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Updated: Jun 22, 2026
A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit
Published on: July 13, 2019
[Catheter-associated bloodstream infections: implementation of a new consensus protocol]
M Urrea Ayala1, L Rozas Quesada
1Unidad Control de Infecciones Nosocomiales, Hospital Sant Joan de Déu, Barcelona, España. murrea@hsjdbcn.org
Insights
A new protocol for central venous catheter care significantly reduced catheter-associated bloodstream infections (CA-BSIs) in pediatric patients. Strict adherence to the protocol and staff training were key to controlling these infections.
Area of Science:
- Infectious Diseases
- Pediatric Critical Care
- Hospital Epidemiology
Context:
- Catheter-associated bloodstream infections (CA-BSIs) are a significant concern in pediatric intensive care units.
- Existing preventive measures may not be sufficient to control CA-BSI rates.
- Implementing standardized protocols is crucial for infection control.
Purpose:
- To evaluate the effectiveness of a new consensus protocol in reducing CA-BSIs in pediatric patients.
- To assess compliance with the new protocol in pediatric and neonatal intensive care units.
- To determine the impact of the protocol on infection rates across different hospital settings.
Summary:
- A prospective study compared CA-BSI rates before and after implementing a new central venous catheter (CVC) protocol.
- Key protocol changes included hermetic connections, medication line labeling, and CVC date labeling.
- Compliance with the protocol was monitored using a checklist in intensive care units.
Impact:
- The new protocol led to a reduction in CA-BSI rates across pediatric and neonatal intensive care units, hematology-oncology, and general hospital wards.
- High compliance rates were observed for sealed connectors (>95%) and CVC labeling with insertion date (85%).
- The study underscores the importance of standardized protocols and epidemiological surveillance in managing nosocomial infections.
Introduction:
Catheter-associated bloodstream infection is highly prevalent and often associated with fatal complications. Some studies have shown that applying preventive interventions could help to reduce and control this type of infection.
Objective:
To determine whether a new consensus protocol for the manipulation and maintenance of central venous catheters would decrease catheter-associated bloodstream infections (CA-BSIs) in paediatric patients. To evaluate its compliance in intensive care units.
Method:
Prospective study in the paediatric (PICU) and neonatal (NICU) intensive cares units, haematology, oncology and hospital wards in a Maternal and Paediatric reference Hospital in Barcelona. The study period is divided into two periods: before (first semester) and after the start of the new protocol (second semester) in 2007. The most important changes have been the insertion of the hermetic connection in the proximal and distal site (between the line and the syringe) of the central venous catheter (CVC), the labelling of the medication line and the CVC with the date of placement. A check-list to evaluate compliance was introduced in both intensive care units (paediatrics and neonatal) during the second study period. The rates of bloodstream infection per 1000 catheter-days were assessed.
Results:
The rate of bloodstream infections per 1000 catheter-days before and after the start of the new protocol was 5.7 and 4.9 in PICU; 24.6 and 18.0 in NICU; 7.6 and 4.6 in haematology-oncology, and 11.9 and 10.3 in hospital wards. As regards compliance to the protocol, we found that proximal sealed connectors were used in more than 95% of the cases and up to 85% of the central venous catheter were labelled with the insertion date in both intensive care units.
Conclusions:
A consensus protocol for the use and maintenance of central venous catheters and healthcare worker training helped to control the rate of CA-BSIs. We reaffirm the importance of epidemiological surveillance as a measure for controlling nosocomial infections.
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