ABSTRACT
Central line-associated bloodstream infections are the most common and significant complications of central venous catheters. The development of central line-associated bloodstream infection in children is increasingly recognized worldwide, although it is often preventable. Guidelines recommend the application of a central catheter insertion bundle and appropriate catheter care to prevent central line-associated bloodstream infections. Central catheter insertion and maintenance care bundles consist of interventions that, when used together, are effective in preventing central lineassociated bloodstream infections. Recent literature on central line-associated bloodstream infection prevention shows that using a care bundle approach to improve central catheter insertion and maintenance practices reduces the rates of central line-associated bloodstream infections. Nurses have a direct and permanent role in the handling of central venous catheters. Therefore, they have a unique opportunity to contribute to the prevention of central line-associated bloodstream infections. However, prevention of central line-associated bloodstream infections is an important responsibility for nurses. The nurse’s knowledge of the evidence-based recommendations plays a key role in preventing catheter-related infections. This review summarizes recent literature regarding the prevention of central line-associated bloodstream infections in critically ill children.
Keywords: Child, central venous catheter, catheter-related infections, nursing care, care bundles
References
1
Aslan N, Yıldızdaş D, Menemencioğlu A, Korkmaz F, Horoz ÖÖ, Gündeşlioğlu ÖÖ. Çocuk yoğun bakım ünitemizde kateter ilişkili kan akımı enfeksiyonunun önlenmesi açısından standart bakım örtüsü ve klorheksidin glukonat içeren bakım örtüsünün karşılaştırılması. J Pediatr Emerg Intensive Care Med. 2020;7:24-9.
2
Bennett J, Cheung M. Intravenous access in children. Paediatrics and Child Health. 2020;30:224-9.
3
Leibowitz A, Oren-Grinberg A, Matyal R. Ultrasound Guidance for Central Venous Access: Current Evidence and Clinical Recommendations. J Intensive Care Med. 2020;35:303-21.
4
Santos FKY, Flumignan RLG, Areias LL, Sarpe AKP, Amaral FCF, et al. Peripherally inserted central catheter versus central venous catheter for intravenous access: A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2020;99:20352.
5
Ergül AB, Özcan A, Aslaner H, Aslaner HA, Köse S ve ark. Çocuk yoğun bakım ünitesinde santral venöz kateterizasyon komplikasyonlarının ve ılişkili risk faktörlerinin değerlendirilmesi. Journal of Medical and Surgical Intensive Care Medicine. 2016;7:9-14.
6
İşgüder R, Gülfidan G, Ağın H, Devrim İ, Karaarslan U, ve ark. Çocuk yoğun bakım ünitesinde santral venöz kateterizasyon uygulamalar: Dört yıllık deneyim. CAYD. 2014;1:31-8.
7
Paioni P, Kuhn S, Strässle Y, Seifert B, Berger C. Risk factors for central line-associated bloodstream infections in children with tunneled central venous catheters. Am J Infect Control. 2020;48:33-9.
8
Lai NM, Lai NA, O’Riordan E, Chaiyakunapruk N, Taylor JE, et al. Skin antisepsis for reducing central venous catheter-related infections. Cochrane Database Syst Rev. 2016;7:CD010140.
9
Kurt B. Santral venöz kateter enfeksiyonlarını önlemeye yönelik hemşirelik uygulamaları. Adnan Menderes Üniversitesi Sağlık Bilimleri Fakültesi Dergisi. 2018;2:148-54.
10
Yılmaz E. Yoğun bakım ünitelerinde sık görülen enfeksiyonlar ve kanıta dayalı uygulamalar. In: Özer N, editors, Yoğun bakım hemşireliği,1. Baskı, İstanbul: Türkiye Klinikleri, 2019:27-36.
11
Myatra SN. Improving Hand Hygiene Practices to Reduce CLABSI Rates: Nurses Education Integral for Success. Indian J Crit Care Med. 2019;23:291-3.
12
İşgüder R, Devrim İ, Ceylan G, Kara A, Gülfidan G, ve ark. Risk factors for recurrent central line-associated bloodstream infections in a pediatric intensive care unit. Turk J Med Sci. 2017;47:1128-36.
