Nosocomial infections rates in hospitalized patients with central venous catheters (CVCs) are a nursing sensitive quality indicator. Pediatric oncology patients with CVCs are a target population at high risk for adverse outcomes by the nature of the device, their disease, and their treatment. Reported strategies to prevent CVC-related bloodstream infections (BSIs) exist in support of CVC evidence-based bundle care, education, surveillance and accountability. Nonetheless, data show that education and monitoring alone have not decreased CVC-related BSI rates consistently. Lapses in compliance are believed to be related to understaffing, increased staff workloads, and downsizing or elimination of specialty care teams (Farrington, 2007;Ryder et al., 1998). Together, these cost-saving attempts may be counterproductive when it comes to CVC-related BSIs. Complication reports indicate that 52% of reported CVC infections are related to staff technique (Ryder et al. 1998). One potential solution is developing or """"""""re-engineering"""""""" specialty CVC teams. Two important issues in reducing CVC-related BSIs remain unresolved: 1) the use of specialized CVC teams and 2) nurse-patient ratios (Marschall et al, 2008). The overall purpose of this study is to determine if a CVC team intervention will reduce CVC-related BSIs in pediatric oncology patients. To accomplish this, a two-group randomized crossover trial of a CVC team intervention vs. usual care is proposed.
The specific aims of the proposed study are:
Specific Aim #1 A (unit level): To describe the monthly rate of BSIs over a 12 month period in which on two units patients receive a CVC team intervention (Experimental Unit [EU]) X 6months and patients receive usual CVC care (Usual Care Unit[UCU]) X 6 months.
Specific Aim #1 B (unit level): To determine whether the CVC team intervention results in a clinically important reduction in CVC-related BSI compared to standard care.
Specific Aim #2 (Individual level): To examine factors related to CVC-related BSIs and method of CVC care (EU vs.UCU). To support causal inference while controlling for treatment diffusion and crossover, randomization at the unit level will be used. After informed consent, patients in the Experimental Unit will receive CVC blood sampling from a team of specially trained nurses. In the Usual Care Unit, CVC blood sampling will be performed by staff nurses following established hospital protocols. Delivery of CVC care in both units will be monitored by study personnel to determine adherence to protocols via a reliable and valid checklist. Analysis will include measures of central tendency (median, inter-quartile ranges) to describe the distribution of BSIs at the unit level (Aim #1A). Multivariate Cox regression will be used to investigate specific aims #1B/2). The results of this study will hope to provide a nursing model of care that may reduce infections in pediatric oncology patients and improve quality of care.

Public Health Relevance

Reducing or eliminating hospital acquired infections is a national quality of care priority. Many of the 10,000 to 12,000 children diagnosed with cancer each year require long term intravenous access for the delivery of intensive and complex therapies. Pediatric cancer patients are at high risk for infection by nature of their disease, treatment and with a central intravenous catheter device in place. Nursing is often frontline care providers for these catheters in providing safe quality care to minimize the risk of potentially life threatening infections. There is associated substantial hospital financial costs in the care of these infections related to prolonged hospital lengths of stay and increase in the amount of care required to treat these infections. An experimental study is proposed to implement a specialty team of nurses to provide the evidence-based central venous catheter care to pediatric oncology patients as opposed to the assigned bedside nurses to determine its effectiveness in reducing these types of infections in pediatric cancer patients with a central venous catheter. The study will hope to improve a nursing model of care and improve pediatric oncology patient outcomes.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Dissertation Award (R36)
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HSR Health Care Research Training SS (HCRT)
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Harding, Brenda
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University of California Los Angeles
Schools of Nursing
Los Angeles
United States
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