Kinderonkologie: Erhaltungspflege von Broviac- und Port-Kathetern

Die meisten Kinder mit Krebs erhalten zu Beginn der Chemotherapie einen zentralen Venenkatheter. Die Prävention von Blutstrominfektionen, die von solchen Gefäßkathetern ausgehen, ist ein wichtiges Merkmal guter klinischer Praxis. Dieser Beitrag diskutiert verschiedene Aspekte von Präventionsbündeln in diesem speziellen klinischen Kontext.

Kernaussagen

• Nur ein Teil der CA-BSI geht tatsächlich vom Gefäßkatheter aus und lässt sich durch gezielte Präventionsmaßnahmen verhindern [37] [86].

• BSI und deren Therapie die Chemotherapie relevant verzögern, was sich möglicherweise ungünstig auf die Gesamtprognose auswirkt.

• Bei jedem Verbandswechsel ist eine antiseptische Behandlung der Eintrittsstelle des Broviac-Katheters nötig. Denn sie ist eine wichtige Quelle für Infektionen, von der eine sekundäre Bakteriämie oder eine Weichteilinfektion ausgehen kann.

• Bestimmte Zytostatika (v. a. hoch dosiertes Methotrexat und Anthrazykline) können lokale Hautreaktionen am Broviac-Eintritt auslösen, die bei granulozytopenischen Patienten (kein Eiter!) klinisch schwer von Lokalinfektionen zu unterscheiden sind.

• Die Kontamination von Hubs und Dreiwegehähnen ist eine wichtige Quelle von CR-BSI [65]. Der Umgang mit einem NFC erfordert daher ein gut geschultes Behandlungsteam und die vor jedem Zugriff sorgfältige Desinfektion der NFC-Membran [89].

• Kontaminierte Infusionslösungen bzw. i. v. Medikamente können eine BSI verursachen [10] [102]. In der Praxis ist die nicht sachgerechte (unzulässige) Teilentnahme aus der gleichen Ampulle für mehrere Patienten ein ernstes Problem [9].

• Zum Blocken von CVAD soll ausschließlich patientenbezogenes Heparin aus Fertigampullen zum Einsatz kommen.

• Durch intermittierendes Blocken des Katheters mit Taurolidin lassen sich CR-BSI vermeiden.

• Eine von PVKs ausgehende Bakteriämie kann zu einer hämatogenen Besiedlung des CVAD führen. Auch für die Anlage und Erhaltungspflege von PVKs sollte es einen eigenen infektionspräventiven Standard geben.

• Ein einheitliches KISS-Erfassungsmodul für Blutstrominfektionen (mit oder ohne Bezug zum CVAD) bei kinderonkologischen Patienten ist wünschenswert.

