258 Infection 34 · 2006 · No. 5 © URBAN & VOGEL Infection Clinical and Epidemiological Study Influence of Prolonged Use of Intravenous Administration Sets in Paediatric Cancer Patients on CVAD-related Bloodstream Infection Rates and Hospital Resources A. Simon, G. Fleischhack, G. Wiszniewsky, C. Hasan, U. Bode, M. H. Kramer Abstract Background: To assess the effects of extending the routine intravenous administration set (IVAS) change-interval from 72 h (group 1) to 7 days (group 2) on the incidence density for central venous access device (CVAD)-related bloodstream infections (BSIs) and on resource expenditures in a single- centre pilot study. Procedure: Prospective pre-/post-intervention comparison of two consecutive 12-month surveillance periods (2001–2003) in a 17-bed paediatric oncology tertiary care unit. IVAS changes and nosocomial infections (NIs) were prospec- tively analysed using a standardized unit-based surveillance system (Oncopaed NI). Results: All 175 eligible patients were enrolled, 96 in group 1 and 79 in group 2. Both groups had similar distributions of primary diagnoses and risk factors. The proportion of IVAS changes performed after 3 days increased from 5.6% to 22.5%, but only 8% of IVASs in group 2 were changed after 7 days. Most IVAS changes (64.8% in group 1 and 92.9% in group 2) were done because of therapeutic interven- tions (blood products, parenteral nutrition [TNP]) before the scheduled endpoint. Overall, the rates and incidence densities of NIs were significantly lower during the second period. The corresponding results for CVAD-related BSIs did not show significant differences. No death attributable to a NI occurred. The ‘7-day’ strategy resulted in cost savings for devices (3,300$/year) and of nursing time (23 working days/year). Conclusions: Extending the routine IVAS change-interval from 3 days to 7 days appears to be safe and cost-effective in a paediatric oncology unit with high infection control standards and continuous surveillance for NIs. These results do not prove that 7-day intervals prevent infections, but they do suggest that this policy probably is not harmful and that a prospec- tively randomized study with sufficient power is needed. Infection 2006; 34: 258–263 DOI 10.1007/s15010-006-5646-y Introduction The use of long-term central venous access devices (CVADs) in supportive care contributes to the intriguing success of chemotherapy in paediatric oncology. However, the use of CVADs also increases the risk for infection [1, 2]. A reduced dose intensity due to a therapeutic delay in patients with infectious complications negatively affects the success of anticancer treatment and may increase mor- tality [3]. Catheter-related infections result in an increased length of hospital stay and in higher costs [4, 5] and drain resources for nursing care, antimicrobials and for surgical removal of the device in some cases [6]. Thus, the preven- tion of CVAD-related bloodstream infections (BSIs) is an issue of high priority in paediatric oncology. Therefore, infection control advisory committees in the USA (since 1996) [7, 8] and in Germany (since 2002) [9] recommend to extend the routine change-intervals of the intravenous administration sets (IVAS) to 72 h, which was followed in our department except for patients receiving blood prod- ucts [10, 11] or TPN with iv lipids [12] (change after 6 h and 24 h, respectively). The safety of extending the routine IVAS change-interval beyond 96 h is still not fully inves- tigated [13]. The only available prospectively randomized study among adult oncology patients suggested an IVAS change-interval of 7 days to be safe and cost-effective for low risk patients [14] but, unlike in paediatric cancer patients, more than 90% of the catheters in this study were short-term, non-tunnelled devices. The principle aim of this pilot study was to investigate the practical consequences of extending the routine IVAS change-interval to 7 days in a paediatric oncology unit. A. Simon (corresponding author), G. Fleischhack, G. Wiszniewsky, C. Hasan, U. Bode Dept. of Paediatric Hematology and Oncology, Children’s Hospital, Medical Center, University of Bonn, Adenauerallee 119, 53113 Bonn, Germany; Phone: (+49/228) 287-3254, Fax: -3301, e-mail: asimon@ukb.uni-bonn.de M. H. Kramer Institute for Hygiene and Public Health, University of Bonn, Bonn, Germany Received: November 1, 2005 • Revision accepted: May 23, 2006 5646.indd 258 5646.indd 258 9/23/2006 6:06:46 PM 9/23/2006 6:06:46 PM