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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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References

1. van Hoff, J, Berg, AT, Seashore, JH. The effect of right atrial catheters on infectious complications of chemotherapy in children. J Clin Oncol 1990;8:1255–1262.CrossRefGoogle ScholarPubMed
2. Darbyshire, PJ, Weightman, NC, Speller, DCE. Problems associated with indwelling central venous catheters. Arch Dis Child 1985;60:129–134.CrossRefGoogle ScholarPubMed
3. Decker, MD, Edwards, KM. Central venous catheter infections. Pediatr Clin North Am 1988;35:579–612.CrossRefGoogle ScholarPubMed
4. Hiemenz, J, Skelton, J, Pizzo, PA. Perspective on the management of catheter-related infections in cancer patients. J Infect Dis 1986;5:6–11.CrossRefGoogle ScholarPubMed
5. Severien, C, Nelson, D. Frequency of infections associated with implanted systems vs cuffed, tunneled silastic venous catheters in patients with acute leukemia. Am J Dis Child 1991;145:1433–1438.Google ScholarPubMed
6. Mulloy, RH, Jadavji, T, Russell, ML. Tunneled central venous catheter sepsis: risk factors in a pediatric hospital. Journal of Parenteral and Enteral Nutrition 1991;15:460–463.CrossRefGoogle Scholar
7. Cairo, M, Spooner, S, Sowden, L, Bennetts, GA, Towne, B, Hodder, F. Long-term use of indwelling multipurpose silastic catheters in pediatric cancer patients treated with aggressive chemotherapy. J Clin Oncol 1986;4:784–788.CrossRefGoogle ScholarPubMed
8. Daghistani, D, Horn, M, Rodriguez, Z, Schoenike, S, Toledano, S. Prevention of indwelling central venous catheter sepsis in pediatric oncology patients. Proceedings of the American Society of Pediatric Hematology/Oncology 1994;3:26.Google Scholar
9. Rackoff, W, Weiman, M, Jakobowski, D, et al. A randomized controlled trial of the efficacy of a vancomycin and heparin solution in preventing central venous catheter infections in children. J Pediatr 1995;127:147–151.CrossRefGoogle ScholarPubMed
10. Bell, L, Alpert, G, Campos, J, Plotkin, S. Routine quantitative blood cultures in children with Haemophilus influenzae or Streptococcus pneumoniae bacteremia. Pediatrics 1985;76:901–904.CrossRefGoogle ScholarPubMed
11. Campos, J, Spainour, J. Comparison of the isolator 1.5 microbial tube with a conventional blood culture system for detection of bacteremia in children. Diagn Microbiol Infect Dis 1985;3:167–174.CrossRefGoogle ScholarPubMed
12. Fan, ST, Teoh, CCH, Lau, KF. Evaluation of central venous catheter sepsis by differential quantitative blood culture. Eur J Clin Microbiol Infect Dis 1989;8:142–144.CrossRefGoogle ScholarPubMed
13. Curtas, S, Tramposch, K. Culture methods to evaluate central venous catheter sepsis. Nutr Clin Pract 1991;6:43–48.CrossRefGoogle ScholarPubMed
14. Flynn, PM, Shenep, JL, Barrett, FF. Differential quantitation with a commercial blood culture tube for diagnosis of catheterrelated infection. J Clin Microbiol 1988;26:1045–1046.CrossRefGoogle Scholar
15. Ederer, F, Mantel, N. Confidence limits for the ratio of two Poisson variables. Am J Epidemiol 1974;100:165–167.CrossRefGoogle ScholarPubMed
16. Cutler, SJ, Ederer, F. Maximum utilization of the life table method in analyzing survival. Journal of Chronic Diseases 1958;8:699–712.CrossRefGoogle ScholarPubMed
17. Harris, GJ, Rosenquist, MD, Kealey, GP. An in vitro model for studying the effect of the subcutaneous tunnel and the skin exit site on the accuracy of central venous catheter tip cultures. J Burn Care Rehabil 1992;13:628–631.CrossRefGoogle Scholar