• Literaturverzeichnis

• 1 Adams D, Karpanen T, Worthington T. et al. Infection risk associated with a closed luer access device. J Hosp Infect 2006; 62: 353-357
• 2 Adler A, Yaniv I, Solter E. et al. Catheter-associated bloodstream infections in pediatric hematology-oncology patients: factors associated with catheter removal and recurrence. J Pediatr Hematol Oncol 2006; 28: 23-28
• 3 Adler A, Yaniv I, Steinberg R. et al. Infectious complications of implantable ports and Hickman catheters in paediatric haematology-oncology patients. J Hosp Infect 2006; 62: 358-365
• 4 Allen RC, Holdsworth MT, Johnson CA. et al. Risk determinants for catheter-associated blood stream infections in children and young adults with cancer. Pediatr Blood Cancer 2008; 51: 53-58
• 5 Ammann RA, Bodmer N, Hirt A. et al. Predicting adverse events in children with fever and chemotherapy-induced neutropenia: the prospective multicenter SPOG 2003 FN study. J Clin Oncol 2010; 28: 2008-2014
• 6 Ammann RA, Hirt A, Luthy AR. et al. Predicting bacteremia in children with fever and chemotherapy-induced neutropenia. Pediatr Infect Dis J 2004; 23: 61-67
• 7 Ammann RA, Laws HJ, Schrey D. et al. Bloodstream infection in paediatric cancer centres-leukaemia and relapsed malignancies are independent risk factors. Eur J Pediatr 2015; 174: 675-686
• 8 Ammann RA, Tissing WJ, Phillips B. Rationalizing the approach to children with fever in neutropenia. Curr Opin Infect Dis 2012; 25: 258-265
• 9 Arbeitsgruppe KRINKO-BfArM-RKI. Bericht der Arbeitsgruppe KRINKO-BfArM-RKI: Zu spezifischen Fragen bezüglich Rekonstitution, Zubereitung und Applikation von Arzneimitteln und Infusionslösungen sowie zur Hautantiseptik. Berlin: Epidemiol Bulletin des Robert Koch-Instituts; 2016. Nr. 20 173-178
• 10 Austin PD, Elia M. A systematic review and meta-analysis of the risk of microbial contamination of aseptically prepared doses in different environments. J Pharm Pharm Sci 2009; 12: 233-242
• 11 Averbuch D, Cordonnier C, Livermore DM. et al. Targeted therapy against multi-resistant bacteria in leukemic and hematopoietic stem cell transplant recipients: guidelines of the 4th European Conference on Infections in Leukemia (ECIL-4, 2011). Haematologica 2013; 98: 1836-1847
• 12 Averbuch D, Orasch C, Cordonnier C. et al. European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia. Haematologica 2013; 98: 1826-1835
• 13 Barrell C, Covington L, Bhatia M. et al. Preventive strategies for central line-associated bloodstream infections in pediatric hematopoietic stem cell transplant recipients. Am J Infect Control 2012; 40: 434-439
• 14 Bass P, Karki S, Rhodes D. et al. Impact of chlorhexidine-impregnated washcloths on reducing incidence of vancomycin-resistant enterococci colonization in hematology-oncology patients. Am J Infect Control 2013; 41: 345-348
• 15 Berrueco R, Rives S, Catala A. et al. Prospective Surveillance Study of Blood Stream Infections Associated With Central Venous Access Devices (Port-type) in Children With Acute Leukemia: An Intervention Program. J Pediatr Hematol Oncol 2013; 35: e194-e199
• 16 Bertoglio S, Rezzo R, Merlo FD. et al. Pre-filled normal saline syringes to reduce totally implantable venous access device-associated bloodstream infection: a single institution pilot study. J Hosp Infect 2013; 84: 85-88
• 17 Bishay M, Retrosi G, Horn V. et al. Chlorhexidine antisepsis significantly reduces the incidence of sepsis and septicemia during parenteral nutrition in surgical infants. J Pediatr Surg 2011; 46: 1064-1069
