A preoperative protocol for the prevention of infection in children with tunnelled right atrial catheters
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Published on: December 23, 2022
S Dawson1, P Fitzgerald, J C Langer
1Children's Hospital, Hamilton Health Sciences Corporation, Hamilton, Ontario L8S 4J9, Canada.
Insights
Implementing a new protocol significantly reduced central venous line infections in pediatric cancer patients. This involved antiseptic skin preparation and antibiotics, leading to fewer staphylococcal infections and catheter removals.
Area of Science:
- Pediatric Oncology
- Infectious Disease Control
- Medical Device Management
Background:
- Central venous lines are essential for pediatric cancer treatment but carry infection risks.
- Catheter-related bacteremia, often caused by skin bacteria like coagulase-negative staphylococci, is a significant complication.
- Reducing catheter colonization is crucial for patient safety.
Purpose of the Study:
- To evaluate a protocol aimed at decreasing skin colonization at the catheter insertion site.
- To assess the impact of the protocol on catheter-related infection rates and types.
- To identify key factors contributing to improved infection control.
Main Methods:
- A protocol involving antiseptic skin scrubs (4% chlorhexidine gluconate) before surgery was implemented.
- Prophylactic antibiotics (cephalothin or vancomycin) were administered intravenously before the procedure.
- Data on infection rates, causative organisms, and device removal were compared pre- and post-protocol.
Main Results:
- Catheter-related infection rates decreased from 8 to 4.9 per 1,000 catheter days.
- The proportion of staphylococcal infections fell from 93% to 63%.
- The rate of non-port catheters removed within 30 days dropped from 45% to 0%.
Conclusions:
- The implemented protocol effectively reduced catheter-related infections in pediatric cancer patients.
- Increased use of central venous ports was a major factor in improving infection control.
- Antiseptic skin preparation and prophylactic antibiotics contribute to safer central venous line use.
Abstract:
The use of central venous lines has come to be widely accepted by children with cancer and their families. However, attendant infection is a cause of considerable morbidity. Coagulase-negative staphylococci, the predominant aerobic species on the skin, are now the commonest cause of catheter-related bacteremia. We introduced a protocol to reduce the colonization of the skin at the catheter insertion site. Antiseptic skin scrubs, with 4% chlorhexidine gluconate, were performed on the neck and anterior chest the night before and again on the morning of the surgical procedure. A single dose of cephalothin (or vancomycin for penicillin-allergic patients) was administered IV immediately before the operation. Compared to the 12 month period prior to initiation of this protocol, the rate of infections (occurring within 30 days of catheter placement) in the 3.5 year period of intervention dropped from 8 to 4.9 per 1,000 catheter days. The proportion of infections that were staphylococcal was reduced from 93 to 63% and the proportion of non-ports removed within 30 days of placement fell from 45 to 0%. Despite these changes, the major contribution to improved infection control appeared to be the use of an increased proportion of ports (a rise from <10 to almost 60%).
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