Following some basic rules of central line hygiene and maintenance, Johns Hopkins Children’s Center and 87 other pediatric hospitals have, over five years, saved hundreds of patient lives and more than $100 million by preventing nearly 3,000 central line-related bloodstream infections, hospital officials announced this week.
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 bloodstream infections. Each infection carries a price tag of up to $45,000, experts estimate.
The program debuted across pediatric intensive care units (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," says Marlene Miller, MD, MSc, 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, MD, PhD, MHS, 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 adds. "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.