• 18 Bisseling TM, Willems MC, Versleijen MW. et al. Taurolidine lock is highly effective in preventing catheter-related bloodstream infections in patients on home parenteral nutrition: a heparin-controlled prospective trial. Clin Nutr 2010; 29: 464-468
• 19 Biwersi C, Hepping N, Bode U. et al. Bloodstream infections in a German paediatric oncology unit: Prolongation of inpatient treatment and additional costs. Int J Hyg Environ Health 2009; 212: 541-546
• 20 Blijlevens NM, Donnelly JP, De Pauw BE. Mucosal barrier injury: biology, pathology, clinical counterparts and consequences of intensive treatment for haematological malignancy: an overview. Bone Marrow Transplant 2000; 25: 1269-1278
• 21 Bosk CL, Dixon-Woods M, Goeschel CA. et al. Reality check for checklists. Lancet 2009; 374: 444-445
• 22 Bradshaw JH, Puntis JW. Taurolidine and catheter-related bloodstream infection: a systematic review of the literature. J Pediatr Gastroenterol Nutr 2008; 47: 179-186
• 23 Bundy DG, Gaur AH, Billett AL. et al. Preventing CLABSIs among pediatric hematology/oncology inpatients: national collaborative results. Pediatrics 2014; 134: e1678-e1685
• 24 Cheng S, Teuffel O, Ethier MC. et al. Health-related quality of life anticipated with different management strategies for paediatric febrile neutropaenia. Br J Cancer 2011; 105: 606-611
• 25 Chesshyre E, Goff Z, Bowen A. et al. The prevention, diagnosis and management of central venous line infections in children. J Infect 2015; 71 (Suppl. 01) 59-75
• 26 Choi SW, Chang L, Hanauer DA. et al. Rapid reduction of central line infections in hospitalized pediatric oncology patients through simple quality improvement methods. Pediatr Blood Cancer 2013; 60: 262-269
• 27 Chu HP, Brind J, Tomar R. et al. Significant Reduction in Central Venous Catheter-related Bloodstream Infections in Children on HPN After Starting Treatment With Taurolidine Line Lock. J Pediatr Gastroenterol Nutr 2012; 55: 403-407
• 28 Climo MW, Yokoe DS, Warren DK. et al. Effect of daily chlorhexidine bathing on hospital-acquired infection. N Engl J Med 2013; 368: 533-542
• 29 Cullis PS, McKee RF. Taurolidine lock - experience from the West of Scotland. Clin Nutr 2011; 30: 399-400
• 30 Deutsche Gesellschaft für pädiatrische Infektiologie (DGPI), Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH). Diagnostik und Therapie bei Kindern mit onkologischer Grunderkrankung, Fieber und Granulozytopenie (mit febriler Neutropenie) außerhalb der allogenen Stammzelltransplantation. Arbeitsgemeinschaft Wissenschaftlicher Fachgesellschaften (AWMF); 2016 Registernummer 048/14
• 31 Diorio C, Martino J, Boydell KM. et al. Parental perspectives on inpatient versus outpatient management of pediatric febrile neutropenia. J Pediatr Oncol Nurs 2011; 28: 355-362
• 32 Duffy EA, Rodgers CC, Shever LL. et al. Implementing a Daily Maintenance Care Bundle to Prevent Central Line-Associated Bloodstream Infections in Pediatric Oncology Patients. J Pediatr Oncol Nurs 2015; 32: 394-400
• 33 Ellger B, Kiski D, Diem E. et al. Non-return valves do not prevent backflow and bacterial contamination of intravenous infusions. J Hosp Infect 2011; 78: 31-35
• 34 Engelhart S, Exner M, Simon A. In vitro study on the disinfectability of two split-septum needle-free connection devices using different disinfection procedures. GMS hygiene and infection control 2015; 10 Doc17
• 35 Furtwangler R, Laux C, Graf N. et al. Impact of a modified Broviac maintenance care bundle on bloodstream infections in paediatric cancer patients. GMS hygiene and infection control 2015; 10 Doc15
• 36 Gastmeier P, Kampf KP, Behnke M. et al. An observational study of the universal use of octenidine to decrease nosocomial bloodstream infections and MDR organisms. J Antimicrob Chemother 2016; 71: 2569-2576
