Interventions to reduce central venous catheter-associated infections in children: which ones are beneficial?

Mok, Quen; Gilbert, Ruth

doi:10.1007/s00134-011-2135-2

Cited by 9 publications

(6 citation statements)

References 19 publications

(16 reference statements)

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“…For paediatric ICUs the 48% reduction did not achieve statistical significance; the difficulty of reducing CVC-BSIs in paediatric intensive care is well recognised. [29][30][31][32] A conventional narrative might run thus: training in technical and non-technical interventions to improve patient safety combined with measurement and performance feedback stimulated a change in behaviour which resulted in a reduction in BSIs from CVCs.…”

Section: Discussionmentioning

confidence: 99%

‘Matching Michigan’: a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England

et al. 2012

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BackgroundBloodstream infections from central venous catheters (CVC-BSIs) increase morbidity and costs in intensive care units (ICUs). Substantial reductions in CVC-BSI rates have been reported using a combination of technical and non-technical interventions.MethodsWe conducted a 2-year, four-cluster, stepped non-randomised study of technical and non-technical (behavioural) interventions to prevent CVC-BSIs in adult and paediatric ICUs in England. Random-effects Poisson regression modelling was used to compare infection rates. A sample of ICUs participated in data verification.ResultsOf 223 ICUs in England, 215 (196 adult, 19 paediatric) submitted data on 2479 of 2787 possible months and 147 (66%) provided complete data. The exposure rate was 438 887 (404 252 adult and 34 635 paediatric) CVC-patient days. Over 20 months, 1092 CVC-BSIs were reported. Of these, 884 (81%) were ICU acquired. For adult ICUs, the mean CVC-BSI rate decreased over 20 months from 3.7 in the first cluster to 1.48 CVC-BSIs/1000 CVC-patient days (p<0.0001) for all clusters combined, and for paediatric ICUs from 5.65 to 2.89 (p=0.625). The trend for infection rate reduction did not accelerate following interventions training. CVC utilisation rates remained stable. Pre-ICU infections declined in parallel with ICU-acquired infections. Criterion-referenced case note review showed high agreement between adjudicators (κ 0.706) but wide variation in blood culture sampling rates and CVC utilisation. Generic infection control practices varied widely.ConclusionsThe marked reduction in CVC-BSI rates in English ICUs found in this study is likely part of a wider secular trend for a system-wide improvement in healthcare-associated infections. Opportunities exist for greater harmonisation of infection control practices. Future studies should investigate causal mechanisms and contextual factors influencing the impact of interventions directed at improving patient care.

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Section: Discussionmentioning

confidence: 99%

‘Matching Michigan’: a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England

et al. 2012

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“…This is a low risk medical device trial [35]. Further research is required to explore clinician experiences in differing trial types (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…In order to access practitioners who had experience of deferred consent the questionnaire was also distributed to practitioners who were actively recruiting to the CATCH trial at the time that this survey was conducted. CATCH was a multi-centre UK trial that incorporated a deferred consent process to investigate interventions to reduce central venous catheter-associated infections in children [35]. For CONNECT, practitioners were asked to complete questionnaires for each paediatric emergency care trial they had been involved in since 2004.…”

Section: Methodsmentioning

confidence: 99%

How experience makes a difference: practitioners’ views on the use of deferred consent in paediatric and neonatal emergency care trials

et al. 2013

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BackgroundIn 2008 UK legislation was amended to enable the use of deferred consent for paediatric emergency care (EC) trials in recognition of the practical and ethical difficulties of obtaining prospective consent in an emergency situation. However, ambiguity about how to make deferred consent acceptable to parents, children and practitioners remains. In particular, little is known about practitioners’ views and experiences of seeking deferred consent in this setting.MethodsAs part of a wider study investigating consent methods in paediatric emergency care trials (called CONNECT), a 20 item online questionnaire was sent by email inviting practitioners (doctors and nurses) who were involved in talking with families about children’s and young people’s (aged 0–16 years) participation in UK EC trials. To ensure those with and without experience of deferred consent were included, practitioners were sampled using a combination of purposive and snowball sampling methods. Simple descriptive statistics were used to analyse the quantitative data, whilst the constant comparative method was used to analyse qualitative data. Elements of a symbiotic empirical ethics approach was used to integrate empirical evidence and bioethical literature to explore the data and draw practice orientated conclusions.ResultsViews on deferred consent differed depending upon whether or not practitioners were experienced in this consent method. Practitioners who had no experience of deferred consent reported negative perceptions of this consent method; these practitioners were concerned about the impact that deferred consent would have upon the parent-practitioner relationship. In contrast, practitioners experienced in deferred consent described how families had been receptive to the consent method, if conducted sensitively and in a time appropriate manner. Experienced practitioners also described how deferred consent had improved recruitment, parental decision-making capacity and parent-practitioner relationships in the emergency care setting.ConclusionsThe views of practitioners with first-hand experience of deferred consent should be considered in the design and ethical review of future paediatric EC trials; the design and ethical review of such trials should not solely be informed by the beliefs of those without experience of using deferred consent. Further research involving parents and children is required to inform practitioner training and normative guidance on the use and appropriateness of deferred consent in emergency settings.

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“…Previous trials in urgent situations have used alternatives to prospective consent, involving a process in which a lesser form of permission is sought prospectively to administer the urgent randomized intervention as part of the trial and consent seeking is deferred until after implementation of the randomized intervention and the child's condition has been stabilized. 5,6 Yet in such trials, it is not clear what is the most appropriate way to inform parents, "after the event," that their child has received treatment as part of a trial. Inappropriate timeframes or approaches could adversely affect the informed consent process, jeopardize the clinician-patient relationship, cause parental anxiety, lead to unethical recruitment of children into a clinical trial, or limit fair access to the research.…”

mentioning

confidence: 99%

Clinical Trial Decisions in Difficult Circumstances: Parental Consent Under Time Pressure

et al. 2015

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Treatments and interventions used to care for children in emergencies should be based on strong evidence. Well-designed clinical trials investigating these interventions for children are therefore indispensable. Parental informed consent is a key ethical requirement for the enrollment of children in such studies. However, if time is limited because of an urgent need for intervention, there are additional ethical challenges to adequately support the informed consent process. The acute situation and associated psychological impact may compromise the ability of parents to give informed consent. Little evidence exists to guide the process of consent seeking for a child’s research participation when time is limited. It is also unclear in what circumstances alternatives to prospective informed consent could be applied. This article describes possible options to manage the informed consent process in an appropriate, practical, and, we believe, ethical way when time is limited.

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Interventions to reduce central venous catheter-associated infections in children: which ones are beneficial?

Cited by 9 publications

References 19 publications

‘Matching Michigan’: a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England

‘Matching Michigan’: a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England

How experience makes a difference: practitioners’ views on the use of deferred consent in paediatric and neonatal emergency care trials

Clinical Trial Decisions in Difficult Circumstances: Parental Consent Under Time Pressure

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