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Oladapo-Shittu O, Cosgrove SE, Rock C, Hsu YJ, Klein E, Harris AD, Mejia-Chew C, Saunders H, Ching PR, Gadala A, Mayoryk S, Pineles L, Maragakis L, Salinas A, Helsel T, Keller SC. Characterizing Patients Presenting on Hospital Admission With Central Line-Associated Bloodstream Infections: A Multicenter Study. Clin Infect Dis 2024; 78:1632-1639. [PMID: 38483930 DOI: 10.1093/cid/ciae144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/05/2024] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND There are no systematic measures of central line-associated bloodstream infections (CLABSIs) in patients maintaining central venous catheters (CVCs) outside acute care hospitals. To clarify the burden of CLABSIs in these patients, we characterized patients with CLABSI present on hospital admission (POA). METHODS Retrospective cross-sectional analysis of patients with CLABSI-POA in 3 health systems covering 11 hospitals across Maryland, Washington DC, and Missouri from November 2020 to October 2021. CLABSI-POA was defined using an adaptation of the acute care CLABSI definition. Patient demographics, clinical characteristics, and outcomes were collected via record review. Cox proportional hazard analysis was used to assess factors associated with the all-cause mortality rate within 30 days. RESULTS A total of 461 patients were identified as having CLABSI-POA. CVCs were most commonly maintained in home infusion therapy (32.8%) or oncology clinics (31.2%). Enterobacterales were the most common etiologic agent (29.2%). Recurrent CLABSIs occurred in a quarter of patients (25%). Eleven percent of patients died during the hospital admission. Among patients with CLABSI-POA, mortality risk increased with age (hazard ratio vs age <20 years by age group: 20-44 years, 11.2 [95% confidence interval, 1.46-86.22]; 45-64 years, 20.88 [2.84-153.58]; ≥65 years, 22.50 [2.98-169.93]) and lack of insurance (2.46 [1.08-5.59]), and it decreased with CVC removal (0.57 [.39-.84]). CONCLUSIONS CLABSI-POA is associated with significant in-hospital mortality risk. Surveillance is required to understand the burden of CLABSI in the community to identify targets for CLABSI prevention initiatives outside acute care settings.
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Affiliation(s)
- Opeyemi Oladapo-Shittu
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
| | - Sara E Cosgrove
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA
| | - Clare Rock
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA
| | - Yea-Jen Hsu
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA
| | - Eili Klein
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
| | - Anthony D Harris
- University of Maryland School of Medicine, Department of Medicine, Baltimore, Maryland, USA
- University of Maryland School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA
- Institute for Health Computing, University of Maryland, Baltimore, Maryland, USA
| | - Carlos Mejia-Chew
- Washington University School of Medicine, Department of Medicine, St Louis, Missouri, USA
| | - Heather Saunders
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
| | - Patrick R Ching
- Washington University School of Medicine, Department of Medicine, St Louis, Missouri, USA
- Virginia Commonwealth University School of Medicine, Department of Medicine, Richmond, Virginia, USA
| | - Avi Gadala
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
| | - Stephanie Mayoryk
- University of Maryland School of Medicine, Department of Medicine, Baltimore, Maryland, USA
- University of Maryland School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA
| | - Lisa Pineles
- University of Maryland School of Medicine, Department of Medicine, Baltimore, Maryland, USA
- University of Maryland School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA
| | - Lisa Maragakis
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA
| | - Alejandra Salinas
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
| | - Taylor Helsel
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
| | - Sara C Keller
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, Maryland, USA
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Reynolds H, Gowardman J, Woods C. Care bundles and peripheral arterial catheters. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S34-S41. [PMID: 38271041 DOI: 10.12968/bjon.2024.33.2.s34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
HIGHLIGHTS What we know about the topic: Recommendations for the use of vascular access care bundles to reduce infection are followed for different devices. The risk of arterial catheter-related infection is comparable with short-term, non-cuffed central venous catheters. There are practice concerns for clinicians inserting and caring for peripheral arterial catheters. What this paper adds: The selected studies had a theme of decreased infection after using bundled strategies for all devices. Few studies addressed use of bundles for care of peripheral arterial catheters. High-quality research should be performed about using care bundles for insertion and care of arterial catheters. INTRODUCTION A scoping review of the literature was performed. AIMS/OBJECTIVES To find information on the use of care bundles for care of arterial, central, and peripherally inserted venous catheters. METHODS Data was extracted by 2 independent researchers using standardized methodology. RESULTS Results of 84 studies included 2 (2.4%) randomized controlled trials, 38 (45.2%) observational studies, 29 (34.5%) quality projects, and 15 (17.9%) reviews. Populations had more adults than pediatric patients. All studies had the most prominent theme of decreased infection in all devices after using bundle strategies. DISCUSSION AND CONCLUSIONS The mapping of available evidence strongly supports the use of care bundles to reduce infection in the care of all intravascular devices. However, deficiencies regarding practice concerns about insertion and care of arterial catheters highlight areas for future research with the aim to eliminate the gap in the evidence of studies of care bundles for peripheral arterial catheters.
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Affiliation(s)
- Heather Reynolds
- Department of Anaesthesia & Perioperative Medicine, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia, The University of Queensland, St Lucia, Queensland, Australia, Alliance for Vascular Access Teaching & Research, Griffith University, Nathan, Queensland, Australia
| | - John Gowardman
- Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia, The University of Queensland, St Lucia, Queensland, Australia
| | - Christine Woods
- Department of Anaesthesia & Perioperative Medicine, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia, The University of Queensland, St Lucia, Queensland, Australia
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Reppucci M, Prendergast C, Flynn K, Scarbro S, Derderian SC, Diaz-Miron J. Trainee educational curriculum to standardize central venous catheter repair. BMC MEDICAL EDUCATION 2023; 23:978. [PMID: 38115058 PMCID: PMC10731855 DOI: 10.1186/s12909-023-04977-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 12/14/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Children may require durable central venous catheters (CVCs) for various reasons. CVC-related integrity complications are common and can often be repaired at the bedside to increase lifetime. Variability in repair techniques can lead to complications, including the need for repeat repair and Central Line Associated Blood Stream Infection (CLABSI). METHODS The impact of an educational curriculum to standardize tunneled CVC repairs for trainees on a pediatric surgery service was studied, focusing on comfort level with tunneled CVC repair and to determine the impact on complication rates. Rotating trainees studied a dedicated audiovisual educational curriculum comprised of a video, educational slides, and a practical component from November 2020 through January 2022. Experience and comfort level with tunneled CVC repairs were assessed before and after the rotation. CVCs repaired during the duration of the study were evaluated and compared to the period prior. RESULTS Forty-nine individuals completed the pre- and post-training survey. Respondents (34.7%, n = 17) most commonly reported one year of surgical experience, and (79.6%, n = 39) had never observed or assisted in a repair previously. Following training, respondents felt more comfortable with all aspects of the CVC repair process (p < 0.001). There were no statistically significant differences in re-repair rates or CLABSI rates following the implementation of the curriculum. CONCLUSIONS Tunneled CVC procedural repair variability can be standardized with a dedicated educational curriculum for rotating trainees, which improves knowledge and comfort with such procedures.
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Affiliation(s)
- Marina Reppucci
- Department of General Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Connor Prendergast
- Pediatric Surgery, Children's Hospital Colorado, 13213 E 16th Ave, Box 323, 80045, Aurora, CO, USA
| | - Katherine Flynn
- Pediatric Surgery, Children's Hospital Colorado, 13213 E 16th Ave, Box 323, 80045, Aurora, CO, USA
| | - Sharon Scarbro
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - S Christopher Derderian
- Pediatric Surgery, Children's Hospital Colorado, 13213 E 16th Ave, Box 323, 80045, Aurora, CO, USA
| | - Jose Diaz-Miron
- Pediatric Surgery, Children's Hospital Colorado, 13213 E 16th Ave, Box 323, 80045, Aurora, CO, USA.
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Devrim İ, Celebi MY, Karakaya N, Sahinkaya S, Acar SO, Cem E, Demirağ B, Oruc Y, Kara AA, Oymak Y, Karapınar TH, Bayram N. The evaluation of Candida-related central line-related bloodstream infections in pediatric cancer patients: A pre- and post-intervention study. J Infect Prev 2023; 24:219-222. [PMID: 37736125 PMCID: PMC10510660 DOI: 10.1177/17571774231191334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/28/2023] [Indexed: 09/23/2023] Open
Abstract
Aim/Objections The purpose of this study was to assess the efficacy of a central line maintenance bundle in preventing catheter-related (implanted venous access devices, port) Candida bloodstream infections. Methods The study encompassed two distinct time periods, namely, pre-bundle and bundle. The number of catheter-related bloodstream infections (CRBSI) episodes per catheter days for each timeframe was determined. Findings/Results Upon implementation of the central line bundle, the rate of CRBSI reduced significantly from 4.27 per 1000 central line days in the pre-bundle period to 1.0 per 1000 central line days in the bundle period (p < .001). Discussion Using a central line bundle to avoid CRBSIs in pediatric cancer patients with ports led to a significant decrease in Candida species-related CRBSIs.
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Affiliation(s)
- İlker Devrim
- Department of Pediatric Hematology and Oncology, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Miray Yılmaz Celebi
- Department of Pediatric Infectious Diseases, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Nurgul Karakaya
- Department of Pediatric Hematology and Oncology, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Sahika Sahinkaya
- Department of Pediatric Infectious Diseases, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Sultan Okur Acar
- Department of Pediatric Hematology and Oncology, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Ela Cem
- Department of Pediatric Infectious Diseases, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Bengü Demirağ
- Department of Pediatric Hematology and Oncology, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Yeliz Oruc
- Department of Pediatric Infectious Diseases, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Aybuke Akaslan Kara
- Department of Pediatric Infectious Diseases, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Yesim Oymak
- Department of Pediatric Hematology and Oncology, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Tuba Hilkay Karapınar
- Department of Pediatric Hematology and Oncology, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Nuri Bayram
- Department of Pediatric Hematology and Oncology, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
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5
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Central-line-associated bloodstream infections and central-line-associated non-CLABSI complications among pediatric oncology patients. Infect Control Hosp Epidemiol 2023; 44:377-383. [PMID: 35475427 PMCID: PMC10015264 DOI: 10.1017/ice.2022.91] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess central venous catheter (CVC) harm in pediatric oncology patients, we explored risks for central-line-associated bloodstream infections (CLABSIs) and central-line-associated non-CLABSI complications (CLANCs). DESIGN Retrospective cohort study. SETTING Midwestern US pediatric oncology program. PATIENTS The study cohort comprised 592 pediatric oncology patients seen between 2006 and 2016. METHODS CLABSIs were defined according to Centers for Disease Control and Prevention (CDC)/National Health Safety Network (NHSN) definitions. CLANCs were classified using a novel definition requiring CVC removal. Patient-level and central-line-level risks were calculated using a negative binomial model to adjust for correlations between total events and line numbers. RESULTS CVCs were inserted in 62% of patients, with 175,937 total catheter days. The inpatient CLABSI and CLANC rates were 5.8 and 8.5 times higher than outpatient rates. At the patient level, shared risks included acute myeloid leukemia (AML) and age <1 year at diagnosis. At the line level, shared risks included age <1 year at diagnosis, non-mediports, and >1 lumen. AML was a CLABSI-specific risk. CLANC-specific risks included non-brain-tumor diagnosis, younger age at diagnosis or central-line placement, and age <1 year at diagnosis or line placement. Multivariable risks were for CLABSI >1 lumen and for CLANC age <1 year at placement. CONCLUSIONS Among patients with CVCs, CLABSI and CLANC rates were similar, higher among inpatients than outpatients. For both CLABSIs and CLANCs, infants and patients with AML were at higher risk. In both univariate and multivariate models, lines with >1 lumen were associated with CLABSIs and placement during infancy with CLANCs.
