Using Practice-Based Evidence to Improve Supportive Care Practices to Reduce Central Line–Associated Bloodstream Infections in a Pediatric Oncology Unit

2016 ◽  
Vol 34 (3) ◽  
pp. 185-195 ◽  
Author(s):  
Lauri A. Linder ◽  
Cheryl Gerdy ◽  
Rouett Abouzelof ◽  
Andrew Wilson
Keyword(s):  
Supportive Care ◽  
Pediatric Oncology ◽  
Clinical Care ◽  
Oral Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Coagulase Negative Staphylococci ◽  
Principles Of Practice ◽  
Oncology Unit ◽  
Viridans Group Streptococci

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.

Back to Basics: CLABSI Reduction Through Implementation of an Oral Care and Hygiene Bundle

2019 ◽  
Vol 36 (5) ◽  
pp. 321-326 ◽  
Author(s):  
Gina Kemp ◽  
Melissa Hallbourg ◽  
Diane Altounji ◽  
Rita Secola
Keyword(s):  
Oral Hygiene ◽  
Oral Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Direct Care ◽  
Care Staff ◽  
Mucosal Barrier ◽  
Care Bundle ◽  
Hygiene Practices ◽  
Oncology Unit

Children with cancer often undergo treatments that render them severely immunocompromised. Side effects of treatment place them at risk for developing oral mucositis (OM), which can potentially lead to infection and bacteremia. Staff nurses on an inpatient pediatric oncology unit noted inconsistent daily oral hygiene practices despite assessing OM consistently. Basic oral hygiene can reduce the severity of OM, and evidence-based bundled care has shown to increase consistency of practice. Based on findings and recommendations from the literature, an oral care and hygiene bundle was developed. The oral care bundle included a soft bristled toothbrush, fluoride toothpaste, twice-daily brushing and sodium bicarbonate rinses, lip balm, and oral moisturizer. The hygiene component consisted of a daily bath or shower and daily linen changes. Education on the rationale and purpose for the use of an oral care and hygiene bundle was provided to the inpatient direct care staff prior to implementation on two inpatient oncology units. Audits were performed to measure the adherence of the oral care and hygiene bundle. Central line–associated bloodstream infections were measured in collaboration with the quality and infection prevention departments. Since the oral care and hygiene bundle was implemented, laboratory-confirmed bloodstream infection rates decreased from 1.05 to 0.54 per 1,000 catheter days, while mucosal barrier injury rates decreased from 2.98 to 1.27 per 1,000 catheter days.

Reducing Oncology Unit Central Line–Associated Bloodstream Infections: Initial Results of a Simulation-Based Educational Intervention

2016 ◽  
Vol 12 (1) ◽  
pp. e83-e87 ◽  
Author(s):  
Jenna Page ◽  
Maureen Tremblay ◽  
Cate Nicholas ◽  
Ted A. James
Keyword(s):  
Educational Intervention ◽  
Bloodstream Infections ◽  
Central Line ◽  
Care Model ◽  
Simulation Based ◽  
Oncology Unit ◽  
Initial Results

A targeted educational intervention using a simulated central line care model improved competence in central line care and resulted in decreased CLABSI rates for oncology inpatients.

scholarly journals 81. Reducing Unnecessary Blood Cultures Through Diagnostic Stewardship

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S157-S157
Author(s):  
Sujeet Govindan ◽  
Luke Strnad
Keyword(s):  
Blood Culture ◽  
Positive Blood Culture ◽  
Cost Savings ◽  
Bloodstream Infections ◽  
Central Line ◽  
Blood Cultures ◽  
Coagulase Negative Staphylococci ◽  
Candida Sp ◽  
Daily Frequency ◽  
Oregon Health