• 37 Gaur AH, Bundy DG, Gao C. et al. Surveillance of hospital-acquired central line-associated bloodstream infections in pediatric hematology-oncology patients: lessons learned, challenges ahead. Infect Control Hosp Epidemiol 2013; 34: 316-320
• 38 Gyssens IC, Kern WV, Livermore DM. The role of antibiotic stewardship in limiting antibacterial resistance among hematology patients. Haematologica 2013; 98: 1821-1825
• 39 Handrup MM, Moller JK, Frydenberg M. et al. Placing of tunneled central venous catheters prior to induction chemotherapy in children with acute lymphoblastic leukemia. Pediatr Blood Cancer 2010; 55: 309-313
• 40 Helm RE, Klausner JD, Klemperer JD. et al. Accepted but unacceptable: peripheral IV catheter failure. J Infus Nurs 2015; 38: 189-203
• 41 Herbig S, Kaiser V, Maurer J. et al. ADKA-Leitlinie: Aseptische Herstellung und Prüfung applikationsfertiger Parenteralia. Krankenhauspharmazie 2013; 34: 93-106
• 42 Holroyd JL, Paulus DA, Rand KH. et al. Universal intravenous access cleaning device fails to sterilize stopcocks. Anesth Analg 2014; 118: 333-343
• 43 Hong H, Morrow DF, Sandora TJ. et al. Disinfection of needleless connectors with chlorhexidine-alcohol provides long-lasting residual disinfectant activity. Am J Infect Control 2013; 41: e77-e79
• 44 Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008; 36: 309-332
• 45 Horvath B, Norville R, Lee D. et al. Reducing central venous catheter-related bloodstream infections in children with cancer. Oncol Nurs Forum 2009; 36: 232-238
• 46 Huang SS, Septimus E, Kleinman K. et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med 2013; 368: 2255-2265
• 47 Hubner NO, Siebert J, Kramer A. Octenidine dihydrochloride, a modern antiseptic for skin, mucous membranes and wounds. Skin Pharmacol Physiol 2010; 23: 244-258
• 48 Ivy DD, Calderbank M, Wagner BD. et al. Closed-hub systems with protected connections and the reduction of risk of catheter-related bloodstream infection in pediatric patients receiving intravenous prostanoid therapy for pulmonary hypertension. Infect Control Hosp Epidemiol 2009; 30: 823-829
• 49 Jack T, Boehne M, Brent BE. et al. In-line filtration reduces severe complications and length of stay on pediatric intensive care unit: a prospective, randomized, controlled trial. Intensive Care Med 2012; 38: 1008-1016
• 50 Jack T, Brent BE, Boehne M. et al. Analysis of particulate contaminations of infusion solutions in a pediatric intensive care unit. Intensive Care Med 2010; 36: 707-711
• 51 Jurewitsch B, Jeejeebhoy KN. Taurolidine lock: the key to prevention of recurrent catheter-related bloodstream infections. Clin Nutr 2005; 24: 462-465
• 52 Jurewitsch B, Lee T, Park J. et al. Taurolidine 2% as an antimicrobial lock solution for prevention of recurrent catheter-related bloodstream infections. JPEN J Parenter Enteral Nutr 1998; 22: 242-244
• 53 Kelly M, Conway M, Wirth K. et al. Moving CLABSI prevention beyond the intensive care unit: risk factors in pediatric oncology patients. Infect Control Hosp Epidemiol 2011; 32: 1079-1085
• 54 Kelly MJ, Vivier PM, Panken TM. et al. Bacteremia in febrile nonneutropenic pediatric oncology patients. Pediatr Blood Cancer 2010; 54: 83-87
• 55 Kommission für Krankenhaushygiene und Infektionsprävention beim Robert Koch-Institut (KRINKO). Empfehlungen zu den Anforderungen an die Hygiene bei der medizinischen Versorgung von immunsupprimierten Patienten. Bundesgesundheitsbl – Gesundheitsforsch – Gesundheitsschutz 2010; 53: 357-388
