Does the number of exogenous infections increase in paediatric oncology patients when sterile surgical gloves are not worn for accessing Central Venous Access Devices?

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Summary

The aim of this study was to determine whether the routine use of sterile gloves when accessing central venous catheters (CVCs) affects the incidence of exogenous septicaemia in paediatric oncology patients. The 36-month study period ran prospectively from September 2000 to August 2003. During this time the routine use of sterile gloves for accessing CVCs was suspended. Sterile gloves were only used when obtaining blood samples from the line or injecting substances that required direct entry into the lumen with removal of line cap. Surveillance cultures of throat and rectum were obtained to detect carriage of potential pathogens. Exogenous septicaemia was defined as a blood stream infection due to microorganisms not carried by the patient in throat and/or rectum. The incidence of exogenous septicaemia following a change of practice of not routinely using sterile gloves for accessing lines was compared to the incidence of exogenous septicaemia in a historical control group. The number of exogenous septicaemia episodes per inpatient days with gloves and without gloves was calculated for the total number of episodes and for the first episode for each child. The relative incidence and 95% confidence intervals was also calculated for first and total episodes. For both, all episodes and first episodes there was no statistically significant difference in the incidence of exogenous septicaemia comparing the control and study patients. In summary, this study does not support or approve the use of sterile gloves when accessing CVCs in respect of exogenous septicaemia.

Zusammenfassung

Hintergrund

Das Ziel dieser Studie bestand darin, zu untersuchen, ob die routinemäßige Anwendung von sterilen Schutzhandschuhen bei der Handhabung von zentralen Venenkathetern (ZVK) einen Einfluss auf die Inzidenz von extraluminalen Septikämien bei krebskranken Kindern hat.

Methodik

Die 36-monatige prospektive Studie dauerte von September 2000 bis August 2003. Während dieses Zeitraumes wurde die routinemäßige Anwendung von sterilen Schutzhandschuhen bei der Handhabung von ZVKs eingestellt. Sterile Handschuhe wurden nur verwendet, um Blutproben aus dem Katheter zu entnehmen oder Arzneimittel in den Katheter injiziert zu injizieren; hierzu war ein direkter Zugang zum Lumen durch Entfernen der Schutzkappe des ZVK erforderlich.

Zu Surveillance-Zwecken wurden Rachen- und Rektalabstriche entnommen, um Besiedlungen mit potentiell pathogenen Keimen zu identifizieren. Als „extraluminal“galten Septikämien, die durch Mikroorganismen verursacht wurden, mit denen die Patienten im Bereich des Rachens und/oder Rektums nicht besiedelt Waren. Nachdem die Praxis, bei der Handhabung von ZVKs routinemäßig sterile Schutzhandschuhe zu verwenden, aufgegeben worden war, wurde die Inzidenz extraluminaler Septikämien mit derjenigen bei Probanden einer historischen Kontrollgruppe verglichen.

Ergebnisse

Bei jedem Kind wurde die Zahl der Episoden extraluminaler Septikämien pro stationärer Patiententag mit und ohne Schutzhandschuhe anhand der Gesamtzahl der Episoden sowie anhand der ersten Episode berechnet. Die relative Inzidenz und das 95%-Konfidenzintervall wurden ebenfalls anhand der Gesamtzahl der Episoden sowie ersten Episode berechnet. In beiden Fällen (Gesamtzahl der Episoden und erste Episoden) fand sich kein statistisch signifikanter Unterschied zwischen Probanden und Kontrollpersonen im Hinblick auf die Inzidenz von extraluminalen Septikämien.

Schlussfolgerung

Die Ergebnisse dieser Studie sprechen dafür, dass es nicht sinnvoll ist, beim Handhaben von ZVKs sterile Schutzhandschuhe zu verwenden.

Section snippets

Background

Central venous catheters (CVCs) represent one of the most important advances in the care of children with cancer. Currently there is a range of devices in use including external Hickman and Broviac lines and implantable ports. These devices are used for the administration of chemotherapy, blood products, parenteral nutrition, intravenous antibiotics and also blood sampling. Whilst these advances have contributed significantly to the management of children with cancer the use of these devices

Aim

This study looked at the incidence of exogenous infection for our paediatric oncology population following a change in practice, i.e. not wearing sterile gloves for all procedures. The incidence of infection following change of practice was compared to that for historical controls.

Setting

The study was undertaken at the Regional Oncology Unit at the Royal Liverpool Children's Hospital which is the referral centre for Merseyside, North Wales, Isle of Man and parts of Cheshire. Until March 2003, patients

Methods

The 36-month prospective study period ran from September 2000 to August 2003. During this time, the routine use of sterile gloves for accessing CVCs was suspended, unless the injection obturator was being removed, i.e. for blood sampling in all patients presenting to the Oncology Unit. Non-sterile gloves were worn to safeguard operator safety when handling any blood products and non-sterile nitrile gloves were used for the delivery of cytotoxic chemotherapy. A closed system i.e. Bionnector® was

Results

Patient demographics are presented according to the number of the septicaemia episodes in Table 1. There were 78 episodes (65 first episodes) of exogenous septicaemia during the 3-year control period and 99 episodes (73 first episodes) of exogenous septicaemia during the study period. A year-by-year breakdown of all exogenous septicaemias is shown in Table 2 and isolates in Table 3. Unit activity is shown in Table 4.

For all episodes of exogenous septicaemia, the incidence of infection during

Discussion

To our knowledge this observational study is the first study to examine the effect of the routine use of sterile gloves on the risk of septicaemia in children being treated for cancer. For all episodes of septicaemia, there was a small increase in the rate of exogenous septicaemia in the period after the routine use of sterile gloves was abandoned, although this difference was not statistically significant. When only the first episode of exogenous septicaemia for an individual child was

Conflict of interest

There are no conflicting interests from any of the authors.

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