Neonatal central line associated blood stream infection

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Abstract:

Late onset sepsis (LOS) and central line associated blood stream infection (CLA-BSI) contribute towards the mortality and morbidity in prematurely born infants.

AIM: To investigate the effects of hospital wide and unit based interventions on LOS and CLA-BSI in infants born at <32 weeks gestation.

METHODS: Intensive care, high dependency (IC-HD) days and catheter days were obtained from the unit database and blood culture results from a Microbiology laboratory database. Poisson regression was used to evaluate the effects of interventions on LOS and CLA-BSI.

RESULTS: Quarterly rates of LOS reduced from 26.1 to 2.9 per 1000 IC-HD days and CLA-BSI from 31.6 to 4.3 per 1000 catheter days between 2007 and 2012. Appointment of a specialist vascular device nurse, a change in the mode of administration of vancomycin, standardization of the hospital skin and hub disinfection policy, and the introduction of a venous infusion phlebitis scoring system was associated with a reduction of LOS to 55%(95% CI 40-74%) and CLA-BSI 45%(95% CI 33-61%) of pre-intervention levels. The standardization of the neonatal unit policy for skin disinfection and a move to a new building were associated with reductions of LOS to 64%(47%-87%) and 54%(34% – 88%) respectively, and aseptic no touch technique (ANTT) for infusion access with CLA-BSI to 53%(37-75%) of pre-intervention levels.

CONCLUSION: A multifaceted approach involving changes in antimicrobial and skin disinfection policy, training for ANTT and surveillance resulted in sustained reduction in LOS and CLA-BSI rates.

Reference:

Sinha, A.K., Murthy, V., Nath, P., Morris, J.K. and Millar, M. (2015) Prevention of Late Onset Sepsis and Central Line Associated Blood Stream Infection in Preterm Infants. The Pediatric Infectious Disease Journal. November 30th. [epub ahead of print].

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