How to minimize central line–associated bloodstream infections in a neonatal intensive care unit: a quality improvement intervention based on a retrospective analysis and the adoption of an evidence-based bundle

Bierlaire, Stéphanie; Danhaive, Olivier; Carkeek, Katherine; Piersigilli, Fiammetta

doi:10.1007/s00431-020-03844-9

Cited by 34 publications

(24 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Similar to our study, many of the previous studies have reported comparable rates of NEC among twins and triplets [ 20 , 37 , 44 , 45 ]. Similar to other care practices in neonatology, during this study period, changes in neonatal feeding practices and central line care bundles may have significantly modified the neonatal outcomes such as NEC and sepsis [ 34 , 35 , 46 – 52 ].…”

Section: Discussionmentioning

confidence: 95%

Outcomes of multiple gestation births compared to singleton: analysis of multicenter KID database

Thekkeveedu

Dankhara

Desai

et al. 2021

matern health, neonatol and perinatol

View full text Add to dashboard Cite

Background The available data regarding morbidity and mortality associated with multiple gestation births is conflicting and contradicting. Objective To compare morbidity, mortality, and length of stay (LOS) outcomes between multiple gestation (twin, triplet and higher-order) and singleton births. Methods Data from the national multicenter Kids’ Inpatient Database of the Healthcare Cost and Utilization Project from the years 2000, 2003, 2006, 2009, 2012, and 2016 were analyzed using a complex survey design using Statistical Analysis System (SAS) 9.4 (SAS Institute, Cary NC). Neonates with ICD9 and ICD10 codes indicating singletons, twins or triplets, and higher-order multiples were included. Mortality was compared between these groups after excluding transfer outs to avoid duplicate inclusion. To analyze LOS, we included inborn neonates and excluded transfers; who died inpatient and any neonates who appear to have been discharged less than 33 weeks PMA. The LOS was compared by gestational age groups. Results A total of 22,853,125 neonates were analyzed for mortality after applying inclusion-exclusion criteria; 2.96% were twins, and 0.13% were triplets or more. A total of 22,690,082 neonates were analyzed for LOS. Mean GA, expressed as mean (SD), for singleton, twins and triplets, were 38.30 (2.21), 36.39 (4.21), and 32.72 (4.14), respectively. The adjusted odds for mortality were similar for twin births compared to singleton (aOR: 1.004, 95% CI:0.960–1.051, p = 0.8521). The adjusted odds of mortality for triplet or higher-order gestation births were higher (aOR: 1.33, 95% CI: 1.128–1.575, p = 0.0008) when compared to the singleton births. Median LOS (days) was significantly longer in multiple gestation compared to singleton births overall (singletons: 1.59 [1.13, 2.19] vs. twins 3.29 [2.17, 9.59] vs. triplets or higher-order multiples 19.15 [8.80, 36.38], p < .0001), and this difference remained significant within each GA category. Conclusion Multiple gestation births have higher mortality and longer LOS when compared to singleton births. This population data from multiple centers across the country could be useful in counseling parents when caring for multiple gestation pregnancies.

show abstract

Section: Discussionmentioning

confidence: 95%

Outcomes of multiple gestation births compared to singleton: analysis of multicenter KID database

Thekkeveedu

Dankhara

Desai

et al. 2021

matern health, neonatol and perinatol

View full text Add to dashboard Cite

show abstract

“…It was also included to communicate technical complaints as soon as they are identified, so that they can be resolved more effectively and quickly. 24 In the last one, it was suggested to remove the administration of blood products, since the caliber of the catheters used in neonates, smaller than 3.8 French, does not allow the administration of these components and blood collections due to risk of obstruction and thrombosis. 2 The limitation of this study is related to the inclusion of the target audience of only one Brazilian institution; the diversity of regions could give rise to suggestions that were not raised.…”

Section: Discussionmentioning

confidence: 99%

Bundle appearance validation for peripherally inserted central catheter handling in neonates / Validação de aparência do bundle para manuseio do cateter central de inserção periférica em neonatos

