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Impact of Changes in Catheter Management on Infectious Complications Among Children With Central Venous Catheters

Published online by Cambridge University Press:  02 January 2015

Beverly J. Lange ,
Marjorie Weiman ,
Eric J. Feuer ,
Diane Jakobowski ,
Julia Bilodeau ,
Virginia A. Stallings ,
Ronald Hirschl ,
Louis M. Bell ,
James Harper  and
Avital Cnaan
Beverly J. Lange*
Affiliation:
Departments of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Marjorie Weiman
Affiliation:
Departments of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Eric J. Feuer
Affiliation:
Departments of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Surveillance Program, Division of Cancer Prevention and Control, National Cancer Institute, Bethesda, Maryland
Diane Jakobowski
Affiliation:
Nursing, Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Julia Bilodeau
Affiliation:
Nursing, Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Virginia A. Stallings
Affiliation:
Departments of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Ronald Hirschl
Affiliation:
Surgery, Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Louis M. Bell
Affiliation:
Departments of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
James Harper
Affiliation:
Corning Pact, Inc, Radnor, Pennsylvania
Avital Cnaan
Affiliation:
Departments of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
*
Division of Oncology, 324 S 34th St, Philadelphia, PA 19104
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Abstract

Objectives:

To characterize and enumerate central venous catheter (CVC)-related complications among children with chronic illnesses, and to reduce the complication rate through changes in CVC management and education.

Design:

A prospective obser vational study followed by an educational program and a nonrandomized inter ventional trial.

Setting:

The Children's Hospital of Philadelphia, a tertiary, pediatric facility.

Patients:

268 children with Broviac, Hickman, or Infusaport catheters in place during 58,290 catheter days.

Interventions:

Development and implementation of protocols for cleaning insertion site and hub, use of nonocclusive dressings, and manipulation of access; formal staff and parental education about protocols.

Results:

CVC-related infections fell from 4.58/1,000 catheter-days preinter vention to 3.83 postintervention (risk ratio [RR], 0.20; 95% confidence interval [CI95], 0.89-1.622; P=.25); exit-site infections fell from 0.58 to 0.11 (CI95, 1.22-45.64; P=.02); rates among infants on the surgical service fell from 15.46 to 6.67 (RR, 2.31; CI95, 1.10-4.30; P=.02).

Conclusions:

Education and changes in management protocols reduced the incidence of exit-site infections among all patients and reduced the overall infectious complication rate among the infants receiving parenteral nutrition on the surgical ser vice. Other interventions are needed to decrease further the infectious complications in these children

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 5 , May 1997 , pp. 326 - 332
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

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