13
Hecht SM, Ardura MI, Yildiz VO, Ouellette CP. Central Venous Catheter Management in High-risk Children With Bloodstream Infections. Pediatr Infect Dis J. 2020;39:17-22.
14
Patel N, Petersen TL, Simpson PM, Feng M, Hanson SJ. Rates of Venous Thromboembolism and Central Line-Associated Bloodstream Infections Among Types of Central Venous Access Devices in Critically Ill Children. Crit Care Med. 2020;48:1340-8.
15
Kikuchi M, Sato T, Okada S, Abe N, Sato A, et al. Maintenance antisepsis in reducing the rate of late-onset central venous catheter-related bloodstream infection: A comparison of 0.05% and 1% chlorhexidine. J Infect Chemother. 2020;26:188-93.
16
Lutwick L, Al-Maani AS, Mehtar S, Memish Z, Rosenthal VD, et al. Managing and preventing vascular catheter infections: A position paper of the international society for infectious diseases. Int J Infect Dis. 2019;84:22-9.
17
Mavrovounis G, Mermiri M, Chatzis DG, Pantazopoulos I. Peripherally Inserted Central Catheter lines for Intensive Care Unit and onco-hematologic patients: A systematic review and meta-analysis. Heart Lung. 2020;49:922-33.
18
Özalp Gerçeker G, Yardımcı F, Aydınok Y. Central Line-Associated Bloodstream Infections in Children With Hematologic and Oncologic Diseases: First Prevalence Results From a University Hospital. J Pediatr Oncol Nurs. 2019;36:327-36.
19
T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü Bulaşıcı Hastalıklar Dairesi Başkanlığı. Ulusal sağlık hizmeti ilişkili enfeksiyonlar sürveyans ağı özet raporu 2019. https://hsgm.saglik.gov.tr/depo/birimler/Bulasici-hastaliklar-db/hastaliklar/SHIE/Raporlar/USHESA_Ozet_Raporu_2019.pdf
20
Whalen A, Mack EH. Prevention of central line-associated bloodstream ınfections in children: Current challenges and opportunities. Current Treatment Options in Pediatrics. 2020;6:203-13.
21
Broudic M, Bodet LM, Dumont R, Joram N, Jacqmarcq O, et al. A 1-year survey of catheter-related infections in a pediatric university hospital: A prospective study. Arch Pediatr. 2020;27:79-86.
22
Altounji D, McClanahan R, O’Brien R, Murray P. Decreasing Central Line-Associated Bloodstream Infections Acquired in the Home Setting Among Pediatric Oncology Patients [Formula: see text]. J Pediatr Oncol Nurs. 2020;37:204-11.
23
Ista E, van der Hoven B, Kornelisse RF, van der Starre C, Vos MC, et al. Effectiveness of insertion and maintenance bundles to prevent central-line-associated bloodstream infections in critically ill patients of all ages: a systematic review and meta-analysis. Lancet Infect Dis. 2016;16:724-34.
24
Kendirli T, Yaman A, Ödek Ç, Özdemir H, Karbuz A, ve ark. Central line-associated bloodstream ınfections in pediatric ıntensive care unit. J Pediatr Emerg Intensive Care Med. 2017;4:42-6.
25
Martinez T, Baugnon T, Vergnaud E, Duracher C, Perie AC, et al. Central-line-associated bloodstream infections in a surgical paediatric intensive care unit: Risk factors and prevention with chlorhexidine bathing. J Paediatr Child Health. 2020;56:936-42.
26
Şanlı D, Sarıkaya A, Katırcıoğlu K. Yoğun bakım hastalarında kateter ilişkili kan dolaşımı enfeksiyonlarının önlenmesinde kanıta dayalı önerilerin etkinliğinin incelenmesi. Medical Journal of Bakırköy. 2016;12:163-87.
27
Li S, Faustino EV, Golombek SG. Reducing central line infections in pediatric and neonatal patients. Curr Infect Dis Rep. 2013;15:269-77.
