Central Line–Associated Bloodstream Infection in Neonatal Intensive Care Units

Blanchard, Ana C.; Fortin, Élise; Rocher, Isabelle; Moore, Dorothy; Frenette, Charles; Tremblay, Claude; Quach, Caroline

doi:10.1086/673464

Cited by 32 publications

(16 citation statements)

References 33 publications

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“…The reported incidences of CLABSI in neonates admitted to NICUs vary from 0.8 to 18.1 per 1,000 catheter-days (3, 10, 14–19). Variation in reported incidences is probably due to methodological differences between the studies including different cohort characteristics, but may also be attributable to differences in actions to prevent the development of CLABSI between the departments, such as emphasizing hand hygiene, avoidance of certain medications, and using bundles of care.…”

Section: Discussionmentioning

confidence: 99%

Bloodstream Infection Incidence of Different Central Venous Catheters in Neonates: A Descriptive Cohort Study

et al. 2017

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Central venous catheters (CVCs) in neonates are associated with a risk of central line-associated bloodstream infections (CLABSI). Most reports on the incidence of CLABSI in neonates focus on umbilical venous catheters (UVCs) and peripherally inserted central catheters (PICCs). We evaluated the incidence and risk factors for CLABSI in a cohort of neonates with femoral venous catheters (FVCs), UVCs, and PICCs, with a gestational age ≥34 weeks born between January 1, 2006 and June 30, 2013. We included 2,986 neonates with a total of 656 catheters. The CLABSI incidence rate varied from 12.3 per 1,000 catheter-days in FVCs to 10.6 per 1,000 catheter-days in UVCs and 5.3 per 1,000 catheter-days in PICCs. In a Kaplan–Meier survival analysis, we did not find a difference in CLABSI risk between the catheter types (p = 0.29). The following factors were independently associated with an increased risk of CLABSI: parenteral nutrition [hazard ratio (HR) 2.60, 95% confidence interval (CI) 1.25–5.41], male gender (HR 2.63, 95% CI 1.17–5.90), and higher birth weight (HR 1.04, 95% CI 1.002–1.09), whereas antibiotic treatment at birth (HR 0.25, 95% CI 0.12–0.52) was associated with a decreased risk. Conclusion: In our cohort, we did not find a difference between the CLABSI incidence in FVCs, PICCs, and UVCs. Occurrence of CLABSI is associated with parenteral nutrition, male gender, and higher birth weight. Antibiotic treatment at birth was associated with a decreased risk of CLABSI.

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Section: Discussionmentioning

confidence: 99%

Bloodstream Infection Incidence of Different Central Venous Catheters in Neonates: A Descriptive Cohort Study

et al. 2017

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“…A decrease in the CLABSI rate by nearly 20% from a baseline rate of 1.333 would prevent ∼35 CLABSIs and save as many as 7 lives. 41 Based on published estimates of up to $69 000 attributable-cost per CLABSI, we could expect a cost-saving of up to $2.4 million. 6-11…”

Section: Figurementioning

confidence: 99%

SLUG Bug: Quality Improvement With Orchestrated Testing Leads to NICU CLABSI Reduction

