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Intervention to reduce catheter-related bloodstream infections in a pediatric intensive care unit

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Abstract

Objective

Identification of catheter-related bloodstream infection (CR-BSI) risk factors and determination of whether intervention related to identified risk factors would reduce CR-BSI rates.

Design

Prospective, observational, interventional and interrupted time-series study.

Setting

Pediatric Intensive Care Unit (PICU) in a university hospital.

Methods

During a 7-year period, 609 central venous catheters (CVC) were placed in 389 patients. CR-BSI risk factors were determined by multivariate analysis during two periods (January 2000–November 2002 and January 2003–April 2007). An intervention to reduce identified risk factors was performed after the first period. CR-BSI rates per 1,000 catheters-days were compared during the two periods.

Results

The CR-BSI rate was 11.94 [(95% CI 7.94–15.94)/1,000 catheter-days during the first period]. Weight [OR 0.96 (0.91–0.99)], parenteral nutrition (PN) [OR 3.38 (1.40–8.19)] and indwelling time (IT) [OR 1.08 (1.02–1.14)] were CR-BSI risk factors. Practice changes aimed at reducing PN and IT were introduced. PN decreased from 49.8% [95% CI (49.7–49.9)] to 26.7% [(95% CI 26.6–26.8)] (p < 0.001), and IT dropped from 9.92 (95% CI 9.09–10.75) to 8.13 (95% CI 7.47–8.79) days (p < 0.001). The CR-BSI rate was reduced to 3.05 (95% CI 0.93–5.17)/1,000 catheter-days. During the last period, PN and IT were no longer CR-BSI risk factors. Type of catheterisation (guide wire exchange) [OR 6.66 (1.40–31.7)] was the only CR-BSI risk factor.

Conclusions

PN and IT were independent CR-BSI risk factors during the first period. An intervention focused on PN and IT reduction resulted in a sustained decrease of CR-BSI rates in our PICU.

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References

  1. Bhutta A, Gilliam C, Honeycutt M, Schexnayder S, Green J, Moss M et al (2007) Reduction of bloodstream infections associated with catheters in paediatric intensive care unit: stepwise approach. BMJ 334:362–365

    Article  PubMed  Google Scholar 

  2. Milliken J, Tait GA, Ford-Jones EL, Mindorff CM, Gold R, Mullins G (1988) Nosocomial infections in a pediatric intensive care unit. Crit Care Med 16:233–237

    Article  CAS  PubMed  Google Scholar 

  3. Richards MJ, Edwards JR, Culver DH, Gaynes RP (1999) Nosocomial infections in pediatric intensive care units in the United States. National nosocomial infections surveillance system. Pediatrics 103:e39

    Article  CAS  PubMed  Google Scholar 

  4. Yogaraj JS, Elward AM, Fraser VJ (2002) Rate, risk factors, and outcomes of nosocomial primary bloodstream infection in pediatric intensive care unit patients. Pediatrics 110:481–485

    Article  PubMed  Google Scholar 

  5. Elward AM, Hollenbeak CS, Warren DK, Fraser VJ (2005) Attributable cost of nosocomial primary bloodstream infection in pediatric intensive care unit patients. Pediatrics 115:868–872

    Article  PubMed  Google Scholar 

  6. Slonim AD, Kurtines HC, Sprague BM, Singh N (2001) The costs associated with nosocomial bloodstream infections in the pediatric intensive care unit. Pediatr Crit Care Med 2:170–174

    Article  PubMed  Google Scholar 

  7. Siempos II, Kopterides P, Tsangaris I, Dimopoulou I, Armaganidis AE (2009) Impact of catheter-related bloodstream infections on the mortality of critically ill patients: a meta-analysis. Crit Care Med 37:2283–2289

    Article  PubMed  Google Scholar 

  8. Newman CD (2006) Catheter-related bloodstream infections in the pediatric intensive care unit. Semin Pediatr Infect Dis 17:20–24

    Article  PubMed  Google Scholar 

  9. Elward AM, Fraser VJ (2006) Risk factors for nosocomial primary bloodstream infection in pediatric intensive care unit patients: a 2-year prospective cohort study. Infect Control Hosp Epidemiol 27:553–560

    Article  PubMed  Google Scholar 

  10. Hammarskjold F, Wallen G, Malmvall BE (2006) Central venous catheter infections at a county hospital in Sweden: a prospective analysis of colonization, incidence of infection and risk factors. Acta Anaesthesiol Scand 50:451–460

    Article  CAS  PubMed  Google Scholar 

  11. Almuneef MA, Memish ZA, Balkhy HH, Hijazi O, Cunningham G, Francis C (2006) Rate, risk factors and outcomes of catheter-related bloodstream infection in a paediatric intensive care unit in Saudi Arabia. J Hosp Infect 62:207–213

    Article  CAS  PubMed  Google Scholar 

  12. National nosocomial infections surveillance (NNIS) (2004) System report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 32:470–485

    Article  Google Scholar 

  13. Edwards JR, Peterson KD, Mu Y, Banerjee S, Allen-Bridson K, Morrell G et al (2009) National healthcare safety network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control 37:783–805