28
Şanlı D, Sarıkaya A. Yoğun bakım hemşirelerinin santral venöz kateter ilişkili enfeksiyonları önlemede kanıta dayalı kılavuz bilgilerini değerlendirme testinin Türkçe’ye uyarlanması. İzmir Kâtip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi. 2020;5:7-14.
29
Paplawski S. Prevention of central line-associated bloodstream infections in the neonatal intensive care unit: A literature review. Journal of Neonatal Nursing. 2020;26:142-8.
30
Marschall J, Mermel LA, Fakih M, Hadaway L, Kallen A, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35:753-71.
31
O’grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control. 2002;30:476-89.
32
O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011;52:162-93.
33
Talbot TR, Stone EC, Irwin K, Overholt AD, Dasti M, Kallen A, et al. 2017 Recommendations on use of chlorhexidine-impregnated dressings for prevention of intravascular catheter-related infections: An update to the 2011 guidelines for the prevention of intravascular catheter-related infections from the Centers for Disease C. Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality and Promotion. https://www.cdc.gov/infectioncontrol/guidelines/bsi/c-i-dressings/index.html Erişim tarihi: 22.08.2020
34
Institute for Healthcare Improvement. How-to Guide: Prevent Central Line-Associated Bloodstream Infections. 2012 http://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventCentralLineAssociatedBloodstreamInfection.aspx Erişim tarihi: 20.02.2020
35
Gorski L, Hadaway L, Hagle ME, McGolldrick M, Orr M, et al. Infusion therapy standarts of practice. Journal of Infusion Nursing. 2016;39(Supp 1):1-159.
36
Ling ML, Apisarnthanarak A, Jaggi N, Harrington G, Morikane K, et al. APSIC guide for prevention of Central Line Associated Bloodstream Infections (CLABSI). Antimicrob Resist Infect Control. 2016;5:16.
37
Ulusoy S, Akan H, Arat M, Baskan S, Bavbek S, ve ark. Damar içi kateter infeksiyonlarının önlenmesi kılavuzu. Hastane Enfeksiyonları Dergisi. 2005;9:1-32.
38
Çetinkaya Şardan Y, Güner R, Çakar N, Ağalar F, Zahit B, ve ark. Damar içi kateter infeksiyonlarının önlenmesi kılavuzu. Turkish Journal of Hospital Infections. 2013;17:233-79.
39
İşeri A, Hamdemir K, Çınar B, Dizbay M, Düzkaya DS, ve ark. Ulusal Damar Erişimi Yönetimi Rehberi 2019. Hastane İnfeksiyonları Dergisi. 2019;23(Suppl 1):1-54.
40
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.
41
Özen N, Köse T, Terzioğlu F. Santral venöz kateter enfeksiyonlarının önlenmesinde kanıta dayalı uygulamalar: Yoğun bakım hemşirelerinin bilgileri. J Turk Soc Intens Care. 2020;18:91-8.
42
Polat F, Şahinoğlu AH, Dilek A, Köksal E, Üstün YB, ve ark. Rehberlere dayalı önlem ve bakım paketlerinin yoğun bakım ünitesinde santral venöz kateter enfeksiyonları üzerine etkisi. Türk Yoğun Bakım Derneği Dergisi. 2014;12:86-93.
43
The Joint Commission. Preventing Central Line – Associated Bloodstream Infections: A Global Challenge, a Global Perspective. Joint Commission Resources. 2012 https://doi.org/10.1016/B978-1-4557-4007-9.00245-4 Erişim tarihi: 05 Eylül 2020.
44
Devrim İ, Yaşar N, İşgüder R, Ceylan G, Bayram N, et al. Clinical impact and cost-effectiveness of a central line bundle including split-septum and single-use prefilled flushing devices on central line-associated bloodstream infection rates in a pediatric intensive care unit. Am J Infect Control. 2016;44:125-8.
45
Şen S, Uğur E, Afacan S, Sönmezoğlu M. Yoğun bakım enfeksiyonlarının önlenmesinde bakım paketlerinin kullanımı. Yoğun Bakım Hemşireliği Dergisi. 2019;23:27-35.
