title: Effectiveness of non-pharmacological interventions for the prevention of bloodstream infections in infants admitted to a neonatal intensive care unit: A systematic review.
abstract: BACKGROUND
  Bloodstream infections are associated with increased morbidity and mortality in very low birth weight infants admitted to neonatal intensive care units.
  
  
  OBJECTIVE
  To evaluate the available evidence for the effectiveness of non-pharmacological bloodstream infection-preventive measures in infants admitted to a neonatal intensive care unit.
  
  
  METHODS
  A systematic review of randomized, controlled trials, controlled clinical trials, interrupted time series and pretest-posttest studies.
  
  
  METHODS
  PubMed, CINAHL, Web-of-Science, Cochrane Central Register of Controlled Trials, and Embase were searched.
  
  
  METHODS
  The systematic review was carried out according to the guidelines of the Center for Reviews and Dissemination. The methodological quality of the individual studies was evaluated with the quantitative evaluation form of McMaster University. The review included randomized, controlled trials, controlled clinical trials, interrupted time series, and pre-posttest studies published from January 1990 to January 2011. Quantitative pooling of the results was not feasible due to the high heterogeneity of the interventions, methods and outcome measures. Instead, we present the studies in tabular form and provide a narrative account of the study characteristics and results.
  
  
  RESULTS
  Fifteen studies out of 288 generated hits were selected and categorized as research on: hand hygiene (5), intravenous (IV) bundles (4), closed IV sets/patches/filters (4), surveillance (1), and percutaneously inserted central catheter teams (1). IV bundles including proper insertion and proper maintenance showed to be the most effective intervention for preventing bloodstream infection in infants; in three out of four studies on IV bundles, a statistically significant reduction of bloodstream infections was mentioned.
  
  
  CONCLUSIONS
  Although the methodological quality of most studies was not very robust, we conclude that IV bundles may decrease bloodstream infections in infants. However, differences in IV bundle components and in practices limited the underpinning evidence. There is limited evidence that the introduction of a percutaneously inserted central catheter team results in bloodstream infection reduction. Hand hygiene promotion increases hand hygiene among healthcare workers, but there is inconclusive evidence that this intervention subsequently leads to a bloodstream infection reduction in infants. Future studies must be well designed, with standardized outcome measures.
authors.affiliation: Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands. o.helder@erasmusmc.nl
authors.forename: Onno
authors.initials: O
authors.lastname: Helder
authors.forename: Agnes
authors.initials: A
authors.lastname: van den Hoogen
authors.forename: Coby
authors.initials: C
authors.lastname: de Boer
authors.forename: Johannes
authors.initials: J
authors.lastname: van Goudoever
authors.forename: Malgosia
authors.initials: M
authors.lastname: Verboon-Maciolek
authors.forename: René
authors.initials: R
authors.lastname: Kornelisse
mesh_terms: D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D018805:Sepsis / Q000517:prevention & control*