Central Line–Associated Bloodstream Infection in Neonatal Intensive Care Units

Objective.Describe the epidemiology of central line-associated bloodstream infections (CLABSIs) in neonatal intensive care units (NICUs) participating in a standardized and mandatory CLABSI surveillance program.Design.Retrospective cohort.Setting.We included patients admitted (April 2007-March 2011) to 7 level II/III NICUs who developed a CLABSI (as defined by the National Healthcare Safety Network).Methods. CLABSIs/1,000 central line–days and device utilization ratio were calculated; x2 test, Student t test, Kruskal-Wallis, and Poisson regression were used.Results.Overall, 191 patients had 202 CLABSI episodes for a pooled mean rate of 4.0 CLABSIs/1,000 central line-days and a device utilization ratio of 0.20. Annual pooled mean CLABSI rates increased from 3.6 in 2007-2008 to 5.1 CLABSIs/1,000 central line-days in 2010-2011 (P = .01). The all-cause 30-day case fatality proportion was 8.9% (n = 17) and occurred a median of 8 days after CLABSI. Coagulase-negative Staphylococcus was identified in 112 (50.5%) cases. Staphylococcus aureus was identified in 22 cases, and 3 (13.6%) were resistant to methicillin. An underlying intra-abdominal pathology was found in 20% (40/202) of CLABSI cases, 50% of which were reported in the last year of study. When adjusted for mean birth weight, annual CLABSI incidence rates were independently associated with the proportion of intra-abdominal pathology (P = .007) and the proportion of pulmonary pathology (P = .016) reported.Conclusion.The increase in CLABSI rates in Quebec NICUs seems to be associated with an increased proportion of cases with underlying intra-abdominal and pulmonary pathologies, which needs further investigation.

Download Full-text

Central Line-Associated Bloodstream Infections in Neonatal Intensive Care Units

Paediatrics & Child Health ◽

10.1093/pch/17.suppl_a.15a ◽

2012 ◽

Vol 17 (suppl_A) ◽

pp. 15A-15A

Author(s):

AC Blanchard ◽

E Fortin ◽

I Rocher ◽

D Moore ◽

C Frenette ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Neonatal Intensive Care ◽

Bloodstream Infections ◽

Central Line ◽

Neonatal Intensive Care Units

Download Full-text

Compliance with prevention practices and their association with central line–associated bloodstream infections in neonatal intensive care units

American Journal of Infection Control ◽

10.1016/j.ajic.2014.04.020 ◽

2014 ◽

Vol 42 (8) ◽

pp. 847-851 ◽

Cited By ~ 19

Author(s):

Philip Zachariah ◽

E. Yoko Furuya ◽

Jeffrey Edwards ◽

Andrew Dick ◽

Hangsheng Liu ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Neonatal Intensive Care ◽

Bloodstream Infections ◽

Central Line ◽

Neonatal Intensive Care Units

Download Full-text

Central-Line–Associated Bloodstream Infections in Québec Intensive Care Units: Results from the Provincial Healthcare-Associated Infections Surveillance Program (SPIN)

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.150 ◽

2016 ◽

Vol 37 (10) ◽

pp. 1186-1194 ◽

Cited By ~ 5

Author(s):

Lynne Li ◽

Elise Fortin ◽

Claude Tremblay ◽

Muleka Ngenda-Muadi ◽

Caroline Quach ◽

...

Keyword(s):

Intensive Care ◽

Central Venous Catheter ◽

Intensive Care Units ◽

Bloodstream Infections ◽

Venous Catheter ◽

Central Line ◽

Incidence Rates ◽

Surveillance Program ◽

Central Venous ◽

Healthcare Associated

BACKGROUNDFollowing implementation of bundled practices in 2009 in Quebec and Canadian intensive care units (ICUs), we describe CLABSI epidemiology during the last 8 years in the province of Québec (Canada) and compare rates with Canadian and American benchmarks.METHODSCLABSI incidence rates (IRs) and central venous catheter utilization ratios (CVCURs) by year and ICU type were calculated using 2007–2014 data from the Surveillance Provinciale des Infections Nosocomiales (SPIN) program. Using American and Canadian surveillance data, we compared SPIN IRs to rates in other jurisdictions using standardized incidence ratios (SIRs).RESULTSIn total, 1,355 lab-confirmed CLABSIs over 911,205 central venous catheter days (CVC days) were recorded. The overall pooled incidence rate (IR) was 1.49 cases per 1,000 CVC days. IRs for adult teaching ICUs, nonteaching ICUs, neonatal ICUs (NICUs), and pediatric ICUs (PICUs) were 1.04, 0.91, 4.20, and 2.15 cases per 1,000 CVC days, respectively. Using fixed SPIN 2007–2009 benchmarks, CLABSI rates had decreased significantly in all ICUs except for PICUs by 2014. Rates declined by 55% in adult teaching ICUs, 52% in adult nonteaching ICUs, and 38% in NICUs. Using dynamic American and Canadian CLABSI rates as benchmarks, SPIN adult teaching ICU rates were significantly lower and adult nonteaching ICUs had lower or comparable rates, whereas NICU and PICU rates were higher.CONCLUSIONQuébec ICU CLABSI surveillance shows declining CLABSI rates in adult ICUs. The absence of a decrease in CLABSI rate in NICUs and PICUs highlights the need for continued surveillance and analysis of factors contributing to higher rates in these populations.Infect Control Hosp Epidemiol 2016;1–9

Download Full-text

Successful Reduction of Central Line-Associated Bloodstream Infections in Neonatal Intensive Care Units via 'Aim for Zero' Task Force

American Journal of Infection Control ◽

10.1016/j.ajic.2014.03.299 ◽

2014 ◽

Vol 42 (6) ◽

pp. S140

Author(s):

Caitlin A. Price

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Neonatal Intensive Care ◽

Task Force ◽

Bloodstream Infections ◽

Central Line ◽

Neonatal Intensive Care Units ◽

Successful Reduction

Download Full-text

Preventing and Reducing Central Line-Associated Bloodstream Infections in a Large Teaching Hospital's 148-bed Level 2 and Level 3 Neonatal Intensive Care Units

American Journal of Infection Control ◽

10.1016/j.ajic.2011.04.078 ◽

2011 ◽

Vol 39 (5) ◽

pp. E31-E32

Author(s):

Kathy Ware

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Neonatal Intensive Care ◽

Bloodstream Infections ◽

Central Line ◽

Neonatal Intensive Care Units ◽

Level 3 ◽

Level 2

Download Full-text

Assessment of the Reported Effectiveness of Five Different Quality- Improvement Initiatives for the Prevention of Central Line-Associated Bloodstream Infections in Intensive Care Units

The Open Epidemiology Journal ◽

10.2174/1874297101205010005 ◽

2012 ◽

Vol 5 (1) ◽

pp. 5-12 ◽

Cited By ~ 1

Author(s):

Lawrence F. Muscarella

Keyword(s):

Intensive Care ◽

Quality Improvement ◽

Intensive Care Units ◽

Neonatal Intensive Care ◽

Bloodstream Infections ◽

Central Line ◽

Qualitative Assessment ◽

Neonatal Intensive Care Units ◽

Cautious Interpretation

Five studies that evaluated five different quality-improvement initiatives for the prevention of central line-associated bloodstream infections (CLABSIs) in adult, pediatric and/or neonatal intensive care units (ICUs) and that were published within the past two years in an infection-control and epidemiology journal were reviewed, assessed and compared. Each is a prospective cohort study that similarly concludes that the evaluated initiative was responsible for a significant and calculated reduction in the CLABSI rate, ranging from 30.3% to 85%. The soundness of these conclusions and calculations, however, like the legitimacy of several other common uses of CLABSI data, requires, in addition to satisfying a number of other criteria, that each study's CLABSI rates be accurate and complete. The primary goal of this analysis, therefore, was to confirm the hypothesis that each of these five studies had validated its CLABSI rates. The analysis found, however, that these five studies did not validate the accuracy and completeness of their CLABSI rates, which raises reasonable questions about each study’s assessment of and conclusions about the initiative's effectiveness for the prevention of CLABSIs. In addition to their aims, calculations, and conclusions, these five studies share in common a number of features, as well as circumscribing qualities, which are discussed. The distinction between a qualitative assessment and a quantitative determination of an initiative's performance is also discussed. Both the circumspective use of CLABSI data that have not been validated and the cautious interpretation of conclusions about central-line care that are based on these CLABSI data are recommended.

Download Full-text

The Association of State Legal Mandates for Data Submission of Central Line–Associated Bloodstream Infections in Neonatal Intensive Care Units with Process and Outcome Measures

Infection Control and Hospital Epidemiology ◽

10.1086/677635 ◽

2014 ◽

Vol 35 (9) ◽

pp. 1133-1139 ◽

Cited By ~ 11

Author(s):

Philip Zachariah ◽

Julie Reagan ◽

E. Yoko Furuya ◽

Andrew Dick ◽

Hangsheng Liu ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Outcome Measures ◽

Neonatal Intensive Care ◽

Bloodstream Infections ◽

Central Line ◽

Neonatal Intensive Care Units ◽

Data Submission ◽

Legal Mandates ◽

Process And Outcome

ObjectiveTo determine the association between state legal mandates for data submission of central line–associated bloodstream infections (CLABSIs) in neonatal intensive care units (NICUs) with process and outcome measures.DesignCross-sectional study.Participants. National sample of level II/III and III NICUs participating in National Healthcare Safety Network (NHSN) surveillance.MethodsState mandates for data submission of CLABSIs in NICUs in place by 2011 were compiled and verified with state healthcare-associated infection coordinators. A web-based survey of infection control departments in October 2011 assessed CLABSI prevention practices, ie, compliance with checklist/bundle components (process measures) in ICUs including NICUs. Corresponding 2011 NHSN NICU CLABSI rates (outcome measures) were used to calculate standardized infection ratios (SIRs). Association between mandates and process and outcome measures was assessed by multivariable logistic regression.ResultsAmong 190 study NICUs, 107 (56.3%) were located in states with mandates, with mandates in place >3 years in 52 (49%). More NICUs in states with mandates reported ≥95% compliance to at least 1 CLABSI prevention practice (52.3%–66.4%) than NICUs in states without mandates (28.9%–48.2%). Mandates were predictors of ≥95% compliance with all practices (odds ratio, 2.8; 95% confidence interval, 1.4–6.1). NICUs in states with mandates reported lower mean CLABSI rates in the ≤750-g birth weight group (2.4 vs 5.7 CLABSIs/1,000 central line–days) but not in others. Mandates were not associated with SIR <1.ConclusionsState mandates for NICU CLABSI data submission were significantly associated with ≥95% compliance with CLABSI prevention practices, which declined with the duration of mandate but not with lower CLABSI rates.Infect Control Hosp Epidemiol 2014;35(9):1133-1139

Download Full-text

Central Line-Associated Blood Stream Infections and Non–Central Line-Associated Blood Stream Infections Surveillance in Canadian Tertiary Care Neonatal Intensive Care Units

The Journal of Pediatrics ◽

10.1016/j.jpeds.2018.12.011 ◽

2019 ◽

Vol 208 ◽

pp. 176-182.e6 ◽

Cited By ~ 1

Author(s):

Amy R. Zipursky ◽

Eugene W. Yoon ◽

Julie Emberley ◽

Valerie Bertelle ◽

Jaideep Kanungo ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Neonatal Intensive Care ◽

Tertiary Care ◽

Blood Stream ◽

Central Line ◽

Neonatal Intensive Care Units ◽

Blood Stream Infections

Download Full-text

582. Impact of Central Line Bundle for Prevention of Umbilical Vein Catheter-Related Bloodstream Infections in a Neonatal Intensive Care Unit

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.651 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S275-S275

Author(s):

İlker devrim ◽

Ferit Kulalı ◽

İlknur Çağlar ◽

Yeliz Oruc ◽

Nevbahar Demiray ◽

...

Keyword(s):

Intensive Care ◽

Neonatal Intensive Care ◽

Umbilical Vein ◽

Bloodstream Infections ◽

Central Line ◽

Neonatal Intensive Care Units ◽

Vein Catheter ◽

Single Use ◽

Umbilical Vein Catheter ◽

Central Line Bundle

Abstract Background Umbilical vein catheters (UVC) are one of the most common types of vascular access device in the neonatal intensive care units. Central line-associated bloodstream infections were reported to be in the first place of healthcare-associated infections in preterm infants. In this study, we aimed to evaluate the effectiveness of the bundle applications in the prevention of umbilical vein catheter-associated bloodstream infections in neonates including premature infants. Methods This 40 months cross-sectional study included two periods, including pre-bundle period (from August 1, 2015 to March 31, 2017) and bundle period (April 1, 2017 to November 30, 2018). The umbilical vein catheter-related bloodstream infections, catheter line days, number of the patients were recorded and compared between the prebundle and bundle periods. Bundle steps were defined as education-training-assignment, evaluation of daily catheter indications, hand hygiene and aseptic technique while insertion, maximal sterile barrier precautions, closure of the catheter area with transparent semi-permeable membrane, using needless connectors in stead of 3-way stop-cocks, and single-use prefilled saline syringes for flushing. Results During the whole study period total umbilical vein catheter days were 2,228 days. During the prebundle period there was 10 and in the bundle period there was 2 umbilical vein catheter-related bloodstream infections (Table 1). While umbilical vein-associated bloodstream infection rate was 8.9 per 1,000 catheter days in the pre-bundle period, and significantly decreased to 1.79 in the bundle period (P < 0.05). After the introduction of bundle applications, it was observed that the rate of infection decreased by 68% (P < 0.05) Conclusion Our study showed that implementation of central line bundle including needless connectors and single-use prefilled syringes for umbilical vein-related bloodstream infections was effective for the prevention of catheter-related bloodstream infections in neonatal intensive care units. Disclosures All authors: No reported disclosures.

Download Full-text