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Using Practice-Based Evidence to Improve Supportive Care Practices to Reduce Central Line-Associated Bloodstream
Lauri A Linder1,2, Cheryl Gerdy2, Rouett Abouzelof2
11 University of Utah College of Nursing, Salt Lake City, UT, USA.
Insights
Implementing structured supportive care protocols, including daily bathing and oral care, significantly reduced central line-associated bloodstream infections in pediatric cancer patients. This practice-based evidence approach improved patient outcomes when specific evidence was limited.
Area of Science:
- Pediatric Oncology
- Infectious Disease Prevention
- Evidence-Based Practice
Background:
- Children with cancer have unique risks for central line infections due to neutropenia and compromised mucous membranes.
- Central line-associated bloodstream infections (CLABSIs) are a significant concern in pediatric oncology units.
- Existing evidence-based guidelines may not fully address the specific needs of this vulnerable population.
Purpose of the Study:
- To implement practice-based evidence to develop interventions aimed at reducing CLABSIs in pediatric oncology patients.
- To identify effective strategies beyond standard care bundles for preventing infections caused by viridans group streptococci and coagulase-negative staphylococci.
- To evaluate the impact of structured supportive care protocols on CLABSI rates.
Main Methods:
- Utilized practice-based evidence principles and individual event reviews to inform protocol development.
- Implemented structured protocols emphasizing a 1-2-3 mnemonic: daily bathing, twice-daily oral care, and three-times-daily out-of-bed activity.
- Employed Poisson regression to analyze CLABSI rates before and after intervention implementation.
Main Results:
- A significant reduction in CLABSIs caused by viridans group streptococci and coagulase-negative staphylococci was observed.
- Statistical analysis revealed significant differences in infection rates between the preintervention baseline and the intervention periods.
- The supportive care protocols demonstrated a positive impact on infection control outcomes.
Conclusions:
- Practice-based evidence is valuable for developing targeted interventions when evidence-based sources are limited.
- Structured supportive care protocols, focusing on hygiene and mobility, can effectively reduce CLABSIs in pediatric cancer patients.
- This approach highlights the importance of adapting care strategies to the specific risk factors of immunocompromised pediatric populations.
Abstract:
Children with cancer are a subset of patients with central lines with distinct risk factors for infection including periods of prolonged neutropenia and compromised mucous membrane integrity. This article relates the implementation of principles of practice-based evidence to identify interventions in addition to best practice maintenance care bundles to reduce central line-associated bloodstream infections involving viridans group streptococci and coagulase-negative staphylococci on an inpatient pediatric oncology unit. Review of individual events combined with review of current clinical practice guided the development of structured protocols emphasizing routine oral care and general supportive cares. Key principles of the protocols emphasized a 1-2-3 mnemonic and included daily bathing, twice daily oral care, and out-of-bed activity 3 times daily. Poisson regression identified a significant main effect for time period for central line-associated bloodstream infection rates involving both viridans group streptococci and coagulase-negative staphylococci. Significant differences were present between the preintervention baseline and implementation of the supportive care protocols. Project outcomes demonstrate the added value of using principles of practice-based evidence to guide the development of interventions to improve clinical care when evidence-based sources are limited.
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