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Central Line-Associated Bloodstream Infection (CLABSI)

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Healthcare-Associated Infections in Children

Abstract

Central line-associated bloodstream infections (CLABSIs) represent a significant threat to patient safety in pediatrics. Many CLABSIs can be prevented by utilizing proven strategies for central line insertion and maintenance. Reliable CLABSI surveillance data form the foundation of hospital infection prevention efforts. Understanding risk factors for CLABSI, educating providers regarding prevention practices, ensuring adequate healthcare staffing, and adhering to insertion and maintenance bundles are all components of an effective prevention program. Institutional support for infection prevention is key to successful attainment of CLABSI prevention goals.

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References

  1. Marschall J, Mermel LA, Fakih M, Hadaway L, Kallen A, O’Grady N, et al. Strategies to prevent central line associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35:753–71.

    Article  Google Scholar 

  2. O’Grady NP, Alexander M, Burns LA, Dellinger P, Garland J, Heard SO, et al. Guidelines for prevention of intravascular catheter-related infections. Am J Infect Control. 2011;39:S1–34.

    Article  Google Scholar 

  3. Niedner MF, Huskins WC, Colantuoni E, Muschelli J, Harris JM, Rice TB, et al. Epidemiology of central line-associated bloodstream infections in the pediatric intensive care unit. Infect Control Hosp Epidemiol. 2011;32:1200–8.

    Article  Google Scholar 

  4. Carter JH, Langley JM, Kuhle S, Kirkland S. Risk factors for central venous catheter-associated bloodstream infection in pediatric patients: a cohort study. Infect Control Hosp Epidemiol. 2016;37:939–45.

    Article  Google Scholar 

  5. Advani S, Reich NG, Sengupta A, Gosey L, Milstone AM. Central line-associated bloodstream infection in hospitalized children with peripherally inserted central venous catherters: extending risk analyses outside the intensive care unit. Clin Infect Dis. 2011;52:1108–15.

    Article  Google Scholar 

  6. Slonim AD, Kurtines HC, Sprague BM, Singh N. The costs associated with nosocomial bloodstream infections in the pediatric intensive care unit. Pediatric Crit Care Med. 2001;2:170–4.

    Article  Google Scholar 

  7. Elward AM, Hollenbeak CS, Warren DK, Fraser VJ. Attributable cost of nosocomial primary bloodstream infection in pediatric intensive care unit patients. Pediatrics. 2005;115:868–72.

    Article  Google Scholar 

  8. Wilson MZ, Rafferty C, Deeter D, Comito MA, Hollenbeak CS. Attributable costs of central line-associated bloodstream infections in a pediatric hematology/oncology population. Am J Infect Control. 2014;42:1157–60.

    Article  Google Scholar 

  9. Dudeck MA, Edwards JR, Allen-Bridson K, Gross C, Malpiedi PJ, Peterson KD, et al. National healthcare safety network report, data summary for 2013, device-associated module. Am J Infect Control. 2015;43:206–21.

    Article  Google Scholar 

  10. Edwards JR, Peterson KD, Andrus ML, Dudeck MA, Pollock DA, Horan TC, et al. National healthcare safety network (NHSN) report, data summary for 2006 through 2007, issued November 2008. Am J Infect Control. 2008;36:609–26.

    Article  Google Scholar 

  11. National Healthcare Safety Network, Centers for Disease Control and Prevention. The National Healthcare Safety Network (NHSN) manual: patient safety component protocol. 2018. Accessed 22 Feb 2018. http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf.

  12. Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the infectious diseases society of America. Clin Infect Dis. 2009;49:1–45.

    Article  CAS  Google Scholar 

  13. Kelly M, Conway M, Wirth K, Potter-Bynoe G, Billett AL, Sandora TJ. Moving CLABSI prevention beyond the ICU: risk factors in pediatric oncology patients. Infect Control Hosp Epidemiol. 2011;32:1079–85.

    Article  Google Scholar 

  14. de Jonge RC, Polderman KH, Gemke RJ. Central venous catheter use in the pediatric patient: mechanical and infectious complications. Pediatr Crit Care Med. 2005;6:329–39.