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Prudowsky ZD, Bledsaw K, Staton S, Zobeck M, DeJean J, Johnson-Bishop L, George A, Steffin D, Stevens A. Chlorhexidine gluconate (CHG) foam improves adherence, satisfaction, and maintains central line associated infection rates compared to CHG wipes in pediatric hematology-oncology and bone marrow transplant patients. Pediatr Hematol Oncol 2023; 40:159-171. [PMID: 35838063 DOI: 10.1080/08880018.2022.2090644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CHG-based hygiene methods are often a component of daily hygiene bundles to prevent central line-associated blood stream infections (CLABSIs) in pediatric hematology-oncology patients; however, adherence with 2% CHG wipes was inconsistent within our institution, risking infection for immunocompromised patients. A new 4% CHG foam method offers an alternative and is applied while bathing, as opposed to wipes used 1 h after bathing. An initial cohort of 24 high-risk oncology and bone marrow transplant (BMT) patients agreed to use 4% CHG foam in place of wipes, and then answered surveys to describe their experiences. Ninety-two percent preferred foam over wipes and were more likely to use the foam moving forward. CHG foam was then made available as an option to all patients in need of central line care upon admission to the hospital. Hygiene bundles in the electronic medical record were reviewed to measure baseline adherence rates. Random audits by nursing administration prospectively assessed CHG adherence. CLABSI data were collected prospectively with routine quality metric reports. Results were analyzed using run charts and u-charts, respectively. Hematology-Oncology unit adherence rates remained at a higher rate of adherence, and BMT unit adherence rates increased from an average of 55%-81.6% (p < 0.001). Primary CLABSIs remained rare events (average <1/1000 CVL days). On cost analysis, utilizing CHG foam results in an annual savings estimate of $40,000 for a 24-bed unit. In conclusion, 4% CHG foam provides a cost-effective and patient-preferred option for daily hygiene that maintains CLABSI preventative efforts.
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Affiliation(s)
- Zachary D Prudowsky
- Texas Children's Hospital Cancer and Hematology Centers, Houston, Texas, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Kandice Bledsaw
- Texas Children's Hospital Cancer and Hematology Centers, Houston, Texas, USA
| | - Sharon Staton
- Texas Children's Hospital Cancer and Hematology Centers, Houston, Texas, USA
| | - Mark Zobeck
- Texas Children's Hospital Cancer and Hematology Centers, Houston, Texas, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Janet DeJean
- Texas Children's Hospital Cancer and Hematology Centers, Houston, Texas, USA
| | - Lindsay Johnson-Bishop
- Texas Children's Hospital Cancer and Hematology Centers, Houston, Texas, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Anil George
- Texas Children's Hospital Cancer and Hematology Centers, Houston, Texas, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - David Steffin
- Texas Children's Hospital Cancer and Hematology Centers, Houston, Texas, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Alexandra Stevens
- Texas Children's Hospital Cancer and Hematology Centers, Houston, Texas, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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Lehane R, Svensson C, Ormsby JA, Yuen JC, Priebe GP, Sandora TJ, Vaughan-Malloy AM. Preventing pediatric catheter-associated urinary tract infections utilizing urinary catheter Kamishibai cards (K-cards). Am J Infect Control 2022:S0196-6553(22)00845-8. [PMID: 36463976 DOI: 10.1016/j.ajic.2022.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND We instituted Kamishibai (K-card rounding) with the goals of improving indwelling urinary catheter maintenance bundle reliability and decreasing catheter-associated urinary tract infection (CAUTI) rates. METHOD In a free-standing children's hospital, we undertook a hospital-wide quality improvement project from January 2019 to June 2021 after developing a K-card based on our urinary catheter maintenance bundle. Auditors used K-cards to ask standardized questions during weekly rounds. Bundle reliability and CAUTI rates were analyzed prospectively. RESULTS During the study period, 826 K-card audits were performed for 657 unique patients. While overall maintenance bundle reliability remained stable at 84%, there was a statistically significant improvement in reliability to the bundle element "medical discussion of need for the urinary catheter" from 88% to 94% (P = .01). The hospital-wide CAUTI rate significantly decreased (incidence rate ratio, 0.38; 95% CI, 0.15-0.93; P = .04). DISCUSSION Hospital-wide urinary catheter K-card rounding facilitated standardized data collection, discussion of reliability and real-time feedback to nurses. Maintenance bundle reliability remained stable after implementation, accompanied by a significant decrease in the CAUTI rate. CONCLUSIONS Implementation of hospital-wide urinary catheter K-card rounding was associated with reduction in CAUTI rates. The project demonstrated likelihood of reproducibility with support of a multidisciplinary team.
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Affiliation(s)
- Renee Lehane
- Infection Prevention and Control, Boston Children's Hospital, Boston, MA
| | - Catherine Svensson
- Infection Prevention and Control, Boston Children's Hospital, Boston, MA.
| | - Jennifer A Ormsby
- Infection Prevention and Control, Boston Children's Hospital, Boston, MA
| | - Jenny Chan Yuen
- Infection Prevention and Control, Boston Children's Hospital, Boston, MA
| | - Gregory P Priebe
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA; Department of Anesthesia, Harvard Medical School, Boston, MA; Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Thomas J Sandora
- Infection Prevention and Control, Boston Children's Hospital, Boston, MA; Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Ana M Vaughan-Malloy
- Infection Prevention and Control, Boston Children's Hospital, Boston, MA; Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
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8
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Central-line–associated bloodstream infections in a pediatric oncology and hematology hospital at home program. Infect Control Hosp Epidemiol 2022; 44:780-785. [DOI: 10.1017/ice.2022.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Objective:
Central-line–associated bloodstream infections (CLABSIs) are associated with significant morbidity among pediatric oncology-hematology patients, and risk factors remain largely unknown in the setting of hospital at home (HAH). Children in HAH receive intensive treatment (eg, chemotherapy and parenteral nutrition), with frequent central-line handling; thus, they may be at higher risk for CLABSI.
Methods:
We conducted a monocentric retrospective study of patients with a central line included in our HAH program from January 1 to December 31, 2016. HAH patient characteristics for children developing CLABSIs were compared to those who did not, based on blood cultures positive for infection and clinical data of all patients included.
Results:
Overall, 492 HAH stays were analyzed, with 144 patients. The overall CLABSI rate in these patients was 2.6 per 1,000 central-line days. Children who developed CLABSIs were younger (median age, 2.5 vs 8.8 years; P < .001), suffered more from hematological pathologies (malignant or nonmalignant, 75% vs 52%; P = .02), and had more frequently undergone hematopoietic stem-cell transplantation (30.8% vs 6.5%; P = .01). In addition, these patients often had a tunneled externalized catheter as the central line and were more frequently given parenteral nutrition at home (46% vs 8%; P < .001).
Conclusions:
CLABSI rates for children in HAH were more similar to those of inpatients than to rates previously reported for ambulatory patients. The factors associated with infection identified herein should be further validated in multicentric studies and considered to improve HAH practices, parallel to prevention measures used in the inpatient setting.
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9
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Hamza WS, Hamed EATM, Alfadhli MA, Ramadan MAM. A multidisciplinary intervention to reduce central line-associated bloodstream infection in pediatrics and neonatal intensive care units. Pediatr Neonatol 2022; 63:71-77. [PMID: 34620576 DOI: 10.1016/j.pedneo.2021.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/05/2021] [Accepted: 08/27/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND To date, central line-associated bloodstream infections (CLABSIs) are the most common healthcare-associated infections in high-risk neonates and children. These infections are associated with significantly longer hospital stays, increased health care cost, and mortality in the health care systems. Application of evidence-based preventive interventions has proven to decrease CLABSI rate. The purpose of this study is to reduce the undesired relative high CLABSI rate through the adoption of standardized quality improvement interventions. METHODS and Methods: The study employed a pre-post-intervention design. Phase one is a retrospective calculation of 12 months of surveillance period as a baseline. Phase 2 establishes a multidisciplinary quality improvement intervention, which includes the formation of a dedicated central line insertion team, provision of central line kit at the bedside, training and educating the team, and selecting bundle checklist. In the third phase, we performed auditing and calculating the checklist compliance and monthly feedback for 12 consecutive post-intervention months. During phase 1 and 3, we calculated the following measures; CLABSI per 1000 catheter-days, duration of central line use, and device utilization ratio. RESULTS During the post-intervention phase the CLABSI rate significantly reduced by 59.5% from 7.5 to 3.0 per 1000 central line day, and the duration of use of the central line decreased from 21.3 ± 9.9 to 11.0 ± 3.2 days (P < 0.05). CONCLUSION Implementation of quality improvement multidisciplinary intervention; central line insertion and maintenance care bundle, dedicated IV team, education and feedback effectively reduced the rate of CLABSI within our pediatrics and neonatal ICUs.
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Affiliation(s)
- Wafaa Seddik Hamza
- Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Egypt.
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10
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Martynov I, Schoenberger J. Impact of Perioperative Absolute Neutrophil Count on Central Line-Associated Bloodstream Infection in Children With Acute Lymphoblastic and Myeloid Leukemia. Front Oncol 2021; 11:770698. [PMID: 34888247 PMCID: PMC8649799 DOI: 10.3389/fonc.2021.770698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background There is lack of evidence concerning safety of placement of tunneled central venous catheters (TCVCs) in neutropenic children with acute leukemias. Here, we evaluate the impact of absolute neutrophil count (ANC) at the time of TCVC placement on development of central line-associated bloodstream infections (CLABSI) in children with lymphoblastic (ALL) or myeloid leukemia (AML). Materials and Methods A retrospective observational study of children undergoing TCVC placement at a tertiary referral hospital between January 2000 and December 2019 was performed. Traditional and competing-risks regression models were used to estimate the effect of perioperative ANC on development of CLABSI. Results A total of 350 children (median age 6.4 [IQR: 3.1–10.9] years) underwent 498 consecutive TCVC implantations in neutropenic (n = 172, 34.5%) and non-neutropenic conditions (n = 326, 65.5%). The median length of observation per TCVC was 217.1 (IQR: 116.1–260.5) days with a total of 99,681 catheter days (CD). There were no differences in early (within first 30 days after TCVC placement) and overall CLABSI rates between neutropenic and non-neutropenic patients (HR 1.250, p = 0.502; HR 1.633, p = 0.143). We identified female sex (HR 2.640, p = 0.006) and the use of TCVC for treatment of relapsed leukemia (HR 4.347, p < 0.0001) as risk factors for early CLABSI and the use of double-lumen catheters (HR 2.607, p = 0.003) and use of TCVCs during leukemia relapse (HR 2.004, p = 0.005) for overall study period. Conclusion The placement of TCVC in children with neutropenia undergoing anticancer therapy for acute leukemia is safe and not associated with an elevated rate of CLABSI.
