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Published on: July 13, 2019
Intervention to reduce catheter-related bloodstream infections in a pediatric intensive care unit
Corsino Rey1, Francisco Alvarez, Victoria De-La-Rua
1Paediatric Intensive Care Unit, Department of Paediatrics, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Asturias, Spain. corsino.rey@sespa.princast.es
Insights
Interventions targeting parenteral nutrition and indwelling time significantly reduced catheter-related bloodstream infections (CR-BSI) in a pediatric intensive care unit. This study highlights key risk factors and the effectiveness of targeted strategies for CR-BSI prevention.
Area of Science:
- Infection Control
- Pediatric Critical Care
- Clinical Interventions
Background:
- Catheter-related bloodstream infections (CR-BSI) are a significant concern in pediatric intensive care units (PICUs).
- Identifying modifiable risk factors is crucial for developing effective prevention strategies.
- Previous studies have indicated various factors contributing to CR-BSI, necessitating further investigation in specific patient populations.
Purpose of the Study:
- To identify independent risk factors for CR-BSI in a pediatric intensive care unit.
- To evaluate the impact of targeted interventions aimed at reducing identified risk factors on CR-BSI rates.
- To determine the sustained effectiveness of these interventions over time.
Main Methods:
- A prospective, observational, interventional, and interrupted time-series study was conducted over seven years in a university hospital's PICU.
- Multivariate analysis was used to identify CR-BSI risk factors during two distinct periods.
- Interventions focused on reducing parenteral nutrition (PN) and indwelling time (IT) were implemented between the study periods.
Main Results:
- Initial CR-BSI rate was 11.94 per 1,000 catheter-days. Identified risk factors included weight, parenteral nutrition (PN), and indwelling time (IT).
- Following interventions, PN use decreased from 49.8% to 26.7%, and IT reduced from 9.92 to 8.13 days.
- The CR-BSI rate significantly decreased to 3.05 per 1,000 catheter-days, with PN and IT no longer identified as risk factors.
Conclusions:
- Parenteral nutrition and indwelling time were confirmed as independent CR-BSI risk factors in the initial study period.
- A targeted intervention program focused on reducing PN and IT led to a sustained reduction in CR-BSI rates.
- These findings underscore the importance of addressing specific risk factors for effective CR-BSI prevention in pediatric critical care settings.
Objective:
Identification of catheter-related bloodstream infection (CR-BSI) risk factors and determination of whether intervention related to identified risk factors would reduce CR-BSI rates.
Design:
Prospective, observational, interventional and interrupted time-series study.
Setting:
Pediatric Intensive Care Unit (PICU) in a university hospital.
Methods:
During a 7-year period, 609 central venous catheters (CVC) were placed in 389 patients. CR-BSI risk factors were determined by multivariate analysis during two periods (January 2000-November 2002 and January 2003-April 2007). An intervention to reduce identified risk factors was performed after the first period. CR-BSI rates per 1,000 catheters-days were compared during the two periods.
Results:
The CR-BSI rate was 11.94 [(95% CI 7.94-15.94)/1,000 catheter-days during the first period]. Weight [OR 0.96 (0.91-0.99)], parenteral nutrition (PN) [OR 3.38 (1.40-8.19)] and indwelling time (IT) [OR 1.08 (1.02-1.14)] were CR-BSI risk factors. Practice changes aimed at reducing PN and IT were introduced. PN decreased from 49.8% [95% CI (49.7-49.9)] to 26.7% [(95% CI 26.6-26.8)] (p < 0.001), and IT dropped from 9.92 (95% CI 9.09-10.75) to 8.13 (95% CI 7.47-8.79) days (p < 0.001). The CR-BSI rate was reduced to 3.05 (95% CI 0.93-5.17)/1,000 catheter-days. During the last period, PN and IT were no longer CR-BSI risk factors. Type of catheterisation (guide wire exchange) [OR 6.66 (1.40-31.7)] was the only CR-BSI risk factor.
Conclusions:
PN and IT were independent CR-BSI risk factors during the first period. An intervention focused on PN and IT reduction resulted in a sustained decrease of CR-BSI rates in our PICU.
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