Application Of Parafilm As A Physical Barrier On Cvc Connections Is Feasible And May Reduce Clabsi Among Pediatric Hct Patients

Central line associated bloodstream infections (CLABSI) result in significant morbidity and mortality in hematopoietic cell transplantation (HCT) patients. Pediatric data is sparse, and previous/current interventions may impact bacterial flora and antibiotic resistance. Risks in pediatric HCT patients include prolonged immunosuppression, long-term central venous catheter (CVC) need, and external environmental contamination. Parafilm is made of paraffin and primarily utilized to seal/protect containers in laboratories; applied as a barrier, it significantly reduced CLABSI in TPN-dependent pediatric short gut patients. We hypothesized that parafilm application on CVC connections would be feasible and reduce CLABSI occurrence in pediatric HCT patients. The aims of this non-randomized pilot quality improvement initiative were to examine the feasibility of parafilm as a physical barrier on CVC tubing connections and obtain preliminary data to support its use preventing CLABSI among pediatric HCT patients. This IRB-approved cohort study included pediatric patients ages 0-21, with a tunneled external CVC, who were undergoing allogeneic or autologous HCT for any indication. Patients receiving other interventions to prevent CLABSI were ineligible. Parafilm was supplied in pre-cut 2 × 2 inch, single-use sections. It was applied over the CVC hub (if not connected) or around the CVC connection sites (if connected) and was reapplied at least once daily, as well as when connections were accessed or at the caregiveru0027s discretion. Data were collected on patient, disease, and HCT characteristics as well as standard HCT outcomes and compared to a historical control group. The occurrence of NHSN/CDC-defined CLABSI was compared between groups using pairwise comparison, with significance defined as p Forty-eight patients undergoing first HCT from 6/2015-1/2017 received parafilm and were compared to historical control patients (n=71; HCT in preceding 16 months). No difference in age, sex, indication for HCT, stem cell source, or type of HCT was observed between groups. Patients receiving parafilm had a CLABSI rate of 3.69 per 1000 line days, compared to 4.37 for historical controls (p=0.6919). Univariate analysis of all patients demonstrated no impact of HCT type or sex on CLABSI rate, although the rate was lower in patients transplanted for a non-malignant disease compared to solid tumor (p=0.0326). Application of parafilm as a protective CVC barrier in pediatric HCT patients is feasible, and it may lead to a decrease in CLABSI. Sub-analyses are ongoing to see if parafilm may be more beneficial in subset(s) of patients, such as younger aged patients who remain in diapers or patients with graft-versus-host disease. Future trials will examine the use of a novel device, created specifically to protect CVC hubs/connection sites from environmental contamination, to reduce CLABSI.