Medical School for International Health, Beer Sheva, Israel.
Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
J Pediatric Infect Dis Soc. 2020 Apr 30;9(2):188-193. doi: 10.1093/jpids/piz006.
Central line-associated bloodstream infections (CLABSIs) are major sources of morbidity, death, and healthcare costs in patients who receive home parenteral nutrition (HPN). The majority of HPN-dependent children in southern Israel reside in poor communities with substandard living conditions, which creates significant challenges for the safe provision of HPN. We developed a pilot intervention that aimed to reduce the rates of CLABSI and central venous catheter (CVC) replacements in this vulnerable population in our region.
Between 2012 and 2014, all HPN-dependent children with intestinal failure who were treated in our center, received HPN through a Hickman catheter, and experienced at least 1 previous CLABSI episode participated in the intervention. The intervention included home visits to assess the caregivers' CVC-handling technique, instillation of prophylactic ethanol lock solution, and the convening of regular multidisciplinary staff debriefings. We calculated CLABSI and CVC-replacement rates before and after the intervention.
Eight patients who served as their own historical controls were included in the intervention (total of 2544 catheter-days during the intervention period). The mean CLABSI rate decreased from 9.62 to 0.79 CLABSI episodes per 1000 catheter-days; the CVC-replacement rate decreased from 2.5 to 1.2 replacements per 1000 catheter-days in the preintervention and intervention periods respectively. The median hospital length of stay and individual monthly cost of medical care decreased compared to those found in the preintervention period.
The results of this study offer a proof of concept for a strategy to reduce CLABSI rates in pediatric patients who reside in remote and low-resource environments and are undergoing HPN.
中心静脉导管相关性血流感染（CLABSIs）是接受家庭肠外营养（HPN）治疗的患者发病率、死亡率和医疗保健费用的主要来源。在以色列南部，大多数依赖 HPN 的儿童居住在生活条件较差的贫困社区，这给 HPN 的安全提供带来了重大挑战。我们开发了一项试点干预措施，旨在降低我们地区这一弱势群体中 CLABSI 和中心静脉导管（CVC）更换的发生率。
2012 年至 2014 年，我们中心治疗的所有患有肠衰竭且依赖 HPN 的儿童均通过 Hickman 导管接受 HPN，并至少经历过 1 次 CLABSI 发作，他们参与了该干预措施。该干预措施包括家访以评估护理人员的 CVC 处理技术、灌输预防性乙醇锁溶液以及定期召开多学科工作人员情况汇报会。我们计算了干预前后 CLABSI 和 CVC 更换率。
8 名患者作为自身历史对照纳入干预组（干预期间共 2544 个导管日）。CLABSI 发生率从 9.62 降至 0.79 例/1000 导管日；CVC 更换率从干预前的 2.5 降至 1.2 例/1000 导管日。与干预前相比，住院时间中位数和个人每月医疗费用中位数均有所下降。
这项研究的结果为在远程和资源匮乏环境中接受 HPN 治疗的儿科患者中降低 CLABSI 率的策略提供了概念验证。
