Intensive Care Medicine

, 37:1641

Consistency between guidelines and reported practice for reducing the risk of catheter-related infection in British paediatric intensive care units

  • Katie Harron
  • Geethanjali Ramachandra
  • Quen Mok
  • Ruth Gilbert
  • on behalf of the CATCH team
Original

Abstract

Purpose

Optimal strategies for reducing catheter-related blood stream infection (CR-BSI) differ for adults and children. National guidelines do not make child-specific recommendations. We determined whether evidence explained the inconsistencies between guidelines and reported practice in paediatric intensive care units (PICUs).

Methods

We conducted a survey of eight interventions for reducing CR-BSI in all 25 British PICUs in 2009. Interventions were categorised as requiring child-specific evidence, generalisable to adults and children, or organisational recommendations.

Results

Twenty-four of the 25 PICUs responded. For child-specific interventions, practice diverged from guidelines for “Insert into subclavian/jugular veins” (18 PICUs frequently used femoral veins, supported by observational evidence for increased safety in children). Practice reflected guidelines for “Use standard but consider antimicrobial-impregnated central venous catheters (CVCs) for high-risk patients” (14 used standard only, 3 used standard and antimicrobial-impregnated despite no randomised controlled trial (RCT) evidence for antimicrobial-impregnated CVCs in children, 7 used heparin-bonded for some or all children); “Use 2% chlorhexidine for skin preparation” (20 PICUs); “Avoid routine CVC replacement” (20 PICUs). For generalisable interventions, practice was consistent with guidelines for “Administration set replacement” (21 PICUs) but deviated for “Maintenance of CVC asepsis” (11 PICUs used alcohol due to inconclusive evidence for chlorhexidine). Practice diverged from guidelines for organisational interventions: “Train healthcare workers in CVC care” (9 PICUs); “Monitor blood stream infection (BSI) rates” (8 PICUs).

Conclusions

Guidelines should explicitly address paediatric practice and report the quality of evidence and strength of recommendations. Organisations should ensure doctors are trained in CVC insertion and invest in BSI monitoring, especially in PICUs. The type of CVC and insertion site are important gaps in evidence for children.

Keywords

Central venous catheter (CVC) Infection Guidelines Paediatric 

Supplementary material

134_2011_2343_MOESM1_ESM.doc (62 kb)
Supplementary material (DOC 62kb)

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Copyright information

© Copyright jointly held by Springer and ESICM 2011

Authors and Affiliations

  • Katie Harron
    • 1
  • Geethanjali Ramachandra
    • 2
  • Quen Mok
    • 2
  • Ruth Gilbert
    • 1
  • on behalf of the CATCH team
  1. 1.MRC Centre of Epidemiology and Child HealthUCL Institute of Child HealthLondonUK
  2. 2.Paediatric Intensive Care UnitGreat Ormond Street HospitalLondonUK

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