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Published on: July 13, 2019
Evaluating central venous catheter care in a pediatric intensive care unit
Carol Hatler1, Linda Buckwald, Zoraida Salas-Allison
1St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Insights
Catheter-related bloodstream infections in children are a concern. Focusing on infection control processes, not just products like dressings, is key for preventing these infections in pediatric intensive care units.
Area of Science:
- Pediatric critical care medicine
- Infection control
- Nursing research
Background:
- Catheter-related bloodstream infections (CRBSI) are a significant issue in hospitalized children.
- Central venous catheters (CVCs), while life-saving, pose a risk for infection.
- Limited research exists on CVC care specifically for pediatric intensive care unit (PICU) patients.
Purpose of the Study:
- To assess evidence-based practices for CVC insertion site care in a PICU.
- To evaluate the impact of two dressing regimens on CRBSI rates and costs.
- To understand nurses' knowledge of infection control practices for CVCs.
Main Methods:
- An exploratory design with a convenience sample was used.
- Data collected in two 30-day phases: baseline, transparent dressing alone, and transparent dressing with chlorhexidine-impregnated dressing.
- Nurses completed a survey on infection control knowledge related to CVCs.
Main Results:
- Minimal differences observed between transparent dressing alone and chlorhexidine-impregnated plus transparent dressing.
- A notable finding was the frequency of daily CVC access.
- No significant difference in CRBSI rates was found between the two dressing regimens.
Conclusions:
- Infection control strategies for CVCs in PICUs should prioritize process-focused interventions.
- The findings suggest that optimizing care processes may be more impactful than product selection alone.
- Further investigation into CVC access frequency and its relation to infection is warranted.
Background:
Catheter-related bloodstream infection remains an important health problem for hospitalized children. Although placement of a central venous catheter is a life-saving intervention for critically ill children, these same central catheters are a potential source of infection.
Objectives:
Few studies that directly address care of central venous catheters for children in intensive care units have been reported. This evaluation was designed to describe the extent of evidence-based practices for care of insertion sites of central venous catheters in the pediatric intensive care unit of an urban tertiary care center. Another goal was to determine the influence of 2 different regimens for dressing changes on rates of catheter-related bloodstream infections and costs.
Methods:
A convenience sample and an exploratory design were used to collect data in 2 phases, including 30 days to establish baseline information and 30 days each during which patients received dressing care for a central venous catheter with a transparent dressing alone and with a transparent dressing plus a chlorhexidine-impregnated dressing. Nurses also participated in a survey of knowledge about infection control practices related to central catheters.
Results:
Few differences were found between the transparent dressing alone and a chlorhexidine-impregnated dressing plus the transparent dressing. A serendipitous finding was the number of times that central catheters were accessed daily.
Conclusions:
The results of this project suggest that infection control efforts may be most appropriately focused on processes rather than on products.
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