Effectiveness of insertion and maintenance bundles to prevent central-line-associated bloodstream infections in critically ill patients of all ages: a systematic review and meta-analysis

Care bundles to reduce central line-associated bloodstream infections in the neonatal unit: a systematic review and meta-analysis

“…This appears to be supported by a recent meta-analysis by Ista et al 32 which was the first systematic review to investigate CLABSI rates across all ages, performing separate subgroup analyses of adult ICU, Paediatric Intensive Care Units and Neonatal Intensive Care Unitss. It found that care bundles statistically reduced CLABSI rates across all age ranges, including 14 neonatal studies (Incidence Risk Ratio 0.47, 95% CI 0.38 to 0.59).…”

“…Moderate heterogeneity was found in the neonatal subgroup analysis performed by Ista et al 32 with an I 2 of 74%, though there were fewer studies included in their meta-analysis. Despite several studies being reported as cohort or case–control, the studies were all non-randomised interventional studies, which not only means there are multiple risks of bias, but may also partially explain the lack of statistical heterogeneity.…”

“…Other practices potentially affecting the reduction of CLABSIs were not frequently reported, and it should be noted that five studies specified removing central lines at 120 mL/kg/day enteral feed volumes. The study by Ista et al found minimising central line access significantly contributed to reducing CLABSIs in the NICU 32. The authors did not contact the researchers for clarification on bundled elements, and are unable to ascertain if any bundled elements were used but not reported.…”

“…It is often unclear why specific elements were chosen, and absence of reported elements does not necessarily equate to absence in the NNU. Unlike the study by Ista et al ,32 this study has not attempted to associate specific bundled elements with reductions in CLABSIs, but instead identified the most frequently reported elements.…”

The CVC and CRBSI: don’t use it and lose it!

“…Previous works have looked at this topic most commonly using the "pre-post" design with bundles of care [12]. The PROHIBIT study included numerous items on its catheter insertion and management protocol.…”