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Title: Catheter-Related Bloodstream Infection Rates in a Pediatric Population Can be Reduced by Pediatric-Relevant Intervention: Presented at AAP

"Catheter-Related Bloodstream Infection Rates in a Pediatric Population Can be Reduced by Pediatric-Relevant Intervention: Presented at AAP"

By Brian Reid WASHINGTON, DC -- October 11, 2005 -- A four-part intervention designed to drive down the rate of catheter-related bloodstream infections in children can effectively lower infection rates, though other factors should be carefully monitored to minimize the potential for infection, researchers reported here at the American Academy of Pediatrics (AAP) National Conference and Exhibition. Christopher McKee, a fellow in anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine, and colleagues modified a set of interventions designed for adult patients to target to fight catheter-related bloodstream infections in children. Dr. McKee presented the results of their interventions at the AAP meeting on October 9[^th.

The team emphasized four elements to ensure the site remained sterile during the catheter placement -- hand hygiene, use of chlorhexidine instead of betadine, maximal barrier protections and steps to ensure that the line would remain sterile while dressed.

Shortly after the intervention, however, infection rates spiked, according to Christopher McKee.

"We couldn't figure out how people doing everything right could lead to a rise in infections," he said. Researchers examined carefully the protocol and the setup and determined that a change to a positive displacement mechanical pump was causing the problems. Dr. McKee said the infection rate dropped quickly once the problem was corrected.

That outcome underscores the importance of evaluating carefully the changes in technology that could affect infection rates. "Vigilance needs to occur, because despite our best efforts, other [complications] may crop up."

The infection rate is now "almost zero" as a result of the intervention, he said. In addition to emphasizing the four steps to ensure a sterile procedure, the team's efforts were helped by the development of "line carts" to carry all the equipment needed to perform the procedure according to the new guidelines. Those carts are the only expense in an intervention that McKee said was implemented at "essentially no cost."

The other important factor in driving down infection rates in the pediatric setting was the empowerment of nurses to stop any procedure that does not follow the guidelines. That decision was particularly effective in ensuring that the guidelines were followed, he said.

[Presentation title: Elimination of Catheter-Related Bloodstream Infections in Pediatric Patients.]

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