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Closed catheter access system implementation in reducing the bloodstream infection rate in low birth weight preterm
Lily Rundjan1, Rinawati Rohsiswatmo1, Tiara Nien Paramita1
1Neonatology Division, Child Health Department, Cipto Mangunkusumo Hospital - University of Indonesia , Jakarta , Indonesia.
Insights
Implementing a closed catheter access system significantly reduced bloodstream infections (BSI) in low birth weight preterm infants. This intervention offers a protective effect against BSI in neonatal intensive care units.
Area of Science:
- Neonatal Medicine
- Infectious Disease Control
- Medical Device Technology
Background:
- Bloodstream infection (BSI) is a major cause of mortality in neonatal intensive care units, particularly in developing nations.
- Despite infection control measures like hand hygiene, BSI rates remain high in some hospitals.
- The efficacy of closed catheter access systems for reducing intravascular catheter-related BSI has not been previously assessed in this setting.
Purpose of the Study:
- To evaluate the impact of implementing a closed catheter access system on reducing BSI rates among low birth weight preterm neonates.
Main Methods:
- A randomized clinical trial involving 60 low birth weight preterm infants was conducted.
- Infants were assigned to either a closed or non-closed catheter access system group.
- Subjects were monitored for 2 weeks for BSI development, confirmed by clinical signs, infection markers, and blood cultures.
Main Results:
- The closed catheter access system demonstrated a significant protective effect against culture-proven BSI (RR 0.095, p=0.026).
- The control group had a significantly higher risk of culture-proven BSI (10.545, p=0.026).
- No BSI cases occurred in the study group, compared to 75% of neonates without infection risk factors in the control group.
Conclusions:
- Closed catheter access systems effectively reduce BSI in low birth weight preterm infants.
- Optimal outcomes require simultaneous attention to device design, proper disinfection, and appropriate connector change frequency.
Background:
Bloodstream infection (BSI) is one of the significant causes of morbidity and mortality encountered in a neonatal intensive care unit, especially in developing countries. Despite the implementation of infection control practices, such as strict hand hygiene, the BSI rate in our hospital is still high. The use of a closed catheter access system to reduce BSI related to intravascular catheter has hitherto never been evaluated in our hospital.
Objective:
To determine the effects of closed catheter access system implementation in reducing the BSI rate in preterm neonates with low birth weight.
Methods:
Randomized clinical trial was conducted on 60 low birth weight preterm infants hospitalized in the neonatal unit at Cipto Mangunkusumo Hospital, Jakarta, Indonesia from June to September 2013. Randomized subjects either received a closed or non-closed catheter access system. Subjects were monitored for 2 weeks for the development of BSI based on clinical signs, abnormal infection parameters, and blood culture.
Results:
Closed catheter access system implementation gave a protective effect toward the occurrence of culture-proven BSI (relative risk 0.095, 95% CI 0.011-0.85, p = 0.026). Risk of culture-proven BSI in the control group was 10.545 (95% CI 1.227-90.662, p = 0.026). BSI occurred in 75% of neonates without risk factors of infection in the control group compared to none in the study group.
Conclusion:
The use of a closed catheter access system reduced the BSI in low birth weight preterm infants. Choosing the right device design, proper disinfection of device, and appropriate frequency of connector change should be done simultaneously.
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