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Methods for Preventing Central Line Associated Bloodstream Infection in Pediatric Hematology-Oncology Patients: a Systematic Literature Review, 2010-2020

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Methods for Preventing Central Line Associated Bloodstream Infection in Pediatric Hematology-Oncology Patients: a Systematic Literature Review, 2010-2020 THESIS CALIFORNIA STATE UNIVERSITY SAN MARCOS THESIS SIGNATURE PAGE PROJECT SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE MASTER OF PUBLIC HEALTH TITLE: Methods for preventing central line associated bloodstream infection in pediatric hematology-oncology patients: A systematic literature review, 2010-2020 AUTHOR(S): Kimberly Balkan DATE OF SUCCESSFUL DEFENSE: 11/16/2020 THETHE THESISPROJECT HAS HAS BEEN BEEN ACCEPTED ACCEPTED BY BY THE THE THESIS PROJECT COMMITTEE COMMITTEE IN IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF PUBLIC HEALTH Deborah Morton Nov 17, 2020 COMMITTEE CHAIR SIGNATURE DATE Christina Holub COMMITTEE MEMBER SIGNATURE DATE COMMITTEE MEMBER SIGNATURE DATE COMMITTEE MEMBER SIGNATURE DATE 1 Methods for preventing central line associated bloodstream infection in pediatric hematology-oncology patients: A systematic literature review, 2010 - 2020 Kim Balkan Department of Public Health, California State University, San Marcos PH 698: Thesis Dr. Deborah Morton November 30, 2020 2 Abstract Central line associated bloodstream infections (CLABSIs) are a significant source of patient morbidity and mortality with high financial costs. CLABSI is the most common complication of having a central line (Castro et al., 2020). Central lines are used for a variety of purposes, including the transportation of life-saving fluids and medicine in emergent situations, nutrition and cancer therapies (Castro et al., 2020). Potential sources of CLABSI infection include skin colonization, intraluminal contamination of central lines, hematogenous seeding, and infusate contamination (Marschall et al., 2014; O’Grady et al., 2011). A systematic literature review was conducted to identify methods of preventing the first occurrence of CLABSI in pediatric cancer patients. Pediatric patients age 18 and younger have unique microbiology and epidemiology of infection, pharmacology, and physiological development (McNeil et al., 2019). Pediatric patients undergoing cancer treatment are disproportionately affected by CLABSI (Duffy et al., 2015). Susceptibility to infection, caused by prolonged periods of immunosuppression from cancer or cancer therapy, can result in CLABSI rates up to 17.95% (McMullen et al., 2013). Cancer patients may receive treatment in an inpatient or outpatient setting. In recent years, central lines have become more common for outpatients. Patients must take proper care of the catheter outside of the healthcare environment to prevent infection. The preventative methods to reduce the risk of CLABSI focus on staff education, patient hygiene, and insertion and maintenance of central lines (McNeil et al., 2019). Based on the articles included in this systematic literature review, care bundles, catheter flushing, and catheter lock therapy should be part of infection control best practices for preventing CLABSI in pediatric cancer patients. 3 Acknowledgements I have much appreciation for California State University, San Marcos and the Master of Public Health program and staff for keeping my cohort on track to graduate as scheduled during the COVID-19 pandemic. I wish to thank Dr. Deborah Morton for serving as my thesis chair and Dr. Christina Holub for serving as my second committee member. A special thanks to Dr. Rodney Beaulieu for taking the time to read my thesis drafts and provide helpful feedback. I have sincere gratitude for everyone else who supported my participation in this graduate program and for being accommodating and flexible throughout my studies, especially Kathleen Korn, Ekaette Mbong and Pam Balkan. 4 List of Tables Table 1. Characteristics of included literature Table 2. Analysis of included literature Table 3. Research findings Table 4. Research conclusions 5 List of Figures Figure 1. Flowchart of literature screening and assessment 6 Table of Contents Methods for preventing central line associated bloodstream infection in pediatric hematology-oncology patients: A systematic literature review, 2010 - 2020 .......................... 1 Abstract .........................................................................................................................................2 Acknowledgements .......................................................................................................................3 List of Tables .................................................................................................................................4 List of Figures ................................................................................................................................5 Methods for preventing central line associated bloodstream infection in pediatric hematology- oncology patients: A systematic literature review, 2010 - 2020 .......................................................7 Healthcare-associated infections .................................................................................................................... 7 Infection prevention ...................................................................................................................................... 7 Surveillance .................................................................................................................................................. 10 CLABSI ......................................................................................................................................................... 11 Statement of the Problem ............................................................................................................ 13 Morbidity, Mortality and Financial Cost ..................................................................................................... 13 Pediatric Population ..................................................................................................................................... 13 Hematology-Oncology ................................................................................................................................. 14 Methods of CLABSI Prevention ................................................................................................................... 14 Research Goal .............................................................................................................................. 16 Literature Themes ........................................................................................................................................ 16 Hypotheses ................................................................................................................................................... 17 Methods ...................................................................................................................................... 17 Search Strategy ............................................................................................................................................. 18 Characteristics of Literature ......................................................................................................................... 19 Results ......................................................................................................................................... 19 Methods for preventing CLABSI .................................................................................................................. 19 Research Themes and Conclusions .............................................................................................................. 21 Discussion ................................................................................................................................... 22 Strengths ...................................................................................................................................................... 23 Limitations ................................................................................................................................................... 23 Public Health Implications .......................................................................................................................... 24 Future Direction ........................................................................................................................................... 25 References ................................................................................................................................... 26 Table 1 ........................................................................................................................................ 36 Table 2 ..........................................................................................................................................1 Table 3 ..........................................................................................................................................1 Table 4 ..........................................................................................................................................2 Figure 1 ........................................................................................................................................3 7 Methods for preventing central line associated bloodstream infection in pediatric hematology-oncology patients: A systematic literature review, 2010 - 2020 Healthcare-associated infections Patients seeking care at hospitals and outpatient clinics
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