Outcomes after bloodstream infection in hospitalized pediatric hematology/oncology and stem cell transplant patients.

BACKGROUND: Pediatric hematology/oncology (PHO) patients receiving therapy or undergoing hematopoietic stem cell transplantation (HSCT) often require a central line and are at risk for bloodstream infections (BSI). There are limited data describing outcomes of BSI in PHO and HSCT patients. METHODS: This is a multicenter (n = 17) retrospective analysis of outcomes of patients who developed a BSI. Centers involved participated in a quality improvement collaborative referred to as the Childhood Cancer and Blood Disorder Network within the Children's Hospital Association. The main outcome measures were all-cause mortality at 3, 10, and 30 days after positive culture date; transfer to the intensive care unit (ICU) within 48 hours of positive culture; and central line removal within seven days of the positive blood culture. RESULTS: Nine hundred fifty-seven BSI were included in the analysis. Three hundred fifty-four BSI (37%) were associated with at least one adverse outcome. All-cause mortality was 1% (n = 9), 3% (n = 26), and 6% (n = 57) at 3, 10, and 30 days after BSI, respectively. In the 165 BSI (17%) associated with admission to the ICU, the median ICU stay was four days (IQR 2-10). Twenty-one percent of all infections (n = 203) were associated with central line removal within seven days of positive blood culture. CONCLUSIONS: BSI in PHO and HSCT patients are associated with adverse outcomes. These data will assist in defining the impact of BSI in this population and demonstrate the need for quality improvement and research efforts to decrease them.

Multidisciplinary approach to reduction of central line associated blood stream infections (CLABSI): an institutional experience with collaborative guidelines.

Central line associated blood stream infections (CLABSI) among hematology-oncology patients significantly increase morbidity and mortality and remain a universal challenge. Strategies to decrease risk of CLABSI include adherence to standardized practices for central venous line (CVL) care with sustained long-term compliance on the part of caregivers. In our efforts to reduce CLABSI, a multidisciplinary task force was created to systematically introduce standardized CVL insertion and maintenance care bundles in the hematology-oncology inpatient unit. Data was collected in standardized format according to CDC criteria and compared to historical institutional CLABSI rates. During the first year after implementation of these interventions, our CLABSI rate decreased by 68% and rate reduction has been sustained during following two years. The overall impact (2009-2011) includes 40 CLABSIs prevented, 3 lives saved and institutional health care cost savings in excess of 1 million dollars.