Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Central line-associated bloodstream infections in neonates

  • Cho, Hye Jung (Department of Pediatrics, Gil Medical Center, Gachon University College of Medicine) ;
  • Cho, Hye-Kyung (Department of Pediatrics, Gil Medical Center, Gachon University College of Medicine)
  • Received : 2018.09.02
  • Accepted : 2018.12.19
  • Published : 2019.03.15
Download PDF
⟨ Previous Next ⟩

Abstract

Newborn infants, including premature infants, are high-risk patients susceptible to various microorganisms. Catheter-related bloodstream infections are the most common type of nosocomial infections in this population. Regular education and training of medical staffs are most important as a preventive strategy for central line-associated bloodstream infections (CLABSIs). Bundle approaches and the use of checklists during the insertion and maintenance of central catheters are effective measures to reduce the incidence of CLABSIs. Chlorhexidine, commonly used as a skin disinfectant before catheter insertion and dressing replacement, is not approved for infants <2 months of age, but is usually used in many neonatal intensive care units due to the lack of alternatives. Chlorhexidine-impregnated dressing and bathing, recommended for adults, cannot be applied to newborns. Appropriate replacement intervals for dressing and care sets are similar to those recommended for adults. Umbilical catheters should not be used longer than 5 days for the umbilical arterial catheter and 14 days for the umbilical venous catheter. It is most important to regularly educate, train and give feedback to the medical staffs about the various preventive measures required at each stage from before insertion to removal of the catheter. Continuous efforts are needed to develop effective and safe infection control strategies for neonates and young infants.

