title: Bringing central line-associated bloodstream infection prevention home: catheter maintenance practices and beliefs of pediatric oncology patients and families.
abstract: BACKGROUND
  A study was conducted to investigate (1) the extent to which best-practice central line maintenance practices were employed in the homes of pediatric oncology patients and by whom, (2) caregiver beliefs about central line care and central line-associated blood stream infection (CLABSI) risk, (3) barriers to optimal central line care by families, and (4) educational experiences and preferences regarding central line care.
  
  
  METHODS
  Researchers administered a survey to patients and families in a tertiary care pediatric oncology clinic that engaged in rigorous ambulatory and inpatient CLABSI prevention efforts.
  
  
  RESULTS
  Of 110 invited patients and caregivers, 105 participated (95% response rate) in the survey (March-May 2012). Of the 50 respondents reporting that they or another caregiver change central line dressings, 48% changed a dressing whenever it was soiled as per protocol (many who did not change dressings per protocol also never personally changed dressings); 67% reported the oncology clinic primarily cares for their child's central line, while 29% reported that an adult caregiver or the patient primarily cares for the central line. Eight patients performed their own line care "always" or "most of the time." Some 13% of respondents believed that it was "slightly likely" or "not at all likely" that their child will get an infection if caregivers do not perform line care practices perfectly every time. Dressing change practices were the most difficult to comply with at home. Some 18% of respondents wished they learned more about line care, and 12% received contradictory training. Respondents cited a variety of preferences regarding line care teaching, although the majority looked to clinic nurses for modeling line care.
  
  
  CONCLUSIONS
  Interventions aimed at reducing ambulatory CLABSIs should target appropriate educational experiences for adult caregivers and patients and identify ways to improve compliance with best-practice care.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Rinke
authors.forename: Allen R
authors.initials: AR
authors.lastname: Chen
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Milstone
authors.forename: Lindsay C
authors.initials: LC
authors.lastname: Hebert
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: Cynthia
authors.initials: C
authors.lastname: Herpst
authors.forename: Michelle
authors.initials: M
authors.lastname: Kokoszka
authors.forename: Marlene R
authors.initials: MR
authors.lastname: Miller
mesh_terms: D000553:Ambulatory Care / Q000592:standards*; D055499:Catheter-Related Infections / Q000451:nursing* / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000451:nursing* / Q000592:standards*; D002648:Child; D003710:Demography; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D016522:Oncology Service, Hospital / Q000592:standards*; D061214:Patient Safety / Q000592:standards*; D010372:Pediatrics / Q000592:standards*; D058996:Quality Improvement / Q000592:standards*; D012307:Risk Factors; D011795:Surveys and Questionnaires