Central Venous Catheter (CVC)- Related Bloodstream Infections in Pediatric Cancer

小儿癌症中与中心静脉导管 (CVC) 相关的血流感染

• 批准号: 7981684
• 负责人: Rita Lynne Secola
• 金额: $ 3.92万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-06-01 至 2011-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7981684
• 关键词: Central; Venous; Catheter; CVC; Related

DESCRIPTION (provided by applicant): Nosocomial infections rates in hospitalized patients with central venous catheters (CVCs) are a nursing sensitive quality indicator. Pediatric oncology patients with CVCs are a target population at high risk for adverse outcomes by the nature of the device, their disease, and their treatment. Reported strategies to prevent CVC-related bloodstream infections (BSIs) exist in support of CVC evidence-based bundle care, education, surveillance and accountability. Nonetheless, data show that education and monitoring alone have not decreased CVC-related BSI rates consistently. Lapses in compliance are believed to be related to understaffing, increased staff workloads, and downsizing or elimination of specialty care teams (Farrington, 2007; Ryder et al., 1998). Together, these cost-saving attempts may be counterproductive when it comes to CVC-related BSIs. Complication reports indicate that 52% of reported CVC infections are related to staff technique (Ryder et al. 1998). One potential solution is developing or "re-engineering" specialty CVC teams. Two important issues in reducing CVC-related BSIs remain unresolved: 1) the use of specialized CVC teams and 2) nurse-patient ratios (Marschall et al, 2008). The overall purpose of this study is to determine if a CVC team intervention will reduce CVC-related BSIs in pediatric oncology patients. To accomplish this, a two-group randomized crossover trial of a CVC team intervention vs. usual care is proposed. The specific aims of the proposed study are: Specific Aim #1A (unit level): To describe the monthly rate of BSIs over a 12 month period in which on two units patients receive a CVC team intervention (Experimental Unit [EU]) X 6months and patients receive usual CVC care (Usual Care Unit[UCU]) X 6 months. Specific Aim #1B (unit level): To determine whether the CVC team intervention results in a clinically important reduction in CVC-related BSI compared to standard care. Specific Aim #2(Individual level): To examine factors related to CVC-related BSIs and method of CVC care (EU vs.UCU). To support causal inference while controlling for treatment diffusion and crossover, randomization at the unit level will be used. After informed consent, patients in the Experimental Unit will receive CVC blood sampling from a team of specially trained nurses. In the Usual Care Unit, CVC blood sampling will be performed by staff nurses following established hospital protocols. Delivery of CVC care in both units will be monitored by study personnel to determine adherence to protocols via a reliable and valid checklist. Analysis will include measures of central tendency (median, inter-quartile ranges) to describe the distribution of BSIs at the unit level (Aim #1A). Multivariate Cox regression will be used to investigate specific aims #1B/2). The results of this study will hope to provide a nursing model of care that may reduce infections in pediatric oncology patients and improve quality of care. PUBLIC HEALTH RELEVANCE: Reducing or eliminating hospital acquired infections is a national quality of care priority. Many of the 10,000 to 12,000 children diagnosed with cancer each year require long term intravenous access for the delivery of intensive and complex therapies. Pediatric cancer patients are at high risk for infection by nature of their disease, treatment and with a central intravenous catheter device in place. Nursing is often frontline care providers for these catheters in providing safe quality care to minimize the risk of potentially life threatening infections. There is associated substantial hospital financial costs in the care of these infections related to prolonged hospital lengths of stay and increase in the amount of care required to treat these infections. An experimental study is proposed to implement a specialty team of nurses to provide the evidence-based central venous catheter care to pediatric oncology patients as opposed to the assigned bedside nurses to determine its effectiveness in reducing these types of infections in pediatric cancer patients with a central venous catheter. The study will hope to improve a nursing model of care and improve pediatric oncology patient outcomes.

描述（由申请方提供）：中心静脉导管（CVC）住院患者的医院感染率是一项护理敏感质量指标。根据器械的性质、疾病和治疗，患有CVC的儿科肿瘤患者是不良结局的高风险目标人群。已报告的预防CVC相关血流感染（BSI）的策略支持CVC循证一揽子护理、教育、监测和问责。尽管如此，数据显示，教育和监测本身并没有持续降低CVC相关的BSI发生率。合规性的缺失被认为与人员不足、工作量增加以及专业护理团队的缩减或取消有关（法林顿，2007; Ryder等人，1998年）。总之，当涉及到CVC相关的BSI时，这些节省成本的尝试可能会适得其反。并发症报告表明，报告的CVC感染中有52%与工作人员技术有关（Ryder et al. 1998）。一个潜在的解决方案是开发或“重新设计”专业CVC团队。减少CVC相关BSI的两个重要问题仍未解决：1）使用专门的CVC团队和2）护士-患者比率（Marschall et al，2008）。本研究的总体目的是确定CVC团队干预是否会减少儿科肿瘤患者中的CVC相关BSI。为了实现这一点，提出了CVC团队干预与常规护理的两组随机交叉试验。拟议研究的具体目的是：具体目的#1A（单位水平）：描述12个月期间的每月BSI发生率，其中两个单位的患者接受CVC团队干预（实验单位[EU]）× 6个月，患者接受常规CVC护理（住院护理单位[UCU]）× 6个月。具体目标#1B（单位水平）：确定与标准治疗相比，CVC团队干预是否导致CVC相关BSI发生具有临床意义的减少。具体目标#2（个体水平）：检查与CVC相关BSI相关的因素和CVC护理方法（EU vs.UCU）。为了在控制治疗扩散和交叉的同时支持因果推断，将使用单位水平的随机化。在知情同意后，实验单元中的患者将从一组受过专门训练的护士那里接受CVC血液采样。在监护室，CVC血液采样将由护士按照既定的医院方案进行。两个单位中CVC护理的提供将由研究人员监测，以通过可靠和有效的检查表确定对方案的依从性。分析将包括集中趋势指标（中位数、四分位数间距），以描述单位水平的BSI分布（目标#1A）。多变量考克斯回归将用于研究特定目标#1 B/2）。本研究的结果将有望提供一种护理模式，可以减少儿科肿瘤患者的感染，提高护理质量。 公共卫生相关性：减少或消除医院获得性感染是国家护理质量的优先事项。每年有10，000至12，000名儿童被诊断患有癌症，其中许多儿童需要长期静脉注射，以提供强化和复杂的治疗。儿科癌症患者因其疾病、治疗和中心静脉导管装置的性质而处于感染的高风险中。护理人员通常是这些导管的一线护理提供者，提供安全优质的护理，以最大限度地降低潜在危及生命的感染风险。在这些感染的护理中存在与延长的住院时间和治疗这些感染所需的护理量的增加相关的大量医院财务成本。一项实验性研究建议实施一个专业的护士团队，为儿科肿瘤患者提供循证的中心静脉导管护理，而不是指定的床边护士，以确定其在减少这些类型的感染的儿科癌症患者的中心静脉导管的有效性。这项研究将有望改善护理模式，改善儿科肿瘤患者的预后。