Keywords

References

  1. Stoll BJ, Shane AL. Infections of the neonatal infant. In: Kliegman RM, Stanton BF, St Geme III JW, Schor NF, editors. Nelson textbook of pediatrics. 20th ed. ed. Philadelphia (PA): Elsevier Saunders, 2016: 909-25.
  2. Goudie A, Dynan L, Brady PW, Rettiganti M. Attributable cost and length of stay for central line-associated bloodstream infections. Pediatrics 2014;133:e1525-32. https://doi.org/10.1542/peds.2013-3795
  3. Bell T, O'Grady NP. Prevention of central line-associated bloodstream infections. Infect Dis Clin North Am 2017;31:551-9. https://doi.org/10.1016/j.idc.2017.05.007
  4. Centers for Disease Control and Prevention. National Healthcare Safety Network (NHSN) Patient Safety Component Manual 2017 [Internet]. Atlanta (GA): Centers for Disease Control and Prevention; 2017 [cited 2018 Sep 1]. Available from: https://www.cdc.gov/nhsn/pdfs/validation/2017/pcsmanual_2017.pdf.
  5. Nationales Referenzzentrum fur Surveillance von nosokomialen Infektionen. NEO-KISS Protocol, Nosocomial infection surveillance for preterm infants with birthweight <1500g [Internet]. Berlin (Germany): Nationales Referenzzentrum fur Surveillance von nosokomialen Infektionen; 2010 [cited 2018 Aug 16]. Available from: http://www.nrz-hygiene.de/fileadmin/nrz/module/neo/NEO-KISSProtocol_english_240210.pdf.
  6. van der Zwet WC, Kaiser AM, van Elburg RM, Berkhof J, Fetter WP, Parlevliet GA, et al. Nosocomial infections in a Dutch neonatal intensive care unit: surveillance study with definitions for infection specifically adapted for neonates. J Hosp Infect 2005;61:300-11. https://doi.org/10.1016/j.jhin.2005.03.014
  7. Mobley RE, Bizzarro MJ. Central line-associated bloodstream infections in the NICU: Successes and controversies in the quest for zero. Semin Perinatol 2017;41:166-74. https://doi.org/10.1053/j.semperi.2017.03.006
  8. Schulman J, Stricof R, Stevens TP, Horgan M, Gase K, Holzman IR, et al. Statewide NICU central-line-associated bloodstream infection rates decline after bundles and checklists. Pediatrics 2011;127:436-44. https://doi.org/10.1542/peds.2010-2873
  9. Couto RC, Carvalho EA, Pedrosa TM, Pedroso ER, Neto MC, Biscione FM. A 10-year prospective surveillance of nosocomial infections in neonatal intensive care units. Am J Infect Control 2007;35:183-9. https://doi.org/10.1016/j.ajic.2006.06.013
  10. Chun P, Kong SG, Byun SY, Park SE, Lee HD. Analysis of neonatal sepsis in one neonatal intensive care unit for 6 years. Korean J Pediatr 2010;53;495-502. https://doi.org/10.3345/kjp.2010.53.4.495
  11. Crnich CJ, Maki DG. The promise of novel technology for the prevention of intravascular device-related bloodstream infection. I. Pathogenesis and short-term devices. Clin Infect Dis 2002;34:1232-42. https://doi.org/10.1086/339863
  12. Raad I, Costerton W, Sabharwal U, Sacilowski M, Anaissie E, Bodey GP. Ultrastructural analysis of indwelling vascular catheters: a quantitative relationship between luminal colonization and duration of placement. J Infect Dis 1993;168:400-7. https://doi.org/10.1093/infdis/168.2.400
  13. Aslam S. Effect of antibacterials on biofilms. Am J Infect Control 2008;36:S175.e9-11. https://doi.org/10.1016/j.ajic.2008.10.002
  14. Centers for Disease Control and Prevention. Guidelines for the prevention of intravascular catheter-related infections, 2011 [Internet]. Atlanta (GA): Centers for Disease Control and Prevention; 2017 [cited 2018 Aug 16]. Available from: https://www.cdc.gov/infectioncontrol/guidelines/bsi/.
  15. Krein SL, Kuhn L, Ratz D, Chopra V.Use of designated nurse PICC teams and CLABSI prevention practices among U.S. Hospitals: a wurvey-based study. J Patient Saf 2015.
  16. Tucker J; UK Neonatal Staffing Study Group. Patient volume, staffing, and workload in relation to risk-adjusted outcomes in a random stratified sample of UK neonatal intensive care units: a prospective evaluation. Lancet 2002;359:99-107. https://doi.org/10.1016/S0140-6736(02)07366-X
  17. Panagiotounakou P, Antonogeorgos G, Gounari E, Papadakis S, Labadaridis J, Gounaris AK. Peripherally inserted central venous catheters: frequency of complications in premature newborn depends on the insertion site. J Perinatol 2014;34:461-3. https://doi.org/10.1038/jp.2014.36
  18. Wrightson DD. Peripherally inserted central catheter complications in neonates with upper versus lower extremity insertion sites. Adv Neonatal Care 2013;13:198-204. https://doi.org/10.1097/ANC.0b013e31827e1d01
