Minimizing Catheter-Related Bloodstream Infections

Gwinnett Medical Center, Gwinnett Women's Pavilion, Neonatal Intensive Care Unit, Lawrenceville, Georgia 30046, USA.
Advances in Neonatal Care (Impact Factor: 1.12). 10/2009; 9(5):209-26; quiz 227-8. DOI: 10.1097/
Source: PubMed


Catheter-related bloodstream infection (CRBSI) is the most common complication related to peripherally inserted central catheters in the neonatal intensive care unit. CRBSIs are responsible for many morbidities and mortalities occurring in special care nurseries. However, these vascular access devices are an essential aspect of neonatal care and therefore are indispensable. To minimize CRBSI incidences and improve patient outcomes, objectives must be established to focus on the prevention of these potentially life-threatening infections. This article identifies the interventions incorporated by our facility to prevent nosocomial bloodstream infections.

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    • "The diagnostic criteria to confirm an infection related to central lines varied. Four studies (Cooley and Grady, 2009; Curry et al., 2009; Holzmann-Pazgal et al., 2012; Taylor Table 2 Key characteristics of the included studies. "
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    ABSTRACT: OBJECTIVE: To review the effect of a vascular access team on the incidence of central line-associated bloodstream infections in infants admitted to a neonatal intensive care unit. Data sources MEDLINE, CINAHL, Embase, Web-of-Science and the Cochrane Library were searched until December 2013. Study Selection Studies that evaluated the implementation of a vascular access team, and focused on the incidence of central line-associated bloodstream infections in infants admitted to a neonatal intensive care unit, were selected. Data Extraction Incidence rates of central line-associated bloodstream infections were extracted, as well as information on vascular access team tasks and team composition. The quality of studies was critically appraised using the McMaster tool for quantitative studies. Data Synthesis Seven studies involving 136 to 414 participants were included. In general, the implementation of a vascular access team coincided with the implementation of concurrent interventions. All vascular access teams included nurses, and occasionally included physicians. Main tasks included insertion and maintenance of central lines. In all studies, a relative decrease of 45-79% in central line-associated bloodstream infections was reported. CONCLUSIONS: A vascular access team is a promising intervention to decrease central line-associated bloodstream infections in infants admitted to a neonatal intensive care unit. However, level of evidence for effectiveness is low. Future research is required to improve the strength of evidence for vascular access teams.
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    ABSTRACT: To evaluate whether the establishment of a dedicated percutaneously inserted central catheter (PICC) team is associated with reduced risk of catheter-related bloodstream infection (CRBSI) in the neonatal intensive care unit. Participants were extremely low-birth-weight infants admitted to a level IIIC neonatal intensive care unit. A before- versus after-intervention study design was implemented. Intervention group participants were admitted after April 2006 when the PICC team was established, dedicating line insertion and maintenance responsibilities to the team. Historical control group participants were managed via the previous standard of care. The risk of CRBSI over time was estimated by Kaplan-Meier analyses and the effect of the PICC team on CRBSI risk was evaluated after controlling for covariables in a Cox proportional hazards model. Mean birth weight and gestational age were similar between groups. After controlling for gestational age, central line days, respiratory support days, and average daily census at time of admission in a Cox regression model, the intervention group had 49% lower risk of CRBSI in patients who had a central line in place for more than 30 days. There was no difference in rate of CRBSI between groups that had central lines of short or intermediate duration (<30 days). Catheter-related bloodstream infection in extremely low-birth-weight infants requiring long-term central venous access was reduced by nearly half after the institution of a dedicated PICC team in the neonatal intensive care unit. Standardizing PICC line placement is important, but standardizing line maintenance is essential to improvement of CRBSI rates.
    Advances in Neonatal Care 04/2011; 11(2):122-8. DOI:10.1097/ANC.0b013e318210d059 · 1.12 Impact Factor
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    ABSTRACT: Patient safety is a worldwide priority aimed at preventing medical errors before they cause death, harm, or injury. Medical errors impact 1 in 10 patients worldwide (WHO), and their implications may include death, permanent, or temporary harm, financial loss, and psychosocial harm to the patient and in some cases to the caregiver. The unique aspects and the complexity of the neonatal intensive (NICU) environment, in addition to the vulnerability of the neonatal population increase the risk for medical errors. The following article offers an overview of safety issues specific to neonatal intensive care and provides strategies and examples on how to ensure safe practice. In particular, the authors focus on strategies to improve the team process. Practice recommendations and research implications are presented.
    The Journal of perinatal & neonatal nursing 04/2011; 25(2):123-32. DOI:10.1097/JPN.0b013e31821693b2 · 1.10 Impact Factor
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