Abstract Background At our institution, we learned the frequency of blood cultures was sometimes being changed from “Once” to “Daily” without a defined number of days. We hypothesized this led to unnecessary blood cultures being performed. Methods Over a 3 month period from 12/6/2019-3/6/2020, we retrospectively evaluated the charts of patients who had a blood culture frequency changed to “Daily”. We evaluated if there was an initial positive blood culture within 48 hours of the “Daily” order being placed and the number of positive, negative, or “contaminant” sets of cultures drawn with the order. Contaminant blood cultures were defined as a contaminant species, present only once in the repeat cultures, and not present in initial positive cultures. Results 95 unique orders were placed with 406 sets of cultures drawn from 89 adults. ~20% of the time (17 orders) the order was placed without an initial positive blood culture. This led to 62 sets of cultures being drawn, only 1 of which came back positive. 78/95 orders had an initial positive blood culture. The most common initial organisms were Staphylococcus aureus (SA) (38), Candida sp (10), Enterobacterales sp (10), and coagulase negative staphylococci (7). 43/78 (55%) orders with an initial positive set had positive repeat cultures. SA (26) and Candida sp (8) were most common to have positive repeats. Central line associated bloodstream infections (CLABSI) were found in 5 of the orders and contaminant species were found in 4 of the orders. 54% of the patients who had a “Daily” order placed did not have positive repeat cultures. The majority of the cultures were drawn from Surgical (40 orders) and Medical (35 orders) services. Assuming that SA and Candida sp require 48 hours of negative blood cultures to document clearance and other species require 24 hours, it was estimated that 51% of the cultures drawn using the "Daily" frequency were unnecessary. Cost savings over a year of removing the "Daily" frequency would be ~&14,000. Data from "Daily" blood culture orders drawn at Oregon Health & Science University from 12/6/2019-3/6/2020 Conclusion Unnecessary blood cultures are drawn when the frequency of blood cultures is changed to "Daily". Repeat blood cultures had the greatest utility in bloodstream infections due to SA or Candida sp, and with CLABSI where the line is still in place. These results led to a stewardship intervention to change blood culture ordering at our institution. Disclosures All Authors: No reported disclosures

scholarly journals Bloodstream infections (BSI) with multidrug resistant organism (MDRO) in a pediatric oncology unit: Outcomes and risk factors

2020 ◽  
Vol 5 (4) ◽  
pp. S54
Author(s):  
Juhi J. Shah ◽  
Nirmalya R. Moulik ◽  
Sanjay Biswas ◽  
Rohini Kelkar ◽  
Girish Chinnaswamy ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pediatric Oncology ◽  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
Oncology Unit

Candida parapsilosisBloodstream Infection in Pediatric Oncology Patients: Results of an Epidemiologic Investigation

2004 ◽  
Vol 25 (8) ◽  
pp. 641-645 ◽  
Author(s):  
Brunella Posteraro ◽  
Stefania Bruno ◽  
Stefania Boccia ◽  
Antonio Ruggiero ◽  
Maurizio Sanguinetti ◽  
...  
Keyword(s):  
Gastrointestinal Tract ◽  
Pediatric Oncology ◽  
Genetic Relatedness ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Staff Members ◽  
First Case ◽  
Catheter Tip ◽  
Oncology Unit ◽  
Gastrointestinal Colonization

AbstractObjective:To investigate an outbreak ofCandida parapsilosisbloodstream infections (BSIs) involving three patients admitted to a pediatric oncology unit between April and June 2002.Methods:After the third case was documented, cultures were performed of the hands of all medical and paramedical staff members in the pediatric oncology unit and of environmental surfaces in the rooms occupied by the three patients. Electrophoretic karyotyping with pulsed-field gel electrophoresis and arbitrarily primed polymerase chain reaction were used to assess the genetic relatedness amongC. parapsilosisisolates.Results:The three cases ofC. parapsilosisBSI were diagnosed based on blood cultures performed during a 38-day period. Evidence of priorC. parapsilosiscolonization of the gastrointestinal tract was present in only the first case. Each patient had an indwelling central venous catheter (CVC), which was promptly removed, and semiquantitative catheter tip cultures also revealedC. parapsilosis. None of the 30 environmental cultures performed was positive forC. parapsilosis, but the fungus was isolated from the hands of 6 of the 20 nurses tested. Both molecular typing methods revealed identical DNA fingerprinting patterns for all 13 patient isolates (7 from blood, 3 from CVC tips, and 3 from the gastrointestinal tract) and for 5 of the 6 recovered from the nurses' hands.Conclusions:These findings suggest the possibility of cross-infection with a singleC. parapsilosisstrain that was transmitted (probably during CVC dressing changes) by nurses whose hands were colonized with it. The role of previous gastrointestinal colonization in the first case cannot be excluded.

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