title: Intervention to reduce catheter-related bloodstream infections in a pediatric intensive care unit.
abstract: OBJECTIVE
  Identification of catheter-related bloodstream infection (CR-BSI) risk factors and determination of whether intervention related to identified risk factors would reduce CR-BSI rates.
  
  
  METHODS
  Prospective, observational, interventional and interrupted time-series study.
  
  
  METHODS
  Pediatric Intensive Care Unit (PICU) in a university hospital.
  
  
  METHODS
  During a 7-year period, 609 central venous catheters (CVC) were placed in 389 patients. CR-BSI risk factors were determined by multivariate analysis during two periods (January 2000-November 2002 and January 2003-April 2007). An intervention to reduce identified risk factors was performed after the first period. CR-BSI rates per 1,000 catheters-days were compared during the two periods.
  
  
  RESULTS
  The CR-BSI rate was 11.94 [(95% CI 7.94-15.94)/1,000 catheter-days during the first period]. Weight [OR 0.96 (0.91-0.99)], parenteral nutrition (PN) [OR 3.38 (1.40-8.19)] and indwelling time (IT) [OR 1.08 (1.02-1.14)] were CR-BSI risk factors. Practice changes aimed at reducing PN and IT were introduced. PN decreased from 49.8% [95% CI (49.7-49.9)] to 26.7% [(95% CI 26.6-26.8)] (p < 0.001), and IT dropped from 9.92 (95% CI 9.09-10.75) to 8.13 (95% CI 7.47-8.79) days (p < 0.001). The CR-BSI rate was reduced to 3.05 (95% CI 0.93-5.17)/1,000 catheter-days. During the last period, PN and IT were no longer CR-BSI risk factors. Type of catheterisation (guide wire exchange) [OR 6.66 (1.40-31.7)] was the only CR-BSI risk factor.
  
  
  CONCLUSIONS
  PN and IT were independent CR-BSI risk factors during the first period. An intervention focused on PN and IT reduction resulted in a sustained decrease of CR-BSI rates in our PICU.
authors.affiliation: Paediatric Intensive Care Unit, Department of Paediatrics, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Asturias, Spain. corsino.rey@sespa.princast.es
authors.forename: Corsino
authors.initials: C
authors.lastname: Rey
authors.forename: Francisco
authors.initials: F
authors.lastname: Alvarez
authors.forename: Victoria
authors.initials: V
authors.lastname: De-La-Rua
authors.forename: Andrés
authors.initials: A
authors.lastname: Concha
authors.forename: Alberto
authors.initials: A
authors.lastname: Medina
authors.forename: Juan-José
authors.initials: JJ
authors.lastname: Díaz
authors.forename: Sergio
authors.initials: S
authors.lastname: Menéndez
authors.forename: Marta
authors.initials: M
authors.lastname: Los-Arcos
authors.forename: Juan
authors.initials: J
authors.lastname: Mayordomo-Colunga
mesh_terms: D000293:Adolescent; D055499:Catheter-Related Infections / Q000209:etiology / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000379:methods*; D012307:Risk Factors