    Article  Google Scholar 

  15. Rogers AE, Eisenman KM, Dolan SA, Belderson KM, Zauche JR, Tong S, et al. Risk factors for bacteremia and central line-associated blood stream infections in children with acute myelogenous leukemia: a single institution report. Pediatr Blood Cancer. 2017;64:e26254.

    Article  Google Scholar 

  16. Shepherd EG, Kelly TJ, Vinsel JA, Cunningham DJ, Keels E, Beauseau W, et al. Significant reduction of central-line associated bloodstream infections in a network of diverse neonatal nurseries. J Pediatr. 2015;167:41–6.

    Article  Google Scholar 

  17. Holzmann-Pazgal G, Kubanda A, Davis K, Khan AM, Brumley K, Denson SE. Utilizing a line maintenance team to reduce central-line-associated bloodstream infections in a neonatal intensive care unit. J Perinatol. 2012;32:281–6.

    Article  CAS  Google Scholar 

  18. Golombek SG, Rohan AJ, Parvez B, Salice AL, LaGamma EF. “Proactive” management of percutaneously inserted central catheters results in decreased incidence of infection in the ELBW population. J Perinatol. 2002;22:209–13.

    Article  Google Scholar 

  19. Stratton KM. Pediatric nurse staffing and quality of care in the hospital setting. J Nurs Care Qual. 2008;23:105–14.

    Article  Google Scholar 

  20. Archibald LK, Manning ML, Bell LM, Banerjee S, Jarvis WR. Patient density, nurse to patient ratio and nosocomial infection risk in a pediatric cardiac intensive care unit. Pediatr Infect Dis J. 1997;16:1045–8.

    Article  CAS  Google Scholar 

  21. Haley RW, Bregman DA. The role of understaffing and overcrowding in recurrent outbreaks of staphylococcal infection in a neonatal special care unit. J Infect Dis. 1982;145:875–85.

    Article  CAS  Google Scholar 

  22. Harbarth S, Sudre P, Dharan S, Cadenas M, Pittet D. Outbreak of Enterobacter cloacae related to understaffing, overcrowding and poor hygiene practices. Infect Control Hosp Epidemiol. 1999;20:598–603.

    Article  CAS  Google Scholar 

  23. Tamma PD, Aucott SW, Milstone AM. Chlorhexidine use in the neonatal intensive care unit: results from a national survey. Infect Control Hosp Epidemiol. 2010;31:846–9.

    Article  Google Scholar 

  24. Bryant KA, Zerr DM, Huskins WC, Milstone AM. The past, present, and future of healthcare-associated infection prevention in pediatrics: catheter-associated bloodstream infections. Infect Control Hosp Epidemiol. 2010;31:S27–31.

    Article  Google Scholar 

  25. 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.

    Article  Google Scholar 

  26. 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.

    Article  CAS  Google Scholar 

  27. Milstone AM, Elward A, Song X, Zerr DM, Orscheln R, Speck K, et al. Daily chlorhexidine bathing to reduce bacteremia in critically ill children: a multicenter, cluster-randomized, crossover trial. Lancet. 2013;381:1099–106.

    Article  CAS  Google Scholar 

  28. Lee A, Harlan R, Breaud AR, Speck K, Perl TM, Clarke W, et al. Blood concentrations of chlorhexidine in hospitalized children undergoing daily chlorhexidine bathing. Infect Control Hosp Epidemiol. 2011;32:395–7.

    Article  Google Scholar 

  29. 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.

    Article  Google Scholar 

  30. Casey AL, Worthington T, Lambert PA, Quinn D, Faroqui MH, Elliott TS. A randomized prospective clinical trial to assess the potential infection risk associated with the Posiflow needleless connector. J Hosp Infect. 2003;54:288–93.

    Article  CAS  Google Scholar 

  31. Soothill JS, Barvery K, Ho A, Macqueen S, Collins J, Lock P. A fall in bloodstream infections followed a change to 2% chlorhexidine in 70% isopropanol for catheter connection antisepsis: a pediatric single center before/after study on a hematopoietic stem cell transplant ward. Am J Infect Control. 2009;37:626–30.

