day, nurses access and care for CVCs in infants, children, and adolescents; the precision of this care can prevent life-threatening complications. The purpose of this review and the case study is to highlight the importance and components of evidence-based nursing practice in pediatric CVC care. A historical perspective of CVC care is provided in conjunction with current national initiatives to improve patient outcomes for children with CVCs. Infection prevention, clinical practice guidelines, quality improvement, and evidence-based care bundles are discussed. Keywords: pediatric nursing, central venous catheters, central line-associated bloodstream infection, care bundles, pediatric case study Case studyRyker is a previously healthy 9-year old boy. He was brought to the emergency department by ambulance after being hit by a car while riding his bicycle. His injuries included fractures of the pelvis and femur, a pulmonary laceration, and a laceration of spleen. He required multiple surgeries to manage his injuries. During his second surgery, a right subclavian central venous catheter (CVC) was placed. This catheter provides stable venous access for administration of fluids, medications, and labs during his recovery. On hospital day #10, Ryker developed a fever, and labs and blood cultures were drawn. His labs were significant for a white blood cell count of 22,000 cells/mm 3 . The initial gram stain of his blood revealed gram-positive cocci in clusters with a culture positive for coagulase-negative staphylococcus. Ryker was started on antibiotics and his CVC was removed. He continued to recover from his injuries, and he responded well to treatment with antibiotics for his bloodstream infection. He was discharged to an inpatient rehabilitation program on hospital day #18.After further review, and ruling out other potential sources of infection such as a urinary tract infection, surgical site infections, and pulmonary infections, Ryker's positive bloodstream infection was classified as a central line associated-bloodstream infection (CLABSI) using the Center for Disease Control and Prevention (CDC) criteria. This health care-associated infection (HAI) triggered a review by the health care team. Physicians, nurses, respiratory therapists, pharmacists, and other interdisciplinary staff Correspondence: elizabeth A Duffy

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Implementation of a Central Line Maintenance Care Bundle in Hospitalized Pediatric Oncology Patients

Abstract: 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.

Cited by 100 publications

References 30 publications

Central Line Maintenance Bundles and CLABSIs in Ambulatory Oncology Patients

Central Line Maintenance Bundles and CLABSIs in Ambulatory Oncology Patients

Bacterial bloodstream infections in the allogeneic hematopoietic cell transplant patient: new considerations for a persistent nemesis

Pediatric central venous access devices: nursing interventions

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