title: Using Practice-Based Evidence to Improve Supportive Care Practices to Reduce Central Line-Associated Bloodstream Infections in a Pediatric Oncology Unit [Formula: see text].
abstract: Children with cancer are a subset of patients with central lines with distinct risk factors for infection including periods of prolonged neutropenia and compromised mucous membrane integrity. This article relates the implementation of principles of practice-based evidence to identify interventions in addition to best practice maintenance care bundles to reduce central line-associated bloodstream infections involving viridans group streptococci and coagulase-negative staphylococci on an inpatient pediatric oncology unit. Review of individual events combined with review of current clinical practice guided the development of structured protocols emphasizing routine oral care and general supportive cares. Key principles of the protocols emphasized a 1-2-3 mnemonic and included daily bathing, twice daily oral care, and out-of-bed activity 3 times daily. Poisson regression identified a significant main effect for time period for central line-associated bloodstream infection rates involving both viridans group streptococci and coagulase-negative staphylococci. Significant differences were present between the preintervention baseline and implementation of the supportive care protocols. Project outcomes demonstrate the added value of using principles of practice-based evidence to guide the development of interventions to improve clinical care when evidence-based sources are limited.
authors.affiliation: 1 University of Utah College of Nursing, Salt Lake City, UT, USA.|2 Primary Children's Hospital, Salt Lake City, UT, USA.
authors.forename: Lauri A
authors.initials: LA
authors.lastname: Linder
authors.affiliation: 2 Primary Children's Hospital, Salt Lake City, UT, USA.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Gerdy
authors.affiliation: 2 Primary Children's Hospital, Salt Lake City, UT, USA.
authors.forename: Rouett
authors.initials: R
authors.lastname: Abouzelof
authors.affiliation: 1 University of Utah College of Nursing, Salt Lake City, UT, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wilson
mesh_terms: D016470:Bacteremia / Q000517:prevention & control*; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002408:Catheters, Indwelling / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control*; D055317:Evidence-Based Practice; D006801:Humans; D017053:Infection Control / Q000379:methods*; D016522:Oncology Service, Hospital / Q000592:standards*
keywords: central line–associated bloodstream infection; outcomes; practice-based evidence; supportive care