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Affiliation(s)
- Illya Martynov
- Department of Pediatric Surgery, University Hospital of Freiburg, Freiburg, Germany.,Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
| | - Joachim Schoenberger
- Department of Pediatric Surgery, University Hospital of Freiburg, Freiburg, Germany.,Department of Pediatric Surgery, Helios Kliniken Schwerin, Schwerin, Germany
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11
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Rosati P, Saulle R, Amato L, Mitrova Z, Crocoli A, Brancaccio M, Ciliento G, Alessandri V, Piersigilli F, Nunziata J, Cecchetti C, Inserra A, Ciofi Degli Atti M, Raponi M. Mindful organizing as a healthcare strategy to decrease catheter-associated infections in neonatal and pediatric intensive care units. A systematic review and grading recommendations (GRADE) system. J Vasc Access 2021; 22:955-968. [PMID: 33570016 DOI: 10.1177/1129729821990215] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To explore the clinical evidence available on mindful organizing (MO) that will improve teamwork for positioning and managing central venous catheters in patients admitted to neonatal intensive care and other pediatric intensive care units to decrease central-line-associated and catheter-related bloodstream infections (CLABSI and CRBSI). METHODS We searched several databases (PubMed, Embase, CINAHL, CENTRAL, SCOPUS, and Web of Science) up to June 2018. We included studies investigating the effectiveness of MO teamwork in reducing CLABSI and CRBSI. The systematic review followed the PRISMA guidelines. We used validated appraisal checklists to assess quality. RESULTS Seven studies were included: only one was a non-randomized case-controlled trial (CCT). All the others had a pre-post intervention design, one a time-series design and one an interrupted time-series design. The methodological heterogeneity precluded a meta-analysis. Despite the low certainty of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, three studies including thousands of participants provided numerical data for calculating risk ratios (RR) and 95% confidence intervals (CI) comparing MO with no intervention for decreasing the CLABSI rate in neonatal and pediatric ICUs. The one CCT disclosed no significant difference in the CLABSI rate decrease between groups (RR = 0.96; 95%CI 0.47-1.97). Nor did the pre- and post-intervention interrupted time-series design disclose a significant decrease (RR = 0.80; 95%CI 0.36 1.77). In the study using a before-after study design, the GRADE system found that the CLABSI rate decrease differed significantly in favor of post-intervention (RR = 0.13; 95%CI 0.03 0.57; p = 0.007). CONCLUSIONS Despite the decreased CLABSI rate, the available evidence is low in quality. To reduce the unduly high CLABSI rates in neonatal and pediatric intensive care settings, custom-designed clinical trials should further define the clinical efficacy of MO to include it in care bundles as a new international standard.
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Affiliation(s)
- Paola Rosati
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rosella Saulle
- Department of Epidemiology (DEP), Lazio Region-ASL Rome 1, Rome, Italy
| | - Laura Amato
- Department of Epidemiology (DEP), Lazio Region-ASL Rome 1, Rome, Italy
| | - Zuzana Mitrova
- Department of Epidemiology (DEP), Lazio Region-ASL Rome 1, Rome, Italy
| | - Alessandro Crocoli
- Department of Surgery and Surgical Oncology Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Matilde Brancaccio
- Health Management Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Gaetano Ciliento
- Health Management Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Valeria Alessandri
- Department of Anesthesia and Intensive Care Medicine, Bambino Gesù Children's Hospital, Rome, Italy
| | - Fiammetta Piersigilli
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium
| | - Joseph Nunziata
- Emergency Department, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Alessandro Inserra
- Department of Surgery and Surgical Oncology Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Marta Ciofi Degli Atti
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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12
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Low Risk of Central Line-associated Bloodstream Infections in Pediatric Hematology/Oncology Patients. Pediatr Infect Dis J 2021; 40:827-831. [PMID: 33990520 DOI: 10.1097/inf.0000000000003177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Central venous lines (CVLs) are essential for standard care of pediatric hematology/oncology patients providing safe administration of cytotoxic drugs and pain-free blood sampling. Central line-associated bloodstream infections (CLABSIs) cause significant morbidity. This study describes the epidemiology, microbiology, and risk factors for CLABSI in all children with malignancies in Iceland. METHODS All children that were diagnosed with malignancy in Iceland and received a CVL during 2008-2017 were included in the study. Characteristics of CVLs and patients were registered, information on risk factors, and microbiology was collected. International standards were used for CLABSI definition. RESULTS One hundred forty-three CVLs were placed in 94 children. Acute lymphoblastic leukemia was the most common underlying disease (31/94). Median age was 7 years. Implantable ports were the most commonly placed CVLs (82/143, 57%), tunneled lines were 39 (27%). Overall CLABSI rate was 0.24 infections/1000 line-days (14 episodes in 58,830 line-days), with little fluctuations. No CLABSI episodes occurred for 4 consecutive years (2012-2015). Staphylococci (of which 7 Staphylococcus aureus) were the cause of 10/14 episodes. Nine CLABSI episodes led to line removal, but no deaths were linked to CLABSIs. CONCLUSION We report very low CLABSI rates over a 9-year period at our hospital, with 4 consecutive CLABSI-free years. Even with the addition of episodes of possible CLABSI, rates were still very low and lower than most published reports.
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13
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Chaiyakulsil C, Pharadornuwat O. Can central venous access device care bundles and regular feedback reduce central line-associated complications in pediatric patients? Clin Exp Pediatr 2021; 64:123-129. [PMID: 32683808 PMCID: PMC7940089 DOI: 10.3345/cep.2020.00143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/23/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The use of indwelling central venous access devices (CVADs) in children can result in complications such as infection, occlusion, and dislodgement. PURPOSE To evaluate whether reinforcing CVAD care bundles by using a regular direct feedback system could reduce such complications in children. METHODS The intervention in this retrospective interrupted time-series study was initiated in January 2019. The study was divided into the preintervention (October-December 2018), 3-month postintervention (January-March 2019), and 6-month postintervention (April-June 2019) phases. Risk difference and Poisson regression analyses were used to illustrate the effectiveness of the intervention. RESULTS The hospital-wide central line-related bloodstream infection rate decreased from 10.0/1,000 catheter-days to 4.5/1,000 catheter-days at 3-month postintervention (P=0.39) and to 1.4/1,000 catheter-days at 6-month postintervention (P=0.047). The central line occlusion rate significantly decreased from 30% to 12.8% (P=0.04) and 8.3% (P=0.002) at 3 and 6 months, respectively. Approximately 7% of CVADs became dislodged during the preintervention phase versus 8.5% (P=0.364) and 3.3% (P=0.378) at 3 and 6 months, respectively. CONCLUSION Reinforcing CVAD care bundles with direct feedback could significantly decrease CVAD-associated complications in terms of infection at 6-month postintervention, and occlusion at 3- and 6-month postintervention. Thus, reinforcement and regular direct feedback might improve care quality in children with CVADs.
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Affiliation(s)
- Chanapai Chaiyakulsil
- Division of Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine, Thammasat University, Prathumthani, Thailand
| | - Onsuthi Pharadornuwat
- Division of Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine, Thammasat University, Prathumthani, Thailand
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14
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Rinke ML, Heo M, Saiman L, Bundy DG, Rosenberg RE, DeLaMora P, Rabin B, Zachariah P, Mirhaji P, Ford WJH, Obaro-Best O, Drasher M, Klein E, Peshansky A, Oyeku SO. Pediatric Ambulatory Central Line-Associated Bloodstream Infections. Pediatrics 2021; 147:peds.2020-0524. [PMID: 33386333 DOI: 10.1542/peds.2020-0524] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Inpatient pediatric central line-associated bloodstream infections (CLABSIs) cause morbidity and increased health care use. Minimal information exists for ambulatory CLABSIs despite ambulatory central line (CL) use in children. In this study, we identified ambulatory pediatric CLABSI incidence density, risk factors, and outcomes. METHODS Retrospective cohort with nested case-control study at 5 sites from 2010 through 2015. Electronic queries were used to identify potential cases on the basis of administrative and laboratory data. Chart review was used to confirm ambulatory CL use and adjudicated CLABSIs. Bivariate followed by multivariable backward logistic regression was used to identify ambulatory CLABSI risk factors. RESULTS Queries identified 4600 potentially at-risk children; 1658 (36%) had ambulatory CLs. In total, 247 (15%) patients experienced 466 ambulatory CLABSIs with an incidence density of 0.97 CLABSIs per 1000 CL days. Incidence density was highest among patients with tunneled externalized catheters versus peripherally inserted central catheters and totally implanted devices: 2.58 CLABSIs per 1000 CL days versus 1.46 vs 0.23, respectively (P < .001). In a multivariable model, clinic visit (odds ratio [OR] 2.8; 95% confidence interval [CI]: 1.4-5.5) and low albumin (OR 2.3; 95% CI: 1.2-4.3) were positively associated with CLABSI, and prophylactic antimicrobial agents for underlying conditions within the preceding 30 days (OR 0.22; 95% CI: 0.12-0.40) and operating room CL placement (OR 0.36; 95% CI: 0.16-0.79) were inversely associated with CLABSI. A total of 396 patients (85%) were hospitalized because of ambulatory CLABSI with an 8-day median length of stay (interquartile range 5-13). CONCLUSIONS Ambulatory pediatric CLABSI incidence density is appreciable and associated with health care use. CL type, patients with low albumin, prophylactic antimicrobial agents, and placement setting may be targets for reduction efforts.
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Affiliation(s)
- Michael L Rinke
- The Children's Hospital at Montefiore, Bronx, New York; .,Albert Einstein College of Medicine, Bronx, New York
| | - Moonseong Heo
- Department of Public Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina
| | - Lisa Saiman
- Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York
| | - David G Bundy
- Department of Pediatrics, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Rebecca E Rosenberg
- Department of Pediatrics, School of Medicine, New York University, New York, New York
| | - Patricia DeLaMora
- Department of Pediatrics, Weill Cornell Medical College, New York, New York
| | - Barbara Rabin
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Philip Zachariah
- Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York
| | - Parsa Mirhaji
- Albert Einstein College of Medicine, Bronx, New York
| | - William J H Ford
- Department of Pediatrics, School of Medicine, New York University, New York, New York
| | - Oghale Obaro-Best
- Department of Medicine, State University of New York Upstate Medical University, Syracuse, New York; and
| | - Michael Drasher
- School of Medicine, Wayne State University, Detroit, Michigan
| | | | | | - Suzette O Oyeku
- The Children's Hospital at Montefiore, Bronx, New York.,Albert Einstein College of Medicine, Bronx, New York
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15
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Ardura MI, Bibart MJ, Mayer LC, Guinipero T, Stanek J, Olshefski RS, Auletta JJ. Impact of a Best Practice Prevention Bundle on Central Line-associated Bloodstream Infection (CLABSI) Rates and Outcomes in Pediatric Hematology, Oncology, and Hematopoietic Cell Transplantation Patients in Inpatient and Ambulatory Settings. J Pediatr Hematol Oncol 2021; 43:e64-e72. [PMID: 32960848 DOI: 10.1097/mph.0000000000001950] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric hematology, oncology, and hematopoietic cell transplantation (HCT) patients are at increased risk for bloodstream infections. The authors sought to evaluate the influence of a standardized best practice central venous catheter (CVC) maintenance bundle on the burden of and risk factors for mucosal barrier injury (MBI) and non-MBI central line-associated bloodstream infections (CLABSIs) across a common inpatient and ambulatory continuum in this high-risk population. METHODS A retrospective cohort study of patients with underlying malignancy, hematologic disorders, and HCT recipients with a CVC in place at the time of CLABSI diagnosis in both inpatient and ambulatory settings from January 1, 2012 to December 31, 2016. Descriptive, nonparametric statistics were used to describe patient characteristics and outcomes. Logistic regression analyses were applied to identify potential risk factors for inpatient versus ambulatory and MBI versus non-MBI CLABSI. RESULTS During the 5-year period, 118 of 808 (14.6%) patients had 159 laboratory-confirmed CLABSIs for ambulatory and inpatient CLABSI rates of 0.27 CLABSI/1000 and 2.2 CLABSI/1000 CVC days, respectively. CLABSI occurred more frequently in hospitalized patients after HCT and with underlying leukemia, most frequently caused by Gram-negative bacteria. MBI CLABSI accounted for 42% of all CLABSI with a 3-fold higher risk in hospitalized patients. Having multiple CVC or a CVC that was not a port independently associated with higher CLABSI risk. CONCLUSIONS In our cohort, non-MBI CLABSI continued to account for the majority of CLABSI. CVC type is independently associated with higher overall CLABSI risk. Further studies are needed to reliably define additional prevention strategies when CLABSI maintenance bundles elements are optimized in this high-risk population.
