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'Triple-threat' approach reduces life-threatening central line infections in children with cancer
Date:9/2/2012

ohns Hopkins pediatric inpatient cancer unit. To keep bacteria and other pathogens at bay, the nurses deployed strict device-handling precautions that included -- among other things -- frequent and regular changing of the dressing covering the central line; regular changing of the tubes and caps attached to central line; cleaning of the line before and after each use; use of facial mask and gloves when handling the device; and hand-washing before and after handling the line.

In a novel twist, the Johns Hopkins investigators asked parents to provide additional oversight, equipping them with wallet flash cards on the "do's" and "don'ts" of central line care.

"Parents can act as an invaluable second set of eyes, and we urged them to be vigilant about the way their child's central line was handled." says co-investigator Kim Drucis, M.S.N., R.N., a pediatric oncology nurse. "We also encouraged them to ask questions and to speak up every time they noticed something different."

The oncology nurses also held monthly briefings to discuss every infection that occurred during the study. Such root-cause analysis is already a staple of error reduction in other industries including airline, nuclear and military.

"Honest dissection of one's practice is neither easy nor pleasant but is absolutely critical to illuminate areas for improvement," says co-investigator Stephanie Panton, M.S.N., R.N., C.P.O.N.

The approach reduced infections by 20 percent over two years. During year one, the infection rate remained unchanged but in the second year, infections plummeted by 64 percent -- a delayed ramp-up effect that points to the often-slow pace of meaningful change, the investigators say.

"Real change rarely occurs overnight. It requires sustained effort and unwavering focus, day after day, month after month, year after year," Rinke says. "It's a slow, arduous process, but the payoff can be dramatic."

Each year, 250,000 centra
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Contact: Ekaterina Pesheva
epeshev1@jhmi.edu
410-502-9433
Johns Hopkins Medicine
Source:Eurekalert

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