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Prevention of peripherally inserted central line-associated blood stream infections in very low-birth-weight infants
Wei Wang1, Chunling Zhao2, Qinglian Ji3
1Departments of Neonatal, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China. weiwcn@yeah.net.
Insights
Implementing a central line bundle (CLB) guideline significantly reduced catheter-related infections (CRIs) in very low-birth-weight infants (VLBWIs). This approach also extended the duration of peripherally inserted central catheter (PICC) use.
Area of Science:
- Neonatal care
- Infectious disease prevention
- Medical device safety
Background:
- Catheter-related infections (CRIs) pose a significant risk to very low-birth-weight infants (VLBWIs) undergoing peripherally inserted central catheter (PICC) placement.
- VLBWIs exhibit diminished immune responses and subtle infection symptoms, complicating early diagnosis and treatment.
- The central line bundle (CLB) is a guideline comprising five key measures designed to prevent CRIs.
Purpose of the Study:
- To evaluate the effectiveness of a central line bundle (CLB) guideline in preventing catheter-related infections (CRIs) in very low-birth-weight infants (VLBWIs).
- To assess the impact of the CLB guideline on the duration of peripherally inserted central catheter (PICC) indwelling time in VLBWIs.
Main Methods:
- A comparative study involving 110 very low-birth-weight infants (VLBWIs) undergoing PICC insertion.
- The study group (n=57) received care adhering to a CLB guideline and standard checklist.
- The control group (n=53) received standard care without the CLB guideline or checklist.
Main Results:
- The incidence of CRIs in the control group decreased significantly from 10.0 to 2.20 per 1000 catheter days (P<0.05).
- Catheter-related bloodstream infections reduced from 3.1 to 0 per 1000 catheter days, and colonization infections decreased from 6.9 to 2.2 per 1000 catheter days (P<0.05).
- Indwelling catheter time was significantly longer in the CLB group (31.9 days) compared to the control group (24.8 days) (P<0.05).
Conclusions:
- The implementation of a central line bundle (CLB) guideline, coupled with a standard checklist, is an effective strategy for preventing CRIs in VLBWIs.
- This evidence-based approach not only reduces infection rates but also safely prolongs the necessary indwelling time of PICCs in this vulnerable population.
Backgrounds:
Catheter-related infections (CRIs) are one of the severe complications of PICC placement. If treatment is not timely or correct, the incidence of infection and mortality rate can be high. A central line bundle (CLB) guideline was first proposed by the Institute for Healthcare Improvement, and included five key measures. Very low-birth-weight infants (VLBWIs) have a low immune response and indistinct symptoms after infection compared with other populations (Costa P, Kimura AF, de Vizzotto MP, de Castro TE, West A, Dorea E. Prevalence and reasons for non-elective removal of peripherally inserted central catheter in neonates. Rev Gaucha Enferm. 2012;33:126-33). Some reviews have focused on the effect and safety of a CLB in VLBWIs and its preventive effect on bacterial colonization and infection.
Methods:
Fifty-seven VLBWIs who underwent PICC insertion at a hospital in Qingdao, China, between November 2012 and June 2013, and for whom a CLB guideline and a standard checklist were adopted, were included in the CLB group. In contrast, 53 VLBWIs who underwent PICC insertion, but for whom a CLB guideline and a standard checklist were not adopted, were included in the control group. The incidence of CRIs was compared between before and after the treatment.
Results:
The incidence of infection showed a statistically significant reduction from 10.0 to 2.20 per 1000 catheter days in the control group (P < 0.05). The incidence of catheter-related bloodstream infections decreased from 3.1 to 0 per 1000 catheter days, and that of colonization infections decreased from 6.9 to 2.2 per 1000 catheter days (P < 0.05), both of which indicated a statistically significant difference. The indwelling catheter time was 24.8 ± 7.4 days in the control group and 31.9 ± 15.0 days in the study group (P < 0.05), and these values were significantly different.
Conclusion:
The use of a CLB guideline with a standard checklist could be effective and feasible for preventing CRIs in VLBWIs and prolonging indwelling catheter time.
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