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Published on: July 13, 2019
Catheter related blood stream infections in the paediatric intensive care unit: A descriptive study
Diana Thomas1, Narayanan Parameswaran, B N Harish
1Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Insights
Catheter related blood stream infections (CRBSI) are frequent in pediatric intensive care units (PICUs), especially in infants. Good insertion practices alone are insufficient; catheter maintenance is crucial for reducing CRBSI.
Area of Science:
- Pediatric Intensive Care
- Infectious Diseases
- Critical Care Medicine
Background:
- Catheter related blood stream infections (CRBSI) are a significant cause of morbidity, mortality, and increased healthcare costs in intensive care units (ICUs).
- Pediatric intensive care units (PICUs) in developing countries have unique patient profiles, infrastructure, and resource limitations compared to Western settings.
- Limited studies exist on CRBSI in Indian PICUs.
Purpose of the Study:
- To determine the incidence and identify risk factors associated with CRBSI in children admitted to a PICU.
- To assess adherence to established guidelines for catheter insertion.
Main Methods:
- A descriptive study was conducted in a tertiary care teaching hospital's PICU over four months.
- Children were monitored from catheterization to discharge, with blood cultures every 72 hours starting at 48 hours post-catheterization.
- Adherence to Centre for Disease Control (CDC) guidelines for catheter insertion was evaluated using a checklist.
Main Results:
- Out of 41 children, 21 experienced central venous catheter colonization (66.24/1000 catheter days) and two developed CRBSI (6.3/1000 catheter days).
- Infants showed a significantly higher risk of catheter colonization (P = 0.01).
- Adherence to CDC guidelines for catheter insertion was high, at 85%.
Conclusions:
- The incidence of CRBSI and catheter colonization remains high in this PICU despite good catheter insertion practices.
- Further research is needed to evaluate the impact of catheter maintenance practices on reducing CRBSI risk.
- Intervention packages, including insertion and maintenance bundles tailored for infants, require investigation to decrease colonization and CRBSI rates.
Context:
Catheter related blood stream infections (CRBSI) contributes significantly to morbidity, mortality and costs in intensive care unit (ICU). The patient profile, infrastructure and resources in ICU are different in the developing world as compared to western countries. Studies regarding CRBSI from pediatric intensive care unit (PICU) are scanty in the Indian literature.
Aims:
To determine the frequency and risk factors of CRBSI in children admitted to PICU.
Settings And Design:
Descriptive study done in the PICU of a tertiary care teaching hospital over a period of four months.
Materials And Methods:
Study children were followed up from the time of catheterization till discharge. Their clinical and treatment details were recorded and blood culture was done every 72 h, starting at 48 h after catheterization. The adherence of doctors to Centre for Disease Control (CDC) guidelines for catheter insertion was assessed using a checklist.
Statistical Analysis:
Clinical parameters were compared between colonized and non-colonized subjects and between patients with and without CRBSI. Unpaired t-test and Chi-square test were used to test the significance of observed differences.
Results:
Out of the 41 children, 21 developed colonization of their central venous catheter (66.24/1000 catheter days), and two developed CRBSI (6.3/1000 catheter days). Infants had a higher risk for developing colonization (P = 0.01). There was 85% adherence to CDC guidelines for catheter insertion.
Conclusions:
The incidence of CRBSI and catheter colonization is high in our in spite of good catheter insertion practices. Hence further studies to establish the role of adherence to catheter maintenance practices in reducing risk of CRBSI is required. The role of a composite package of interventions including insertion and maintenance bundles specifically targeting infants needs to be studied to bring down the catheter colonization as well as CRBSI rates.
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