    Article  Google Scholar 

  32. Kaler W, Chinn R. Successful disinfection of needleless access ports: a matter of time and friction. JAVA. 2007;12:140–2.

    Article  Google Scholar 

  33. Piazza AJ, Brozanski B, Provost L, Grover TR, Chuo J, Smith JR, et al. SLUG bug: quality improvement with orchestrated testing leads to NICU CLABSI reduction. Pediatrics. 2016;137:e20143642.

    Article  Google Scholar 

  34. Erdei C, McAvoy LL, Gupta M, Pereira S, McGowan EC. Is zero central line-associated bloodstream infection rate sustainable? A 5 year perspective. Pediatrics. 2015;135:e1485.

    Article  Google Scholar 

  35. Menyhay SZ, Maki DG. Preventing central venous catheter-associated bloodstream infections: development of an antiseptic barrier cap for needleless connectors. Am J Infect Control. 2008;36:S174e1–5e5.

    Article  Google Scholar 

  36. Sweet MA, Cumpston A, Briggs F, Craig M, Hamadani M. Impact of alcohol-impregnated port protectors and needleless neutral pressure connectors on central line-associated bloodstream infections and contamination of blood cultures in an inpatient oncology unit. Am J Infect Control. 2012;40:931–4.

    Article  Google Scholar 

  37. Wright MO, Tropp J, Schora DM, Dillon-Grant M, Peterson K, Boehm S, et al. Continuous passive disinfection of catheter hubs prevents contamination and bloodstream infection. Am J Infect Control. 2013;41:33–8.

    Article  Google Scholar 

  38. Edwards JD, Herzig C, Liu H, Pogorzelska-Maziarz M, Zachariah P, Dick AW, et al. Central line-associated blood stream infections in pediatric ICU’s: longitudinal trends and compliance with bundle strategies. Am J Infect Control. 2015;43:489–93.

    Article  Google Scholar 

  39. Miller MR, Griswold M, Harris JM, Yenokyan G, Huskins WC, Moss M, et al. Decreasing PICU catheter-associated bloodstream infections: NACHRI’s quality transformation efforts. Pediatrics. 2010;125:206–13.

    Article  Google Scholar 

  40. Jeffries HE, Mason W, Brewer M, Oakes KL, Munoz EI, Gornick W, et al. Prevention of central venous catheter associated bloodstream infections in pediatric intensive care units: a performance improvement collaborative. Infect Control Hosp Epidemiol. 2009;30:645–51.

    Article  Google Scholar 

  41. Rinke ML, Bundy DG, Chen AR, Milstone AM, Colantuoni E, Pehar M, et al. Central line maintenance bundles and CLABSIs in ambulatory oncology patients. Pediatrics. 2013;132:31403–e1412.

    Article  Google Scholar 

  42. Bundy DG, Gaur AH, Billett AL, He B, Colantuoni EA, Miller MR. Preventing CLABSIs among pediatric hematology/oncology inpatients: National Collaborative Results. Pediatrics. 2014;134:e1678–85.

    Article  Google Scholar 

  43. Schoot RA, van Ommen CH, Stijnen T, Tissing W, Michiels E, Abbink F, et al. Prevention of central venous catheter-associated bloodstream infections in pediatric oncology patients using 70% ethanol locks: a randomized controlled multi centre trial. Eur J Cancer. 2015;51:2031–8.

    Article  Google Scholar 

  44. Ardura MI, Lewis J, Tansmore JL, Harp PL, Dienhart MC, Balint JP. Central catheter-associated bloodstream infection reduction with ethanol lock prophylaxis in pediatric intestinal failure. JAMA Pediatr. 2015;169:324–31.

    Article  Google Scholar 

  45. Oliveira C, Nasr A, Brindle M, Wales PW. Ethanol locks to prevent catheter-related bloodstream infections in parenteral nutrition: a meta analysis. Pediatrics. 2012;129:318–29.

