Investigators at McGill University Health Center in Montreal, Canada report that implementation of a dedicated inter-professional peripherally inserted central catheter (PICC) team and a prevention bundle was successful in decreasing rates of CLABSI in the neonatal intensive care unit (NICU).
From 2007 to 2011 surveillance for CLABSI was performed in a tertiary-level, 26-bed NICU. All laboratory confirmed blood cultures from the NICU were evaluated to determine CLABSI using the National Healthcare Safety Network (NHSN) definition prior and after 2008.The PICC team members are specific bedside nurses trained to insert, monitor insertion site and line removal. They use age/weight specific skin antiseptics (2% CHG, 0.5% and 2% CHG in 70% alcohol) with designated equipment. Bedside nurses access infusion lines for administering medication, total parenteral nutrition and changing the line/connectors.
Over the past four years there were 37 CLABSI using the old NHSN definition versus 22 CLABSI with the new definition. The infection rate was 5.97/1,000 catheter days (CD) and 3.55/1,000 CD respectively. The overall catheter utilization ratio was 0.20. The most prevalent microorganisms recovered were Coagulase-negative Staphylococci (71 percent) followed by Candida, Enterobacter and Klebsiellaspecies (6 percentÂ each). There were two associated CLABSI mortalities within 30 days. Rates of CLABSI decreased from 8.1 to 3.71 using old definition and from 4.7 to 1.06 per 1,000 CD using new definition 2007-2008 to 2010-2011. Catheter utilization ratio increased from 0.19 to 0.24.
The researchers emphasize that the change in definition considerably affects the rates of CLABSI (-41 percent).
Reference: A DÃ©cary, R Mandel, R Rodrigues, C Frenette, B Lussier. Four year surveillance of central line-associated bloodstream infection (CLABSI) in neonatal intensive care unit (NICU). Presentation at International Conference on Prevention & Infection Control (ICPIC). BMC Proceedings 2011, 5(Suppl 6):O8