The results mark a pivotal milestone in an ongoing national pediatric quality improvement program launched in 2006 and spearheaded by the National Association of Children’s Hospitals and Related Institutions (NACHRI).
The program examined whether and how a series of low-tech steps involving proper daily care and maintenance of the central lines can reduce infection rates. These steps included daily assessment of the need for the line, regularly changing the dressing covering the device, cleaning the line before and after use and hand washing before handling the line, among others
Comparing current infections rates with infection rates before the program’s 2006 launch, experts estimate that, thus far, the initiative has:
- prevented 2,964 central line infections
- saved 355 children’s lives, and
- saved nearly $104 million that would have gone toward treating complications stemming from invasive blood-stream infections. Each infection carries a price tag of up to $45,000, experts estimate.
The program debuted across pediatric intensive care units, or PICUs, with pediatric hematology and oncology units — two other frequent users of central lines — joining a few years later. In the two years since joining the program, hematology and oncology units have prevented 129 infections, saved 15 lives and more than $4.5 million in treatment.
“These results are a powerful example of how some of the most basic and low-tech practices, if followed unapologetically and without fail, can not only benefit the individual patient immediately but yield dramatic long-term improvement for the healthcare system as a whole,” said Marlene Miller, M.D. M.Sc., director of Pediatric Quality and Safety at Hopkins Children’s and vice president for Quality Transformation at NACHRI.
“Pediatric oncology patients are at risk for severe infections from their lines, as well as from many other sources, so I’ve been delighted to see a dramatic decrease in central-line associated bloodstream infections on our own unit over the past year,” says Allen Chen, M.D., Ph.D., M.H.S., director of the pediatric bone-marrow transplant program at Hopkins Children’s.
“These results from children’s hospitals across the country are proof that what we’re seeing is no accident. Simple strategies can drive real progress when applied consistently,” Chen added. “I’m eager to see the impact as we apply similar strategies to other medical procedures and devices and settings.”
A central line, or a central venous catheter, is a tube inserted into a major blood vessel in the neck, chest or groin to serve as a portal for medication, fluids or blood draws in patients who need them frequently. Because central lines also provide quick direct access into a patient’s bloodstream in emergencies, children in the PICU or those undergoing chemotherapy or bone-marrow transplants often have them for weeks to months or, in some cases, years. Inserted incorrectly or not maintained properly thereafter, the central line can become contaminated and provide bacteria and other pathogens easy entry into the patient’s bloodstream. Bloodstream infections can cause organ damage and are fatal in up to one-fifth of children who get them.
The National Association of Children’s Hospitals and Related Institutions (NACHRI) is a membership organization of more than 200 children’s hospitals in the United States, Canada and abroad. NACHRI promotes the health and well-being of children and their families through support of children’s hospitals and health systems that are committed to excellence in providing health care to children. www.childrenshospitals.net
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Founded in 1912 as the children’s hospital of the Johns Hopkins Medical Institutions, the Johns Hopkins Children’s Center offers one of the most comprehensive pediatric medical programs in the country, with more than 92,000 patient visits and nearly 9,000 admissions each year. Hopkins Children’s is consistently ranked among the top children’s hospitals in the nation. Hopkins Children’s is Maryland’s largest children’s hospital and the only state-designated Trauma Service and Burn Unit for pediatric patients. It has recognized Centers of Excellence in dozens of pediatric subspecialties, including allergy, cardiology, cystic fibrosis, gastroenterology, nephrology, neurology, neurosurgery, oncology, pulmonary, and transplant. Hopkins Children’s will celebrate its 100th anniversary and move to a new home in 2012. For more information, please visit www.hopkinschildrens.org
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