Intravenous literature: Miller, M.R., Niedner, M.F., Huskins, C., Colantuoni, E., Yenokyan, G., Moss, M., Rice, T.B., Ridling, D., Campbell, D. and Brilli, R.J. (2011) Reducing PICU Central Lineâ€“Associated Bloodstream Infections: 3-Year Results. Pediatrics. 128(5), p.e1077-e1083.
OBJECTIVES: To evaluate the long-term impact of pediatric central line care practices in reducing PICU central lineâ€“associated bloodstream infection (CLA-BSI) rates and to evaluate the added impact of chlorhexidine scrub and chlorhexidine-impregnated sponges.
METHODS: A 3-year, multi-institutional, interrupted time-series design (October 2006 to September 2009), with historical control data, was used. A nested, 18-month, nonrandomized, factorial design was used to evaluate 2 additional interventions. Twenty-nine PICUs were included. Two central line care bundles (insertion and maintenance bundles) and 2 additional interventions (chlorhexidine scrub and chlorhexidine-impregnated sponges) were used. CLA-BSI rates (January 2004 to September 2009), insertion and maintenance bundle compliance rates (October 2006 to September 2009), and chlorhexidine scrub and chlorhexidine-impregnated sponge compliance rates (January 2008 to June 2009) were assessed.
RESULTS: The average aggregate baseline PICU CLA-BSI rate decreased 56% over 36 months from 5.2 CLA-BSIs per 1000 line-days (95% confidence interval [CI]: 4.4â€“6.2 CLA-BSIs per 1000 line-days) to 2.3 CLA-BSIs per 1000 line-days (95% CI: 1.9â€“2.9 CLA-BSIs per 1000 line-days) (rate ratio: 0.44 [95% CI: 0.37â€“0.53]; P < .0001). No statistically significant differences in CLA-BSI rate decreases between PICUs using or not using either of the 2 additional interventions were found.
CONCLUSIONS: Focused attention on consistent adherence to the use of pediatrics-specific central line insertion and maintenance bundles produced sustained, continually decreasing PICU CLA-BSI rates. Additional use of either chlorhexidine for central line entry scrub or chlorhexidine-impregnated sponges did not produce any statistically significant additional reduction in PICU CLA-BSI rates.