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Affiliation(s)
- Monica I Ardura
- Department of Pediatrics, Division of Infectious Diseases
- Host Defense Program
| | - Mindy J Bibart
- Division of Hematology/Oncology/Blood and Bone Marrow Transplantation, Nationwide Children's Hospital and The Ohio State University, Columbus, OH
| | - Lauren C Mayer
- Division of Hematology/Oncology/Blood and Bone Marrow Transplantation, Nationwide Children's Hospital and The Ohio State University, Columbus, OH
| | - Terri Guinipero
- Division of Hematology/Oncology/Blood and Bone Marrow Transplantation, Nationwide Children's Hospital and The Ohio State University, Columbus, OH
| | - Joseph Stanek
- Division of Hematology/Oncology/Blood and Bone Marrow Transplantation, Nationwide Children's Hospital and The Ohio State University, Columbus, OH
| | - Randal S Olshefski
- Division of Hematology/Oncology/Blood and Bone Marrow Transplantation, Nationwide Children's Hospital and The Ohio State University, Columbus, OH
| | - Jeffery J Auletta
- Department of Pediatrics, Division of Infectious Diseases
- Host Defense Program
- Division of Hematology/Oncology/Blood and Bone Marrow Transplantation, Nationwide Children's Hospital and The Ohio State University, Columbus, OH
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16
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Cellini M, Bergadano A, Crocoli A, Badino C, Carraro F, Sidro L, Botta D, Pancaldi A, Rossetti F, Pitta F, Cesaro S. Guidelines of the Italian Association of Pediatric Hematology and Oncology for the management of the central venous access devices in pediatric patients with onco-hematological disease. J Vasc Access 2020; 23:3-17. [PMID: 33169648 DOI: 10.1177/1129729820969309] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Central venous accesses devices (CVADs) have a fundamental importance for diagnostic and therapeutic purposes in pediatric onco-hematological patients. The treatment of pediatric onco-hematological diseases is complex and requires the use of integrated multimodal therapies. Long-lasting and safe central venous access is therefore a cornerstone for any successful treatment. METHODS The aim of this work is to define pediatric guidelines about the management of CVADs in onco-hematology. A panel of experts belonging to the working groups on Infections and Supportive Therapy, Surgery and Nursing of the Italian Pediatric Hematology Oncology Association (AIEOP) revised the scientific literature systematically, scored the level of evidence and prepared these guidelines. The content of the following guidelines was approved by the Scientific Board of AIEOP. RESULTS AND CONCLUSIONS Important innovations have been developed recently in the field of CVADs, leading to new insertion methods, new materials and new strategy in the overall management of the device, especially in the adult population. These guidelines recommend how to apply these innovations in the pediatric population, and are directed to all physicians, nurses and health personnel active in the daily management of CVADs. Their aim is to update the knowledge on CVAD and improve the standard of care in pediatric patients with malignancies.
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Affiliation(s)
- Monica Cellini
- Pediatric Hematology Oncology Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena, Emilia-Romagna, Italy
| | - Anna Bergadano
- Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Piemonte, Italy
| | - Alessandro Crocoli
- Surgical Oncology Unit, Department of Surgery, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Clara Badino
- Pediatric Hematology and Oncology Unit, Giannina Gaslini's Children Hospital, Genova, Liguria, Italy
| | - Francesca Carraro
- Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Piemonte, Italy
| | - Luca Sidro
- Anesthesiology and Intensive Care Unit, AORN Santobono Pausillipon, Napoli, Campania, Italy
| | - Debora Botta
- Pediatric Unit Ospedale Santissima Annunziata di Savigliano, Savigliano, Piemonte, Italy
| | - Alessia Pancaldi
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Rossetti
- Anesthesiology and Intensive Care Unit, Azienda Ospedaliero Universitaria Meyer, Firenze, Italy
| | - Federica Pitta
- Pediatric Hematology and Oncology Unit AORN Santobono Pausillipon, Napoli, Campania, Italy
| | - Simone Cesaro
- Pediatric Hematology and Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Veneto, Italy
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17
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Central venous catheter bundle adherence: Kamishibai card (K-card) rounding for central-line-associated bloodstream infection (CLABSI) prevention. Infect Control Hosp Epidemiol 2020; 41:1058-1063. [PMID: 32493532 DOI: 10.1017/ice.2020.235] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To institute facility-wide Kamishibai card (K-card) rounding for central venous catheter (CVC) maintenance bundle education and adherence and to evaluate its impact on bundle reliability and central-line-associated bloodstream infection (CLABSI) rates. DESIGN Quality improvement project. SETTING Inpatient units at a large, academic freestanding children's hospital. PARTICIPANTS Data for inpatients with a CVC in place for ≥1 day between November 1, 2017 and October 31, 2018 were included. INTERVENTION A K-card was developed based on 7 core elements in our CVC maintenance bundle. During monthly audits, auditors used the K-cards to ask bedside nurses standardized questions and to conduct medical record documentation reviews in real time. Adherence to every bundle element was required for the audit to be considered "adherent." We recorded bundle reliability prospectively, and we compared reliability and CLABSI rates at baseline and 1 year after the intervention. RESULTS During the study period, 2,321 K-card audits were performed for 1,051 unique patients. Overall maintenance bundle reliability increased significantly from 43% at baseline to 78% at 12 months after implementation (P < .001). The hospital-wide CLABSI rate decreased from 1.35 during the 12-month baseline period to 1.17 during the 12-month intervention period, but the change was not statistically significant (incidence rate ratio [IRR], 0.87; 95% confidence interval [CI], 0.60-1.24; P = .41). CONCLUSIONS Hospital-wide CVC K-card rounding facilitated standardized data collection, discussion of reliability, and real-time feedback to nurses. Maintenance bundle reliability increased after implementation, accompanied by a nonsignificant decrease in the CLABSI rate.
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18
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Dadlez NM, Adelman J, Bundy DG, Singh H, Applebaum JR, Rinke ML. Contributing Factors for Pediatric Ambulatory Diagnostic Process Errors: Project RedDE. Pediatr Qual Saf 2020; 5:e299. [PMID: 32656467 PMCID: PMC7297397 DOI: 10.1097/pq9.0000000000000299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 04/15/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Pediatric ambulatory diagnostic errors (DEs) occur frequently. We used root cause analyses (RCAs) to identify their failure points and contributing factors. METHODS Thirty-one practices were enrolled in a national QI collaborative to reduce 3 DEs occurring at different stages of the diagnostic process: missed adolescent depression, missed elevated blood pressure (BP), and missed actionable laboratory values. Practices were encouraged to perform monthly "mini-RCAs" to identify failure points and prioritize interventions. Information related to process steps involved, specific contributing factors, and recommended interventions were reported monthly. Data were analyzed using descriptive statistics and Pareto charts. RESULTS Twenty-eight (90%) practices submitted 184 mini-RCAs. The median number of mini-RCAs submitted was 6 (interquartile range, 2-9). For missed adolescent depression, the process step most commonly identified was the failure to screen (68%). For missed elevated BP, it was the failure to recognize (36%) and act on (28%) abnormal BP. For missed actionable laboratories, failure to notify families (23%) and document actions on (19%) abnormal results were the process steps most commonly identified. Top contributing factors to missed adolescent depression included patient volume (16%) and inadequate staffing (13%). Top contributing factors to missed elevated BP included patient volume (12%), clinic milieu (9%), and electronic health records (EHRs) (8%). Top contributing factors to missed actionable laboratories included written communication (13%), EHR (9%), and provider knowledge (8%). Recommended interventions were similar across errors. CONCLUSIONS EHR-based interventions, standardization of processes, and cross-training may help decrease DEs in the pediatric ambulatory setting. Mini-RCAs are useful tools to identify their contributing factors and interventions.
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Affiliation(s)
- Nina M. Dadlez
- From the Department of Pediatrics, Floating Hospital for Children at Tufts Medical Center and Tufts University School of Medicine, Boston, Mass
| | - Jason Adelman
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, N.Y
| | - David G. Bundy
- Department of Pediatrics, Medical University of South Carolina, Charleston, S.C
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Department of Medicine, Baylor College of Medicine, Center of Innovation, Houson, Tex
| | - Jo R. Applebaum
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, N.Y
| | - Michael L. Rinke
- Department of Pediatrics, The Children’s Hospital at Montefiore and The Albert Einstein College of Medicine, Bronx, N.Y
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19
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Devrim İ, Özkul MT, Çağlar İ, Oruç Y, Demiray N, Tahta N, Vergin C. Central line bundle including split-septum device and single-use prefilled flushing syringes to prevent port-associated bloodstream infections: a cost and resource-utilization analysis. BMC Health Serv Res 2020; 20:336. [PMID: 32316939 PMCID: PMC7171837 DOI: 10.1186/s12913-020-05221-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 04/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background Central line bundle programs were found to be effective in decreasing central line-associated bloodstream infection rates in pediatric cancer patients with ports. However, cost-effectiveness studies of central line bundle programs in pediatric cancer patients are limited, and most available data are from intensive care unit or adult studies. Methods In this cross-sectional study spanning 6 years, comprehensive assessment of total health care costs attributable to CLABSI’s associated with ports between two periods. Results This cross-sectional study was carried out in the pediatric hematology-oncology ward of Dr. Behçet Uz Children’s Hospital from 1 August November 2011 to 31 July 2017. The CLABSI rates decreased significantly from 8.31 CLABSIs to 3.04 per 1000 central line days (p < 0.001). In the pre-bundle period, total attributable costs spent for of patients with CLABSI were $130,661, and in the bundle period, total attributable costs spent for patients with CLABSI were $116,579. Within bundle implantation, 71 potential CLABSI were prevented, which saved an additional $208,977. Conclusion Our study shows that central line bundles decreases not only the CLABSI rate but also decreases attributable costs due to CLABSI. Expenses spent for bundle elements, were covered by savings by preventing CLABSI with higher costs.
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Affiliation(s)
- İlker Devrim
- Department of Pediatric Infectious Diseases, Dr. Behçet Uz Children's Hospital, İzmir, Turkey.
| | - Mustafa Taha Özkul
- Department of Pediatrics, Dr. Behçet Uz Children's Hospital İzmir, İzmir, Turkey
| | - İlknur Çağlar
- Department of Pediatric Infectious Diseases, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Yeliz Oruç
- Department of Infection Control Committee, Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Nevbahar Demiray
- Department of Infection Control Committee, Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Neryal Tahta
- Department of Pediatric Hematology and Oncology, Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | - Canan Vergin
- Department of Pediatric Hematology and Oncology, Dr. Behçet Uz Children's Hospital, Izmir, Turkey
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20
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Chong CY, Ong RYL, Seah VXF, Tan NWH, Chan MY, Soh SY, Ong C, Lim AS, Thoon KC. Taurolidine-citrate lock solution for the prevention of central line-associated bloodstream infection in paediatric haematology-oncology and gastrointestinal failure patients with high baseline central-line associated bloodstream infection rates. J Paediatr Child Health 2020; 56:123-129. [PMID: 31145505 DOI: 10.1111/jpc.14506] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 03/19/2019] [Accepted: 05/06/2019] [Indexed: 11/27/2022]
Abstract
AIM Central line-associated bloodstream infection associated bloodstream infection (CLABSI) is a serious complication of patients on central venous catheters (CVC). Taurolidine-citrate solution (TCS) is a catheter-lock solution with broad-spectrum antimicrobial action. This study's aim was to evaluate the efficacy of TCS in reducing CLABSI rates in paediatric haematology-oncology (H/O) and gastrointestinal (GI) patients with long-term CVC. METHODS This was an open-label trial of H/O and GI inpatients with the following inclusion criteria: <17 years old, more than or equal to one previous CLABSI and a minimum TCS dwell time of ≥8 h. CLABSI per 1000 catheter-days was calculated from each patient's first CVC insertion till 14 December 2017 or until TCS discontinuation. RESULTS Thirty-three patients were recruited with a median age of 3.5 years; H/O and GI constituted 60.6 and 39.4% respectively. CVC types were Hickman line (45.5%), implantable port (24.2%) and peripherally inserted central catheter (30.3%). Mean pre- and post-TCS CLABSI rates per 1000 catheter-days were 14.44 and 2.45 (P < 0.001) for all patients; 16.55 and 2.81 for H/O patients; and 11.21 and 1.90 for GI patients, respectively. Pre- and post-TCS rate ratio was 0.20, 0.10 and 0.30 for all, H/O and GI patients, respectively (P < 0.001). TCS also led to a reduction in CVC removal from 66.7 to 9.09% (P < 0.001). CONCLUSIONS TCS usage was highly successful in CLABSI reduction by 80% in all patients, 90% in H/O and 70% in GI patients. In patients with high baseline CLABSI rates, TCS is an effective catheter-lock therapy to reduce CLABSI rates in paediatric patients.