• 56 Kommission für Krankenhaushygiene und Infektionsprävention beim Robert Koch-Institut (KRINKO). Empfehlungen zur Prävention und Kontrolle von Methicillin-resistenten Staphylococcus aureus-Stämmen (MRSA) in medizinischen und pflegerischen Einrichtungen. Bundesgesundheitsbl - Gesundheitsforsch – Gesundheitsschutz 2014; 57: 696-732
• 57 Kommission für Krankenhaushygiene und Infektionsprävention beim Robert Koch-Institut (KRINKO). Empfehlungen zur Händehygiene in Einrichtungen des Gesundheitswesens. Bundesgesundheitsbl – Gesundheitsforsch – Gesundheitsschutz 2016; 59: 1189-1220
• 58 Krenn T, Fleischhack G, Moser O. et al. Bloodstream infections in paediatric cancer patients. Prospective comparative study in 2 university hospitals. Klin Padiatr 2011; 223: 335-340
• 59 Lehrnbecher T, Phillips R, Alexander S. et al. Guideline for the Management of Fever and Neutropenia in Children With Cancer and/or Undergoing Hematopoietic Stem-Cell Transplantation. J Clin Oncol 2012; 30: 4427-4438
• 60 Liu H, Liu H, Deng J. et al. Preventing catheter-related bacteremia with taurolidine-citrate catheter locks: a systematic review and meta-analysis. Blood purification 2014; 37: 179-187
• 61 Lockman JL, Heitmiller ES, Ascenzi JA. et al. Scrub the hub! Catheter needleless port decontamination. Anesthesiology 2011; 114: 958
• 62 Lopez-Briz E, Ruiz-Garcia V. [Effectiveness of heparin versus NaCl 0.9% in central venous catheter flushing. A systematic review]. Farm Hosp 2005 29: 258-264
• 63 Lukac PJ, Bonomo RA, Logan LK. Extended-spectrum beta-lactamase-producing Enterobacteriaceae in children: Old Foe, Emerging Threat. Clin Infect Dis 2015; 60
• 64 Maragakis LL, Bradley KL, Song X. et al. Increased catheter-related bloodstream infection rates after the introduction of a new mechanical valve intravenous access port. Infect Control Hosp Epidemiol 2006; 27: 67-70
• 65 Marschall J, Mermel LA, Fakih M. et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014; 35: 753-771
• 66 McMullan C, Propper G, Schuhmacher C. et al. A multidisciplinary approach to reduce central line-associated bloodstream infections. Jt Comm J Qual Patient Saf 2013; 39: 61-69
• 67 Meckler G, Lindemulder S. Fever and neutropenia in pediatric patients with cancer. Emerg Med Clin North Am 2009; 27: 525-544
• 68 Miedema KG, Winter RH, Ammann RA. et al. Bacteria causing bacteremia in pediatric cancer patients presenting with febrile neutropenia--species distribution and susceptibility patterns. Support Care Cancer 2013; 21: 2417-2426
• 69 Miller MR, Griswold M, Harris JM. et al. Decreasing PICU catheter-associated bloodstream infections: NACHRI's quality transformation efforts. Pediatrics 2010; 125: 206-213
• 70 Miller MR, Niedner MF, Huskins WC. et al. Reducing PICU central line-associated bloodstream infections: 3-year results. Pediatrics 2011; 128: e1077-1083
• 71 Milstone AM, Elward A, Song X. et al. Daily chlorhexidine bathing to reduce bacteraemia in critically ill children: a multicentre, cluster-randomised, crossover trial. Lancet 2013; 381: 1099-1106
• 72 Pohl F, Hartmann W, Holzmann T. et al. Risk of infection due to medical interventions via central venous catheters or implantable venous access port systems at the middle port of a three-way cock: luer lock cap vs. luer access split septum system (Q-Syte). BMC Infect Dis 2014; 14: 41
• 73 Raymond J, Aujard Y. Nosocomial infections in pediatric patients: a European, multicenter prospective study. European Study Group. Infect Control Hosp Epidemiol 2000; 21: 260-263
