PhD

dissertationCentral vascular catheters (CVCs) are essential for patients receiving a bone marrow transplant (BMT). Central line infections (CLI) pose a serious threat to BMT patients, causing increases in morbidity, financial expenses, and even treatment-related mortality. Determining best practices in prevention of CLI in BMT patients is vital but understudied. The Centers for Disease Control and Prevention (CDC) has published guidelines, including four specific performance indicators (Pis), for prevention of intravascular catheter-related infections. To date, no published study has examined use of the Pis in the CDC guidelines in the care of BMT patients. The purpose of this study was to examine practice patterns among US BMT centers and to determine whether select recommendations in the CDC guidelines are used to prevent CLI in BMT patients. Specific aims of this study were to (a) describe selfreported practice patterns for prevention of CLI in participating US BMT centers, (b) to determine the extent of use of the Pis, (c) to determine which other practice factors are associated with self-reported use of the Pis, and (d) to describe self-reported rates of CLI in participating BMT centers. A survey was mailed to all US BMT centers listed on the BMT InfoNet website. Sixty of 189 BMT centers (32%) participated by completing and returning the survey. The survey assessed practices related to prevention of CLI in BMT patients. Results of the study indicated (a) that practice patterns for CLI prevention vary among participating BMT centers, (b) that overall self-reported use of three of the four CDC Pis was generally high, (c) that six factors were associated with self-reported use of the Pis, and (d) that most participants could not or would not report CLI incidence rates for their BMT centers. CLI in BMT patients can be a matter of life and death. Improving patient outcomes by decreasing rates of CLI depends upon tracking and trending rates of CLI, strengthening roles and coordination within the BMT care team, and strengthening BMT center healthcare worker education programs