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Affiliation(s)
- Chia-Yin Chong
- Infectious Diseases, Department of Paediatrics, KK Women's and Children's Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Rina Y-L Ong
- Department of Pharmacy, KK Women's and Children's Hospital, Singapore
| | - Valerie X-F Seah
- Department of Pharmacy, KK Women's and Children's Hospital, Singapore
| | - Natalie W-H Tan
- Infectious Diseases, Department of Paediatrics, KK Women's and Children's Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Mei-Yoke Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Haematology-Oncology, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Shui-Yen Soh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Haematology-Oncology, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Christina Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Gastroenterology, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Ashley S Lim
- Department of Pharmacy, KK Women's and Children's Hospital, Singapore
| | - Koh-Cheng Thoon
- Infectious Diseases, Department of Paediatrics, KK Women's and Children's Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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21
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Project RedDE: Cluster Randomized Trial to Reduce Missed or Delayed Abnormal Laboratory Value Actions. Pediatr Qual Saf 2019; 4:e218. [PMID: 31745521 PMCID: PMC6805103 DOI: 10.1097/pq9.0000000000000218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 08/27/2019] [Indexed: 11/29/2022] Open
Abstract
Supplemental Digital Content is available in the text. Failure of timely abnormal laboratory result follow-up is relatively common and may lead to harm. This study hypothesized that a quality improvement collaborative (QIC) could reduce the frequency of missed or delayed action on abnormal laboratory values.
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22
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Increasing Recognition and Diagnosis of Adolescent Depression: Project RedDE: A Cluster Randomized Trial. Pediatr Qual Saf 2019; 4:e217. [PMID: 31745520 PMCID: PMC6805099 DOI: 10.1097/pq9.0000000000000217] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 08/27/2019] [Indexed: 12/28/2022] Open
Abstract
Supplemental Digital Content is available in the text. Adolescent depression causes appreciable morbidity and is underdiagnosed in primary care. This study investigated whether a quality improvement collaborative (QIC) increases the frequency of adolescent depression diagnoses, thus reducing missed diagnoses.
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Rinke ML, Singh H, Brady TM, Heo M, Kairys SW, Orringer K, Dadlez NM, Bundy DG. Cluster Randomized Trial Reducing Missed Elevated Blood Pressure in Pediatric Primary Care: Project RedDE. Pediatr Qual Saf 2019; 4:e187. [PMID: 31745503 PMCID: PMC6831043 DOI: 10.1097/pq9.0000000000000187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/28/2019] [Indexed: 11/26/2022] Open
Abstract
Recognition of childhood hypertension is essential, but pediatricians routinely fail to identify elevated blood pressure (BP). This study investigated if a quality improvement collaborative (QIC) reduces missed elevated BP in primary care. METHODS During a cluster-randomized clinical trial, a national cohort worked sequentially to reduce each of three different errors, including missed elevated BP. While working on their first error during an 8-month action period, practices collected control data for a different error. Practices worked to reduce two additional errors in subsequent action periods but continued to provide sustain and maintainenance data on BP. QIC intervention included video learning sessions, transparent data, failures analysis, coaching, and tools to reduce errors. Mixed-effects logistic regression models compared the mean percentage of patients with an elevated BP with appropriate actions taken and documented. RESULTS We randomized 43 practices and included 30 in the final analysis. Control and intervention phases included 1,728 and 1,834 patients with an elevated BP, respectively. Comparing control versus intervention phases, the mean percentage of patients who received appropriate actions increased from 58% to 74% [risk difference (RD) 16%; 95% CI;12%, 20%]. Practices continued to improve during the sustain phase as compared to the intervention phase (RD 5%; 95% CI; 2%, 9%) and did not worsen during the maintenance phase (RD 0.9%; 95% CI -5%, 7%). CONCLUSIONS Missed pediatric elevated BP can be sustainably reduced via a QIC intervention, demonstrating a possible model for other error reduction efforts.
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Affiliation(s)
- Michael L. Rinke
- From the Department of Pediatrics, The Children’s Hospital at Montefiore and the Albert Einstein College of Medicine, Bronx, N.Y
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Department of Medicine, Baylor College of Medicine, Center of Innovation, Houston, Tex
| | - Tammy M. Brady
- Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Moonseong Heo
- Department of Public Health Sciences, and School of Mathematical Sciences, Clemson University, Clemson, S.C
| | - Steven W. Kairys
- Department of Pediatrics, K. Hovnanian Children’s Hospital, Neptune, N.J
- American Academy of Pediatrics and Quality Improvement Innovation Networks, Itasca, Ill
| | - Kelly Orringer
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Mich
| | - Nina M. Dadlez
- Department of Pediatrics, Floating Hospital for Children at Tufts Medical Center, Boston, Mass
| | - David G. Bundy
- Department of Pediatrics, Medical University of South Carolina, Charleston, S.C
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Multi-level Intervention Program - A Quality Improvement Initiative to Decrease Central Line-Associated Bloodstream Infections in the Pediatric Acute and Hematology/Oncology Units. J Pediatr Nurs 2019; 48:106-113. [PMID: 31377635 DOI: 10.1016/j.pedn.2019.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/04/2019] [Accepted: 07/04/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Central Venous Catheters (CVCs) are placed in pediatric patients that require frequent and/or long-term access for intravenous treatments and increase the risk for Central line-associated bloodstream infections (CLABSIs). The specific aims of the study were to evaluate adherence to the intervention components and rates of Central Line Associated Bloodstream Infections (CLABSIs) over five years. METHODS Implementation occurred on the acute care and hematology-oncology pediatric units of a quaternary health care setting in Southern California. Adherence rates were quantified using a CVC audit sheet and CLABSI rates were obtained quarterly before, and at year 1, 2, 3, 4, 5 of implementation. RESULTS CLABSI rates for both pediatric units decreased over the five-year period. Adherence rates were 90% to 100% on the different features of the intervention; the lowest was adherence to Patient Protective Equipment (PPE). A total of 41 incidents of hospital-acquired CLABSIs were reported the year prior to the Bug Buster Committee, which decreased steadily to 9 incidents after implementation. The quarterly CLABSI rates in the Pediatric Acute Care ranged from 2.8 to 6.6/1,000 catheter days and in Pediatric Hematology-Oncology from 2.1 to 4.3/1,000 catheter days the year prior to implementation. CONCLUSIONS While adherence for staff remains high, parent/family adherence was low. We recommend including in the multi-level intervention, procedures targeting parent adherence such as patient education handouts, reviewing content on admission, placing signs on doors indicating PPE requirements, and promptly providing PPE to non-adherent family members.
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Özalp Gerçeker G, Yardımcı F, Aydınok Y. Central Line-Associated Bloodstream Infections in Children With Hematologic and Oncologic Diseases: First Prevalence Results From a University Hospital. J Pediatr Oncol Nurs 2019; 36:327-336. [PMID: 31027430 DOI: 10.1177/1043454219844226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Central line-associated bloodstream infections (CLABSIs) are still a major cause of morbidity and mortality in pediatric hematology-oncology patients in many countries. This cross-sectional study was a retrospective review of CLABSI in inpatient pediatric hematology-oncology cases with long-term central venous catheter at the Pediatric Hematology Department from January 2013 to June 2014. Characteristics of CLABSI events in pediatric patients with hematologic malignancies and related nonmalignant hematologic conditions are documented. CLABSI developed in 61.8% (n = 21) of the 34 hospitalized patients included in the study. The CLABSI rate was 7.8 per 1,000 inpatient central venous catheter days. Coagulase-negative staphylococci was the predominant pathogen in 47.6% of the patients with CLABSI. The high rate of CLABSI requires prevention strategies to reduce CLABSI immediately. This study provides guidance in prioritizing strategies for reducing rates of infection.
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Kulali F, Çalkavur Ş, Oruç Y, Demiray N, Devrim İ. Impact of central line bundle for prevention of umbilical catheter-related bloodstream infections in a neonatal intensive care unit: A pre-post intervention study. Am J Infect Control 2019; 47:387-390. [PMID: 30502109 DOI: 10.1016/j.ajic.2018.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Central line-associated bloodstream infection is the most common infection associated with healthcare in preterm infants. The purpose of this 18-month cross-sectional study was to evaluate the effectiveness of bundle applications in the prevention of umbilical venous catheter (UVC)-associated bloodstream infections. METHODS This study included patients in whom UVCs were inserted and who were diagnosed with central line-associated bloodstream infection between July 1, 2016, and December 31, 2017, according to the Centers for Disease Control and Prevention criteria. During the second 9-month period of the study (April 1, 2017, to December 31, 2017), bundles were implemented. RESULTS In the prebundle period, 589 patients were admitted to the neonatal intensive care unit, and 6,769 hospitalization days and 485 UVC days were recorded. Similarly, during the bundle period, 508 patients were admitted to the neonatal intensive care unit, and 7,789 hospitalization days and 508 UVC days were recorded. The UVC-associated bloodstream infection rate was 12.4 per 1,000 catheter days in the prebundle period and decreased to 3.9 per 1,000 catheter days in the bundle period. Thus, after introducing bundle applications, the rate of infection decreased by 68% (P < .01). CONCLUSIONS This study showed that bundle application effectively reduced UVC-associated bloodstream infection.
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Ariza‐Heredia EJ, Chemaly RF. Update on infection control practices in cancer hospitals. CA Cancer J Clin 2018; 68:340-355. [PMID: 29985544 PMCID: PMC7162018 DOI: 10.3322/caac.21462] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 04/12/2018] [Accepted: 05/09/2018] [Indexed: 12/21/2022] Open
Abstract
Therapies in oncology have evolved rapidly over the last years. At the same pace, supportive care for patients receiving cancer therapy has also evolved, allowing patients to safely receive the newest advances in treatment in both an inpatient and outpatient basis. The recognition of the role of infection control and prevention (ICP) in the outcomes of patients living with cancer has been such that it is now a requirement for hospitals and involves multidisciplinary groups. Some unique aspects of ICP for patients with cancer that have gained momentum over the past few decades include catheter-related infections, multidrug-resistant organisms, community-acquired viral infections, and the impact of the health care environment on the horizontal transmission of organisms. Furthermore, as the potential for infections to cross international borders has increased, alertness for outbreaks or new infections that occur outside the area have become constant. As the future approaches, ICP in immunocompromised hosts will continue to integrate emerging disciplines, such as antibiotic stewardship and the microbiome, and new techniques for environmental cleaning and for controlling the spread of infections, such as whole-genome sequencing. CA Cancer J Clin 2018;000:000-000. © 2018 American Cancer Society.
