Are central line bundles and ventilator bundles effective in critically ill neonates and children?
- 2.4k Downloads
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.
KeywordsCentral line-associated bloodstream infections Ventilator-associated pneumonia Care bundles Neonatal intensive care unit Pediatric intensive care unit Quality improvement
Central line-associated bloodstream infection
Pediatric intensive care unit
Neonatal intensive care unit
National healthcare safety network
Conflicts of interest
The authors indicate no potential conflicts of interests.
- 6.Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R, CDC, Healthcare Infection Control Practices Advisory Committee (2004) Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 53((RR-3)):1–36PubMedGoogle Scholar
- 9.Centers for Disease Control and Prevention Guidelines (CDC) (2009) Guidelines and procedures for monitoring VAP. National Healthcare Safety Network. http://www.cdc.gov/nhsn/pdfs/pscmanual/6pscvapcurrent.pdf accessed 1 dec 2012
- 16.Institute for Healthcare Improvement (2011) What is a bundle. http://www.ihi.org/knowledge/Pages/ImprovementStories/WhatIsaBundle.aspx. Accessed 3 Feb 2012
- 22.Bonello RS, Fletcher CE, Becker WK et al (2008) An intensive care unit quality improvement collaborative in nine Department of Veterans Affairs hospitals: reducing ventilator-associated pneumonia and catheter-related bloodstream infection rates. Jt Comm J Qual Patient Saf 34:639–645PubMedGoogle Scholar