18. Conly, JM, Grieves, K, Peters, B. A prospective randomized study comparing transparent and dry gauze dressings for central venous catheters. J Infect Dis 1989;2:310–319.CrossRefGoogle Scholar
19. Fitchie, C. Central venous catheter-related infection and dressing type. Intensive Crit Care Nurs 1992;8:199–202.CrossRefGoogle ScholarPubMed
20. Marrie, TJ, Costerton, JW. Colonization of transparent dressings for intravenous catheters. Infect Surg 1987;475–480.Google Scholar
21. Ausman, R, Martin, R, Cole, J, Schussman, W. ‘No dressing’ technique for central vein catheter care. Proceedings of the American Society of Clinical Oncology 1991;10:327.Google Scholar
22. Larson, E. Guideline for use of topical antimicrobial agents. Am J Infect Control 1988;16:253–266.CrossRefGoogle ScholarPubMed
23. Maki, DG, Ringer, M, Alvarado, CJ. Prospective randomized trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet 1991;338:339–343.CrossRefGoogle ScholarPubMed
24. MacMillan, S. Could you please comment regarding the use of iodine alcohol, 70% isopropyl alcohol and tincture of chlorhexidine in cleaning of silicone central venous catheter insertion sites and hubs. Can J Infect Control 1993;8:81.Google ScholarPubMed
25. Stotter, AT, Ward, H, Waterfield, AH, Hilton, J, Sim, AJW. Junctional care: the key to prevention of catheter sepsis in intravenous feeding. Journal of Parenteral and Enteral Nutrition 1987;11:159–162.CrossRefGoogle ScholarPubMed
26. Sitges-Serra, A, Linares, J, Garau, J. Catheter sepsis: the clue is in the hub. Surgery 1985;97:355–357.Google ScholarPubMed
27. Sitges-Serra, A, Linares, J, Perez, JL, Juarrieta, E, Lorente, L. A randomized trial on the effect of tubing changes on hub contamination and catheter sepsis during parenteral nutrition. Journal of Parenteral and Enteral Nutrition 1985;9:322–325.CrossRefGoogle ScholarPubMed
28. Jansen, B, Jansen, S, Peters, G, Pulverer, G. In-vitro efficacy of a central venous catheter (‘Hydrocath’) loaded with teicoplanin to prevent bacterial colonization. J Hosp Infect 1992;22:93–107.CrossRefGoogle Scholar
29. Maki, DG, Cobb, L, Garman, JK, Shapiro, JM, Ringer, M, Helgerson, RB. An attachable silver-impregnated cuff for prevention of infection with central venous catheters: a prospective randomized multicenter trial. Am J Med 1988;85:307–314.CrossRefGoogle ScholarPubMed
30. Bentivegna, PE. The Vitacuff and intravascular catheter-related infection. JAMA 1989;262:613–614.CrossRefGoogle ScholarPubMed
31. Schwartz, C, Henrickson, KJ, Roghmann, K, Powell, K. Prevention of bacteremia attributed to luminal colonization of tunneled central venous catheters with vancomycin-susceptible organisms. J Clin Oncol 1990;8:1591–1597.CrossRefGoogle ScholarPubMed
32. Ranson, M, Oppenheim, BA, Jackson, A, Kamthan, AG, Scarffe, JH. Double-blind placebo controlled study of vancomycin prophylaxis for central venous catheter insertion in cancer patients. J Hosp Infect 1990;15:95–102.CrossRefGoogle ScholarPubMed
33. Gaillard, JL, Merlino, R, Pajot, N, et al. Conventional and nonconventional modes of vancomycin administration to decontaminate the internal surface of catheters colonized with coagulasenegative staphylococci. Journal of Parenteral and Enteral Nutrition 1990;14:593–597.CrossRefGoogle Scholar
34. Howe, D, Anderson, R, Muhvic, J, Craft, T. Subcutaneous venous access device: is maintenance flushing necessary? Proceedings of the American Society of Clinical Oncology 1991;10:333.Google Scholar