title: An evidence-based catheter bundle alters central venous catheter strategy in newborn infants.
abstract: OBJECTIVE
  To assess whether introduction of an evidence-based percutaneously inserted central catheter (PICC) care bundle reduced the risk of central line-associated bloodstream infection (CLABSI), thus altering the comparative risk of CLABSI in infants.
  
  
  METHODS
  This retrospective cohort study included all infants for whom an umbilical venous catheter (UVC) was placed as part of routine care between Jan 1, 2006, and Dec 31, 2009, a period during which standardized PICC insertion and care bundles were introduced. Duration of UVC use was divided in ≤ 7 days and >7 days.
  
  
  RESULTS
  Infants in the ≤ 7 days UVC group had 1.0 CLABSI/1000 catheter days, and infants in the >7 days UVC group had 4.0 CLABSI/1000 catheter days (P < .001). Controlling for birth weight, gestational age, and antibiotic use, the >7 days UVC group had a greater risk of CLABSI (OR, 5.48) than the ≤ 7 days UVC group. CLABSI rate increased more rapidly in UVC than PICC with increasing duration of catheter rose.
  
  
  CONCLUSIONS
  Replacement of a UVC with a PICC when central venous access is needed after 7 days of age may reduce CLABSI.
authors.affiliation: School of Nursing, University of Rochester, Rochester, NY, USA. meggan_ohara@urmc.rochester.edu
authors.forename: Meggan
authors.initials: M
authors.lastname: Butler-O'Hara
authors.forename: Carl T
authors.initials: CT
authors.lastname: D'Angio
authors.forename: Hyacinth
authors.initials: H
authors.lastname: Hoey
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Stevens
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000295:instrumentation / Q000592:standards*; D057785:Catheters / Q000592:standards*; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D009518:New York / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D014471:Umbilical Veins