• 74 Reichardt C, Koniger D, Bunte-Schonberger K. et al. Three years of national hand hygiene campaign in Germany: what are the key conclusions for clinical practice?. J Hosp Infect 2013; 83 (Suppl. 01) S11-S16
• 75 Rinke ML, Bundy DG, Chen AR. et al. Central line maintenance bundles and CLABSIs in ambulatory oncology patients. Pediatrics 2013; 132: e1403-e1412
• 76 Rinke ML, Chen AR, Bundy DG. et al. Implementation of a central line maintenance care bundle in hospitalized pediatric oncology patients. Pediatrics 2012; 130: e996-e1004
• 77 Samet A, Sledzinska A, Krawczyk B. et al. Leukemia and risk of recurrent Escherichia coli bacteremia: genotyping implicates E. coli translocation from the colon to the bloodstream. Eur J Clin Microbiol Infect Dis 2013; 32: 1393-1400
• 78 Sammons JS, Localio R, Xiao R. et al. Clostridium difficile infection is associated with increased risk of death and prolonged hospitalization in children. Clin Infect Dis 2013; 57: 1-8
• 79 Sannoh S, Clones B, Munoz J. et al. A multimodal approach to central venous catheter hub care can decrease catheter-related bloodstream infection. Am J Infect Control 2010; 38: 424-429
• 80 Scheithauer S, Lewalter K, Schroder J. et al. Reduction of central venous line-associated bloodstream infection rates by using a chlorhexidine-containing dressing. Infection 2014; 42: 155-159
• 81 Schlicht A, Fleischhack G, Herdeis C. et al. In vitro investigation of the exposure time necessary to yield a 5 log reduction of clinicall relevant bacteria by a taurolidine containing antimicrobial catheter lock solution. Hygiene & Medizin 2009; 34: 343-345
• 82 Shah CB, Mittelman MW, Costerton JW. et al. Antimicrobial activity of a novel catheter lock solution. Antimicrob Agents Chemother 2002; 46: 1674-1679
• 83 Simon A, Ammann RA, Bode U. et al. Nosocomial infections in pediatric cancer patients: results of a prospective surveillance study from 7 University hospitals in Germany and Switzerland. BMC Infect Dis 2008; 70
• 84 Simon A, Beutel K, Trautmann M. et al. Evidenzbasierte Empfehlungen zur Anwendung dauerhaft implantierter, zentralvenöser Zugänge in der pädiatrischen Onkologie. 4. Aufl. Wiesbaden: mhp; 2013
• 85 Simon A, Fleischhack G, Hasan C. et al. Surveillance for nosocomial and central line-related infections among pediatric hematology-oncology patients. Infect Control Hosp Epidemiol 2000; 21: 592-596
• 86 Simon A, Furtwangler R, Graf N. et al. Surveillance of bloodstream infections in pediatric cancer centers – what have we learned and how do we move on?. GMS hygiene and infection control 2016; 11 Doc11
• 87 Simon A, Graf N, Furtwangler R. Results of a Multicentre Survey Evaluating Clinical Practice of Port and Broviac Management in Paediatric Oncology. Klin Padiatr 2013; 225: 145-151
• 88 Simon A, Groger N, Wilkesmann A. et al. Restricted use of glycopeptides in paediatric cancer patients with fever and neutropenia. Int J Antimicrob Agents 2006; 28: 417-422
• 89 Smith JS, Kirksey KM, Becker H. et al. Autonomy and Self-efficacy as Influencing Factors in Nursesʼ Behavioral Intention to Disinfect Needleless Intravenous Systems. J Infus Nurs 2011; 34: 193-200
• 90 Soothill JS, Bravery K, Ho A. et al. A fall in bloodstream infections followed a change to 2% chlorhexidine in 70% isopropanol for catheter connection antisepsis: a pediatric single center before/after study on a hemopoietic stem cell transplant ward. Am J Infect Control 2009; 37: 626-630
• 91 Steinberg JP, Robichaux C, Tejedor SC. et al. Distribution of pathogens in central line-associated bloodstream infections among patients with and without neutropenia following chemotherapy: evidence for a proposed modification to the current surveillance definition. Infect Control Hosp Epidemiol 2013; 34: 171-175
