Intensive Care Medicine

, Volume 39, Issue 8, pp 1352–1358

Are central line bundles and ventilator bundles effective in critically ill neonates and children?

  • Charlotte A. Smulders
  • Josephus P. J. van Gestel
  • Albert P. Bos

DOI: 10.1007/s00134-013-2927-7

Cite this article as:
Smulders, C.A., van Gestel, J.P.J. & Bos, A.P. Intensive Care Med (2013) 39: 1352. doi:10.1007/s00134-013-2927-7


Central line-associated bloodstream infections (CLABSI) and ventilator-associated pneumonia (VAP) are common problems in adult, pediatric (PICU) and neonatal (NICU) intensive care unit patients. Care bundles have been developed to prevent these hospital-acquired infections and to provide best possible care. Studies in adults have proven that care bundles contribute to a decrease in CLABSI and VAP rates. The purpose of this literature review was to critically appraise the known evidence of the effectiveness of central line bundles and ventilator bundles in PICU and NICU patients. The number of publications of central line bundles and ventilator bundles in PICU and NICU patients is limited compared to adults. Ten studies in PICU patients demonstrated a significant decrease in the CLABSI or VAP rate after implementation of the bundle. Two studies in neonates demonstrated a reduction in the CLABSI rate after implementation of the central line bundle. No studies on the effectiveness of the ventilator bundle in neonates were found. Bundle elements differed between studies, and their scientific basis was not as robust as in adults. Monitoring of compliance to bundle elements seems required for optimal reduction of CLABSI and VAP. Bundle components that focus on maintenance of a central line probably are important to prevent CLABSI in children.


Central line-associated bloodstream infectionsVentilator-associated pneumoniaCare bundlesNeonatal intensive care unitPediatric intensive care unitQuality improvement



Central line-associated bloodstream infection


Ventilator-associated pneumonia


Pediatric intensive care unit


Neonatal intensive care unit


Hospital-acquired infection


National healthcare safety network

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2013

Authors and Affiliations

  • Charlotte A. Smulders
    • 1
  • Josephus P. J. van Gestel
    • 2
  • Albert P. Bos
    • 3
  1. 1.Utrecht UniversityUtrechtThe Netherlands
  2. 2.Department of Pediatric Intensive Care, Wilhelmina Children’s HospitalUniversity Medical Center UtrechtUtrechtThe Netherlands
  3. 3.Department of Pediatric Intensive Care, Emma Children’s HospitalAcademic Medical CenterAmsterdamThe Netherlands