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Challenges in the Prevention of CRBSIs in Pediatrics

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Catheter-related bloodstream infections (CRBSIs) cause significant mortality and morbidity each year, and also cause of healthcare-associated infections (HAIs). The Centers for Disease Control and Prevention (CDC) is in the process of releasing new guidelines for the prevention of CRBSIs, but many of these practices apply only to adult settings, and therefore the prevention of these infections is additionally challenging in pediatric settings.

Two pediatric experts were asked several key questions about best practices for prevention of CRBSIs specific to pediatrics: Donna Peace, RN, CPHQ, CIC, epidemiologist and Janet Pettit, MSN, NNP-BC, CNS, neonatal nurse practitioner.

What is the biggest struggle you have in your facility in prevention of CRBSIs?

Pettit: Initially to get staff to believe that CRBSI wasn't an entitlement when you are born prematurely and your life depends upon use of TPN via a central venous catheter (CVC). Once that was accomplished, it continues to be the performance of hand hygiene among all disciplines coming in contact with our babies.

Peace: To me, collaboration amongst the multi-disciplinary team of healthcare professionals in the prevention of these deadly infections is the largest struggle that I see in my facility. In addition, the evolution of clinical literature demonstrating best practices in the prevention of bloodstream infections proves challenging when convincing certain medical disciplines, especially physicians, of changing practices, and sustaining the transformation.

What is your role, and how do you collaborate with other disciplines to combat this problem?

Pettit: As the team leader in our effort, I was amazed at the number of staff (nurses, physicians, respiratory therapists, social workers and managers who composed our HAI prevention teams). The teams tackled all aspects critical to success -- identifying new products to use and processes to change, engaging staff in behavior change, working with non NICU staff and getting by in to our processes, communicating practice change to staff and planning celebrations. Prevention is a lot of work and takes a team of dedicated individuals to make it work. I have also discovered that we must continue to monitor process performance to identify gaps in practice that could lead to patient harm.

Peace: As an infection preventionist, my role is cross functional in the sense that on a daily basis, I interact with a variety of clinicians, patients, as well as family members. I also serve on a system wide committee charged with vascular access excellence, which includes the prevention of catheter-related bloodstream infections. One of my biggest daily challenges is adapting the message of infection prevention and control to the variety of audiences that I meet with on a daily basis.

What role does the use of Chlorhexidine gluconate (CHG) play in the prevention of CRBSIs? What do you use CHG for?

Pettit: CHG has been demonstrated as best practice for the prevention of CRBSI in many patient populations, and evolving evidence suggests that its safety track record applies to younger patient populations. We use a 3.15 percent CHG product for port and hub cleansing, as well as for skin antisepsis. For extremely low birth weight infants, we rinse the CHG off with sterile saline following the procedure.

Peace: At our facilities, we use CHG in both our skin antiseptics, and also certain dressings such as Biopatch. CHG is used for disinfecting the skin prior to the insertion of the device or routine venipuncture, and also prior to accessing any access point on the intravenous line.

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