    Article  Google Scholar 

  46. Handrup MM, Moller JK, Schroder H. Central venous catheters and catheter locks in children with cancer: a prospective randomized trial of taurolidine versus heparin. Pediatr Blood Cancer. 2013;60:1292–8.

    Article  Google Scholar 

  47. Chu HP, Brind J, Tomar R, Hill S. Significant reduction in central venous catheter related bloodstream infections in children on HPN after starting treatment with Taurolidine line lock. JPGN. 2012;55:403–7.

    CAS  PubMed  Google Scholar 

  48. Garland JS, Alex CP, Henrickson KJ, McAuliffe TL, Maki DG. A vancomycin-heparin lock solution for prevention of nosocomial bloodstream infection in critically ill neonates with peripherally inserted central venous catheters: a prospective, randomized trial. Pediatrics. 2005;116:e198–205.

    Article  Google Scholar 

  49. Rackoff WR, Weiman M, Jakobowski D, Hirschl R, Stallings V, Bilodeau J, et al. A randomized controlled trial of the efficacy of a heparin and vancomycin solution in preventing central venous catheter infections in children. J Pediatr. 1995;127:147–51.

    Article  CAS  Google Scholar 

  50. Henrickson KJ, Axtell RA, Hoover SM, Kuhn SM, Pritchett J, Kehl SC, et al. Prevention of central venous catheter related infections and thrombotic events in immunocompromised children by the use of vancomycin/ciprofloxacin/heparin flush solution: a randomized, multicenter, double blind trial. J Clin Oncol. 2000;18:1269–78.

    Article  CAS  Google Scholar 

  51. Chelliah A, Heydon KH, Zaoutis TE, Rettig SL, Dominguez TE, Lin R, et al. Observational trial of antibiotic coated central venous catheters in critically ill pediatric patients. Pediatr Infect Dis J. 2007;26:816–20.

    Article  Google Scholar 

  52. Bhutta A, Gilliam C, Honeycutt M, et al. Reductions of bloodstream infections associated with catheters in paediatric intensive care unit: stepwise approach. BMJ. 2007;334:362–5.

    Article  Google Scholar 

  53. Weber JM, Sheridan RL, Fagan S, Ryan CM, Pasternack MS, Tompkins RG. Incidene of catheter associated bloodstream infection after introduction of minocycline and rifampin antimicrobial coated catheters in a pediatric burn population. J Burn Care Res. 2012;33:539–43.

    Article  Google Scholar 

  54. Bertini G, Elia S, Ceciarini F, Dani C. Reduction of catheter related bloodstream infections in preterm infants by the use of catheters with AgION antimicrobial system. Early Hum Dev. 2013;89:21–5.

    Article  CAS  Google Scholar 

  55. Zachariah P, Furuya EY, Edwards J, Dick A, Liu H, Herzig C, et al. Compliance with prevention practices and their association with central line-associated bloodstream infections in neonatal intensive care units. Am J Infect Control. 2014;42:847–51.

    Article  Google Scholar 

  56. Suresh GK, Edwards WH. Central line-associated bloodstream infections in neonatal intensive care: changing the mental model from inevitability to preventability. Am J Perinatol. 2012;29:57–64.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA

    Galit Holzmann-Pazgal

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  1. Galit Holzmann-Pazgal
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Correspondence to Galit Holzmann-Pazgal .

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Editors and Affiliations

  1. Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA

    J. Chase McNeil

  2. Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA

    Judith R. Campbell

  3. Department of Pediatrics, Baylor College of Medicine and The Children’s Hospital of San Antonio, San Antonio, TX, USA

    Jonathan D. Crews

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Holzmann-Pazgal, G. (2019). Central Line-Associated Bloodstream Infection (CLABSI). In: McNeil, J., Campbell, J., Crews, J. (eds) Healthcare-Associated Infections in Children. Springer, Cham. https://doi.org/10.1007/978-3-319-98122-2_6

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  • DOI: https://doi.org/10.1007/978-3-319-98122-2_6

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-98121-5

  • Online ISBN: 978-3-319-98122-2

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