According to a new John Hopkins Children’s Center study published earlier this week, hospitals can prevent one in five central-line infections by following a list of precautions and measures, encouraging families to speak up when they observe noncompliance and doing an analysis of the causes behind every infection that does occur.
In the study, which was published in the October issue of Pediatrics, the hospital reports that conducting what their researchers call a “triple threat” approach to using a central venous catheter, or central line, contributed to a reduction in infections by 20 percent over a two-year period. During year one, the infection rate remained unchanged but in the second year, infections plummeted by 64 percent.
Michael Rinke, an author of the study and an assistant professor of pediatrics at Johns Hopkins University School of Medicine, says 250,000 central-line infections occur in the U.S. each year, and each infection can cost hospitals $25,000.
Rinke says that in November 2009, Johns Hopkins Children’s Center joined a 27-institution quality transformation effort organized by the Children’s Hospital Association to focus on reducing central-line infections. Those institutions involved in the collaboration used a bundle system addressing all areas of central-line infections that included over 40 best practices for every time a nurse or doctor accesses a central line or changes dressings, he said.
Want to publish your own articles on DistilINFO Publications?
Send us an email, we will get in touch with you.
According to Rinke, the study was carried out by pediatric oncology nurses, physicians and safety experts at the Johns Hopkins pediatric inpatient cancer unit. In order to cut down on infections, the nurses deployed strict device-handling precautions that included 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 masks and gloves when handling the device; and hand-washing before and after handling the line. Additionally, the Johns Hopkins researchers asked parents to provide additional oversight, equipping them with wallet flash cards on the “do’s” and “don’ts” of central-line care.
The Dana-Farber Cancer Institute in Boston has also been involved in the nationwide collaboration to reduce central-line infections.
“The goal in the collaborative and our programs is to say we are going to do our utmost to reduce the total number of infections, but recognizing that it’s probably not possible to get rid of them completely,” said Amy Louise Billett, director of safety and quality in the Division of Pediatric Hematology/Oncology at the Dana-Farber Cancer Institute. “This includes children with cancer that need a lot of treatments involving a central line. Plus, patients undergoing chemotherapy really have an increased risk of infection. What can we do to decrease the likelihood of getting this type of infection? This is really a multi-line effort between nurses and physicians.”
Rinke said the program is really a nursing-led effort and that nurses “deserve 100 percent of the credit.”
“The nurses embraced using this bundle. We do weekly audits of our progress and draw a lot of attention every time we have a failure or infection as a way to provide a learning experience and see where change is needed. And we created a culture without blame. It’s not that someone did a bad job or is a bad nurse, it’s that the system just isn’t working,” he said. “Nurses are the real champions here and are the ones doing this everyday.”
Rinke hopes to see similar programs developed at many more hospitals in the near future.
“I think this will really become the state-of-the-art for how to handle pediatric central lines,” he said.