• 92 Stucki C, Sautter AM, Favet J. et al. Microbial contamination of syringes during preparation: the direct influence of environmental cleanliness and risk manipulations on end-product quality. Am J Health Syst Pharm 2009; 66: 2032-2036
• 93 Tan M, Lau J, Guglielmo BJ. Ethanol locks in the prevention and treatment of catheter-related bloodstream infections. Ann Pharmacother 2014; 48: 607-615
• 94 Teuffel O, Amir E, Alibhai SM. et al. Cost-effectiveness of outpatient management for febrile neutropenia in children with cancer. Pediatrics 2011; 127: e279-286
• 95 Tietz A, Frei R, Dangel M. et al. Octenidine hydrochloride for the care of central venous catheter insertion sites in severely immunocompromised patients. Infect Control Hosp Epidemiol 2005; 26: 703-707
• 96 Timsit JF, Mimoz O, Mourvillier B. et al. Randomized controlled trial of chlorhexidine dressing and highly adhesive dressing for preventing catheter-related infections in critically ill adults. Am J Respir Crit Care Med 2012; 186: 1272-1278
• 97 Timsit JF, Schwebel C, Bouadma L. et al. Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: a randomized controlled trial. Jama 2009; 301: 1231-1241
• 98 Toure A, Lauverjat M, Peraldi C. et al. Taurolidine lock solution in the secondary prevention of central venous catheter-associated bloodstream infection in home parenteral nutrition patients. Clin Nutr 2012; 31: 567-570
• 99 Traub WH, Leonhard B, Bauer D. Taurolidine: in vitro activity against multiple-antibiotic-resistant, nosocomially significant clinical isolates of Staphylococcus aureus, Enterococcus faecium, and diverse Enterobacteriaceae. Chemotherapy 1993; 39: 322-330
• 100 Trautmann M, Kreutzberger M, Bobic R. et al. Disinfection of a needleless connector with alcohol-based disinfectant wipes – an experimental study. Hygiene & Medizin 2012; 37: 354-359
• 101 van der Velden WJ, Herbers AH, Netea MG. et al. Mucosal barrier injury, fever and infection in neutropenic patients with cancer: introducing the paradigm febrile mucositis. Br J Haematol 2014; 167: 441-452
• 102 Vonberg RP, Gastmeier P. Hospital-acquired infections related to contaminated substances. J Hosp Infect 2007; 65: 15-23
• 103 Wanten GJA, Bisseling TM. Responding letter to editor - Taurolidine lock is highly effective in preventing catheter-related bloodstream infections in patients on home parenteral nutrition: a heparin-controlled prospective trial. Clin Nutr 2011; 30: 401-401
• 104 Weichert S, Simon A, von Müller L. et al. Clostridium-difficile-assoziierte Infektionen im Kindes- und Jugendalter. Monatsschrift für Kinderheilkunde 2015; 163: 427-436
• 105 Weiss K, Simon A, Graf N. et al. Clinical Practice Audit: Perioperative Antibiotic Prophylaxis in Paediatric Cancer Patients with Broviac Catheter Implantation. Klin Padiatr 2016; 228: 139-144
• 106 Wilson MZ, Rafferty C, Deeter D. et al. Attributable costs of central line-associated bloodstream infections in a pediatric hematology/oncology population. Am J Infect Control 2014; 42: 1157-1160
• 107 Winters BD, Gurses AP, Lehmann H. et al. Clinical review: checklists - translating evidence into practice. Crit Care 2009; 13: 210
• 108 Wolf J, Shenep JL, Clifford V. et al. Ethanol lock therapy in pediatric hematology and oncology. Pediatr Blood Cancer 2013; 60: 18-25
• 109 Zacharioudakis IM, Zervou FN, Arvanitis M. et al. Antimicrobial Lock Solutions as a Method to Prevent Central Line-Associated Bloodstream Infections: A Meta-analysis of Randomized Controlled Trials. Clin Infect Dis 2014; 59: 1741-1749