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Towards targeting zero CLABSI in umbilical catheterization: insights from a retrospective study
Maria Di Chiara1, Giulia Iacona2, Sarah Yazami3
1Department of Mother and Child Health, Policlinico Umberto I, University "La Sapienza", Rome, Italy.
Abstract:
Umbilical catheters are widely used for vascular access in neonatal intensive care units (NICUs). However, their use is associated with a significant risk of central line-associated bloodstream infections (CLABSIs). This study aimed to evaluate the effectiveness of a structured care bundle for the insertion and maintenance of umbilical catheters in reducing CLABSI rates and to identify risk factors associated with CLABSI after bundle implementation. We conducted a prospective, single-center, before-after cohort quality improvement study in a level III NICU in Belgium. Neonates with umbilical venous or arterial catheters were included and divided into pre-bundle and post-bundle groups. The care bundle consisted of standardized protocols for catheter insertion, maintenance, and daily assessment. The primary outcome was CLABSI rate per 1000 catheter-days. Secondary outcomes included mechanical complications and CLABSI-associated risk factors. A total of 467 neonates were included. The implementation of the bundle significantly reduced CLABSI incidence (5.43% vs. 1.06%, p = 0.017) and mechanical complications (17.4% vs. 3.7%, p < 0.001). Multivariate analysis showed that birth weight was an independent risk factor for CLABSI (p = 0.015), while catheter dwell time was not associated with increased infection risk.
Conclusion:
The use of a standardized care bundle significantly reduced both CLABSI and mechanical complication rates in neonates with umbilical catheters. Nonetheless, very low birth weight remains a key risk factor, underscoring the need for tailored infection prevention strategies in this vulnerable population.
What Is Known:
• Umbilical vessel catheterization is a well-established procedure in neonatal intensive care, primarily used for vascular access in critically ill newborns. It can be associated with high risk of CLABSI.
What Is New:
• The use of a bundle for umbilical catheter dressing and maintenance decreases the incidence of CLABSI related to umbilical catheters.
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