title: Bloodstream infections in pediatric oncology outpatients: a new healthcare systems challenge.
abstract: OBJECTIVE
  To investigate a perceived increase in central venous catheter (CVC)-associated bloodstream infections (BSIs) among pediatric hematology-oncology outpatients.
  
  
  METHODS
  A case-control study.
  
  
  METHODS
  A pediatric hematology-oncology outpatient clinic at Fresno Children's Hospital.
  
  
  METHODS
  Pediatric hematology-oncology clinic outpatients with CVCs at Fresno Children's Hospital between November 1994 and October 1997.
  
  
  METHODS
  A case-patient was defined as any hematology-oncology outpatient with a CVC-associated BSI at Fresno Children's Hospital from November 1996 to October 1997 (study period) without a localizable infection. To identify case-patients, we reviewed Fresno Children's Hospital records for all hematology-oncology clinic patients, those with CVCs and those with CVCs and BSIs. Control-patients were randomly selected hematology-oncology outpatients with a CVC but no BSI during the study period. Case-patient and control-patient demographics, diagnoses, caretakers, catheter types, catheter care, and water exposure were compared.
  
  
  RESULTS
  Twenty-five case-patients had 42 CVC-associated BSIs during the study period. No significant increase in CVC-associated BSI rates occurred among pediatric hematology-oncology patients. However, there was a statistically significant increase in nonendogenous, gram-negative (eg, Pseudomonas species) BSIs during summer months (May-October) compared with the rest of the year. Case-patients and control-patients differed only in catheter type; case-patients were more likely than control-patients to have a transcutaneous CVC. Summertime recreational water exposures were similar and high in the two groups.
  
  
  CONCLUSIONS
  Hematology-oncology clinic patients with transcutaneous CVCs are at greater risk for CVC-associated BSI, particularly during the summer. Caretakers should be instructed on proper care of CVCs, particularly protection of CVCs during bathing and recreational summer water activities, to reduce the risk of nonendogenous, gram-negative BSIs.
authors.affiliation: Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Theresa L
authors.initials: TL
authors.lastname: Smith
authors.forename: Gregg T
authors.initials: GT
authors.lastname: Pullen
authors.forename: Vonda
authors.initials: V
authors.lastname: Crouse
authors.forename: Jon
authors.initials: J
authors.lastname: Rosenberg
authors.forename: William R
authors.initials: WR
authors.lastname: Jarvis
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D002140:California / Q000453:epidemiology; D016022:Case-Control Studies; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D017053:Infection Control; D008297:Male; D008495:Medical Oncology; D020380:Needs Assessment; D009369:Neoplasms / Q000150:complications*; D010372:Pediatrics; D011159:Population Surveillance; D012307:Risk Factors; D012621:Seasons