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

Corsino Rey| Francisco Álvarez| Victoria De-La-Rua| Andrés Concha| Alberto Medina| Juan-José Díaz| Sergio Menéndez| Marta Los-Arcos| Juan Mayordomo-Colunga
Pediatric Original
Volume 37, Issue 4 / April , 2011

Pages 678 - 685

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.

Keywords

References

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