title: Effect of a vascular access team on central line-associated bloodstream infections in infants admitted to a neonatal intensive care unit: a systematic review.
abstract: OBJECTIVE
  To review the effect of a vascular access team on the incidence of central line-associated bloodstream infections in infants admitted to a neonatal intensive care unit.
  
  
  METHODS
  MEDLINE, CINAHL, Embase, Web-of-Science and the Cochrane Library were searched until December 2013.
  
  
  METHODS
  Studies that evaluated the implementation of a vascular access team, and focused on the incidence of central line-associated bloodstream infections in infants admitted to a neonatal intensive care unit, were selected.
  
  
  METHODS
  Incidence rates of central line-associated bloodstream infections were extracted, as well as information on vascular access team tasks and team composition. The quality of studies was critically appraised using the McMaster tool for quantitative studies.
  
  
  RESULTS
  Seven studies involving 136 to 414 participants were included. In general, the implementation of a vascular access team coincided with the implementation of concurrent interventions. All vascular access teams included nurses, and occasionally included physicians. Main tasks included insertion and maintenance of central lines. In all studies, a relative decrease of 45-79% in central line-associated bloodstream infections was reported.
  
  
  CONCLUSIONS
  A vascular access team is a promising intervention to decrease central line-associated bloodstream infections in infants admitted to a neonatal intensive care unit. However, level of evidence for effectiveness is low. Future research is required to improve the strength of evidence for vascular access teams.
authors.affiliation: Nursing Science, program in Clinical Health Sciences, Faculty of Medicine, Utrecht University, The Netherlands; Merem Asthma Centre Heideheuvel, Hilversum, The Netherlands. Electronic address: mlegemaat@merem.nl.
authors.forename: Monique M
authors.initials: MM
authors.lastname: Legemaat
authors.affiliation: Nursing Science, program in Clinical Health Sciences, Faculty of Medicine, Utrecht University, The Netherlands; Department of Intensive Care Medicine, University Medical Center Utrecht, The Netherlands.
authors.forename: Irene P
authors.initials: IP
authors.lastname: Jongerden
authors.affiliation: Department of Neonatology Erasmus MC-Sophia's Childrens Hospital, Rotterdam, The Netherlands; Hamad Medical Corporation, Doha, Qatar.
authors.forename: Roland M F P T
authors.initials: RM
authors.lastname: van Rens
authors.affiliation: Nursing Science, program in Clinical Health Sciences, Faculty of Medicine, Utrecht University, The Netherlands; Reformed University for Applied Sciences, Zwolle, The Netherlands.
authors.forename: Marjanne
authors.initials: M
authors.lastname: Zielman
authors.affiliation: Nursing Science, program in Clinical Health Sciences, Faculty of Medicine, Utrecht University, The Netherlands; Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands.
authors.forename: Agnes
authors.initials: A
authors.lastname: van den Hoogen
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects*; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D010343:Patient Admission; D010348:Patient Care Team; D018805:Sepsis / Q000628:therapy*
keywords: Catheter-related infections; Infants; Infection control; Neonatal intensive care; Systematic review; Vascular access team.