PICU catheter-associated bloodstream infections can be reduced with proper maintenance

Catheter-associated bloodstream infections can be prevented in pediatric intensive care units by focusing on daily maintenance as opposed to maximizing insertion-bundle compliance alone, recent study findings suggested.

Researchers from several U.S. sites conducted a multi-institutional study using historical control data and an interrupted time-series design. Twenty-nine PICUs from 27 hospitals participated collaboratively in the study from Jan. 2004 to Aug. 2006.

Researchers used two central line care bundles, an insertion bundle and a maintenance bundle, for their intervention. The insertion bundle incorporated CDC-recommended procedures based on methods found to be effective either in adults or in a single-institution PICU.

Each PICU self monitored central-line insertions and reported data on insertion-bundle and maintenance-bundle compliance. Researchers then measured this data against the catheter-associated blood stream infection cases per 1,000 central-line days over three different time periods: baseline, Oct. 2006 to Dec. 2006 and Jan. 2007 to Sept. 2007.

Results indicated that the average baseline catheter-associated blood stream infection rate for the 29 PICUs was 5.4 per 1,000 central-line days. The rate decreased during the initial three months of the program to 4.3 per 1,000 central-line days, and further decreased to an average stable-effect rate of 3.1 per 1,000 central-line days. This accounted for an overall 43% reduction in catheter-associated blood stream infection rates. Sustained compliance for the insertion bundle was 84%, and sustained compliance for the maintenance-bundle was 82%, a significant increase from the initial rate of 65%.

“In contrast with adult ICU care, maximizing insertion-bundle compliance alone cannot help PICUs eliminate catheter-associated blood stream infections,” wrote the researchers. “Instead, the main drivers for further reducing pediatric catheter-associated blood stream infection rates seem to be issues that surround daily maintenance care for central lines, an attribute of bedside nursing care and practice.” – by Melissa Foster

This article addresses an important issue involving in-patient pediatrics. Intravascular catheters are generally found in the sickest children, who can least afford exposure to bacteremia. The researchers evaluated the efficacy of two standardized protocols for placement and maintenance of central venous catheters in pediatric patients. They found that using these standardized methods, catheter-associated bloodstream infections were reduced by 43%. Through analysis of data, they further demonstrated that issues surrounding daily maintenance of the catheters were most important drivers of successful reduction in associated infections. The insertion and maintenance protocols are simple to understand and require commonly available equipment and supplies. Although the protocols deserve further evaluation in regard to long-term outcomes, they represent reasonable starting points for institutions looking to improve morbidity related to intravascular catheters in children.

– Douglas Baker, MD
Infectious Diseases in Children Editorial Board

Miller MR. Pediatrics. 2010; 125:206-213.