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Central line maintenance bundles and CLABSIs in ambulatory oncology patients
Michael L Rinke1, David G Bundy, Allen R Chen
1Department of Pediatrics, The Children's Hospital at Montefiore, 3415 Bainbridge Avenue, Bronx, NY 10467. mrinke@montefiore.org.
Insights
A central line maintenance bundle significantly reduced central line-associated bloodstream infections (CLABSIs) and bacteremias in pediatric oncology outpatients. This multidisciplinary approach improved patient safety and decreased infection rates.
Area of Science:
- Pediatric Oncology
- Infectious Disease Prevention
- Healthcare Quality Improvement
Background:
- Central lines are crucial for pediatric oncology outpatients but pose infection risks.
- Immune-compromised pediatric oncology patients are particularly vulnerable to central line-associated bloodstream infections (CLABSIs).
Purpose of the Study:
- To evaluate the effectiveness of a multidisciplinary central line maintenance care bundle.
- To reduce CLABSIs and bacteremias in ambulatory pediatric oncology patients.
Main Methods:
- An interrupted time-series study was conducted, implementing a comprehensive central line maintenance bundle.
- Training, practice audits, and data feedback were provided to clinic staff, homecare nurses, and patient families.
- Incidence rates of CLABSIs and bacteremias were compared pre- and post-intervention using Poisson regression.
Main Results:
- The mean CLABSI rate decreased by 48% post-intervention (0.63 to 0.32 per 1000 central line days, P = .005).
- The mean bacteremia rate decreased by 54% post-intervention (1.27 to 0.59 per 1000 central line days, P < .001).
Conclusions:
- A multidisciplinary central line maintenance care bundle effectively reduced CLABSIs and bacteremia in ambulatory pediatric oncology patients.
- Further research is recommended to assess the efficacy of these bundles in other patient populations.
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, in-service training, and bulletin boards. CLABSI and bacteremia person-time 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.
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