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Bloodstream Infections in Pediatric Oncology Outpatients: A New Healthcare Systems Challenge

Published online by Cambridge University Press:  02 January 2015

Theresa L. Smith ,
Gregg T. Pullen ,
Vonda Crouse ,
Jon Rosenberg  and
William R. Jarvis
Theresa L. Smith*
Affiliation:
Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia
Gregg T. Pullen
Affiliation:
Fresno Children's Hospital, Fresno, California
Vonda Crouse
Affiliation:
Fresno Children's Hospital, Fresno, California
Jon Rosenberg
Affiliation:
California Department of Health Services, Berkeley, California
William R. Jarvis
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Atlanta, Georgia
*
Epidemiology Program Office, New Mexico Department of Health, 1190 St. Francis Dr., N 1307, Santa Fe, NM 87505
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Abstract

Objective:

To investigate a perceived increase in central venous catheter (CVC)–associated bloodstream infections (BSIs) among pediatric hematology–oncology outpatients.

Design:

A case–control study.

Setting:

A pediatric hematology–oncology outpatient clinic at Fresno Children's Hospital.

Patients:

Pediatric hematology–oncology clinic outpatients with CVCs at Fresno Children's Hospital between November 1994 and October 1997.

Methods:

A case-patient was defined as any hematology–oncology outpatient with a CVC-associated BSI at Fresno Children's Hospital from November 1996 to October 1997 (study period) without a localizable infection. To identify case-patients, we reviewed Fresno Children's Hospital records for all hematology–oncology clinic patients, those with CVCs and those with CVCs and BSIs. Control-patients were randomly selected hematology–oncology outpatients with a CVC but no BSI during the study period. Case-patient and control-patient demographics, diagnoses, caretakers, catheter types, catheter care, and water exposure were compared.

Results:

Twenty-five case-patients had 42 CVC-associated BSIs during the study period. No significant increase in CVC-associated BSI rates occurred among pediatric hematology–oncology patients. However, there was a statistically significant increase in nonendogenous, gram-negative (eg, Pseudomonas species) BSIs during summer months (May–October) compared with the rest of the year. Case-patients and control-patients differed only in catheter type; case-patients were more likely than control-patients to have a transcutaneous CVC. Summertime recreational water exposures were similar and high in the two groups.

Conclusions:

Hematology–oncology clinic patients with transcutaneous CVCs are at greater risk for CVC-associated BSI, particularly during the summer. Caretakers should be instructed on proper care of CVCs, particularly protection of CVCs during bathing and recreational summer water activities, to reduce the risk of nonendogenous, gram-negative BSIs.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 5 , May 2002 , pp. 239 - 243
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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