Reducing central venous catheter-related bloodstream infections in children with cancer.

PURPOSE/OBJECTIVES To determine whether a comprehensive educational program influenced the incidence of hub colonization of central venous catheters (CVCs) and bloodstream infection rates in children with cancer, to identify risk factors related to infection rates, and to determine the impact of an educational program on nurses' knowledge of CVC care for children with cancer. DESIGN Prospective, longitudinal. SETTING Pediatric cancer center in a large children's hospital in the southwestern United States. SAMPLE 51 catheter hub cultures were obtained from 27 children with cancer, and 121 nurses participated in the educational intervention. METHODS CVC hub cultures were obtained prior to and three months after an educational intervention. A written pre- and posteducation assessment was used to evaluate the nurses' learning. MAIN RESEARCH VARIABLES Hub colonization and bloodstream infection rates. FINDINGS Post-test mean score of 87% was significantly higher than the pretest mean score of 72%. Prior to the education program, 57% of the hubs were culture positive, and after the educational program, the proportion of culture-positive hubs was reduced to 36%. CONCLUSIONS A comprehensive educational program increases nurses' knowledge of CVC care and reduces CVC hub colonization and catheter-related bloodstream infections in children with cancer. IMPLICATIONS FOR NURSING Patient and family participation in practice changes is very important because they have the most to gain. Additional research evaluating the relationship between hub colonization and subsequent bloodstream infection in a larger sample is warranted.