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 email@example.com (847-434-7084) or Susan Stevens Martin at firstname.lastname@example.org (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
One gene closer to regenerative therapy for muscular disorders
01.06.2017 | Cincinnati Children's Hospital Medical Center
The gut microbiota plays a key role in treatment with classic diabetes medication
01.06.2017 | University of Gothenburg
Heatwaves in the Arctic, longer periods of vegetation in Europe, severe floods in West Africa – starting in 2021, scientists want to explore the emissions of the greenhouse gas methane with the German-French satellite MERLIN. This is made possible by a new robust laser system of the Fraunhofer Institute for Laser Technology ILT in Aachen, which achieves unprecedented measurement accuracy.
Methane is primarily the result of the decomposition of organic matter. The gas has a 25 times greater warming potential than carbon dioxide, but is not as...
Hydrogen is regarded as the energy source of the future: It is produced with solar power and can be used to generate heat and electricity in fuel cells. Empa researchers have now succeeded in decoding the movement of hydrogen ions in crystals – a key step towards more efficient energy conversion in the hydrogen industry of tomorrow.
As charge carriers, electrons and ions play the leading role in electrochemical energy storage devices and converters such as batteries and fuel cells. Proton...
Scientists from the Excellence Cluster Universe at the Ludwig-Maximilians-Universität Munich have establised "Cosmowebportal", a unique data centre for cosmological simulations located at the Leibniz Supercomputing Centre (LRZ) of the Bavarian Academy of Sciences. The complete results of a series of large hydrodynamical cosmological simulations are available, with data volumes typically exceeding several hundred terabytes. Scientists worldwide can interactively explore these complex simulations via a web interface and directly access the results.
With current telescopes, scientists can observe our Universe’s galaxies and galaxy clusters and their distribution along an invisible cosmic web. From the...
Temperature measurements possible even on the smallest scale / Molecular ruby for use in material sciences, biology, and medicine
Chemists at Johannes Gutenberg University Mainz (JGU) in cooperation with researchers of the German Federal Institute for Materials Research and Testing (BAM)...
Germany counts high-precision manufacturing processes among its advantages as a location. It’s not just the aerospace and automotive industries that require almost waste-free, high-precision manufacturing to provide an efficient way of testing the shape and orientation tolerances of products. Since current inline measurement technology not yet provides the required accuracy, the Fraunhofer Institute for Laser Technology ILT is collaborating with four renowned industry partners in the INSPIRE project to develop inline sensors with a new accuracy class. Funded by the German Federal Ministry of Education and Research (BMBF), the project is scheduled to run until the end of 2019.
New Manufacturing Technologies for New Products
19.06.2017 | Event News
13.06.2017 | Event News
13.06.2017 | Event News
22.06.2017 | Life Sciences
22.06.2017 | Materials Sciences
22.06.2017 | Materials Sciences