PI’s: Scott Hollister & Joanna Newton
Children with cancer have central venous catheters (CVCs) – catheters that are inserted into the large blood vessels feeding the heart – in order to safely deliver chemotherapy. These devices may be implanted under the skin (port-a-caths) and then accessed with a needle with attached tubing to deliver medication, or they may be externalized catheters that have 1 or more lumens that can be accessed to deliver medications. Both types of CVCs put patients at risk for central line-associated blood stream infections (CLABSIs), and these infections result in prolonged illness, hospitalization, often with intensive care unit stays, delays in chemotherapy administration leading to suboptimal cancer care, and sometimes death (Bundy, D.G. et al, Pediatrics, 2014). They affect tens of thousands of children and adults with central venous catheters (CVCs) each year (Dudeck, M.A. et al, Am J Infect Control, 2011). Furthermore, they cost the healthcare system substantial money as the charges incurred related to CLABSI can reach $75,000 for a single event (Wilson et al, Am J Infect Control, 2014). Some have reported that the estimated cost to the U.S. Healthcare system annually is $2.3 billion (Guerin, K. et al, Am J Infect Control, 2010).
Preventing CLABSI in pediatric oncology and hematopoietic stem cell transplant (HCT) patients poses unique challenges. Unlike patients admitted to the pediatric ICU who have CVCs placed for just a brief time for a severe, acute illness, pediatric oncology and HCT patients may have their CVCs in place for months or years at a time (Duffy, E.A. et al, J Pediatr Oncol Nurs, 2015). Their CVCs are at high risk of microbial contamination from the environment because they are used so regularly and are in place for so long. Moreover, these patients are at the highest risk for CLABSI, compared to other children with CVCs, due to their immunocompromised state as well as their frequent exposure to blood products and total parenteral nutrition, both known to increase the occurrence of CLABSI (Choi, S. et al, Pediatr Blood Cancer, 2013).
While providers have been relatively successful at preventing CLABSI related to CVC insertion by utilizing the Institute for Healthcare Improvement’s “CVC insertion bundle,” they have not been successful at preventing CLABSI that occurs subsequent to insertion (Provonost, P et al, N Eng J Med, 2006). We believe that this is due, in part, to ineffective strategies for preventing environmental contamination of CVCs, especially while the CVC is in use (Herriage, T et al, J Pediatr Oncol Nurs, 2015). CVC tubing and connections are openly exposed to everything in patients’ environment – it may drag on the floor, contact dirty diapers (in the case of toddlers), and is frequently handled by the patient and healthcare workers. Therefore, it is necessary to create a device that can protect the CVC from environmental contamination without interfering with CVC use.