title: Reduced central line infection rates in children with leukemia following caregiver training: A quality improvement study.
abstract: Infections are a leading cause of morbidity and mortality in children with acute leukemia. Central-line (CL) devices increase this population's risk of serious infections.Within the context of a quality improvement (QI) project, we tested the effect of caregiver education on CL management on the CL-associated bloodstream infection (CLABSI) rate among children with acute leukemia seen at a large referral center in Italy. The intervention consisted of 9 in-person sessions for education and practice using mannequins and children.One hundred and twenty caregivers agreed to participate in the initiative. One hundred and five (87.5%) completed the training, 5 (4.1%) withdrew after the first session, and 10 (8.3%) withdrew during practical sessions. After educational intervention, the overall CLABSI rate was reduced by 46% (from 6.86 to 3.70/1000 CL-days). CLABSI rate was lower in children whose caregivers completed the training (1.74/1000 CL-days, 95% CI 0.43-6.94) compared with those who did not receive any training (12.2/1000 CL-days, 95% CI 7.08-21.0, P < 0.05) or were in-training (3.96/1000 CL-days, 95% CI 1.98-7.91) at the time of infection.Caregiver training in CL management, applied within a multifaceted QI approach, reduced the rate of CLABSI in children with acute leukemia. Specific training and active involvement of caregivers in CL management may be effective to reduce CLABSI in high-risk children.
authors.affiliation: Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio Onco-Hematology Unit, Santobono-Pausilipon Children's Hospital Department of Pediatrics, Azienda Ospedaliera Universitaria Federico II, Naples, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Lo Vecchio
authors.forename: Joshua K
authors.initials: JK
authors.lastname: Schaffzin
authors.forename: Eliana
authors.initials: E
authors.lastname: Ruberto
authors.forename: Maria Angela
authors.initials: MA
authors.lastname: Caiazzo
authors.forename: Loredana
authors.initials: L
authors.lastname: Saggiomo
authors.forename: Daniela
authors.initials: D
authors.lastname: Mambretti
authors.forename: Danila
authors.initials: D
authors.lastname: Russo
authors.forename: Sara
authors.initials: S
authors.lastname: Crispo
authors.forename: Grazia Isabella
authors.initials: GI
authors.lastname: Continisio
authors.forename: Rossano
authors.initials: R
authors.lastname: Dello Iacovo
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Poggi
authors.forename: Alfredo
authors.initials: A
authors.lastname: Guarino
mesh_terms: D017028:Caregivers / Q000193:education*; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000209:etiology; D062905:Central Venous Catheters / Q000009:adverse effects; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education / Q000592:standards*; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000458:organization & administration*; D007558:Italy / Q000453:epidemiology; D007938:Leukemia / Q000150:complications* / Q000628:therapy; D008297:Male; D058996:Quality Improvement; D012189:Retrospective Studies; D013997:Time Factors