A preoperative protocol for the prevention of infection in children with tunnelled right atrial catheters

The use of central venous lines has come to be widely accepted by children with cancer and their families. However, attendant infection is a cause of considerable morbidity. Coagulase-negative staphylococci, the predominant a erobic species on the skin, are now the commonest cause of catheter-related bacteremia. We introduced a protocol to reduce the colonization of the ski n at the catheter insertion site. Antiseptic skin scrubs, with 4% chlorhexi dine gluconate, were performed on the neck and anterior chest the night bef ore and again on the morning of the surgical procedure. A single dose of ce phalothin (or vancomycin for penicillin-allergic patients) was administered IV immediately before the operation. Compared to the 12 month period prior to initiation of this protocol, the rate of 'early' infections (occurring within 30 days of catheter placement) in the 3.5 year period of interventio n dropped from 8 to 4.9 per 1,000 catheter days. The proportion of 'early' infections that were staphylococcal was reduced from 93 to 63% and the prop ortion of non-ports removed within 30 days of placement fell from 45 to 0%. Despite these changes, the major contribution to improved infection contro l appeared to be the use of an increased proportion of ports (a rise from < 10 to almost 60%).