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Published on: July 13, 2019
The impact of central line-specific dwell-times for neonatal central line associated bloodstream infections
Martina Buttera1,2, Carolyn Luhmann-Lunt1, Michael Buettcher3,4,5
1Department of Neonatology and Pediatric Intensive Care, Children's Hospital of Central Switzerland, Spitalstrasse, Lucerne, 6000, Switzerland.
Insights
Central line-associated bloodstream infections (CLABSIs) in neonates varied by catheter type. Reducing central line dwell time may decrease CLABSI rates, aiding in achieving zero infections.
Area of Science:
- Neonatal medicine
- Infectious disease epidemiology
- Healthcare quality improvement
Background:
- Central line-associated bloodstream infections (CLABSIs) are severe complications in neonates requiring central lines.
- Prevention strategies include adherence to "bundles" and prompt central line removal.
- This study focuses on neonatal CLABSIs, analyzing catheter types and dwell times.
Purpose of the Study:
- To describe and analyze neonatal CLABSIs.
- To investigate the relationship between CLABSI rates, central line types, and dwell times.
- To inform quality improvement programs for reducing neonatal CLABSIs.
Main Methods:
- Retrospective descriptive study.
- Data collected from neonates with CLABSI at the Children's Hospital of Central Switzerland (2020-2023).
- Analysis included catheter type, dwell time, and CLABSI rates per 1,000 catheter days.
Main Results:
- An overall neonatal CLABSI rate of 2.9 per 1,000 catheter days was observed.
- CLABSI rates varied significantly by catheter type: UACs (0), PICCs (0.9), UVCs (5.6), and CVCs (17.9).
- All CLABSI episodes occurred after 5 days' dwell time, with increased rates after 9 days.
Conclusions:
- CLABSI rates differ substantially based on central line catheter type.
- Prolonged dwell times (especially >9 days) correlate with increased CLABSI risk for UVCs and CVCs.
- Reducing central line dwell time is a potential strategy for achieving zero CLABSIs.
Background:
Central line-associated bloodstream infections (CLABSIs) are among the most serious infectious complications associated with central lines in neonates. CLABSIs can be prevented by healthcare workers using "bundles" when inserting and managing central lines. These include prompt removal of the central line when it is no longer needed. The aim of this study was to describe and analyze neonatal CLABSIs, focusing on a minimal data set including specific catheter types and dwell times.
Methods:
A retrospective descriptive study reviewing the management and outcome of neonates with CLABSI admitted to the Department of Neonatology and Neonatal Intensive Care at the Children's Hospital of Central Switzerland in Lucerne from 1 January 2020 to 31 December 2023.
Results:
In this four-year period, a total of 27,636 neonates were born in the catchment area and 2599 neonates (9.4%) were admitted to our hospital. In total, 615 neonates (23.7%) had at least one central line with a total of 4940 catheter days. We observed an overall neonatal CLABSI rate of 2.9 per 1,000 catheter days. The rate varied significantly by catheter type: 0 per 1,000 catheter days for umbilical artery catheters (UACs), 0.9 per 1,000 catheter days for peripherally inserted central lines (PICCs), 5.6 per 1,000 catheter days for umbilical venous catheters (UVCs), and 17.9 per 1,000 catheter days for centrally inserted venous catheters (CVCs). All episodes of CLABSI were observed after a dwell time of 5 days, with increasing rates after 9 days.
Conclusions:
We observed a pronounced variation in CLABSI rates between different catheter types. All episodes of CLABSI were observed after a dwell time of 5 days, with increasing rates after 9 days, and the rate of CLABSI increased with longer dwell times for UVCs and CVCs. This suggests a reduction in dwell time as a potential strategy for future quality improvement programs aiming for a zero CLABSI rate and underlines the importance of reporting central-line specific dwell-times for future publications.
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