Secola, R., Lewis, M. A., Pike, N., Needleman, J., & Doering, L. (2012). "Targeting to zero" in pediatric oncology: a review of central venous catheter-related bloodstream infections. Journal of Pediatric Oncology Nursing, 29, 14–27.

To summarize existing adult and pediatric data on central venous catheter (CVC)-related bloodstream infections (BSIs) and identify models of care that can improve pediatric oncology outcomes.

Databases searched were PubMed, CINAHL, and Google Scholar (1998–2010).

Keywords searched were CVC, BSI, and pediatric oncology.

Patients were included if they

• Had a central venous access device.
• Had the device in place 48 hours prior to development of symptoms and/or culture.
• Had a confirmed culture unrelated to another site.
• Reported a fever of higher than 100.4ºF.

No exclusion criteria were specified.

• The total number of studies included was 24. 
• The studies provided 8,682 total cases; the sample range was not relevant.
• Patients were either adult or pediatric in terrtiarty hospitals or intensive care units. 
• Diagnoses involved were not described, although pediatric oncology was included.
   

• Patients were undergoing the active antitumor treatment phase of care. 
• The study has clinical applicability for pediatrics.

Strategies to reduce CVC-related BSIs reported were summarized.  In regard to insertion site selection and catheter type, some data supported the use of an externalized catheter versus a port in children.  Use of impregnated catheters in children is controversial. Evidence-based guidelines (CVC “bundles”) have been shown to be effective to reduce BSI rates.

Bundles include

• Hand hygiene
• Full barriers at insertion
• Chlorhexidine skin cleansing
• Avoiding the femoral site
• Removal of all unnecessary catheters.

For CVC education, studies showed that annual education enhanced adherence to policy.

Findings suggested that the implementation of CVC care bundles was effective in reducing CVC-related BSI rates.
 

Most studies involved critical care patients and not necessarily those with cancer who would be more immunocompromised.  There was limited research information on pediatric oncology cases.

This review supported the use of CVC care bundles to reduce rates of CVC-related BSIs.  Findings suggested that regular and repeated education on CVC care can improve adherence to care protocols.