Piazza

Brozanski

Provost³

et al. 2016

Pediatrics

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Drs Piazza, Pallotto, and Brozanski in collaboration provided leadership for the design and analytics of the collaborative; and drafted, reviewed, and revised the manuscript. Ms Zaniletti and Mr Provost provided data analytics and critically reviewed the manuscript. All authors participated in the design and management of the collaborative, approved the fi nal manuscript as submitted, and agreed to be accountable for all aspects of the work. DOI: 10.1542/peds.2014-3642Accepted for publication Sep 21, 2015 Address correspondence to Anthony J. Piazza, MD, Department of Pediatrics, Division of Neonatal Medicine, Emory School of Medicine, 2015 Uppergate Rd, Atlanta, GA 30322. E-mail: apiazza@ emory.edu PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).Health care-associated infections (HAIs) are a burden to patients and the health care system. It is estimated that up to 50% of HAIs are preventable. 1,2 In 2002, however, HAIs in US hospitals reportedly reached ∼1.7 million, with >33 000 HAIs among infants in high-risk nurseries. 3 Central line-associated bloodstream infections (CLABSIs) have the highest cost per HAI and contribute to significant morbidities, mortality, and length of stay in the adult, pediatric, and neonatal populations. [4][5][6] The overall direct annual cost of US HAIs ranges from $35.7 to $45 billion for inpatient hospital services. 7 Although the actual cost of CLABSIs varies, the attributable cost to care is up to $69 000 per event. [7][8][9][10][11] Despite the risks with their use, central venous catheters (CVCs) play an integral role in modern health care. 12 The need for CVCs is particularly important in children's hospital NICUs for patients who abstract OBJECTIVE: Reduce central line-associated bloodstream infection (CLABSI) rates 15% over 12 months in children's hospital NICUs. Use orchestrated testing as an approach to identify important CLABSI prevention practices. METHODS:Literature review, expert opinion, and benchmarking were used to develop clinical practice recommendations for central line care. Four existing CLABSI prevention strategies (tubing change technique, hub care monitoring, central venous catheter access limitation, and central venous catheter removal monitoring) were identified for study. We compared the change in CLABSI rates from baseline throughout the study period in 17 participating centers. Using orchestrated testing, centers were then placed into 1 of 8 test groups to identify which prevention practices had the greatest impact on CLABSI reduction. RESULTS:CLABSI rates decreased by 19.28% from 1.333 to 1.076 per 1000 line-days. Six of the 8 test groups and 14 of the 17 centers had decreased infection rates; 16 of the 17 centers achieved >75% compliance with process measures. Hub scrub compliance monitoring, when used in combination with sterile tubing change, decreased CLABSI rates by 1.25 per 1000 line-days. CONCLUSIONS:This multicenter improvement collaborative achieved a decrease in CLABSI rates. Orchestrated testing identified infection prev...

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“…8 Additionally, Blanchard et al's cohort study noted an association with underlying intra-abdominal pathology and that 51% of their CLABSI were due to coagulase-negative staphylococci and 11% due to Staphylococcus aureus. 9 In contrast, other studies have found predominantly gram-negative organisms in neonatal CLABSI. 10 Variations in risk factors and pathogens emphasize the need for each NICU to develop an individualized QI approach based on their population's characteristics.…”

Section: Defining the Problemmentioning

confidence: 91%

Quality Improvement to Reduce Neonatal CLABSI: The Journey to Zero

Pearlman

2020

Am J Perinatol

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Neonatal infections, including those associated with central lines, continue to be a major cause of morbidity and mortality despite many other improvements in neonatal outcomes. Over the past decades, significant advances have been made to reduce central line-associated bloodstream infections (CLABSIs) using quality improvement methodology. This article will review pertinent studies that used both the Institute for Healthcare Improvement Model for Improvement and other innovative techniques such as orchestrated testing and health care failure mode and effects analysis. These studies, by applying best practices, have demonstrated substantial and sustainable reductions in CLABSI. Some initiatives have been able to achieve rates of zero CLABSI for prolonged periods of time. While neonates often require prolonged central venous access and suffer from impaired immunity which increases the risk of CLABSI, this review demonstrates the journey to zero is feasible. Key Points

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Central Line–Associated Bloodstream Infection in Neonatal Intensive Care Units

Abstract: The increase in CLABSI rates in Quebec NICUs seems to be associated with an increased proportion of cases with underlying intra-abdominal and pulmonary pathologies, which needs further investigation.

Cited by 32 publications

References 33 publications

Bloodstream Infection Incidence of Different Central Venous Catheters in Neonates: A Descriptive Cohort Study

Bloodstream Infection Incidence of Different Central Venous Catheters in Neonates: A Descriptive Cohort Study

SLUG Bug: Quality Improvement With Orchestrated Testing Leads to NICU CLABSI Reduction

Quality Improvement to Reduce Neonatal CLABSI: The Journey to Zero

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