In a report in the October issue of Pediatrics, published online Sept. 3, the researchers say this triple-threat approach has prevented one in five infections over two years.
Previous studies from Johns Hopkins and other institutions have demonstrated that meticulous daily care of the central line can cut the number of bloodstream infections in critically ill patients, but this is the first study, the researchers say, to focus on the most vulnerable of pediatric patients - those undergoing cancer treatment and bone marrow transplants.
A central venous catheter, or central line, is a tube inserted into a major blood vessel in the neck, chest or groin as a portal for medication, fluids or blood draws.
Inserted incorrectly or mishandled after insertion, the central line can become a gateway for bacteria and other germs into the patient's bloodstream, causing invasive disease and organ damage. Because nurses and doctors access the catheter several times a day -- as much as 10 to 30 times daily in oncology patients, researchers say -- proper handling of the device is critical.
"Children receiving cancer treatment are uniquely prone to invasive bloodstream infections because of their weakened immunity and because their central lines are accessed multiple times a day, with each entry posing a risk for infection," says lead investigator Michael Rinke, M.D., a pediatrician and a patient safety expert at the Johns Hopkins Children's Center.
The current study was carried out by pediatric oncology nurses, physicians and safety experts at the Johns Hopkins pediatric inpatient cancer unit. To keep bacteria and other pathogens at bay, the nurses deployed strict device-handling precautions that included -- among other things -- frequent and regular changing of the dressing covering the central line; regular changing of the tubes and caps attached to central line; cleaning of the line before and after each use; use of facial mask and gloves when handling the device; and hand-washing before and after handling the line.
In a novel twist, the Johns Hopkins investigators asked parents to provide additional oversight, equipping them with wallet flash cards on the "do's" and "don'ts" of central line care.
"Parents can act as an invaluable second set of eyes, and we urged them to be vigilant about the way their child's central line was handled." says co-investigator Kim Drucis, M.S.N., R.N., a pediatric oncology nurse. "We also encouraged them to ask questions and to speak up every time they noticed something different."
The oncology nurses also held monthly briefings to discuss every infection that occurred during the study. Such root-cause analysis is already a staple of error reduction in other industries including airline, nuclear and military.
"Honest dissection of one's practice is neither easy nor pleasant but is absolutely critical to illuminate areas for improvement," says co-investigator Stephanie Panton, M.S.N., R.N., C.P.O.N.
The approach reduced infections by 20 percent over two years. During year one, the infection rate remained unchanged but in the second year, infections plummeted by 64 percent -- a delayed ramp-up effect that points to the often-slow pace of meaningful change, the investigators say.
"Real change rarely occurs overnight. It requires sustained effort and unwavering focus, day after day, month after month, year after year," Rinke says. "It's a slow, arduous process, but the payoff can be dramatic."
Each year, 250,000 central line infections occur in the United States, up to one-fourth of them fatal, according to the Centers for Disease Control and Prevention. Each infection carries a price tag of up to $25,000.
The research was funded by National Institutes of Health under grant number 5KL2RR025006.
Co-investigators on the research team included Allen Chen, M.D., Ph.D.; David Bundy, M.D., M.P.H.; Elizabeth Colantuoni, Ph.D.; Lisa Fratino, M.S.N., R.N.; Michelle Kokoszka, B.S.N., R.N.; Alicia Budd, M.P.H., C.I.C.; Aaron Milstone, M.D., M.H.S., and Marlene Miller, M.D., Ms.C., all of Hopkins.
Note to reporters: To obtain a full text of the paper, please contact journal press officers Debbie Jacobson at firstname.lastname@example.org (847-434-7084) or Susan Stevens Martin at email@example.com (847-434-7131).
Simple Steps Prevent Catheter-Related Bloodstream Infections; Save Hundreds of Kids Lives
Remove Children's Catheters as Soon as Possible to Prevent Bloodstream Infections
In the Fight Against Life-Threatening Catheter Infections, Length of Use is Key
Founded in 1912 as the children's hospital at The Johns Hopkins Hospital, the Johns Hopkins Children's Center offers one of the most comprehensive pediatric medical programs in the country, treating more than 90,000 children each year. Hopkins Children's is consistently ranked among the top children's hospitals in the nation. Hopkins Children's is Maryland's largest children's hospital and the only state-designated Trauma Service and Burn Unit for pediatric patients. It has recognized Centers of Excellence in dozens of pediatric subspecialties, including allergy, cardiology, cystic fibrosis, gastroenterology, nephrology, neurology, neurosurgery, oncology, pulmonary, and transplant. For more information, please visit www.hopkinschildrens.org
The end of pneumonia? New vaccine offers hope
23.10.2017 | University at Buffalo
Scientists track ovarian cancers to site of origin: Fallopian tubes
23.10.2017 | Johns Hopkins Medicine
Salmonellae are dangerous pathogens that enter the body via contaminated food and can cause severe infections. But these bacteria are also known to target...
University of Maryland researchers contribute to historic detection of gravitational waves and light created by event
On August 17, 2017, at 12:41:04 UTC, scientists made the first direct observation of a merger between two neutron stars--the dense, collapsed cores that remain...
Seven new papers describe the first-ever detection of light from a gravitational wave source. The event, caused by two neutron stars colliding and merging together, was dubbed GW170817 because it sent ripples through space-time that reached Earth on 2017 August 17. Around the world, hundreds of excited astronomers mobilized quickly and were able to observe the event using numerous telescopes, providing a wealth of new data.
Previous detections of gravitational waves have all involved the merger of two black holes, a feat that won the 2017 Nobel Prize in Physics earlier this month....
Material defects in end products can quickly result in failures in many areas of industry, and have a massive impact on the safe use of their products. This is why, in the field of quality assurance, intelligent, nondestructive sensor systems play a key role. They allow testing components and parts in a rapid and cost-efficient manner without destroying the actual product or changing its surface. Experts from the Fraunhofer IZFP in Saarbrücken will be presenting two exhibits at the Blechexpo in Stuttgart from 7–10 November 2017 that allow fast, reliable, and automated characterization of materials and detection of defects (Hall 5, Booth 5306).
When quality testing uses time-consuming destructive test methods, it can result in enormous costs due to damaging or destroying the products. And given that...
Using a new cooling technique MPQ scientists succeed at observing collisions in a dense beam of cold and slow dipolar molecules.
How do chemical reactions proceed at extremely low temperatures? The answer requires the investigation of molecular samples that are cold, dense, and slow at...
23.10.2017 | Event News
17.10.2017 | Event News
10.10.2017 | Event News
24.10.2017 | Life Sciences
23.10.2017 | Life Sciences
23.10.2017 | Physics and Astronomy