Catheter-Associated Bloodstream Infections in the NICU: Getting to Zero

Curry, Sabra; Honeycutt, Michele; Goins, Gail; Gilliam, Craig

doi:10.1891/0730-0832.28.3.151

Cited by 55 publications

(54 citation statements)

References 5 publications

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“…However, the CA-BSI rate in the second epoch is similar to the rate reported in the pediatric intensive care units and NICUs that implemented 'CA-BSI-prevention bundles' as quality improvement initiatives. [18][19][20] We agree with Miller et al 18 that policies regarding insertion and maintenance of PICCs, together (1) non-central location of the catheter tip, (2) use of dual lumen catheter and (3) insertion into the cephalic vein. Centrally located PICC tips were associated with fewer complications in a report in which catheters ranging in size gauge from 2F to 5F were used in children.…”

Section: Discussionsupporting

confidence: 84%

Effect of heparin and other factors associated with complications of peripherally inserted central venous catheters in neonates

2012

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Objective: To identify factors associated with complications necessitating unplanned removal of peripherally inserted central venous catheters (PICCs) in neonates.Study Design: A before-and-after comparison following the exclusion of heparin from continuous infusions through PICCs placed by a designated team. Duration of use was assessed during epochs immediately preceding and following the practice change. Multivariable logistic regression was performed to identify independent risk factors associated with unplanned catheter removal.Result: We analyzed 189 PICC placements with heparin (epoch 1) and 188 with no heparin (epoch 2) added to infusions. Rates of complication (23.7 vs 17.2 per 1000 catheter days) and median durations of use (7 vs 8 days) did not differ significantly between the epochs. Non-central position of the catheter tip, use of dual lumen catheters and placement through the cephalic vein were independently associated with complications (each P<0.05). Conclusion:In neonates requiring short-term intravenous access, heparin may be safely omitted from continuous infusions without compromising catheter usability.

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Section: Discussionsupporting

confidence: 84%

Effect of heparin and other factors associated with complications of peripherally inserted central venous catheters in neonates

2012

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“…Currently the placement and management of CVCs, with attention to team work, sterile practices, and hub and dressing care, have become a focus of many collaboratives (such as the New York State California Perinatal Quality Care Collaborative http://www.cpqcc.org/quality_ improvement/qi_toolkits/hospital_acquired_infection_ prevention_rev_march_2008) and for many NICUs, with the emergence of evidence-based data beginning to appear in the literature [49][50][51][52][53] . There are many differences between these bundles, for example, the use or not of chlorhexidine and the use of disks and their safety in preterm infants and other neonates [54][55][56][57] .…”

Section: Central Venous Catheter Management ('Bundles')mentioning

confidence: 99%

Challenging issues in neonatal candidiasis

Kaufman

2010

Current Medical Research and Opinion

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In an era of quality improvement and 'getting to zero (infections and/or related mortality),' neonatal candidiasis is ripe for evidence-based initiatives. Knowledge of each institution's invasive Candida infection (ICI) incidence and infection-related mortality is critical to evaluate disease burden and effective interventions. Evidenced-based interventions include: antifungal prophylaxis, starting with appropriate dosing, and prompt removal of central venous catheters (CVC). There is A-I evidence supporting antifungal prophylaxis with fluconazole, and it should be considered in every neonatal intensive care unit (NICU). The literature supports targeting infants51000 g and/or 27 weeks, because this group has high infection-related mortality and neurodevelopmental impairment in 57% of survivors. Antifungal prophylaxis has been shown to nearly eliminate infection-related mortality. Interventions start with prenatal initiatives, with women being treated for vaginal candidiasis, especially with preterm labor or complications. Targeting modifiable risk factors, including restriction policies for use of third-and fourth-generation cephalosporins, carbapenems, H2-antagonists, proton pump inhibitors, and postnatal steroids; guidelines for CVC care and removal; and feeding practices, with promotion of early feedings and breast milk, may also reduce risk. A few studies have emerged on empiric antifungal therapy with sepsis evaluations for preterm infants 51500 g and other high-risk patients that have shown favorable effects of eliminating mortality, but these have not been compared to appropriate antifungal therapy and central line removal. Further study of empiric therapy, prospective treatment studies with higher targeted dosing of amphotericin B preparations, fluconazole, and new antifungals with prompt CVC removal may contribute to a 100% survival rate for those infants41000 g and 28 weeks not receiving antifungal prophylaxis. Evaluation of ICI incidence and mortality by gestational age and birth week should be followed in each NICU, to evaluate infection control and prevention.

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“…21 In one study, CRBSI; only central venous catheters type was detected at a rate of 9.3 infections per 1,000 catheter days which is lower than our reported rate. 22 Another prospective study of 226 neonates who had PICCs in NICU between January 2006 and June 2009, the PICC infection rate was 17 per 1000 catheterdays. 23 This could be explained by that, the CRBSI were not categorized according to type of catheters in this study.…”

Section: Discussionmentioning

confidence: 99%

Central venous catheter-related blood stream infections in neonatal care unit

Badr

Hammad

Salama

et al. 2013

Int. j. infect. control

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The aim of this study was to detect the rate of catheter-related bloodstream infection (CRBSI) in NICU of Mansoura University Children's Hospital and to focus on possible predictors of infection. A cross sectional comparative study was performed to detect the rate of CRBSI among neonates with central vascular catheters during the period between January 2009 and April 2012. Then, a nested case control study done among CRBSI cases and central vascular catheters none infected as a control group to detect predictors associated with their occurrence. Blood samples were collected from 111 neonates clinically suspected of septicemia and had inserted venous line. Central, peripheral blood and catheter tip cultures were done for each case.CRBSI was confirmed in 69 cases as central blood culture count was more than 3 folds of peripheral blood culture count. Catheter tip culture showed more than 103 CFU/ ml per catheter of the same organisms. Low birth weight, age below 7 days, prematurity, mechanical ventilation, TPN administration and prolonged catheter stay were predictors of CRBSI. Logistic regression of the studied predictors showed that birth weight, TPN administration and length of central venous catheter stay were significant predictors of CRBSI. CRBSI is a common problem in NICU. Predictors of CRBSI included low birth weight, prematurity and mechanical ventilation. Potential use of TPN, prolonged catheter stay and low birth weight are independent predictors for CRBSI.

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Catheter-Associated Bloodstream Infections in the NICU: Getting to Zero

Cited by 55 publications

References 5 publications

Effect of heparin and other factors associated with complications of peripherally inserted central venous catheters in neonates

Effect of heparin and other factors associated with complications of peripherally inserted central venous catheters in neonates

Challenging issues in neonatal candidiasis

Central venous catheter-related blood stream infections in neonatal care unit

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