Log in | Register

Are central line bundles and ventilator bundles effective in critically ill neonates and children?

Charlotte A. Smulders| Josephus P. J. van Gestel| Albert P. Bos
Review
Volume 39, Issue 8 / August , 2013

Pages 1352 - 1358

Abstract

Central line-associated bloodstream infections (CLABSI) and ventilator-associated pneumonia (VAP) are common problems in adult, pediatric (PICU) and neonatal (NICU) intensive care unit patients. Care bundles have been developed to prevent these hospital-acquired infections and to provide best possible care. Studies in adults have proven that care bundles contribute to a decrease in CLABSI and VAP rates. The purpose of this literature review was to critically appraise the known evidence of the effectiveness of central line bundles and ventilator bundles in PICU and NICU patients. The number of publications of central line bundles and ventilator bundles in PICU and NICU patients is limited compared to adults. Ten studies in PICU patients demonstrated a significant decrease in the CLABSI or VAP rate after implementation of the bundle. Two studies in neonates demonstrated a reduction in the CLABSI rate after implementation of the central line bundle. No studies on the effectiveness of the ventilator bundle in neonates were found. Bundle elements differed between studies, and their scientific basis was not as robust as in adults. Monitoring of compliance to bundle elements seems required for optimal reduction of CLABSI and VAP. Bundle components that focus on maintenance of a central line probably are important to prevent CLABSI in children.