    Article  PubMed  Google Scholar 

  14. De Gaetano DK, Tacconelli E, Tumbarello M, Bertagnolio S, Pittiruti M, Leone F et al (1999) Central venous catheter-related sepsis: one year experience in a large university hospital. Infez Med 7:227–230

    Google Scholar 

  15. Garcia-Teresa MA, Casado-Flores J, Delgado Dominguez MA, Roqueta-Mas J, Cambra-Lasaosa F, Concha-Torre A et al (2007) Infectious complications of percutaneous central venous catheterization in pediatric patients: a Spanish multicenter study. Intensive Care Med 33:466–476

    Article  PubMed  Google Scholar 

  16. Odetola FO, Moler FW, Dechert RE, VanDerElzen K, Chenoweth C (2003) Nosocomial catheter-related bloodstream infections in a pediatric intensive care unit: risk and rates associated with various intravascular technologies. Pediatr Crit Care Med 4:432–436

    Article  PubMed  Google Scholar 

  17. Van der Kooi TI, de Boer AS, Mannien J, Wille JC, Beaumont MT, Mooi BW et al (2007) Incidence and risk factors of device-associated infections and associated mortality at the intensive care in the Dutch surveillance system. Intensive Care Med 33:271–278

    Article  PubMed  Google Scholar 

  18. Yilmaz G, Koksal I, Aydin K, Caylan R, Sucu N, Aksoy F (2007) Risk factors of catheter-related bloodstream infections in parenteral nutrition catheterization. JPEN 31:284–287

    Google Scholar 

  19. Garnacho-Montero J, Aldabo-Pallas T, Palomar-Martinez M, Valles J, Almirante B, Garces R et al (2008) Risk factors and prognosis of catheter-related bloodstream infection in critically ill patients: a multicenter study. Intensive Care Med 34:2185–2193

    Article  PubMed  Google Scholar 

  20. Gowardman JR, Robertson IK, Parkes S, Rickard CM (2008) Influence of insertion site on central venous catheter colonization and bloodstream infection rates. Intensive Care Med 34:1038–1045

    Article  PubMed  Google Scholar 

  21. Maki DG, Weise CE, Sarafin HW (1977) A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med 296:1305–1309

    Article  CAS  PubMed  Google Scholar 

  22. Pearson ML (1996) Guideline for prevention of intravascular device-related infections. Part I. Intravascular device-related infections: an overview. The Hospital Infection Control Practices Advisory Committee. Am J Infect Control 24:262–277

    Article  CAS  PubMed  Google Scholar 

  23. Nicolle L, Conly J, Honish A, Johnston L, Kingsbury L, Meunier L et al (1997) Preventing infections associated with indwelling intravascular access devices. Can Commun Dis Rep 23(Suppl 8):1–32

    Google Scholar 

  24. Polderman KH, Girbes AR (2002) Central venous catheter use. Part 2. Infectious complications. Intensive Care Med 28:18–28

    Article  CAS  PubMed  Google Scholar 

  25. Gil RT, Kruse JA, Thill-Baharozian MC, Carlson RW (1989) Triple- vs. single-lumen central venous catheters. A prospective study in a critically ill population. Arch Intern Med 149:1139–1143

    Article  CAS  PubMed  Google Scholar 

  26. Safdar N, Kluger DM, Maki DG (2002) A review of risk factors for catheter-related bloodstream infection caused by percutaneously inserted, noncuffed central venous catheters: implications for preventive strategies. Medicine (Baltimore) 81:466–479

    Article  Google Scholar 

  27. Beghetto MG, Victorino J, Teixeira L, de Azevedo MJ (2005) Parenteral nutrition as a risk factor for central venous catheter-related infection. JPEN 29:367–373

    Google Scholar 

  28. Christensen ML, Hancock ML, Gattuso J, Hurwitz CA, Smith C, McCormick J et al (1993) Parenteral nutrition associated with increased infection rate in children with cancer. Cancer 72:2732–2738

    Article  CAS  PubMed  Google Scholar 

  29. Quinet B (2006) Central venous catheter: epidemiology, diagnosis, prevention and treatment of infectious complications. Arch Pediatr 13:718–720

    Article  CAS  PubMed  Google Scholar 

  30. Castelli GP, Pognani C, Stuani A, Cita M, Paladini R (2007) Central venous catheter replacement in the ICU: new site versus guidewire exchange. Minerva Anestesiol 73:267–273

    CAS  PubMed  Google Scholar 

  31. O’Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG et al (2002) Guidelines for the prevention of intravascular catheter-related infections. The Hospital Infection Control Practices Advisory Committee, Center for disese control and prevention, US. Pediatrics 110:e51

    Article  PubMed  Google Scholar 

  32. Casado-Flores J, Barja J, Martino R, Serrano A, Valdivielso A (2001) Complications of central venous catheterization in critically ill children. Pediatr Crit Care Med 2:57–62

    Article  PubMed  Google Scholar 

  33. Sheridan RL, Weber JM (2006) Mechanical and infectious complications of central venous cannulation in children: lessons learned from a 10-year experience placing more than 1000 catheters. J Burn Care Res 27:713–718