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Affiliation(s)
- Ella J. Ariza‐Heredia
- Associate Professor, Department of Infectious Diseases, Infection Control, and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTX
| | - Roy F. Chemaly
- Professor, Department of Infectious Diseases, Infection Control, and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTX
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Abu Sharour L. Oncology nurses' knowledge about central line catheter: Caring, complications, and applications among cancer patients—A cross-sectional study. JOURNAL OF VASCULAR NURSING 2018; 36:145-148. [DOI: 10.1016/j.jvn.2018.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 04/02/2018] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
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Mantadakis E, Pana ZD, Zaoutis T. Candidemia in children: Epidemiology, prevention and management. Mycoses 2018; 61:614-622. [PMID: 29762868 DOI: 10.1111/myc.12792] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Candidemia is the leading cause of invasive fungal infections in hospitalised children. The highest rates of candidemia have been recorded in neonates and infants <1 year of age. Candidemia is more frequent in neonates and young infants than in adults, and is associated with better clinical outcomes, but higher inpatient costs. Over the last 10 years, a declining trend has been noted in the incidence of paediatric candidemia in the US and elsewhere due to the hospital-wide implementation of central-line insertion and maintenance bundles that emphasise full sterile barrier precautions, chlorhexidine skin preparation during line insertion, meticulous site and tubing care, and daily discussion of catheter necessity. Additional interventions aiming at reducing gut-associated candidemia are required in immunocompromised and critically ill children.
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Affiliation(s)
- Elpis Mantadakis
- Faculty of Medicine, Associate Professor of Pediatrics and Pediatric Hematology/Oncology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Zoe Dorothea Pana
- Department of Pediatrics, Hippokration General Hospital, Thessaloniki, Greece
| | - Theoklis Zaoutis
- Werner and Gertrude Henle Professor of Pediatrics, Professor of Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Chief, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Linder LA, Gerdy C, Jo Y, Wilson A. Changes in Central Line-Associated Bloodstream Infection Rates Among Children With Immune Compromised Conditions: An 11-Year Review. J Pediatr Oncol Nurs 2018; 35:382-391. [PMID: 29665727 DOI: 10.1177/1043454218767885] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This article describes changes in central line-associated bloodstream infection (CLABSI) rates among common causative organisms over an 11-year period on a pediatric inpatient unit prior to and following CLABSI reduction strategies. The setting for this descriptive cohort design study was a 32-bed inpatient unit in a tertiary pediatric hospital serving children with immune compromised conditions, including cancer and recipients of hematopoietic stem cell and solid organ transplants. Between January 2006 and December 2016, 265 CLABSIs involving 189 patients were reported. Data were organized into three time periods: 5-year preintervention baseline (2006-2010), implementation of maintenance care bundles (2011-2012), and addition of formalized supportive care practices to the maintenance care bundles (2013-2016). Organisms were categorized into four groups based on the National Health Safety Network organism list. Time-by-class Poisson regression models evaluated changes in CLABSI rates. Characteristics of patients who developed CLABSIs were unchanged. Infections occurred most frequently among patients with hematologic malignancies and neutropenia. Significant log rate decreases in CLABSI rates were observed with the implementation of maintenance care bundles plus enhanced supportive cares compared to preintervention baseline for the following organisms: (1) common commensal organisms (-1.05, p = .005), (2) mucosal barrier injury (MBI) organisms common to the mouth (-.708, p = .007), and (3) other noncommensal/non-MBI pathogens (-.77, p = .005). Rates were unchanged for MBI organisms common to the lower gastrointestinal tract. Central line maintenance care bundles and formalized supportive care practices resulted in sustained decreased CLABSI rates. Additional interventions are needed to reduce CLABSIs involving MBI-associated organisms common to the lower gastrointestinal tract.
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Affiliation(s)
- Lauri A Linder
- 1 University of Utah, Salt Lake City, UT, USA.,2 Primary Children's Hospital, Salt Lake City, UT, USA
| | - Cheryl Gerdy
- 2 Primary Children's Hospital, Salt Lake City, UT, USA
| | - Yeonjung Jo
- 1 University of Utah, Salt Lake City, UT, USA
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Impact of flushing with aseptic non-touch technique using pre-filled flush or manually prepared syringes on central venous catheter occlusion and bloodstream infections in pediatric hemato-oncology patients: A randomized controlled study. Eur J Oncol Nurs 2018; 33:78-84. [DOI: 10.1016/j.ejon.2018.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/29/2018] [Accepted: 02/02/2018] [Indexed: 01/10/2023]
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Devrim İ, Oruç Y, Demirağ B, Kara A, Düzgöl M, Uslu S, Yaşar N, Aydın Köker S, Töret E, Bayram N, Vergin C. Central line bundle for prevention of central line-associated bloodstream infection for totally implantable venous access devices (ports) in pediatric cancer patients. J Vasc Access 2018; 19:358-365. [PMID: 29926785 DOI: 10.1177/1129729818757955] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The clinical impact of central line bundle programs for central line-associated bloodstream infections has been well demonstrated in intensive care units. However, the experience of central line bundle programs in totally implantable venous access devices (ports) in pediatric-hematology patients was limited. METHODS A retrospective study was designed to compare and evaluate the clinical impact of implementing a central line bundle for a 2-year 5-month period, including 10 months of prebundle period, 11 months of central line bundle (that includes needleless split-septum devices), and finally 8 months of central line bundle period in which single-use prefilled flushing devices were added to the previous central line bundle. RESULTS During the prebundle period, the rate of 14.5 central line-associated bloodstream infections per 1000 CL-days had decreased to 5.49 CLABSIs per 1000 CL-days in the first bundle period. The incidence rate ratio with these two groups was 0.379, indicating a relative risk reduction of 62% ( p = 0.005). By the addition of single-use prefilled flushing devices to the first bundle program, the central line-associated bloodstream infection rate decreased to 2.63 per 1000 CL-days. Port removal rate due to central line-associated bloodstream infections was 0.46 per 1000 catheter days in the bundle period, which was significantly lower than in the prebundle period in which port removal rate was 4.5 per 1000 catheter days ( p < 0.001). CONCLUSION Central line bundle programs were found to be effective in decreasing central line-associated bloodstream infection rates, improving patients' quality of life by preventing ports removal due in pediatric cancer patients.
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Affiliation(s)
- İlker Devrim
- 1 Department of Pediatric Infectious Diseases, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Yeliz Oruç
- 2 Department of Infection Control Committee, Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | - Bengü Demirağ
- 3 Department of Pediatric Hematology and Oncology, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Ahu Kara
- 1 Department of Pediatric Infectious Diseases, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Mine Düzgöl
- 1 Department of Pediatric Infectious Diseases, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Selma Uslu
- 3 Department of Pediatric Hematology and Oncology, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Nevbahar Yaşar
- 2 Department of Infection Control Committee, Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | - Sultan Aydın Köker
- 3 Department of Pediatric Hematology and Oncology, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Ersin Töret
- 3 Department of Pediatric Hematology and Oncology, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Nuri Bayram
- 1 Department of Pediatric Infectious Diseases, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Canan Vergin
- 3 Department of Pediatric Hematology and Oncology, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
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Abstract
BACKGROUND AND PURPOSE Communication breakdown is viewed as a significant contributor to preventable patient harm. Interprofessional rounding (IPR) is one method of communication supporting the evidenced-based care delivery. The purpose of this paper is to explore the benefits of IPR for patients, clinicians, and the healthcare system. REVIEW OF THE LITERATURE Interprofessional rounding supports collaboration, discussion, and timely intervention to prevent miscommunication leading to adverse patient events. Adherence to evidence-based care suggests a positive impact on patient, process, and financial outcomes. Statistically significant IPR-related improvements are seen in reducing mortality, lengths of stay, medication errors, and hospitalization costs as well as improved staff and patient satisfaction. EVIDENCE-BASED STRATEGIES One IPR-related gap in the literature is integrative care delivery, a strategy that provides a unified plan to meet the complex needs of patients and produce optimal outcomes. Activation and standardization with active participation in IPR support a collaborative integration of care. CONCLUSION AND IMPLICATIONS Embracing IPR and advocating for collaboration across the care continuum is a crucial process in preventing adverse events. Integrated care delivery through IPR provides a unified plan to meet the complex needs of patients, prevent harm, and produce best possible outcomes.
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Rupp ME, Majorant D. Prevention of Vascular Catheter-Related Bloodstream Infections. Infect Dis Clin North Am 2017; 30:853-868. [PMID: 27816140 DOI: 10.1016/j.idc.2016.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Catheter-related bloodstream infections (CRBSI) are responsible for significant morbidity, mortality, and excess health care costs. It is increasingly evident that many CRBSI can be prevented with current knowledge and techniques. Preventive measures can be broadly grouped into clinical practice-based interventions and technologic innovations. Clinical practice-based interventions require changes in human behavior and can be subdivided into interventions before and at the time of insertion and postinsertion. Despite recent successes with prevention of CRBSI, pertinent questions regarding pathogenesis and prevention remain unanswered and work on improved surveillance, devices less prone to infection, and more effective prevention techniques are needed.
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Affiliation(s)
- Mark E Rupp
- Division of Infectious Diseases, University of Nebraska Medical Center, 985400 Nebraska Medical Center, Omaha, NE 68198, USA.
| | - Denisa Majorant
- Division of Infectious Diseases, University of Nebraska Medical Center, 984031 Nebraska Medical Center, Omaha, NE 68198, USA
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Redpath Mahon A, Neu AM. A contemporary approach to the prevention of peritoneal dialysis-related peritonitis in children: the role of improvement science. Pediatr Nephrol 2017; 32:1331-1341. [PMID: 27757588 DOI: 10.1007/s00467-016-3531-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/24/2016] [Accepted: 09/27/2016] [Indexed: 01/22/2023]
Abstract
Peritonitis is a leading cause of hospitalizations, morbidity, and modality change in pediatric chronic peritoneal dialysis (CPD) patients. Despite guidelines published by the International Society for Peritoneal Dialysis aimed at reducing the risk of peritonitis, registry data have revealed significant variability in peritonitis rates among centers caring for children on CPD, which suggests variability in practice. Improvement science methods have been used to reduce a variety of healthcare-associated infections and are also being applied successfully to decrease rates of peritonitis in children. A successful quality improvement program with the goal of decreasing peritonitis will not only include primary drivers directly linked to the outcome of peritonitis, but will also direct attention to secondary drivers that are important for the achievement of primary drivers, such as health literacy and patient and family engagement strategies. In this review, we describe a comprehensive improvement science model for the reduction of peritonitis in pediatric patients on CPD.
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Affiliation(s)
- Allison Redpath Mahon
- Pediatric Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - Alicia M Neu
- Pediatric Nephrology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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36
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Gerçeker GÖ, Yardımcı F, Aydınok Y. Randomized controlled trial of care bundles with chlorhexidine dressing and advanced dressings to prevent catheter-related bloodstream infections in pediatric hematology-oncology patients. Eur J Oncol Nurs 2017; 28:14-20. [DOI: 10.1016/j.ejon.2017.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/17/2017] [Accepted: 02/20/2017] [Indexed: 11/28/2022]
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Zakhour R, Chaftari AM, Raad II. Catheter-related infections in patients with haematological malignancies: novel preventive and therapeutic strategies. THE LANCET. INFECTIOUS DISEASES 2017; 16:e241-e250. [PMID: 27788992 DOI: 10.1016/s1473-3099(16)30213-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 06/02/2016] [Accepted: 06/23/2016] [Indexed: 01/02/2023]
Abstract
Central venous catheters are essential for the treatment of patients with haematological malignancies and the recipients of stem-cell transplant. This patient population is, however, at high risk for catheter-related bloodstream infections that can result in substantial morbidity, mortality, and health-care-associated costs. Efficient prevention, early diagnosis, and effective treatment are essential to providing the best care to these patients. Although confirming the catheter as a source of infection remains challenging, the Infectious Diseases Society of America definition of catheter-related bloodstream infection remains the most precise definition to use in these patients. Gram-positive bacteria, particularly coagulase-negative Staphylococcus spp, remain the leading cause of catheter-related bloodstream infection, although an increase in Gram-negative bacteria as the causative agent has been noted. Although removal of the line and appropriate intravenous antibiotics remain the mainstay of treatment in most cases, novel technologies, including exchange with antibiotic-coated catheters and treatment with lock solutions, are particularly relevant in this patient population. In this Review we present the types of central venous catheters used in this patient population and analyse the different definitions of catheter-related infections, with an overview of their prevention and management.
