Review of Selected Comprehensive Cancer Centersʹ Written Policies for Preventing Catheter-Related Bloodstream Infections

SSUE: Cancer (CA) patients often require long-term central venous catheter (CVC) access for intravenous support; catheter-related bloodstream infections (CR-BSI) cause significant morbidity & mortality. The Centers for Disease Control & Prevention (CDC) has published evidence-based guidelines for preventing CR-BSI; Category IA recommendations (Cat IA recs) are strongly supported by well-designed experimental, clinical, or epidemiologic studies. The objective was to determine if Cat IA recs are consistently included in Comprehensive Cancer Center (CCC) CR-BSI prevention policies. PROJECT: The CCC Infection Control Group (C3IC) consists of infection control professionals from 14 CCC. C3IC members voluntarily work together to compare practices & data for preventing infection in CA patients. C3IC compared their individual facilityʹs written policies to prevent CR-BSI with CDC guidelines. For each recommendation, responses were Yes/No; blanks were considered unknown. RESULTS: Ten/14 (71%) C3IC centers submitted policy evaluation. All centers required education about insertion & maintenance of CVCs; 70% required periodic knowledge assessment. Hand hygiene, sterile gloves, & skin disinfection before insertion & sterile dressing on the site were included in 100%; maximal sterile barriers for insertion were specified by 90%. The subclavian was the preferred site for insertion of non-tunneled catheters at 70% of CCC; 20% follow this recommendation though not in their written policy. Half of CCC do not routinely administer antimicrobial prophylaxis before insertion nor use topical antibiotic ointment for non-dialysis sites; 60% specify removal when CVC is no longer necessary. Of 34 Cat 1A recs, only 50% were incorporated in policy at 8-10 centers, while 12/34 (35%) were included at 6 or less. Fourteen (41%) Cat 1A recs were practiced although not included in policy, & 15/34 (44%) were left blank by 1-5 C3ICs, possibly indicating lack of knowledge about those recommendations at their facility. LESSONS LEARNED: Written policy at 10 CCC varies in adherence to CDC evidence-based guidelines for preventing CR-BSI. Actual practice differed from written policy, making identification of facility-specific risk factors & appropriate interventions difficult. Future research will compare CR-BSI rates at C3IC facilities to adherence to CDC CR-BSI prevention guidelines.