"Triple Threat" Against Infections in Children With Cancer

Pediatric cancer patients had fewer central line infections when program followed

/ Author:  / Reviewed by: Chris Galloway, M.D.

(RxWiki News) What’s known as the “central line” is a lifeline for a child being treated for cancer. This is a tube that’s put into a major blood vessel. It’s the way medications and fluids enter the bloodstream and how blood is drawn.  The central line has to be handled properly to avoid infections that can be deadly.

A three-pronged approach can help avoid dangerous central line infections in pediatric cancer patients.

This so-called “triple threat” approach includes: the healthcare team focusing on safe handling, families speaking up when they see something is wrong, and being honest about what’s the root cause of all infections.

"Speak up if something's not right."

According to the Centers for Disease Control and Prevention, about 250,000 central line infections occur in the U.S. every year. Up to one in four of these infections is fatal, and each event costs nearly $25,000.

Researchers at Johns Hopkins Children's Center conducted the first study to learn how to best prevent these infections in children. Pediatric oncology nurses, doctors and safety experts from the pediatric inpatient cancer unit worked together during this two-year study.

"Children receiving cancer treatment are uniquely prone to invasive bloodstream infections because of their weakened immunity and because their central lines are accessed multiple times a day, with each entry posing a risk for infection," said lead investigator Michael Rinke, MD.

Dr. Rinke is both a pediatrician and a patient safety expert at the Johns Hopkins Children's Center.

Nurses and doctors work with the central line anywhere from 10-30 times a day. A central line can cause all sorts of problems if it’s inserted incorrectly or not handled properly after it’s been placed in the child. Bacteria and other germs can enter the child’s bloodstream and cause infections, even organ damage.

Here’s the “triple-threat” the team developed to prevent central line infections in children being treated for cancer or receiving a bone marrow transplant.

First, nurses came up with better ways of handling the device, including:

  • changing the dressing covering the line often
  • changing the tubes and caps attached to the line
  • cleaning the line before and after it’s used
  • wearing gloves and face masks while handling the central line
  • washing hands before and after working with the line


Next, the parents were encouraged to speak up when they saw something that wasn’t right. They were given wallet cards outlining the proper central line care.

"Parents can act as an invaluable second set of eyes, and we urged them to be vigilant about the way their child's central line was handled," said co-investigator, Kim Drucis, MSN., RN, a pediatric oncology nurse. "We also encouraged them to ask questions and to speak up every time they noticed something different."

Finally, the oncology nurses carefully tracked, analyzed and discussed exactly what caused every infection that occurred in a month’s time..

"Honest dissection of one's practice is neither easy nor pleasant, but is absolutely critical to illuminate areas for improvement," says co-investigator, Stephanie Panton, MSN, RN, CPON.

During the two-year study period, there were 20 percent fewer infections. In the first year, there was no meaningful change. The next year, infection dropped by 64 percent.

This study appeared September 3, in the October issue of Pediatrics. The research was funded by the Institutes of Health. This research was funded by the National Institutes of Health.

One of the authors receives grant support from Sage Products, Inc. Other authors reported no conflicting financial relationships.

Reviewed by: 
Review Date: 
September 5, 2012
Last Updated:
September 7, 2012