Rapid reduction of central line infections in hospitalized pediatric oncology patients through simple quality improvement methods.

BACKGROUND: Pediatric hematology-oncology (PHO) patients are at significant risk for developing central line-associated bloodstream infections (CLA-BSIs) due to their prolonged dependence on such catheters. Effective strategies to eliminate these preventable infections are urgently needed. In this study, we investigated the implementation of bundled central line maintenance practices and their effect on hospital-acquired CLA-BSIs. MATERIALS AND METHODS: CLA-BSI rates were analyzed within a single-institution's PHO unit between January 2005 and June 2011. In May 2008, a multidisciplinary quality improvement team developed techniques to improve the PHO unit's safety culture and implemented the use of catheter maintenance practices tailored to PHO patients. Data analysis was performed using time-series methods to evaluate the pre- and post-intervention effect of the practice changes. RESULTS: The pre-intervention CLA-BSI incidence was 2.92 per 1,000-patient days (PD) and coagulase-negative Staphylococcus was the most prevalent pathogen (29%). In the post-intervention period, the CLA-BSI rate decreased substantially (45%) to 1.61 per 1,000-PD (P < 0.004). Early on, blood and marrow transplant (BMT) patients had a threefold higher CLA-BSI rate compared to non-BMT patients (P < 0.033). With additional infection control countermeasures added to the bundled practices, BMT patients experienced a larger CLA-BSI rate reduction such that BMT and non-BMT CLA-BSI rates were not significantly different post-intervention. CONCLUSIONS: By adopting and effectively implementing uniform maintenance catheter care practices, learning multidisciplinary teamwork, and promoting a culture of patient safety, the CLA-BSI incidence in our study population was significantly reduced and maintained.

Promoting parental use of distraction and relaxation in pediatric oncology patients during invasive procedures.

Treatment of children with cancer involves many painful procedures. Invasive procedures such as bone marrow aspiration and lumbar punctures can be very traumatic, painful, and anxiety-producing for both parents and child. The use of distraction and relaxation techniques is a nonpharmacologic strategy to promote comfort and decrease anxiety and procedural pain. This article describes the development of a parent education booklet that promotes the use of distraction and relaxation techniques during invasive procedures across pediatric oncology inpatient and outpatient settings. Promoting parents' use of these techniques with their child can add to the parent and child's repertoire of coping skills that can be used throughout the course of their treatment or during other painful procedures. These techniques in combination with traditional methods of practice enhance quality patient care and significantly decrease the cost and risk associated with performing these procedures under general anesthesia.