46
Biasucci DG, Pittiruti M, Taddei A, Picconi E, Pizza A, et al. Targeting zero catheter-related bloodstream infections in pediatric intensive care unit: a retrospective matched case-control study. J Vasc Access. 2018;19:119-24.
47
Devrim İ, Oruç Y, Demirağ B, Kara A, Düzgöl M, et al. Central line bundle for prevention of central line-associated bloodstream infection for totally implantable venous access devices (ports) in pediatric cancer patients. J Vasc Access. 2018;19:358-65.
48
Linder LA, Gerdy C, Jo Y, Wilson A. Changes in Central Line-Associated Bloodstream Infection Rates Among Children With Immune Compromised Conditions: An 11-Year Review. J Pediatr Oncol Nurs. 2018;35:382-91.
49
Savage T, Hodge DE, Pickard K, Myers P, Powell K, et al. Sustained reduction and prevention of neonatal and pediatric central line-associated bloodstream ınfection following a nurse-driven quality ımprovement ınitiative in a pediatric facility. JAVA - Journal of the Association for Vascular Access. 2018;23:30-41.
50
Helder O, van den Hoogen A, de Boer C, van Goudoever J, Verboon-Maciolek M, et al. Effectiveness of non-pharmacological interventions for the prevention of bloodstream infections in infants admitted to a neonatal intensive care unit: A systematic review. Int J Nurs Stud. 2013;50:819-31.
51
Smulders CA, van Gestel JP, Bos AP. Are central line bundles and ventilator bundles effective in critically ill neonates and children? Intensive Care Med. 2013;39:1352-8.
52
Kavak M, Caner M. Santral kateter ilişkili kan dolaşımı enfeksiyonları ve klorheksidinin etkinliği. Cerrahi Ameliyathane Sterilizasyon Enfeksiyon Kontrol Hemşireliği Dergisi. 2020;1:39-44.
53
Bianco A, Coscarelli P, Nobile CG, Pileggi C, Pavia M. The reduction of risk in central line-associated bloodstream infections: knowledge, attitudes, and evidence-based practices in health care workers. Am J Infect Control. 2013;41:107-12.
54
Levy ER, Hutchins KA, Schears GJ, Rodriguez V, Huskins WC. How We Approach Central Venous Catheter Safety: A Multidisciplinary Perspective. J Pediatric Infect Dis Soc. 2020;9:87-91.
55
Loveday HP, Wilson JA, Pratt RJ, Golsorkhi M, Tingle A, et al. Department of Health. epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect. 2014;86(Suppl 1):1-70.
56
Apfelbaum JL, Rupp SM, Tung A, Connis RT, Domino KB, et al. Practice guidelines for central venous access 2020: an updated report by the american society of anesthesiologists task force on central venous access. Anesthesiology. 2020;132:8-43.
57
Levit O, Shabanova V, Bizzarro M. Impact of a dedicated nursing team on central line-related complications in neonatal intensive care unit. J Matern Fetal Neonatal Med. 2020;33:2618-22.
58
Capretti MG, Sandri F, Tridapalli E, Galletti S, Petracci E, et al. Impact of a standardized hand hygiene program on the incidence of nosocomial infection in very low birth weight infants. Am J Infect Control. 2008;36:430-5.
59
Alay H. Yenidoğan yoğun bakım ünitesinde sık görülen sağlık hizmeti ilişkili enfeksiyonlarından korunma ve önlenmesi. J Biotechnol and Strategic Health Res. 2019;3:176-82.
60
Johnson L, Grueber S, Schlotzhauer C, Phillips E, Bullock P, et al. A multifactorial action plan improves hand hygiene adherence and significantly reduces central line-associated bloodstream infections. Am J Infect Control. 2014;42:1146-51.
61
Chaiyakunapruk N, Veenstra DL, Lipsky BA, Sullivan SD, Saint S. Vascular catheter site care: the clinical and economic benefits of chlorhexidine gluconate compared with povidone iodine. Clin Infect Dis. 2003;37:764-71.
