Central Line “Attention” Is Their Best Prevention

Abstract

Central line associated blood stream infections (CLABIs) are associated with an increase in length of stay, morbidity, hospital costs, and mortality. In 2009, CLABIs were on the increase at Covenant Healthcare's 55 bed Level III neonatal intensive care unit (NICU). Prior to this practice initiative, there were no standardized central line management practices in the NICU. We retrospectively reviewed the incidence CLABIs for the six months prior to the initiation of the standardization of central line management and then 3 months following the implementation of the new practice policy. Specific outcomes measured were the number of CLABIs, length of stay related to CLABIs, and adherence to the policies and procedures. The project was implemented in four phases: 1) hand hygiene, 2) "scrub the hub", 3) central line tubing changes, 4) central line insertion, removal, and dressing changes. Although there were no statistically significant changes in the outcome measures, there were clinically significant differences between length of stay and risk for central line infection, incidence of CLABIs, and an increase in adherence to the central line practice change policies. The study showed for every week that is added to the patient stay, the patient was 7 times more likely to have a CLABIs. The rate of central line infection was decreased from 15.6 percent per 1000 line days to zero in 2010.

Interventions to Decrease Catheter-Associated Bloodstream Infections in Newborns: An Integrative Review

“…Fourteen of the 15 papers selected were written in English [9][10][11][19][20][21][22][23][24][25][26][27][28][29] (93.3%); only one was in Spanish; 30 none were written in Portuguese. In regard to the year of publication, the papers were mainly published in 2011, 9,[19][20]24,[26][27] 40% of the total, followed by 26.6% of the papers published in 2009. [22][23]28,30 In regard to the papers' specific fields, three (20%) addressed catheters both in pediatric and neonatal populations, 11,20,30 and the other 12 9-10,19,21-27-29 (80%) papers included only neonatal populations.…”

Using the knowledge translation framework to change practical care of central catheters in a Brazilian neonatal unit

“…The recommendation to "keep the infusion system closed" [15,[28][29][30][31] was completely achieved by the team pre-and post-implementation of the procedure. The three other expected practices by professionals often included in other bundles were performing hand hygiene before and after handling the CVC [4][5][6][7]13,16,18,[22][23][24][25][26]29,[31][32][33][34], performing correct technique of cleansing of the hands, and carrying out friction side guns and connections for 30 seconds [4,7,15,[22][23]26,28,[30][31]33,35]; only the last recommendation showed no statistically significant difference when compared to the rate of inappropriateness pre-and post-implementation scripts, though it was considered a clinically important improvement in 37%.…”

“…The CABSI density in Brazilian neonatal units was between 10.5 and 12.5 per 1,000 catheter-days in 2011 [2]. These figures are high compared to the international ones [3][4][5][6][7].…”

“…Various studies have compared infection rates before and after the implementation of bundles for central catheters in neonatal units; these consist of a set of evidence-based practices proven to improve the outcomes of patient care [12]. However, such studies did not adopt a conceptual benchmark to guide the way to implement such evidence [3][4][5][6][7]13]. In addition, comparisons of the changes of catheter insertion and maintenance before and after the intervention are lacking.…”

Very low birthweight infants face an increased risk of bloodstream infections following the removal of umbilical catheters

“…A more active approach to the antiseptic management of central lines in the NICU has reduced bacterial infections in such lines . Scrubbing the hub of intravenous catheters with an alcohol wipe has been shown effective in reducing neonatal sepsis .…”