601 A Simple Dressing for Prevention of Central Line Infections in Pediatric Burn Patients

Abstract

Abstract Introduction Between 2017 and 2018, the burn unit saw 16 patients with major burns. A major burn is considered a total body surface area of 20% or greater. The burns ranged from 20% to 85% total body surface area averaging 44.14 %. Of those 16 patients, 8 patients required central lines that could not utilize a traditional occlusive central line dressing. Central line access is often placed near a burn or grafted site, and an occlusive dressing cannot be maintained. On average, a central line was changed in the operating room every seven days for infection prevention or sooner if an infection is suspected. The lines were changed preferably to a new site or over a wire if limited sites. In 2017, our Burn unit’s central line associated bloodstream infection rate of 4.1 infections per 1000 catheter days. This was higher than the national benchmark centerline from the Children’s Hospital Solutions for Patient Safety national collaborative for pediatric intensive care units of 1.365 infections/1000 catheter days. The unit implemented the use of a 4x4 betadine dressing for microbial coverage as an innovative strategy to prevent central line associated blood infections. The method not only proved to be effective but also cost efficient. Methods While the standard of changing the central line every 7 days remained the same, our unit began using a 4x4 gauze soaked in betadine and placed over the central line insertion site. The gauze is moistened with the betadine solution, then rung out so that the gauze is not oversaturated. That gauze is placed directly over the insertion site using sterile technique. A dry gauze is then placed over the wet one to protect from pathogens in the environment. Both gauze pads are then changed every 4 hours to keep the betadine moist and working as an antimicrobial agent. Results In 2018, 4 patients with various central lines utilized the betadine technique with our overall central line associated blood infection rate for 2018 decreased to 0 infections/1000 catheter days. The cost of each occlusive central line dressing in our facility is $2.10, whereas the betadine method costs $0.97. These supplies can be used for more than one dressing change on each patient compared to the occlusive dressing that is used once. Conclusions Using the betadine dressing technique to protect against central line associated bloodstream infections has proven to be an effective, low cost technique to prevent line infections and improve patient outcomes for major burn patients with compromised skin integrity. By utilizing this technique, our overall central line infection rate has dropped significantly below the national average, while decreasing cost by over 50%. Applicability of Research to Practice Maintaining a low cost, effective dressing to help prevent line infections in major pediatric burn patients.