Nursing strategies for preventing central venous cathater infections in pediatric hematology patients

This research was conducted to investigate the effect of developed nursing strategies to prevent the catheter infections in pediatric hematology patients with central venous catheters between June 30th 2014- April 30th 2015 at Ege University Children's Hospital Pediatric Hematology Unit. The developed nursing strategies included in research; determine steps for catheter initiatives, observe nurses' ability status as reliably of catheter initiatives, give education "Controlling Catheter-Related Bloodstream Infections" to nurses, observe nurses again, use needless connector and alcohol swab attempt to secure the catheter, use chlorhexidine at catheter dressing, comparison of the effectiveness of CHG-Tegaderm and IV-Tegaderm on the development of infection, develop " Home Care Guide for Children with Central Catheters and Families". The sample of the first stage of research included 8 nurses, second stage included 34 children and third stage included 27 children determined by stratified randomization. In the first phase of the research, all nurses' catheter initiatives were observed for a day in unit. Education given to nurses, front-end tests evaluated the effectiveness of the education. Each nurse was observed again for one day. Patients with CVC were screened retrospectively from patient files to assess the effectiveness of research at catheter infection rate reduction in the second phase of the research. In the third phase of the research, developed nursing strategies were implemented, patients were randomized, CHG-Tegaderm is applied to study group and IV-Tegaderm is applied the control group. At results of observations and education, nurses' average scores from observation forms and test scores related education were found to show a statistically significant increase. In a retrospective screening results, it was determined that catheter infection developed in 61.8% of patients. Microorganisms isolated in the catheter; CNS, P. aeruginosa, E. faecalis, E. coli , S. maltophilia, P. putida, C. freundii and enterobacter, 28.5% of catheter were removed due to infection. Exit site infections developed in 14.7% of patients. In the randomized controlled trial reported, in 28.6% of patients in the study group, 38.5% of patients in the control group catheters were found to develop infections. Exit site infections in patients in the study group not developed, but developed in 15.4% of patients in the control group. CNS, R. picketti and E. cloaca isolated in patients with study group, CNS, R. picketti and B. cepacia isolated in patients with control group. Catheters were removed at 14.3% of the patients in the study group, 11.1% of patients in the control group. In terms of catheter infection, exit site infection, microorganism and the removal of catheter statistically significant difference was not found. In all the study group of patients with catheter infection was found attached Hickman catheter, all control group were found attached port. A statistically significant difference was found in terms of type of catheter. Average time between the date of catheter placement and recruitment, total catheter days, the treatment phase, neutrophil counts, neutropenia development status, neutropenia time, bacteremia development status, fever duration and CRP terms were not found statistically significant different at study and control group which catheter infection development and not. In the second phase of the research, catheter infection rate of 7.8‰, the CLABSI ratio of 3.7‰ and exit site infection rate was then 1.8‰. In the third phase of the research, catheter infection rate of 4.2‰, the CLABSI ratio of 3.7‰ and exit site infection rate was then 1.7‰. Developed nursing strategy to prevent catheter-related bloodstream infections, between the second and third phase of research, 46% the infection rate reduction, 51% CLABSI reduction and 5% of exit site infection reduction has been achieved. Developed nursing strategies have been found to reduce catheter infections.