    Article  PubMed  Google Scholar 

  34. Deshpande KS, Hatem C, Ulrich HL, Currie BP, Aldrich TK, Bryan-Brown CW et al (2005) The incidence of infectious complications of central venous catheters at the subclavian, internal jugular, and femoral sites in an intensive care unit population. Crit Care Med 33:13–20

    Article  PubMed  Google Scholar 

  35. Goetz AM, Wagener MM, Miller JM, Muder RR (1998) Risk of infection due to central venous catheters: effect of site of placement and catheter type. Infect Control Hosp Epidemiol 19:842–845

    Article  CAS  PubMed  Google Scholar 

  36. Kemp L, Burge J, Choban P, Harden J, Mirtallo J, Flancbaum L (1994) The effect of catheter type and site on infection rates in total parenteral nutrition patients. JPEN 18:71–74

    CAS  Google Scholar 

  37. Shulman RJ, Smith EO, Rahman S, Gardner P, Reed T, Mahoney D (1988) Single- vs. double-lumen central venous catheters in pediatric oncology patients. Am J Dis Child 142:893–895

    CAS  PubMed  Google Scholar 

  38. Vonberg RP, Behnke M, Geffers C, Sohr D, Ruden H, Dettenkofer M et al (2006) Device-associated infection rates for non-intensive care unit patients. Infect Control Hosp Epidemiol 27:357–361

    Article  PubMed  Google Scholar 

  39. McKee C, Berkowitz I, Cosgrove SE, Bradley K, Beers C, Perl TM et al (2008) Reduction of catheter-associated bloodstream infections in pediatric patients: experimentation and reality. Pediatr Crit Care Med 9:40–46

    Article  PubMed  Google Scholar 

  40. Costello JM, Morrow DF, Graham DA, Potter-Bynoe G, Sandora TJ, Laussen PC (2008) Systematic intervention to reduce central line-associated bloodstream infection rates in a pediatric cardiac intensive care unit. Pediatrics 121:915–923

    Article  PubMed  Google Scholar 

  41. Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S et al (2006) An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 355:2725–2732

    Article  CAS  PubMed  Google Scholar 

  42. Chaiyakunapruk N, Veenstra DL, Lipsky BA, Sullivan SD, Saint S (2003) Vascular catheter site care: the clinical and economic benefits of chlorhexidine gluconate compared with povidone iodine. Clin Infect Dis 37:764–771

    Article  CAS  PubMed  Google Scholar 

  43. Hu KK, Veenstra DL, Lipsky BA, Saint S (2004) Use of maximal sterile barriers during central venous catheter insertion: clinical and economic outcomes. Clin Infect Dis 39:1441–1445

    Article  PubMed  Google Scholar 

  44. Hansen S, Schwab F, Behnke M, Carsauw H, Heczko P, Klavs I et al (2009) National influences on catheter-associated bloodstream infection rates: practices among national surveillance networks participating in the European HELICS project. J Hosp Infect 71:66–73

    Article  CAS  PubMed  Google Scholar 

  45. Costello JM, Graham DA, Morrow DF, Potter-Bynoe G, Sandora TJ, Laussen PC (2009) Risk factors for central line-associated bloodstream infection in a pediatric cardiac intensive care unit. Pediatr Crit Care Med 10:453–459

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors gratefully acknowledge the assistance of the PICU medical and nursing staff and of the Microbiology Department of Hospital Universitario Central de Asturias. There was no financial support for the study. The authors do not have an association that might pose a conflict of interest.

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Authors and Affiliations

  1. Paediatric Intensive Care Unit, Department of Paediatrics, Hospital Universitario Central de Asturias, University of Oviedo, Celestino Villamil s/n, 33006, Oviedo, Asturias, Spain

    Corsino Rey, Andrés Concha, Alberto Medina, Juan-José Díaz, Sergio Menéndez, Marta Los-Arcos & Juan Mayordomo-Colunga

  2. Paediatric Day Care Center, Servicio de Salud del Principado de Asturias, Lugo de Llanera, Asturias, Spain

    Francisco Álvarez

  3. Paediatric Day Care Center, Servicio de Salud del Principado de Asturias, El Cristo, Oviedo, Asturias, Spain

    Victoria De-La-Rua

Authors
  1. Corsino Rey
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  2. Francisco Álvarez
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  3. Victoria De-La-Rua
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  4. Andrés Concha
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  7. Sergio Menéndez
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  8. Marta Los-Arcos
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  9. Juan Mayordomo-Colunga
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Corresponding author

Correspondence to Corsino Rey.

Additional information

This article is discussed in the editorial available at doi:10.1007/s00134-011-2135-2.

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Rey, C., Álvarez, F., De-La-Rua, V. et al. Intervention to reduce catheter-related bloodstream infections in a pediatric intensive care unit. Intensive Care Med 37, 678–685 (2011). https://doi.org/10.1007/s00134-010-2116-x

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  • DOI: https://doi.org/10.1007/s00134-010-2116-x

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