Preventive strategies for central line-associated bloodstream infections in pediatric hematopoietic stem cell transplant recipients

详细信息	查看全文 | 推荐本文 |

• 作者：Catherine Barrell ; MSN ; PNP-BC^a ; Lisa Covington ; RN ; MPH^b ; Monica Bhatia ; MD^c ; Jeff Robison ; MD^c ; Sangita Patel ; MD^c ; Judith S. Jacobson ; DrPH ; MBA^d ; Amanda Buet ; MPH^c ; Philip L. Graham ; MD ; MSc^b ; ^c ; ^e ; Lisa Saiman ; MD ; MPH^b ; ^c ; ^{LS5@columbia.edu}
• 关键词：Bone marrow transplantation ; Health care&ndash ; acquired infections ; Community-onset infection ; Bundle strategies
• 刊名：American Journal of Infection Control
• 出版年：2012
• 期刊代码：9_01966553
• 类别：med
• 出版时间：June, 2012
• 卷：40
• 期：5
• 页码：434-439
• 文件大小：482 K

摘要

| Figures/TablesFigures/Tables | ReferencesReferences

Background

Few studies have described preventive strategies for central line-associated bloodstream infections (CLABSIs) in pediatric hematopoietic stem cell transplantation (HSCT) recipients.

Methods

We performed a pilot intervention study in our pediatric HSCT population in 2006-2008 and compared CLABSI rates before and after implementation of preventive strategies (ie, training staff and聽caregivers in procedures for dressing changes and drawing blood) in the inpatient, outpatient, and non-health care (ie, home) settings. We also studied the pathogens associated with hospital-onset versus community-onset CLABSIs.

Results

During the study period, 90 children (median age, 10 years) underwent HSCT. Fifty-nine children (66%) developed a CLABSI; 18 in the hospital, 27 in the community, and 14 in both settings. After implementation of central line (CL) maintenance care strategies, the overall CLABSI rate declined from 10.03 to 3.00 CLABSIs per 1,000 CL-days (rate ratio, 0.3; 95%confidence interval, 0.2-0.5, P < .0001) and rates declined for both hospital- and community-onset CLABSIs. Gram negative pathogens caused more community-onset (45/65, 69%) than hospital-onset (22/46, 48%) CLABSIs (odds ratio, 2.5; 95%confidence interval, 1.1-5.4; P聽= .02).

Conclusions

Standardization of care practices for CL maintenance was associated with a reduction of CLABSIs in our pediatric HSCT population. A multicenter study is needed to confirm these observations.