Care bundles to reduce central line-associated bloodstream infections in the neonatal unit: a systematic review and meta-analysis

Payne, Victoria M.; Hall, Mike; Prieto, J.; Johnson, Michael E.

doi:10.1136/archdischild-2017-313362

Cited by 103 publications

(79 citation statements)

References 44 publications

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“…The mortality related to bloodstream infections has been reported to be 21%. In neonates, they lead to increase in length of stay by 23 days and substantial excess costs (Helder et al, 2013;Verstraete et al, 2014;Payne et al, 2018).…”

Section: Clabsis In Pediatricsmentioning

confidence: 99%

Managing and preventing vascular catheter infections: A position paper of the international society for infectious diseases

Lutwick

Al-Maani

Mehtar

et al. 2019

International Journal of Infectious Diseases

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Section: Clabsis In Pediatricsmentioning

confidence: 99%

Managing and preventing vascular catheter infections: A position paper of the international society for infectious diseases

Lutwick

Al-Maani

Mehtar

et al. 2019

International Journal of Infectious Diseases

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“…Different studies analysed the impact of single measures on microbial colonization or infection. The correct management of central venous accesses proved to be effective against related infections (37). Antimicrobial stewardship for the correct use of antibiotics in term of doses, duration of therapy and administration route is a key point for prevention and control of drug-resistance (38)(39)(40).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of a coordinated strategy for containment of multidrug-resistant Gram-negative bacteria carriage in a Neonatal Intensive Care Unit in the context of an active surveillance program

Saporito

Graziano²,

Mescolo³

et al. 2020

Preprint

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Background: Antimicrobial resistance in Neonatal Intensive Care Unit (NICU) patients is a threat, due to the large use of antimicrobial treatment and invasive devices in fragile babies.Since 2014 an active surveillance program of multidrug-resistant Gram-negative bacteria (MDR-GNB) carriage is in place in the five NICUs of Palermo, Italy. In 2017 an increase in the prevalence of MDR-GNB and in particular of extended-spectrum β-lactamases-producing Klebsiella pneumoniae (ESBL-KP) was observed in “Civico” hospital NICU. Aim: To estimate the impact of a coordinated intervention strategy in achieving long-lasting reduction of MDR-GNB prevalence in the NICU.Methods: Rectal swabs were obtained monthly and processed to detect MDR-GNB using standard methods. MDR-GNB were characterized by pulsed-field gel electrophoresis (PFGE). From November 2017 the following intervention measures were applied: a) two-months strengthening of sample collection; b) stakeholders’ meetings; c) improvement of prevention measures and antimicrobial policy. Prevalence of MDR-GNB carriage observed in the 12 months before and in the 24 months after intervention were compared by chi-square test. Risk factors for MDR-GNB carriage in a subgroup of patients were identified by a multivariate logistic regression model. Findings: During the strengthened microbiological surveillance MDR-GNB and ESBL-KP were detected in rectal swabs (34.8%; 23.2%), nasal swabs (24.6%; 14.5%), oral swabs (14.5%; 5.4%), milk samples (32.1%; 17.9%), soother swabs (30.8%; 17.9%) and from a sub-intensive room surface. Thirteen ESBL-KP strains isolated from clinical and environmental samples showed identical PFGE patterns. ESBL-KP was detected no more until June 2018. No MDR-GNB isolate was detected for three months. Prevalence of MDR-GNB and ESBL-KP carriage after intervention significantly decreased compared to the previous year (20.6% vs 62.2 %; p<0.001 and 11.1% vs 57.8%; p<0.001). Multivariate analysis of principal exposure variables showed that admission in post-intervention period significantly reduced the risk of MDR-GNB carriage (OR=0.15, p=0.01). Conclusions: MDR-GNB broadly circulate in NICU setting and can colonize different body sites and spread by various vehicles. A coordinated strategy of multiple interventions with active cooperation between epidemiologists and clinicians in the NICU can effectively reduce their circulation and in particular the carriage of most dangerous ESBL-KP strains.

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“…These emerging care strategies include limiting elective cesarean deliveries to 39 weeks' gestation or greater 79,80 ; treating infants with neonatal abstinence syndrome outside of the NICU 81 ; reducing the need for antibiotic administration and, therefore, length of hospital stay for mothers with intraamniotic inflammation or infection 82 ; reducing NICU admissions for treatment of hypoglycemia with intravenous glucose administration by using dextrose or glucose gel 83 ; and reducing length of NICU stay through quality improvement strategies, such as decreasing the incidence of central line-associated bloodstream infections. 84 Strategies to increase the NICU provider workforce have mostly been concentrated on increasing the use of pediatric hospitalists, NNPs, and PAs. 11,15,[39][40][41][45][46][47] Workforce surveys conducted by the NANNP have delineated the existing and future NNP workforce needs.…”

Section: Initial and Ongoing Neonatal Competency Acquisition And Mainmentioning

confidence: 99%

Neonatal Provider Workforce

Keels

Goldsmith

Newborn³

2019

Pediatrics

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This technical report reviews education, training, competency requirements, and scopes of practice of the different neonatal care providers who work to meet the special needs of neonatal patients and their families in the NICU. Additionally, this report examines the current workforce issues of NICU providers, offers suggestions for establishing and monitoring quality and safety of care, and suggests potential solutions to the NICU provider workforce shortages now and in the future. To meet the critical and complex health needs of preterm neonates and neonates who are ill in the NICU, collaborative teams of health care providers work to render timely, safe, effective, efficient, and evidencebased care. 1 Many NICU provider teams include neonatologists, advanced practice registered nurses (APRNs), physician assistants (PAs), pediatric hospitalists, neonatal fellows, and pediatric residents. 1 In collaboration, these providers work together to consistently provide high-quality care throughout the neonatal hospitalization. Training and licensure are different for the various NICU provider groups. Most APRNs and PAs working in NICUs have completed master's or doctoral degree programs that require the acquisition of certain cognitive abilities and technical skills aimed at producing safe and effective patient care. 2,3 Neonatal nurse practitioners (NNPs) and pediatric nurse practitioners (PNPs) are registered nurses with advanced education and training to enable them to care for neonatal, infant, and pediatric patients, respectively, as APRNs. 4 PAs are educated as medical generalists in programs that include pediatric and adult medicine. 5 After graduating from a master's-or doctoral-level academic program and achieving national certification and state licensure, APRNs and PAs typically complete medical staff credentialing and a period of orientation to the provider role in the NICU on the basis of demonstrated skill sets and competencies. Pediatric hospitalists are physicians who have completed a graduate medical school program as well as a pediatric residency program that requires proficiency and skills in all areas of pediatrics, including neonatal medicine. 6 A minimum number of months in the newborn nursery and NICU settings are required as part of any

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Care bundles to reduce central line-associated bloodstream infections in the neonatal unit: a systematic review and meta-analysis

Cited by 103 publications

References 44 publications

Managing and preventing vascular catheter infections: A position paper of the international society for infectious diseases

Managing and preventing vascular catheter infections: A position paper of the international society for infectious diseases

Efficacy of a coordinated strategy for containment of multidrug-resistant Gram-negative bacteria carriage in a Neonatal Intensive Care Unit in the context of an active surveillance program

Neonatal Provider Workforce

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