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.
[Show abstract][Hide abstract] 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.
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.
International journal of nursing studies 12/2014; 52(5). DOI:10.1016/j.ijnurstu.2014.11.010. · 2.90 Impact Factor
"Maximal universial precautions (e.g., caps, masks, sterile gowns, and sterile gloves) during catheter acquire reduction of CRBSI incidence, compared with standard precautions. Taylor et al.26) reported that CRBSI in VLBW infants requiring long term central venous access was reduced by nearly half after the institution of a dedicated PICC team in the NICU. "
[Show abstract][Hide abstract] ABSTRACT: Central venous catheters (CVCs) are regularly used in intensive care units, and catheter-related bloodstream infection (CRBSI) remains a leading cause of healthcare-associated infections, particularly in preterm infants. Increased survival rate of extremely-low-birth-weight infants can be partly attributed to routine practice of CVC placement. The most common types of CVCs used in neonatal intensive care units (NICUs) include umbilical venous catheters, peripherally inserted central catheters, and tunneled catheters. CRBSI is defined as a laboratory-confirmed bloodstream infection (BSI) with either a positive catheter tip culture or a positive blood culture drawn from the CVC. BSIs most frequently result from pathogens such as gram-positive cocci, coagulase-negative staphylococci, and sometimes gram-negative organisms. CRBSIs are usually associated with several risk factors, including prolonged catheter placement, femoral access, low birth weight, and young gestational age. Most NICUs have a strategy for catheter insertion and maintenance designed to decrease CRBSIs. Specific interventions slightly differ between NICUs, particularly with regard to the types of disinfectants used for hand hygiene and appropriate skin care for the infant. In conclusion, infection rates can be reduced by the application of strict protocols for the placement and maintenance of CVCs and the education of NICU physicians and nurses.
Korean Journal of Pediatrics 09/2011; 54(9):363-7. DOI:10.3345/kjp.2011.54.9.363
[Show abstract][Hide abstract] ABSTRACT: Zur Prävention häufiger nosokomialer Infektionen wurde bereits eine Vielzahl von Leitlinien erstellt. Die mangelnde Umsetzung in die Praxis ist jedoch ein häufiges Problem, deren Hintergründe vielfältig sind. Um über eine Priorisierung von Maßnahmen die Implementierung zu vereinfachen, wurde das Bündelkonzept entwickelt. Ein Bündel besteht nur aus drei bis fünf praktischen Maßnahmen, deren Relevanz evidenzbasiert ist. Sehr erfolgreich wurde das Konzept zur Vermeidung von katheterassoziierten Blutstrominfektionen und beatmungsassoziierten Pneumonien angewendet. Nur die vollständige Erfüllung aller Komponenten bedeutet eine erfolgreiche Umsetzung, und nur eine hohe Compliance bei der Umsetzung verbessert die Infektionsrate signifikant. Von entscheidender Bedeutung ist somit die richtige Implementierung. Diese beinhaltet eine gute Planung mit Festlegung der Verantwortlichkeiten, Schulungen der einzelnen Maßnahmen, Überwachung der Compliance sowie Surveillance der Infektionsraten.
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