title: Implementation of a central line maintenance care bundle in hospitalized pediatric oncology patients.
abstract: OBJECTIVE
  To investigate whether a multidisciplinary, best-practice central line maintenance care bundle reduces central line-associated blood stream infection (CLABSI) rates in hospitalized pediatric oncology patients and to further delineate the epidemiology of CLABSIs in this population.
  
  
  METHODS
  We performed a prospective, interrupted time series study of a best-practice bundle addressing all areas of central line care: reduction of entries, aseptic entries, and aseptic procedures when changing components. Based on a continuous quality improvement model, targeted interventions were instituted to improve compliance with each of the bundle elements. CLABSI rates and epidemiological data were collected for 10 months before and 24 months after implementation of the bundle and compared in a Poisson regression model.
  
  
  RESULTS
  CLABSI rates decreased from 2.25 CLABSIs per 1000 central line days at baseline to 1.79 CLABSIs per 1000 central line days during the intervention period (incidence rate ratio [IRR]: 0.80, P = .58). Secondary analyses indicated CLABSI rates were reduced to 0.81 CLABSIs per 1000 central line days in the second 12 months of the intervention (IRR: 0.36, P = .091). Fifty-nine percent of infections resulted from Gram-positive pathogens, 37% of patients with a CLABSI required central line removal, and patients with Hickman catheters were more likely to have a CLABSI than patients with Infusaports (IRR: 4.62, P = .02).
  
  
  CONCLUSIONS
  A best-practice central line maintenance care bundle can be implemented in hospitalized pediatric oncology patients, although long ramp-up times may be necessary to reap maximal benefits. Further research is needed to determine if this CLABSI rate reduction can be sustained and spread.
authors.affiliation: Johns Hopkins University School of Medicine, Department of Pediatrics, 2091 Rubenstein Child Health Building, 200 N. Wolfe St, Baltimore MD, 21287, USA. mrinke1@jhmi.edu
authors.forename: Michael L
authors.initials: ML
authors.lastname: Rinke
authors.forename: Allen R
authors.initials: AR
authors.lastname: Chen
authors.forename: David G
authors.initials: DG
authors.lastname: Bundy
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Colantuoni
authors.forename: Lisa
authors.initials: L
authors.lastname: Fratino
authors.forename: Kim M
authors.initials: KM
authors.lastname: Drucis
authors.forename: Stephanie Y
authors.initials: SY
authors.lastname: Panton
authors.forename: Michelle
authors.initials: M
authors.lastname: Kokoszka
authors.forename: Alicia P
authors.initials: AP
authors.lastname: Budd
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Milstone
authors.forename: Marlene R
authors.initials: MR
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D055499:Catheter-Related Infections / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000379:methods / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006760:Hospitalization; D006776:Hospitals, Pediatric / Q000592:standards*; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards*; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000628:therapy; D016522:Oncology Service, Hospital / Q000592:standards*; D016012:Poisson Distribution; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D058996:Quality Improvement; D012044:Regression Analysis