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An evidence-based catheter bundle alters central venous catheter strategy in newborn infants

Meggan Butler-O'Hara1, Carl T D'Angio, Hyacinth Hoey

  • 1School of Nursing, University of Rochester, Rochester, NY, USA. meggan_ohara@urmc.rochester.edu

The Journal of Pediatrics
|January 14, 2012
PubMed

Insights

Introducing a percutaneously inserted central catheter (PICC) bundle reduced central line-associated bloodstream infections (CLABSI) in infants. Prolonged umbilical venous catheter (UVC) use significantly increased CLABSI risk compared to shorter durations.

Area of Science:

  • Neonatal care
  • Infectious disease epidemiology
  • Vascular access devices

Background:

  • Central line-associated bloodstream infections (CLABSI) are a significant concern in neonatal intensive care units.
  • Umbilical venous catheters (UVCs) are commonly used for central venous access in infants, but their prolonged use is associated with increased infection risk.
  • Percutaneously inserted central catheters (PICCs) are an alternative, but their impact on CLABSI rates requires careful evaluation.

Purpose of the Study:

  • To evaluate the impact of introducing an evidence-based percutaneously inserted central catheter (PICC) care bundle on the risk of central line-associated bloodstream infection (CLABSI) in infants.
  • To compare the comparative risk of CLABSI between infants with short-term (≤7 days) and long-term (>7 days) umbilical venous catheter (UVC) use.

Main Methods:

  • Retrospective cohort study of infants requiring central venous access between 2006 and 2009.
  • Analysis of CLABSI rates based on the duration of UVC use (≤7 days vs. >7 days).
  • Statistical adjustment for covariates including birth weight, gestational age, and antibiotic use.

Main Results:

  • Infants with UVC use >7 days had a significantly higher CLABSI rate (4.0 CLABSI/1000 catheter days) compared to those with UVC use ≤7 days (1.0 CLABSI/1000 catheter days).
  • After controlling for relevant factors, prolonged UVC use (>7 days) was associated with a 5.48-fold increased risk of CLABSI.
  • The rate of CLABSI increased more rapidly with increasing duration of UVC use compared to PICCs.

Conclusions:

  • Replacement of UVCs with PICCs for central venous access beyond 7 days of age may be a strategy to reduce CLABSI in neonates.
  • Optimizing the duration of UVC use and considering PICC insertion for longer-term access are crucial for infection prevention.
  • The findings support the implementation of standardized care bundles for vascular access devices to minimize infection risks.
Abstract

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