Influence of prolonged use of intravenous administration sets in paediatric cancer patients on CVAD-related bloodstream infection rates and hospital resources.
BACKGROUND
To assess the effects of extending the routine intravenous administration set (IVAS) change-interval from 72 h (group 1) to 7 days (group 2) on the incidence density for central venous access device (CVAD)-related bloodstream infections (BSIs) and on resource expenditures in a singlecentre pilot study.


METHODS
Prospective pre-/post-intervention comparison of two consecutive 12-month surveillance periods (2001-2003) in a 17-bed paediatric oncology tertiary care unit. IVAS changes and nosocomial infections (NIs) were prospectively analysed using a standardized unit-based surveillance system (Oncopaed NI).


RESULTS
All 175 eligible patients were enrolled, 96 in group 1 and 79 in group 2. Both groups had similar distributions of primary diagnoses and risk factors. The proportion of IVAS changes performed after 3 days increased from 5.6% to 22.5%, but only 8% of IVASs in group 2 were changed after 7 days. Most IVAS changes (64.8% in group 1 and 92.9% in group 2) were done because of therapeutic interventions (blood products, parenteral nutrition [TNP]) before the scheduled endpoint. Overall, the rates and incidence densities of NIs were significantly lower during the second period. The corresponding results for CVAD-related BSIs did not show significant differences. No death attributable to a NI occurred. The '7-day' strategy resulted in cost savings for devices (3,300 dollars/year) and of nursing time (23 working days/year).


CONCLUSIONS
Extending the routine IVAS change-interval from 3 days to 7 days appears to be safe and cost-effective in a paediatric oncology unit with high infection control standards and continuous surveillance for NIs. These results do not prove that 7-day intervals prevent infections, but they do suggest that this policy probably is not harmful and that a prospectively randomized study with sufficient power is needed.
Simon
A
A
Dept. of Paediatric Hematology and Oncology, Children's Hospital, Medical Center, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany. asimon@ukb.uni-bonn.de
Fleischhack
G
G
Wiszniewsky
G
G
Hasan
C
C
Bode
U
U
Kramer
M H
MH
D000293:Adolescent; D000328:Adult; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D003428:Cross Infection / Q000209:etiology*; D005260:Female; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D008297:Male; D009369:Neoplasms / Q000628:therapy*; D011446:Prospective Studies; D018805:Sepsis / Q000209:etiology*; D013997:Time Factors