62
Mimoz O, Lucet JC, Kerforne T, Pascal J, Souweine B, et al. Skin antisepsis with chlorhexidine-alcohol versus povidone iodine-alcohol, with and without skin scrubbing, for prevention of intravascular-catheter-related infection (CLEAN): an open-label, multicentre, randomised, controlled, two-by-two factorial trial. Lancet. 2015;386:2069-77.
63
Shi Y, Yang N, Zhang L, Zhang M, Pei HH, et al. Chlorhexidine disinfectant can reduce the risk of central venous catheter infection compared with povidone: a meta-analysis. Am J Infect Control. 2019;47:1255-62.
64
Chesshyre E, Goff Z, Bowen A, Carapetis J. The prevention, diagnosis and management of central venous line infections in children. J Infect. 2015;71(Suppl 1):59-75.
65
Schvartsman C, Medeiros DNM, Troster EJ. Using new technology to prevent healthcare-associated ınfection in pediatric patients. Current Treatment Options in Infectious Diseases. 2016;8:16-23.
66
Westling T, Cowden C, Mwananyanda L, Kapasa ML, Machona S, et al. Impact of chlorhexidine baths on suspected sepsis and bloodstream infections in hospitalized neonates in Zambia. Int J Infect Dis. 2020;96:54-60.
67
Kinoshita D, Hada S, Fujita R, Matsunaga N, Sakaki H, et al. Maximal sterile barrier precautions independently contribute to decreased central line-associated bloodstream infection in very low birth weight infants: A prospective multicenter observational study. Am J Infect Control. 2019;47:1365-9.
68
Timsit JF, Rupp M, Bouza E, Chopra V, Kärpänen T, et al. A state of the art review on optimal practices to prevent, recognize, and manage complications associated with intravascular devices in the critically ill. Intensive Care Med. 2018;44:742-59.
69
Guembe M, Pérez-Granda MJ. What does really affect the colonization of needleless connectors? Enferm Infecc Microbiol Clin. 2020;38:97-8.
70
Curran E. Needleless connectors: the vascular access catheter’s microbial gatekeeper. J Infect Prev. 2016;17:234-40.
71
Rosenthal VD. Impact of needle-free connectors compared with 3-way stopcocks on catheter-related bloodstream infection rates: A meta-analysis. Am J Infect Control. 2020;48:281-4.
72
Devrim İ, Demiray N, Oruç Y, Sipahi K, Çağlar İ, et al. The colonization rate of needleless connector and the impact of disinfection for 15 s on colonization: A prospective pre- and post-intervention study. J Vasc Access. 2019;20:604-7.
73
Smith JS, Irwin G, Viney M, Watkins L, Morris SP, et al. Optimal disinfection times for needleless intravenous connectors. JAVA - Journal of the Association for Vascular Access. 2012;17:137-43.
74
Holroyd JL, Vasilopoulos T, Rice MJ, Rand KH, Fahy BG. Incidence of central venous catheter hub contamination. J Crit Care. 2017;39:162-8.
75
Flynn JM, Larsen EN, Keogh S, Ullman AJ, Rickard CM. Methods for microbial needleless connector decontamination: A systematic review and meta-analysis. Am J Infect Control. 2019;47:956-62.
76
Huang V. Effect of a patency bundle on central venous catheter complications among hospitalized adult patients: a best practice implementation project. JBI Database System Rev Implement Rep. 2018;16:565-86.
77
Gerçeker, GÖ, Sevgili SA, Yardımcı F. Impact of flushing with aseptic non-touch technique using pre-filled flush or manually prepared syringes on central venous catheter occlusion and bloodstream infections in pediatric hemato-oncology patients: A randomized controlled study. European Journal of Oncology Nursing. 2018;33:78-84.
78
Margatho AS, Ciol MA, Hoffman JM, Dos Reis PED, Furuya RK, et al. Chlorhexidine-impregnated gel dressing compared with transparent polyurethane dressing in the prevention of catheter-related infections in critically ill adult patients: A pilot randomised controlled trial. Aust Crit Care. 2019;32:471-8.
