title: Prevention of peripherally inserted central line-associated blood stream infections in very low-birth-weight infants by using a central line bundle guideline with a standard checklist: a case control study.
abstract: BACKGROUND
  Catheter-related infections (CRIs) are one of the severe complications of PICC placement. If treatment is not timely or correct, the incidence of infection and mortality rate can be high. A central line bundle (CLB) guideline was first proposed by the Institute for Healthcare Improvement, and included five key measures. Very low-birth-weight infants (VLBWIs) have a low immune response and indistinct symptoms after infection compared with other populations (Costa P, Kimura AF, de Vizzotto MP, de Castro TE, West A, Dorea E. Prevalence and reasons for non-elective removal of peripherally inserted central catheter in neonates. Rev Gaucha Enferm. 2012;33:126-33). Some reviews have focused on the effect and safety of a CLB in VLBWIs and its preventive effect on bacterial colonization and infection.
  
  
  METHODS
  Fifty-seven VLBWIs who underwent PICC insertion at a hospital in Qingdao, China, between November 2012 and June 2013, and for whom a CLB guideline and a standard checklist were adopted, were included in the CLB group. In contrast, 53 VLBWIs who underwent PICC insertion, but for whom a CLB guideline and a standard checklist were not adopted, were included in the control group. The incidence of CRIs was compared between before and after the treatment.
  
  
  RESULTS
  The incidence of infection showed a statistically significant reduction from 10.0 to 2.20 per 1000 catheter days in the control group (P < 0.05). The incidence of catheter-related bloodstream infections decreased from 3.1 to 0 per 1000 catheter days, and that of colonization infections decreased from 6.9 to 2.2 per 1000 catheter days (P < 0.05), both of which indicated a statistically significant difference. The indwelling catheter time was 24.8 ± 7.4 days in the control group and 31.9 ± 15.0 days in the study group (P < 0.05), and these values were significantly different.
  
  
  CONCLUSIONS
  The use of a CLB guideline with a standard checklist could be effective and feasible for preventing CRIs in VLBWIs and prolonging indwelling catheter time.
authors.affiliation: Departments of Neonatal, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China. weiwcn@yeah.net.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Departments of Central Supply Service, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China. chunlingz@126.com.
authors.forename: Chunling
authors.initials: C
authors.lastname: Zhao
authors.affiliation: Departments of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China. QinglianJi@yeah.net.
authors.forename: Qinglian
authors.initials: Q
authors.lastname: Ji
authors.affiliation: Departments of Nursing, Weifang Nursing Vocational College, Qing zhou, 262500, China. yingliusci@126.com.
authors.forename: Ying
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Departments of Humanities Nursing, Qingdao Medical College, Qingdao, 266021, China. guirongshen@126.com.
authors.forename: Guirong
authors.initials: G
authors.lastname: Shen
authors.affiliation: Departments of Nursing, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China. liliweicn@126.com.
authors.forename: Lili
authors.initials: L
authors.lastname: Wei
mesh_terms: D016022:Case-Control Studies; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods*; D062905:Central Venous Catheters / Q000009:adverse effects*; D057189:Checklist; D002681:China / Q000453:epidemiology; D002985:Clinical Protocols; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008297:Male; D063868:Patient Outcome Assessment