Keywords

References

  1. Burke JP (2003) Infection control: a problem for patient safety. N Engl J Med 348:651–656
    • View reference on PubMed
    • View reference on publisher's website
  2. Grohskopf LA, Sinkowitz-Cochran RL, Garrett DO, Sohn AH, Levine GL, Siegel JD et al (2002) A national point-prevalence survey of pediatric intensive care unit—acquired infections in the United States. J Pediatr 140:432–438
    • View reference on PubMed
    • View reference on publisher's website
  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
    • View reference on PubMed
    • View reference on publisher's website
  4. Edwards JR, Peterson KD, Andrus ML et al (2007) National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007. Am J Infect Control 35:290–301
    • View reference on PubMed
    • View reference on publisher's website
  5. O’Grady NP, Alexander M, Burns LA et al (2011) Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 52:e162–e193
    • View reference on PubMed
    • View reference on publisher's website
  6. Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R, CDC, Healthcare Infection Control Practices Advisory Committee (2004) Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 53((RR-3)):1–36
    • View reference on PubMed
  7. Jarvis W, Edwards JR, Culver GH et al (1991) Nosocomial infection rates in adult and pediatric intensive care units in the United States. National Nosocomial Infections Surveillance System. Am J Med 91:185s–191s
    • View reference on PubMed
    • View reference on publisher's website
  8. Venkatachalam V, Hendley JO, Wilson DF (2011) The diagnostic dilemma of ventilator-associated pneumonia in critically ill children. Pediatr Crit Care Med 12:286–296
    • View reference on PubMed
    • View reference on publisher's website
  9. Centers for Disease Control and Prevention Guidelines (CDC) (2009) Guidelines and procedures for monitoring VAP. National Healthcare Safety Network. http://www.cdc.gov/nhsn/pdfs/pscmanual/6pscvapcurrent.pdf accessed 1 dec 2012
  10. 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
    • View reference on PubMed
    • View reference on publisher's website
  11. Bhutta A, Gilliam C, Honeycutt M et al (2007) Reduction of bloodstream infections associated with catheters in paediatric intensive care unit: stepwise approach. BMJ 334:362–365
    • View reference on PubMed
    • View reference on publisher's website
  12. Li S, Bizzarro MJ (2011) Prevention of central line associated bloodstream infections in critical care units. Curr Opin Pediatr 23:85–90
    • View reference on PubMed
    • View reference on publisher's website
  13. 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
    • View reference on PubMed
    • View reference on publisher's website
  14. Powers RJ, Wirtschafter DW (2010) Decreasing central line associated bloodstream infection in neonatal intensive care. Clin Perinatol 37:247–272
    • View reference on PubMed
    • View reference on publisher's website
  15. Klevens RM, Edwards JR, Richards CL et al (2007) Estimating health care-associated infections and death in US hospitals, 2002. Public Health Rep 122:160–166
    • View reference on PubMed
  16. Institute for Healthcare Improvement (2011) What is a bundle. http://www.ihi.org/knowledge/Pages/ImprovementStories/WhatIsaBundle.aspx. Accessed 3 Feb 2012
  17. Morris AC, Hay AW, Swann DG et al (2011) Reducing ventilator-associated pneumonia in intensive care: impact of implementing a care bundle. Crit Care Med 39:2218–2224
    • View reference on PubMed
    • View reference on publisher's website
  18. Lachman P, Yuen S (2009) Using care bundles to prevent infection in neonatal and paediatric ICUs. Curr Opin Infect Dis 22:224–228
    • View reference on PubMed
    • View reference on publisher's website
  19. Winters B, Dorman T (2006) Patient-safety and quality initiatives in the intensive-care unit. Curr Opin Anaesthesiol 19:140–145
    • View reference on PubMed
    • View reference on publisher's website
  20. Shuman EK, Washer LL, Arndt JL et al (2010) Analysis of central line-associated bloodstream infections in the intensive care unit after implementation of central line bundles. Infect Control Hosp Epidemiol 31:551–553
    • View reference on PubMed
    • View reference on publisher's website
  21. Pronovost P, Needham D, Bernholtz S et al (2006) An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 355:2725–2732
    • View reference on PubMed
    • View reference on publisher's website
  22. Bonello RS, Fletcher CE, Becker WK et al (2008) An intensive care unit quality improvement collaborative in nine Department of Veterans Affairs hospitals: reducing ventilator-associated pneumonia and catheter-related bloodstream infection rates. Jt Comm J Qual Patient Saf 34:639–645
    • View reference on PubMed
  23. Furuya EY, Dick A, Perencevich EN, Pogorzelska M, Goldmann D, Stone PW (2011) Central line bundle implementation in US intensive care units and impact on bloodstream infections. PLoS One 6:e15452
    • View reference on PubMed
    • View reference on publisher's website
  24. Galpern D, Guerrero A, Tu A, Fahoum B, Wise L (2008) Effectiveness of a central line bundle campaign on line-associated infections in the intensive care unit. Surgery 144:492–495
    • View reference on PubMed
    • View reference on publisher's website
  25. Venkatram S, Rachmale S, Kanna B (2010) Study of device use adjusted rates in health care-associated infections after implementation of “bundles” in a closed-model medical intensive care unit. J Crit Care 25:174.e11–174.e18
    • View reference on publisher's website
  26. Wip C, Napolitano L (2009) Bundles to prevent ventilator-associated pneumonia: how valuable are they? Curr Opin Infect Dis 22:159–166
    • View reference on PubMed
    • View reference on publisher's website
  27. National Nosocomial Infections Surveillance System (2004) National Nosocomial Infections Surveillance System (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 32:470–485
    • View reference on publisher's website
  28. Huskins WC (2012) Quality improvement interventions to prevent healthcare-associated infections in neonates and children. Curr Opin Pediatr 24:103–112
    • View reference on PubMed
    • View reference on publisher's website
  29. Bizzarro MJ, Sabo B, Noonan M et al (2010) A quality improvement initiative to reduce central line-associated bloodstream infections in a neonatal intensive care unit. Infect Control Hosp Epidemiol 31:241–248
    • View reference on PubMed
    • View reference on publisher's website
  30. Schulman J, Stricof R, Stevens TP et al (2011) Statewide NICU central-line-associated bloodstream infection rates decline after bundles and checklists. Pediatrics 127:436–444
    • View reference on PubMed
    • View reference on publisher's website
  31. 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
    • View reference on PubMed
    • View reference on publisher's website
  32. Jeffries HE, Mason W, Brewer M et al (2009) Prevention of central venous catheter-associated bloodstream infections in pediatric intensive care units: a performance improvement collaborative. Infect Control Hosp Epidemiol 30:645–651
    • View reference on PubMed
    • View reference on publisher's website
  33. McKee C, Berkowitz I, Cosgrove SE et al (2008) Reduction of catheter-associated bloodstream infections in pediatric patients: experimentation and reality. Pediatr Crit Care Med 9:40–46
    • View reference on PubMed
    • View reference on publisher's website
  34. Miller MR, Niedner MF, Huskins WC et al (2011) Reducing PICU central line-associated bloodstream infections: 3-year results. Pediatrics 128:e1077–e1083
    • View reference on PubMed
    • View reference on publisher's website
  35. Miller-Hoover S (2011) Pediatric central line: bundle implementation and outcomes. J Infus Nurs 34:36–48
    • View reference on PubMed
    • View reference on publisher's website
  36. Morgan LM, Thomas DJ (2007) Implementing evidence-based nursing practice in the pediatric intensive care unit. J Infus Nurs 30:105–112
    • View reference on PubMed
    • View reference on publisher's website
  37. Wheeler DS, Giaccone MJ, Hutchinson N et al (2011) A hospital-wide quality-improvement collaborative to reduce catheter-associated bloodstream infections. Pediatrics 128:e995–e1004
    • View reference on PubMed
    • View reference on publisher's website
  38. Bigham MT, Amato R, Bondurrant P et al (2009) Ventilator-associated pneumonia in the pediatric intensive care unit: characterizing the problem and implementing a sustainable solution. J Pediatr 154:582–587
    • View reference on PubMed
    • View reference on publisher's website
  39. Brierley J, Highe L, Hines S, Dixon G (2012) Reducing VAP by instituting a care bundle using improvement methodology in a UK paediatric intensive care unit. Eur J Pediatr 171:323–330
    • View reference on PubMed
    • View reference on publisher's website
  40. Brilli RJ, Sparling KW, Lake MR et al (2008) The business case for preventing ventilator-associated pneumonia in pediatric intensive care unit patients. Jt Comm J Qual Patient Saf 34:629–638
    • View reference on PubMed
  41. Chittick P, Sherertz RJ (2010) Recognition and prevention of nosocomial vascular device and related bloodstream infections in the intensive care unit. Crit Care Med 38(8 Suppl):363–372
    • View reference on publisher's website
  42. Marwick C, Davey P (2009) Care bundles: the holy grail of infectious risk management in hospital? Curr Opin Infect Dis 22:364–369
    • View reference on PubMed
    • View reference on publisher's website
  43. Miller MR, Griswold M, Harris JM et al (2010) Decreasing PICU catheter-associated bloodstream infections: NACHRI’s quality transformation efforts. Pediatrics 125:206–213
    • View reference on PubMed
    • View reference on publisher's website
  44. Kilo CM, Kabcenell RN, Berwick DM (1998) Beyond survival: toward continuous improvement in medical care. New Horiz 6:3–11
    • View reference on PubMed

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement