Impact of a Central Line Infection Prevention Bundle in Newborn Infants

Abstract

OBJECTIVETo compare central line use and central line–associated bloodstream infection in newborn infants before and after the introduction of a central line infection prevention bundle in order to determine the effectiveness of the bundle and to identify areas for further improvement.DESIGNRetrospective cohort analysis of prospectively collected data.SETTINGLevel 5 neonatal intensive care unit in Sydney, Australia.PATIENTSNewborn infants admitted to the Royal Prince Alfred Hospital Neonatal Intensive Care Unit who had a central venous catheter (CVC) inserted.METHODSData regarding clinical characteristics, CVC use, and infection were collected before and after the introduction of a bundle of interventions. The bundles encompassed (1) insertion of CVC, (2) maintenance of CVC, (3) an education program, and (4) ongoing surveillance and feedback.RESULTSBaseline and intervention groups were comparable in clinical characteristics. The number of CVCs inserted was reduced in the intervention group (central line utilization rate, 0.16 vs 0.2, P<.0001). Overall CVC dwell time was reduced, resulting from significant reduction in peripherally inserted CVC dwell time (6 days [95% CI, 5.0–11.8 days] vs 7.3 days [4.0–10.4 days], P=.0004). Central line–associated bloodstream infections were significantly reduced, predominantly secondary to decreased peripherally inserted CVC–related bloodstream infections (1.2/1,000 central line–days vs 11.5/1,000 central line–days, P<.0001).CONCLUSIONThis central line infection bundle was effective in reducing CVC use, dwell time, and central line–associated bloodstream infections.Infect Control Hosp Epidemiol 2016;37:1029–1036

Retrospective Cohort Analysis of Central Line Associated Blood Stream Infection following Introduction of a Central Line Bundle in a Neonatal Intensive Care Unit

“…Limitations of the study include a small dataset, particularly due to the study population being restricted to a single NICU facility. This could provide a possible explanation for the discrepancy observed in our 751-1000 g dataset compared to studies conducted on a larger scale [ 14 , 15 , 18 , 19 ]. However, the overall observed reduction in infection rates is consistent with similar outcomes for prevention bundles examined on a much larger scale [ 14 , 15 , 18 , 19 ].…”

“…This could provide a possible explanation for the discrepancy observed in our 751-1000 g dataset compared to studies conducted on a larger scale [ 14 , 15 , 18 , 19 ]. However, the overall observed reduction in infection rates is consistent with similar outcomes for prevention bundles examined on a much larger scale [ 14 , 15 , 18 , 19 ]. Thus, the results of our study suggest that a significant reduction in CLABSI could be pivotal to reducing the burden of HAI in NICUs as well as paediatric and adult ICUs [ 19 ].…”

“…Following recognition of a high rate of CLABSI in the NICU, a central line bundle was proposed [ 7 ]. This bundle was developed from current evidence and literature reviews [ 1 – 8 , 10 , 11 , 13 – 15 ]. The final bundle included a number of interventions: Introduction of insertion and maintenance checklists (Figures 1 and 2 ) Intensive education of medical and nursing staff Implementation of an exclusive central line cart which contained consolidated items required for central line insertion Encouraging nursing staff to enforce the checklist and stop procedure if sterility was breached.…”

“…This idea highlights the importance of seeking prevention for infections such as CLABSI. CLABSI rates have been shown to reduce with the use of healthcare intervention “bundles” [ 13 – 15 ]. These bundles are defined by the Institute for Healthcare Improvement (IHI), as a “small straightforward set of evidence-based practices that, when performed collectively and reliably, have been proven to improve patient outcomes” [ 16 ].…”

Sepsis neonatal tardía nosocomial en una unidad de terapia intensiva: agentes etiológicos y localización más frecuente

“…Si bien no se recuperó un microorganismo en la gran mayoría de ellos, esto se debió, muy posiblemente, a que la inestabilidad hemodinámica del paciente impidió realizar estudio del LCR en etapas tempranas de la infección nosocomial y los pacientes ya se encontraban recibiendo antimicrobianos de amplio espectro por varios días. La alta prevalencia de este hallazgo, en comparación con otros autores 15,25 debe alertar al médico tratante a buscar de manera intencionada el compromiso meníngeo, realizando la punción lumbar una vez que el estado hemodinámico y respiratorio del paciente lo permita, a fin de evitar la pérdida del diagnóstico de infección del SNC dentro del cuadro de sepsis 26 .…”