Published by the Students of Johns Hopkins since 1896
September 19, 2020

Safety procedures eliminate some central line infections

By ELLE PFEFFER | September 13, 2012

Pediatric oncology patients are at uniquely high risk of developing dangerous infections. “Any time a kid gets an infection, it is a failure,” said Michael Rinke, a Hopkins professor of pediatrics in the Division of Quality and Safety and lead investigator on a new study that deals with preventing central line infections in these patients.

A central line, common in most pediatric oncology patients, is a tube connected to a major blood vessel in the groin, chest or neck, instrumental in drawing blood and the transporting medicine.

The central line is an ideal delivery method because patients can receive a stronger, more toxic form of a medication without overloading small veins.

In addition, children do not have to be stuck for each chemotherapy treatment, and many will go home with their central line between treatments.

However, central lines in these patients require constant access for medical purposes— 30-50 times a day, according the researchers’ article published online in Pediatrics on September 3. Repeated contact with tubes leading to the heart leaves a much greater possibility of being exposed to dangerous bacteria and infections. The patients can hardly afford these infections in their extremely immunocompromised state.

In general, one-fourth of the 250,000 central line infections each year in the United States are fatal, according to the Centers for Disease Control and Prevention. The researchers’ journal article states that these types of infections in children cost $45,000 on average.

Infections due to central lines have been the topic of numerous other studies, but studies have never addressed this patient population. “No study has attempted to decrease central line-associated blood stream infection rates for an entire inpatient pediatric oncology cohort, including both stem cell transplant recipients and patients undergoing treatment of malignancies,” the researchers wrote in their article.

The Hopkins research team, driven by the pediatric oncology nurses, put together a three-pronged approach to minimize these central line infections: 1) to continue to establish and improve upon procedures and precautions for dealing with central lines, 2) to analyze all infections that do occur and 3) to encourage parents to be their child’s best advocate.

Standard procedural safety measures for nurses to utilize include everything from face masks and gloves to more frequent changing of the dressings over the tube.

Discussions about cases of infection focus on how to prevent the same problem from ever affecting another patient. “Any time there is a failure, you want to direct as much attention to it as possible,” Rinke said.

Lastly, the researchers aimed to provide parents with the tools to speak openly and respectfully with nurses about treatment of their child’s central line. Parents were given scripts and informational cards with the positive and negative treatment approaches.

The tactics reduced infections by 20 percent during the first year and by 64 percent during the second year of the study. The study is currently in its third year, and researchers continue to see a downward trend. Rinke emphasizes that the goal is to eliminate all medical systems errors and to avoid hospital infections that a child would not get at home.

Rinke gives recognition to the nurses and their advisory team, which met monthly during the study and took charge of dispersing new information on care procedures. “Much of this was doctors stepping back and letting nurses take the lead and doing amazing work,” Rinke said.

The results of this study have already been taken to the outpatient setting and the researchers hope that they will reach even more oncological patients, and ultimately all pediatric patients, with central lines.

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