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