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Affiliation(s)
- Ramia Zakhour
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anne-Marie Chaftari
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Issam I Raad
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Bacterial bloodstream infections in the allogeneic hematopoietic cell transplant patient: new considerations for a persistent nemesis. Bone Marrow Transplant 2017; 52:1091-1106. [PMID: 28346417 DOI: 10.1038/bmt.2017.14] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/20/2016] [Accepted: 01/12/2017] [Indexed: 12/14/2022]
Abstract
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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Govindan S, Chopra V, Iwashyna TJ. Do Clinicians Understand Quality Metric Data? An Evaluation in a Twitter-Derived Sample. J Hosp Med 2017; 12:18-22. [PMID: 28125827 PMCID: PMC5831191 DOI: 10.1002/jhm.2680] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Despite significant efforts and cost, quality metrics do not consistently influence practice. While research has focused on improving data through statistical risk-adjustment, whether clinicians understand these data is unknown. Therefore, we assessed clinician comprehension of central line-associated blood stream infection (CLABSI) quality metric data. DESIGN Cross-sectional survey with an 11-item test of CLABSI data comprehension. Each question assessed 1 of 3 concepts concerning CLABSI understanding: basic numeracy, risk-adjustment numeracy, and risk-adjustment interpretation. Hypothetical data were used and presented in a validated format. PARTICIPANTS Clinicians were recruited from 6 nations via Twitter to take an online survey. Clinician eligibility was confirmed by assessing responses to a question regarding CLABSI. MAIN MEASURES The primary outcome was percent correct of attempted questions pertaining to the presented CLABSI data. RESULTS Ninety-seven clinicians answered at least 1 item, providing 939 responses; 72 answered all 11 items. The mean percentage of correct answers was 61% (95% confidence interval [CI], 57%-65%). Overall, doctor performance was better than performance by nurses and other respondents (68% [95% CI, 63%-73%] vs. 57% [95% CI, 52%-62%], P = 0.003). In basic numeracy, mean percent correct was 82% (95% CI, 77%-87%). For risk-adjustment numeracy, the mean percent correct was 70% (95% CI, 64%-76%). Risk-adjustment interpretation had the lowest average percent correct, 43% (95% CI, 37%-49%). All pairwise differences between concepts were statistically significant at P <0.05. CONCLUSIONS CLABSI quality metric comprehension appears low and varies substantially among clinicians. These findings may contribute to the limited impact of quality metric reporting programs, and further research is needed. Journal of Hospital Medicine 2017;12:18-22.
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Affiliation(s)
- Sushant Govindan
- Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan
- Address for correspondence and reprint requests: Sushant Govindan, MD, Taubman Center, Floor 3 Room 3920, 1500 East Medical Center Drive, SPC 5360, Ann Arbor, MI 48109; Telephone: 734-763-9077; Fax: 734-764-4556;
| | - Vineet Chopra
- Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan
- Center for Clinical Management Research, Ann Arbor VA Healthcare System, Ann Arbor, Michigan
- Patient Safety Enhancement Program, Ann Arbor VA Medical Center, Ann Arbor, Michigan
| | - Theodore J. Iwashyna
- Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan
- Center for Clinical Management Research, Ann Arbor VA Healthcare System, Ann Arbor, Michigan
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Curan GRF, Rossetto EG. INTERVENTIONS TO DECREASE CATHETER-ASSOCIATED BLOODSTREAM INFECTIONS IN NEWBORNS: AN INTEGRATIVE REVIEW. TEXTO & CONTEXTO ENFERMAGEM 2017. [DOI: 10.1590/0104-07072017005130015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to perform an integrative review of strategies presented in care bundles to decrease central catheter-associated bloodstream infection among newborns. . Method a search was conducted of the Cochrane Library, IBECS, PubMed, Lilacs, Medline and Scielo catalogues, using the terms "bundle", "catheter-related infection", "infection control", "prevention", "evidence-based nursing"," evidence-based medicine" and" central venous catheter". Inclusion criteria were: papers published from 2009 to April 2014; written in Portuguese, English or Spanish; addressing both neonatal and pediatric populations or just neonatal populations; describing the use and/or assessing care bundles or protocols to control central catheter-associated infection. Results fifteen studies published between 2009 and 2013 were selected. The main information extracted from the studies was systematized as: 1) measures adopted to prevent central catheter-associated bloodstream infection according to level of scientific evidence, and 2) strategies used to implement evidence into health practice. Conclusion there was a variety of practices adopted, some of which are consistent with scientific evidence and some of which are not. Systematization conducted in this study is expected to contribute to practice, facilitating the use of the best evidence in each context, and research indicating gaps in knowledge to be explored in future studies
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Matthes G, Trentzsch H, Wölfl CG, Paffrath T, Flohe S, Schweigkofler U, Ekkernkamp A, Schulz-Drost S. [Essential measures for prehospital treatment of severely injured patients: The trauma care bundle]. Unfallchirurg 2016; 118:652-6. [PMID: 26160129 DOI: 10.1007/s00113-015-0042-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND In order to ensure adequate treatment and to avoid complications, care bundles are increasingly being implemented. These are comprehensive and evidence-based procedures for the treatment of individual diseases or injuries which should be carried out for every patient. The aim of this study was to define a care bundle for the prehospital treatment of severely injured patients. MATERIAL AND METHODS The scientific contents of the bundle were gathered from the interdisciplinary evidence-based S3 guidelines for the treatment of severely injured patients by the German Trauma Society. The ABCDE scheme suggested by the prehospital trauma life support (PHTLS®) and the advanced trauma life support (ATLS®) functioned as a matrix for the individual elements in the bundles. The identified elements were finalized by a consensus process. RESULTS AND DISCUSSION A bundle of six elements was suggested and a comprehensive summary of key items during prehospital management of severely injured patients was identified. In a next step the effectiveness of the care bundle should be evaluated in a clinical trial.
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Affiliation(s)
- G Matthes
- Klinik für Unfallchirurgie und Orthopädie, Unfallkrankenhaus Berlin, Warener Str.7, 12683, Berlin, Deutschland,
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Chakraborty A, Agrawal S, Datta T, Mitra S, Khemka R. Hickman to central venous catheter: A case of difficult venous access in a child suffering from acute lymphoblastic leukemia. J Indian Assoc Pediatr Surg 2016; 21:202-204. [PMID: 27695218 PMCID: PMC4980887 DOI: 10.4103/0971-9261.186558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Chemotherapy in children suffering from cancer usually requires placement of an indwelling central venous catheter (CVC). A child may need to undergo repeated procedures because of infection and occlusion of previous access devices. We present a case of CVC insertion in a child suffering from acute lymphoblastic leukemia where an innovative technique was employed.
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Affiliation(s)
| | | | - Taniya Datta
- Tata Medical Center, Kolkata, West Bengal, India
| | | | - Rakhi Khemka
- Tata Medical Center, Kolkata, West Bengal, India
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Papp ZE, Horváth MA, Rat N, Băilă L. The Care of Central Venous Catheters in the Oncopediatric Department. JOURNAL OF INTERDISCIPLINARY MEDICINE 2016. [DOI: 10.1515/jim-2016-0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Abstract
Introduction: Childhood cancer, with its major psycho-social and health impact, needs long-term chemotherapy. Increasing the intensity of treatment results in improved outcomes of hematological malignancies and solid tumors. As cytostatics have a vascular irritating effect and multiple peripheric venous punctures cause pain, insertion of a long-term central venous catheter (CVC) during chemotherapy is often necessary.
Materials and methods: All pediatric patients (aged below 18 years) with hematologic and malignant pathologies who underwent CVC insertion at the Pediatric Hemato-oncology Department of the County Emergency Clinical Hospital of Tîrgu Mureș in the February 2014 – May 2016 period were enrolled in the study.
Results: We recorded 24 cases who received central venous catheters, out of which 14 patients received tunneled CVC, 7 patients port CVC, and 3 patients received initially tunneled CVC which was changed with port CVC. Tunneled catheters were preserved in average for 186.06 days and portacaths for 256.6 days. For infection prophylaxis and treatment every child received adequate antibiotic medication.
Conclusions: The use of central lines in pediatric hemato-oncology is accessible and benefic not only for increasing patient comfort, but also to ease the nurses' work, who are often overburdened.
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Affiliation(s)
- Zsuzsanna Erzsébet Papp
- Department of Pediatrics, County Emergency Clinical Hospital, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Mária-Adrienne Horváth
- Department of Pediatrics, County Emergency Clinical Hospital, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Nora Rat
- Clinic of Cardiology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Lucian Băilă
- Department of Anesthesy and Intensive Therapy, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
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Cousin VL, Wildhaber BE, Verolet CM, Belli DC, Posfay-Barbe KM, McLin VA. Complications of indwelling central venous catheters in pediatric liver transplant recipients. Pediatr Transplant 2016; 20:798-806. [PMID: 27346183 DOI: 10.1111/petr.12745] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2016] [Indexed: 11/30/2022]
Abstract
In pLT recipients, the advantages of ICVCs need to be weighed against the risk of complications. This single-center retrospective study aimed to review ICVC complications in our cohort of pLT recipients. We performed chart reviews of pLT patients having undergone transplant between 01/2000 and 03/2014 and who underwent ICVC placement either before or after LT. We identified 100 ICVC in 85 patients. Overall observation time was 90 470 catheter-days. There was no difference in catheter lifespan between those inserted pre- or post-transplant; 46% of ICVC presented a complication. Most frequent complications were MD and infection. The infection rate was 0.09 per 1000 catheter-days, and MD rate was 0.36 per 1000 catheter-days. Patients having received technical variant grafts were more at risk of complications. To the best of our knowledge, this is the first study examining ICVC complications in pLT recipients. We conclude that ICVC have a high rate of MD. Children receiving technical variants may be more at risk of complications. By removing ICVC in a select number of patients at six months post-insertion, we might avoid as much as 60% of complications.
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Affiliation(s)
- Vladimir L Cousin
- Pediatric Gastroenterology Unit, University Hospitals Geneva, Geneva, Switzerland
| | - Barbara E Wildhaber
- Division of Pediatric Surgery, University Hospitals Geneva, Geneva, Switzerland
| | | | - Dominique C Belli
- Pediatric Gastroenterology Unit, University Hospitals Geneva, Geneva, Switzerland.,Department of Pediatrics, University Hospitals Geneva, Geneva, Switzerland
| | | | - Valérie A McLin
- Pediatric Gastroenterology Unit, University Hospitals Geneva, Geneva, Switzerland
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Glater-Welt LB, Schneider JB, Zinger MM, Rosen L, Sweberg TM. Nosocomial Bloodstream Infections in Patients Receiving Extracorporeal Life Support: Variability in Prevention Practices. J Intensive Care Med 2016; 31:654-669. [DOI: 10.1177/0885066615571540] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Nosocomial blood stream infections (BSIs) increase both the morbidity and the mortality of patients receiving extracorporeal life support (ECLS). The aim of this study was to identify common practices for blood stream infection prevention among national Extracorporeal Membrane Oxygenation (ECMO) programs. An electronic survey that comprised of a 16-item questionnaire was sent out to all ECMO program directors and coordinators within the United States that are part of the Extracorporeal Life Support Organization (ELSO) registry. A total of 152 institutions in 40 states were surveyed, with 85 (55%) responses. One-quarter of the institutions responded that an ECMO infection-prevention bundle or checklist was used during the cannulation. Less than half responded that an ECMO infection-prevention bundle or checklist was used for cannula maintenance, although a majority (82.9%) of institutions responded that a “standard approach to cannula dressings” was used. Half of the respondents reported antimicrobial prophylaxis was routinely prescribed for patients on ECMO, although specific regimens varied widely. Of the institutions, 34.2% reported sending daily blood cultures as part of routine surveillance. Smaller programs were more likely to send daily surveillance blood cultures (58.8%, P < .01). We found no clear consensus on practices used to prevent BSI in patients receiving ECMO.
