title: Impact of changes in catheter management on infectious complications among children with central venous catheters.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  A prospective observational study followed by an educational program and a nonrandomized interventional trial.
  
  
  METHODS
  The Children's Hospital of Philadelphia, a tertiary, pediatric facility.
  
  
  METHODS
  268 children with Broviac, Hickman, or Infusaport catheters in place during 58,290 catheter days.
  
  
  METHODS
  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 preintervention 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 service. Other interventions are needed to decrease further the infectious complications in these children.
authors.affiliation: Departments of Pediatrics, Children's Hospital of Philadelphia, PA, USA.
authors.forename: B J
authors.initials: BJ
authors.lastname: Lange
authors.forename: M
authors.initials: M
authors.lastname: Weiman
authors.forename: E J
authors.initials: EJ
authors.lastname: Feuer
authors.forename: D
authors.initials: D
authors.lastname: Jakobowski
authors.forename: J
authors.initials: J
authors.lastname: Bilodeau
authors.forename: V A
authors.initials: VA
authors.lastname: Stallings
authors.forename: R
authors.initials: R
authors.lastname: Hirschl
authors.forename: L M
authors.initials: LM
authors.lastname: Bell
authors.forename: J
authors.initials: J
authors.lastname: Harper
authors.forename: A
authors.initials: A
authors.lastname: Cnaan
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000592:standards*; D002675:Child, Preschool; D016001:Confidence Intervals; D003428:Cross Infection / Q000517:prevention & control*; D004866:Equipment Contamination / Q000517:prevention & control; D006801:Humans; D007223:Infant; D007318:Inservice Training / Q000592:standards; D008134:Long-Term Care; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D010353:Patient Education as Topic / Q000592:standards; D015397:Program Evaluation; D011446:Prospective Studies; D012306:Risk; D016019:Survival Analysis; D013997:Time Factors; D014946:Wound Infection / Q000517:prevention & control