Parent engagement, daily care cut 20% of infections, Johns Hopkins says

Meticulous care and patient engagement can cut one in five central-line infections over two years, according to a Johns Hopkins study published online yesterday in the October issue of Pediatrics.

The Baltimore hospital found that conducting a "triple threat" approach to central venous catheter infections reduced infections by 20 percent over two years: taking clinical precautions, encouraging families to speak up when they see noncompliance and careful analysis of every infection that does occur.

Two hundred and fifty thousand central-line infections occur in the United States, with a fourth of them resulting in death each year.

To cut down on infections, Johns Hopkins employed a "maintenance-of-care bundle," in which nurses took precautions, including frequent dressing changes, regular changing of the tubes and caps attached to the central line, cleaning the line before and after each use, using a facial mask and gloves when handling the device, and hand-washing before and after handling the line.

In addition, parents of the pediatric oncology patients acted as monitors of noncompliance. The hospital supplied parents with wallet-sized flash cards of dos 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," co-investigator and pediatric oncology nurse Kim Drucis said in the research announcement.

The study builds on early literature that found "meticulous daily care of the central line" can cut infections in the critically ill. An earlier Johns Hopkins program found that the simple hygiene changes saved $104 million at 88 pediatric hospitals over five years, according to a separate study last year.

Children are particularly vulnerable because of weakened immunity and the clinicians accessing their central lines multiple times a day--as much as 30 times a day in oncology patients--making each touch point potentially risky.

When infections did occur, nurses held monthly meetings to review why each one happened.

Although researchers said the approach offered results, they noted it didn't happen in the first year. Infection rates stayed relatively the same in the first year but plummeted by 64 percent in the second year. The researchers said in the study, "[L]ong ramp-up times may be necessary to reap maximal benefits."

For more information:
- see the research announcement
- check out the study abstract

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