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Published on: July 13, 2019
Prevention of central line associated bloodstream infections in critical care units
1Department of Pediatrics, Westchester Medical Center, Valhalla, New York, USA. lis@wcmc.com
Insights
Central line-associated bloodstream infections (CLABSIs) remain a concern in neonatal and pediatric ICUs. Evidence-based care bundles significantly reduce CLABSI rates, offering a promising preventive strategy.
Area of Science:
- Neonatal and Pediatric Critical Care Medicine
- Infectious Disease Prevention
- Healthcare-Associated Infections
Background:
- Central line-associated bloodstream infections (CLABSIs) are a major cause of illness and death in neonatal and pediatric intensive care units (NICUs).
- Recent preventive strategies have shown success in reducing CLABSIs and related complications.
Purpose of the Study:
- To review current strategies for preventing CLABSIs in neonatal and pediatric intensive care settings.
- To evaluate the efficacy of various interventions, including antiseptic agents, impregnated dressings, and care bundles.
Main Methods:
- Review of current surveillance data on CLABSI rates.
- Analysis of pilot randomized trials assessing chlorhexidine gluconate and silver alginate dressings.
- Evaluation of the impact of evidence-based catheter care bundles in clinical settings.
Main Results:
- CLABSI rates have recently declined, potentially due to revised diagnostic criteria and improved central line care.
- Pilot trials found no significant reduction in CLABSIs with chlorhexidine gluconate or silver alginate dressings.
- Implementation of evidence-based catheter care bundles has demonstrated significant reductions in CLABSI rates.
Conclusions:
- CLABSIs continue to pose a significant threat in neonatal and pediatric critical care.
- Catheter care bundles are effective in substantially lowering CLABSI rates.
- Further large-scale, multicenter trials are needed to assess the safety and efficacy of chlorhexidine gluconate, silver alginate, and antibiotic-coated catheters.
Purpose Of Review:
Central line associated bloodstream infections (CLABSIs) are a common source of morbidity and mortality in neonatal and pediatric intensive care units. Successful preventive strategies have recently been reported which have resulted in significant reductions in CLABSIs and their associated adverse outcomes.
Recent Findings:
Current surveillance data indicate a recent decline in reported CLABSI rates, likely secondary to changes in diagnostic criteria and improvements in central line care. Recent pilot randomized trials in the neonatal intensive care unit population have assessed the safety and efficacy of chlorhexidine gluconate for cutaneous antisepsis and silver alginate-impregnated dressings. No significant reductions in CLABSIs have been noted with the use of either. The greatest success has come with implementation of evidence-based catheter care bundles, which have been shown in individual units and collaborative critical care networks to significantly reduce CLABSI rates.
Summary:
CLABSIs remain a significant problem in neonatal and pediatric critical care units, but implementation of catheter care bundles can significantly reduce rates of these infections. The safety and efficacy of chlorhexidine gluconate, silver alginate, and antibiotic-coated catheters need to be assessed via large, multicenter trials. Creation of collaborative networks may facilitate this goal.
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