  19. Vegunta RK, Loethen P, Wallace LJ, Albert VL, Pearl RH. Differences in the outcome of surgically placed long-term central venous catheters in neonates: neck vs groin placement. J Pediatr Surg 2005;40:47-51. https://doi.org/10.1016/j.jpedsurg.2004.09.015
  20. Breschan C, Platzer M, Jost R, Schaumberger F, Stettner H, Likar R. Comparison of catheter-related infection and tip colonization between internal jugular and subclavian central venous catheters in surgical neonates. Anesthesiology 2007;107:946-53. https://doi.org/10.1097/01.anes.0000291443.78166.98
  21. Schulman J, Stricof RL, Stevens TP, Holzman IR, Shields EP, Angert RM, et al. Development of a statewide collaborative to decrease NICU central line-associated bloodstream infections. J Perinatol 2009;29: 591-9. https://doi.org/10.1038/jp.2009.18
  22. Lai NM, Taylor JE, Tan K, Choo YM, Ahmad Kamar A, Muhamad NA. Antimicrobial dressings for the prevention of catheter-related infections in newborn infants with central venous catheters. Cochrane Database Syst Rev 2016;3:CD011082.
  23. Williams FL, Watson J, Day C, Soe A, Somisetty SK, Jackson L, et al. Thyroid dysfunction in preterm neonates exposed to iodine. J Perinat Med 2017;45:135-43. https://doi.org/10.1515/jpm-2016-0141
  24. Smerdely P, Lim A, Boyages SC, Waite K, Wu D, Roberts V, et al. Topical iodine-containing antiseptics and neonatal hypothyroidism in very-low-birthweight infants. Lancet 1989;2:661-4.
  25. Linder N, Davidovitch N, Reichman B, Kuint J, Lubin D, Meyerovitch J, et al. Topical iodine-containing antiseptics and subclinical hypothyroidism in preterm infants. J Pediatr 1997;131:434-9. https://doi.org/10.1016/S0022-3476(97)80071-6
  26. Kieran EA, O'Sullivan A, Miletin J, Twomey AR, Knowles SJ, O'Donnell CPF. 2% chlorhexidine-70% isopropyl alcohol versus 10% povidone-iodine for insertion site cleaning before central line insertion in preterm infants: a randomised trial. Arch Dis Child Fetal Neonatal Ed 2018;103:F101-6. https://doi.org/10.1136/archdischild-2016-312193
  27. Foster JP, Richards R, Showell MG, Jones LJ. Intravenous in-line filters for preventing morbidity and mortality in neonates. Cochrane Database Syst Rev 2015;(8):CD005248.
  28. Levy I, Katz J, Solter E, Samra Z, Vidne B, Birk E, et al. Chlorhexidine-impregnated dressing for prevention of colonization of central venous catheters in infants and children: a randomized controlled study. Pediatr Infect Dis J 2005;24:676-9. https://doi.org/10.1097/01.inf.0000172934.98865.14
  29. Garland JS, Alex CP, Mueller CD, Otten D, Shivpuri C, Harris MC, et al. A randomized trial comparing povidone-iodine to a chlorhexidine gluconate-impregnated dressing for prevention of central venous catheter infections in neonates. Pediatrics 2001;107:1431-6. https://doi.org/10.1542/peds.107.6.1431
  30. Jardine LA, Inglis GD, Davies MW. Prophylactic systemic antibiotics to reduce morbidity and mortality in neonates with central venous catheters. Cochrane Database Syst Rev 2008;(1):CD006179.
  31. Taylor JE, Tan K, Lai NM, McDonald SJ. Antibiotic lock for the prevention of catheter-related infection in neonates. Cochrane Database Syst Rev 2015;(6):CD010336.
  32. Quach C, Milstone AM, Perpete C, Bonenfant M, Moore DL, Perreault T. Chlorhexidine bathing in a tertiary care neonatal intensive care unit: impact on central line-associated bloodstream infections. Infect Control Hosp Epidemiol 2014;35:158-63. https://doi.org/10.1086/674862
  33. Kleinman RE. Pediatric nutrition handbook. 6th ed. Elk Grove (IL): American Academy of Pediatrics, 2009:529.
  34. Crill CM, Hak EB, Robinson LA, Helms RA. Evaluation of microbial contamination associated with different preparation methods for neonatal intravenous fat emulsion infusion. Am J Health Syst Pharm 2010;67:914-8. https://doi.org/10.2146/ajhp090199

Cited by

  1. Central line-associated bloodstream infections in the neonatal intensive care unit vol.62, pp.10, 2019, https://doi.org/10.3345/kjp.2019.00269
  2. Bacterial Pathogens and Evaluation of a Cut-Off for Defining Early and Late Neonatal Infection vol.10, pp.3, 2021, https://doi.org/10.3390/antibiotics10030278
  3. Diagnostic accuracy of a dynamically increased red blood cell distribution width in very low birth weight infants with serious bacterial infection vol.47, pp.1, 2019, https://doi.org/10.1186/s13052-021-00994-w