Closed intravenous systems for central vascular access: A difference maker for CLABSI rates in neonates?

Abstract

Background: Infants in neonatal units are susceptible to numerous potential iatrogenic risks. One key concern is central line-associated blood stream infection (CLABSI). To ensure patient safety and reduce the incidence of CLABSI toward zero, numerous evidence-based clinical interventions and product innovations have been implemented. Nevertheless, sustaining zero CLABSI for sustained periods remains challenging. Aim: The purpose of this study was to evaluate the impact on CLABSI rates of introducing a preassembled closed intravenous (IV) administration set in a neonatal intensive care unit (NICU). Methods: This was a retrospective observational analysis of routinely collected anonymized IV therapy infection data in a NICU. The study period was from January 2019 through June 2020. Results: Nine-hundred eighty five patients with a Epicutaneo-Caval Catheter (ECC) were included (456 legacy IV set, 529 closed IV set). Patient demographics were comparable between the two groups. ECC dwell time was the only IV characteristic associated ( p = 0.04) with CLABSI. Mann-Whitney U-test demonstrated significant differences between the two sets for CLABSI complication events ( p = 0.031). Prior to using the closed IV administration sets (January 2019–September 2019) the mean monthly CLABSI rate was 2.87 (/1000 device days). This figure declined to 0.22 (/1000 device days) afterwards (October 2019–June 2020). Zero CLABSIs were observed during January to June 2020. Conclusions: Utilization of a pre-assembled closed IV administration set was associated with a reduction in CLABSI rates. The study results suggest that using a pre-assembled closed IV set concurrently with evidence-based central line infection control interventions can help attain extended periods of zero CLABSI.

Does the antimicrobial-impregnated peripherally inserted central catheter decrease the CLABSI rate in neonates? Results from a retrospective cohort study

“…It has been used in many countries including Germany, Italy, and the UK. Despite the overall gradual decrease in the CLABSI rate in our NICU from 12.18 per 1,000 days dwell time in 2010 to 2.14 per 1,000 days dwell time in 2019, this improvement remained unsteady and showed a lack of sustainability ( 21 , 22 , 24 ). In 2016, the antimicrobial-impregnated PICC was introduced to the unit to help in reducing the CLABSI rate aiming for Zero-CLABSI.…”

“…Exceptions are very limited with chronic patients who have difficult vascular access. Preventive removal refers to the unnecessary premature catheter withdrawal before completion of the IV therapy ( 21 , 22 , 24 , 25 ).…”

“…The core bundle elements include but are not limited to applying maximal personal protective equipment (PPE), proper hand hygiene techniques, optimal catheter site, and device selection, a daily central line needs assessment, using a specialized central line trolley named Mayo Stand, performing the procedure time out, timing the duration of the procedure, using a central line insertion sterile closed kit, cleaning the line hub using chlorhexidine, applying a transparent semipermeable line dressing, using a needleless connector, using an alcohol-impregnated line port protector, applying two-person technique in each step all the time, using cyanoacrylate glue for catheter fixation and sealing of the insertion site, using diluted lipid emulsion solution as a lubricant to facilitate the guidewire removal, using the vein viewer imaging system for vascular assessment, using the microsite and the MST for the catheter insertion, early PICC insertion-early PICC removal approach, use of antimicrobial-impregnated catheters, speak-up campaigns to pick up any infection control breaches, and meticulously keeping a closed IV tubing system all the time. We have locally developed a mnemonic for neonatal vascular access pre-briefing, the “5Rights for Vascular Access” that is, choosing the Right vascular access device, for the Right patient, administering the Right therapy, in the Right vein, for the Right duration ( 24 – 28 ).…”

Comparing conventional and modified Seldinger techniques using a micro-insertion kit for PICC placement in neonates: a retrospective cohort study

“…In this study, only a limited number of the multifactorial variables known to affect the incidence of CLABSI were included in the analysis. For example, previous studies highlighted the effects of adherence to preventative infection control care bundles ( 6 , 7 , 9 , 11 , 22 , 23 , 30 – 32 ) using closed-circuit infusion sets ( 32 ) and cyanoacrylate-based tissue adhesive to secure lines and seal insertion sites ( 22 , 23 ), which were not analyzed here. Further large-scale interventional studies are required to separate the relationships between CLABSI and the PICC insertion technique in everyday clinical situations.…”