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Affiliation(s)
- Lily B. Glater-Welt
- Division of Critical Care Medicine, Steven & Alexandra Cohen Children’s Medical Center of New York, New Hyde Park, NY, USA
- North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA
| | - James B. Schneider
- Division of Critical Care Medicine, Steven & Alexandra Cohen Children’s Medical Center of New York, New Hyde Park, NY, USA
- North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA
| | - Marcia M. Zinger
- Division of Critical Care Medicine, Steven & Alexandra Cohen Children’s Medical Center of New York, New Hyde Park, NY, USA
- North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA
| | - Lisa Rosen
- North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA
- Biostatistics Unit, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Todd M. Sweberg
- Division of Critical Care Medicine, Steven & Alexandra Cohen Children’s Medical Center of New York, New Hyde Park, NY, USA
- North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA
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Robinson PD, Dupuis LL, Tomlinson G, Phillips B, Greenberg M, Sung L. Strategies facilitating practice change in pediatric cancer: a systematic review. Int J Qual Health Care 2016; 28:426-32. [PMID: 27272405 DOI: 10.1093/intqhc/mzw052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2016] [Indexed: 12/14/2022] Open
Abstract
PURPOSE By conducting a systematic review, we describe strategies to actively disseminate knowledge or facilitate practice change among healthcare providers caring for children with cancer and we evaluate the effectiveness of these strategies. DATA SOURCES We searched Ovid Medline, EMBASE and PsychINFO. STUDY SELECTION Fully published primary studies were included if they evaluated one or more professional intervention strategies to actively disseminate knowledge or facilitate practice change in pediatric cancer or hematopoietic stem cell transplantation. DATA EXTRACTION Data extracted included study characteristics and strategies evaluated. In studies with a quantitative analysis of patient outcomes, the relationship between study-level characteristics and statistically significant primary analyses was evaluated. RESULTS OF DATA SYNTHESIS Of 20 644 titles and abstracts screened, 146 studies were retrieved in full and 60 were included. In 20 studies, quantitative evaluation of patient outcomes was examined and a primary outcome was stated. Eighteen studies were 'before and after' design; there were no randomized studies. All studies were at risk for bias. Interrupted time series was never the primary analytic approach. No specific strategy type was successful at improving patient outcomes. CONCLUSIONS Literature describing strategies to facilitate practice change in pediatric cancer is emerging. However, major methodological limitations exist. Studies with robust designs are required to identify effective strategies to effect practice change.
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Affiliation(s)
- Paula D Robinson
- Pediatric Oncology Group of Ontario, 480 University Avenue, Toronto, Canada M5G 1V2
| | - Lee L Dupuis
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada M5G 1X8 Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada M5G 1X8
| | - George Tomlinson
- Department of Medicine, 555 University Avenue, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4
| | - Bob Phillips
- Leeds General Infirmary, Leeds Teaching Hospitals, NHS Trust, Great George Street, Leeds, UK LS1 3EX Centre for Reviews and Dissemination, University of York, York, UK YO10 5DD
| | - Mark Greenberg
- Pediatric Oncology Group of Ontario, 480 University Avenue, Toronto, Canada M5G 1V2 Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada M5G 1X8
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada M5G 1X8 Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada M5G 1X8
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Lo Vecchio A, Schaffzin JK, Ruberto E, Caiazzo MA, Saggiomo L, Mambretti D, Russo D, Crispo S, Continisio GI, Dello Iacovo R, Poggi V, Guarino A. Reduced central line infection rates in children with leukemia following caregiver training: A quality improvement study. Medicine (Baltimore) 2016; 95:e3946. [PMID: 27336888 PMCID: PMC4998326 DOI: 10.1097/md.0000000000003946] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Infections are a leading cause of morbidity and mortality in children with acute leukemia. Central-line (CL) devices increase this population's risk of serious infections.Within the context of a quality improvement (QI) project, we tested the effect of caregiver education on CL management on the CL-associated bloodstream infection (CLABSI) rate among children with acute leukemia seen at a large referral center in Italy. The intervention consisted of 9 in-person sessions for education and practice using mannequins and children.One hundred and twenty caregivers agreed to participate in the initiative. One hundred and five (87.5%) completed the training, 5 (4.1%) withdrew after the first session, and 10 (8.3%) withdrew during practical sessions. After educational intervention, the overall CLABSI rate was reduced by 46% (from 6.86 to 3.70/1000 CL-days). CLABSI rate was lower in children whose caregivers completed the training (1.74/1000 CL-days, 95% CI 0.43-6.94) compared with those who did not receive any training (12.2/1000 CL-days, 95% CI 7.08-21.0, P < 0.05) or were in-training (3.96/1000 CL-days, 95% CI 1.98-7.91) at the time of infection.Caregiver training in CL management, applied within a multifaceted QI approach, reduced the rate of CLABSI in children with acute leukemia. Specific training and active involvement of caregivers in CL management may be effective to reduce CLABSI in high-risk children.
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Affiliation(s)
- Andrea Lo Vecchio
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Joshua K. Schaffzin
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Eliana Ruberto
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Maria Angela Caiazzo
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | | | - Daniela Mambretti
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Danila Russo
- Onco-Hematology Unit, Santobono-Pausilipon Children's Hospital
| | - Sara Crispo
- Onco-Hematology Unit, Santobono-Pausilipon Children's Hospital
| | | | | | - Vincenzo Poggi
- Onco-Hematology Unit, Santobono-Pausilipon Children's Hospital
| | - Alfredo Guarino
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
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Simon A, Furtwängler R, Graf N, Laws HJ, Voigt S, Piening B, Geffers C, Agyeman P, Ammann RA. Surveillance of bloodstream infections in pediatric cancer centers - what have we learned and how do we move on? GMS HYGIENE AND INFECTION CONTROL 2016; 11:Doc11. [PMID: 27274442 PMCID: PMC4886351 DOI: 10.3205/dgkh000271] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Pediatric patients receiving conventional chemotherapy for malignant disease face an increased risk of bloodstream infection (BSI). Since BSI may represent an acute life-threatening event in patients with profound immunosuppression, and show further negative impact on quality of life and anticancer treatment, the prevention of BSI is of paramount importance to improve and guarantee patients' safety during intensive treatment. The great majority of all pediatric cancer patients (about 85%) have a long-term central venous access catheter in use (type Broviac or Port; CVAD). Referring to the current surveillance definitions a significant proportion of all BSI in pediatric patients with febrile neutropenia is categorized as CVAD-associated BSI. This state of the art review summarizes the epidemiology and the distinct pathogen profile of BSI in pediatric cancer patients from the perspective of infection surveillance. Problems in executing the current surveillance definition in this patient population are discussed and a new concept for the surveillance of BSI in pediatric cancer patients is outlined.
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Affiliation(s)
- Arne Simon
- Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Rhoikos Furtwängler
- Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Norbert Graf
- Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Hans Jürgen Laws
- Klinik für Pädiatrische Onkologie, Hämatologie und Immunologie, Universitätskinderklinik, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Sebastian Voigt
- Klinik für Pädiatrie m. S. Onkologie / Hämatologie / Stammzelltransplantation, Charité – Universitätsmedizin Berlin, Germany
| | - Brar Piening
- Institut für Hygiene und Umweltmedizin, Charité – Universitätsmedizin Berlin, Germany
| | - Christine Geffers
- Institut für Hygiene und Umweltmedizin, Charité – Universitätsmedizin Berlin, Germany
| | - Philipp Agyeman
- Pädiatrische Infektiologie und Pädiatrische Hämatologie-Onkologie, Universitätsklinik für Kinderheilkunde, Inselspital, Bern, Switzerland
| | - Roland A. Ammann
- Pädiatrische Infektiologie und Pädiatrische Hämatologie-Onkologie, Universitätsklinik für Kinderheilkunde, Inselspital, Bern, Switzerland
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Neu AM, Richardson T, Lawlor J, Stuart J, Newland J, McAfee N, Warady BA. Implementation of standardized follow-up care significantly reduces peritonitis in children on chronic peritoneal dialysis. Kidney Int 2016; 89:1346-54. [PMID: 27165827 DOI: 10.1016/j.kint.2016.02.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 01/25/2016] [Accepted: 02/04/2016] [Indexed: 11/16/2022]
Abstract
The Standardizing Care to improve Outcomes in Pediatric End stage renal disease (SCOPE) Collaborative aims to reduce peritonitis rates in pediatric chronic peritoneal dialysis patients by increasing implementation of standardized care practices. To assess this, monthly care bundle compliance and annualized monthly peritonitis rates were evaluated from 24 SCOPE centers that were participating at collaborative launch and that provided peritonitis rates for the 13 months prior to launch. Changes in bundle compliance were assessed using either a logistic regression model or a generalized linear mixed model. Changes in average annualized peritonitis rates over time were illustrated using the latter model. In the first 36 months of the collaborative, 644 patients with 7977 follow-up encounters were included. The likelihood of compliance with follow-up care practices increased significantly (odds ratio 1.15, 95% confidence interval 1.10, 1.19). Mean monthly peritonitis rates significantly decreased from 0.63 episodes per patient year (95% confidence interval 0.43, 0.92) prelaunch to 0.42 (95% confidence interval 0.31, 0.57) at 36 months postlaunch. A sensitivity analysis confirmed that as mean follow-up compliance increased, peritonitis rates decreased, reaching statistical significance at 80% at which point the prelaunch rate was 42% higher than the rate in the months following achievement of 80% compliance. In its first 3 years, the SCOPE Collaborative has increased the implementation of standardized follow-up care and demonstrated a significant reduction in average monthly peritonitis rates.
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Affiliation(s)
- Alicia M Neu
- Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - Troy Richardson
- The Children's Hospital Association, Alexandria, Virginia, USA, and Overland Park, Kansas, USA
| | - John Lawlor
- The Children's Hospital Association, Alexandria, Virginia, USA, and Overland Park, Kansas, USA
| | - Jayne Stuart
- The Children's Hospital Association, Alexandria, Virginia, USA, and Overland Park, Kansas, USA
| | - Jason Newland
- Divisions of Pediatric Nephrology and Infectious Diseases, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Nancy McAfee
- Seattle Children's Hospital, Seattle, Washington, USA
| | - Bradley A Warady
- Divisions of Pediatric Nephrology and Infectious Diseases, Children's Mercy Hospital, Kansas City, Missouri, USA
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50
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Cesaro S, Cavaliere M, Pegoraro A, Gamba P, Zadra N, Tridello G. A comprehensive approach to the prevention of central venous catheter complications: results of 10-year prospective surveillance in pediatric hematology-oncology patients. Ann Hematol 2016; 95:817-25. [DOI: 10.1007/s00277-016-2634-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 02/29/2016] [Indexed: 11/24/2022]
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