Machado

Silva

Luzeiro

et al. 2022

RPCF

View full text Add to dashboard Cite

Objetivo: validar a aparência do bundle para manuseio do cateter central de inserção periférica em neonatos pela equipe de enfermagem. Método: estudo metodológico, desenvolvido durante os meses de novembro de 2020 e fevereiro de 2021, em unidades neonatais de um hospital de ensino. A amostra foi composta por 43 membros da equipe de enfermagem e os dados analisados pelo índice de validade de conteúdo acima de 80%. Aplicou-se um instrumento contendo dados de identificação, o bundle e a relevância para prática clínica no Google Formulários. Resultados: todos os itens do bundle apresentaram índice de validade de conteúdo acima de 80% e foram considerados relevantes para prática clínica. Conclusão: este estudo permitiu validar a aparência do bundle junto a equipe de enfermagem e incluiu cuidados relacionados a manutenção do cateter central de inserção periférica em neonatos.

show abstract

“…On the other hand, the birth weight and the gestational age were significantly lower in the miconazole and rifampicin-impregnated catheter group together with the longer dwell time compared with the conventional PICC. These factors are known to contribute to a higher CLABSI rate ( 37 , 38 ). The multivariate logistic regression analysis of our results showed that the gestational age, the number of attempts, and the insertion technique are the predictors associated with CLABSI.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

View full text Add to dashboard Cite

BackgroundThe use of antimicrobial-impregnated peripherally inserted central catheters (PICCs) has been introduced in the last few years to neonatal units aiming to reduce central line-associated bloodstream infection (CLABSI).MethodsThis retrospective observational study aimed to compare the CLABSI rates and other catheter-related parameters including the insertion success rates and catheter-related complications in the antimicrobial-impregnated and conventional (ordinary) PICCs in NICU between 2017 and 2020.ResultsOur dedicated PICC team including physicians and nurses inserted 1,242 conventional (PremiCath and NutriLine) and 791 antimicrobial-impregnated PICCs (PremiStar) over the study period from 2017 to 2020. Of those 1,242 conventional PICCs, 1,171 (94.3%) were 1 Fr single lumen and only 71 (5.7%) were 2 Fr double lumen. The mean ± SD [median (IQR)] for the birth weight in all babies who had a PICC line was 1,343.3 ± 686.75 [1,200 (900, 1,500)] g, while the mean ± SD for the gestational age was 29.6 ± 4.03 [29 (27, 31)] weeks. The mean ± SD [median (IQR)] age at the time of insertion for all catheters was 9.3 ± 21.47 [2 (1, 9)] days, while the mean ± SD [median (IQR)] dwell time was 15.7 ± 14.03 [12 (8, 17)] days. The overall success rate of the PICC insertion is 1,815/2,033 (89.3%), while the first attempt success rate is 1,290/2,033 (63.5%). The mean ± SD [median (IQR)] gestational age, birth weight, age at catheter insertion, and catheter dwell time were 28.8 ± 3.24 [29, (26, 31)] weeks, 1,192.1 ± 410.3 [1,150, (900, 1,450)] g, 6.3 ± 10.85 [2, (1, 8)] days, and 17.73 ± 17.532 [13, (9, 18)] days in the antimicrobial-impregnated catheter compared with 30.1 ± 4.39 [29, (27, 32)] weeks (P < 0.001), 1,439.5 ± 800.8 [1,240, (920, 1,520)] g (P < 0.001), 11.1 ± 25.9 [1, (1, 9)] days (P < 0.001), and 14.30 ± 10.964 [12, (8, 17)] days (P < 0.001), respectively, in the conventional PICCs. The use of the antimicrobial-impregnated catheter was not associated with any significant reduction in the CLABSI rate (per 1,000 days dwell time), either the overall [P = 0.11, risk ratio (RR) (95% CI): 0.60 (0.32, 1.13)] or the yearly CLABSI rates.ConclusionsThe use of miconazole and rifampicin-impregnated PICCs did not reduce the CLABSI rate in neonates compared with conventional PICCs. However, it has a higher overall rate of elective removal after completion of therapy and less extravasation/infiltration, occlusion, and phlebitis compared with the conventional PICCs. Further large RCTs are recommended to enrich the current paucity of evidence and to reduce the risk of bias. Neonatal PICCs impregnation by other antimicrobials is a recommendation for vascular access device manufacturers.

show abstract

How to minimize central line–associated bloodstream infections in a neonatal intensive care unit: a quality improvement intervention based on a retrospective analysis and the adoption of an evidence-based bundle

Cited by 34 publications

References 28 publications

Outcomes of multiple gestation births compared to singleton: analysis of multicenter KID database

Outcomes of multiple gestation births compared to singleton: analysis of multicenter KID database

Bundle appearance validation for peripherally inserted central catheter handling in neonates / Validação de aparência do bundle para manuseio do cateter central de inserção periférica em neonatos

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

Contact Info

Product

Resources

About