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Published in: Intensive Care Medicine 8/2013

01-08-2013 | Review

Are central line bundles and ventilator bundles effective in critically ill neonates and children?

Authors: Charlotte A. Smulders, Josephus P. J. van Gestel, Albert P. Bos

Published in: Intensive Care Medicine | Issue 8/2013

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Abstract

Central line-associated bloodstream infections (CLABSI) and ventilator-associated pneumonia (VAP) are common problems in adult, pediatric (PICU) and neonatal (NICU) intensive care unit patients. Care bundles have been developed to prevent these hospital-acquired infections and to provide best possible care. Studies in adults have proven that care bundles contribute to a decrease in CLABSI and VAP rates. The purpose of this literature review was to critically appraise the known evidence of the effectiveness of central line bundles and ventilator bundles in PICU and NICU patients. The number of publications of central line bundles and ventilator bundles in PICU and NICU patients is limited compared to adults. Ten studies in PICU patients demonstrated a significant decrease in the CLABSI or VAP rate after implementation of the bundle. Two studies in neonates demonstrated a reduction in the CLABSI rate after implementation of the central line bundle. No studies on the effectiveness of the ventilator bundle in neonates were found. Bundle elements differed between studies, and their scientific basis was not as robust as in adults. Monitoring of compliance to bundle elements seems required for optimal reduction of CLABSI and VAP. Bundle components that focus on maintenance of a central line probably are important to prevent CLABSI in children.
Literature
1.
2.
go back to reference Grohskopf LA, Sinkowitz-Cochran RL, Garrett DO, Sohn AH, Levine GL, Siegel JD et al (2002) A national point-prevalence survey of pediatric intensive care unit—acquired infections in the United States. J Pediatr 140:432–438PubMedCrossRef Grohskopf LA, Sinkowitz-Cochran RL, Garrett DO, Sohn AH, Levine GL, Siegel JD et al (2002) A national point-prevalence survey of pediatric intensive care unit—acquired infections in the United States. J Pediatr 140:432–438PubMedCrossRef
3.
go back to reference Richards MJ, Edwards JR, Culver DH, Gaynes RP (1999) Nosocomial infections in pediatric intensive care units in the United States. National Nosocomial Infections Surveillance System. Pediatrics 103:e39PubMedCrossRef Richards MJ, Edwards JR, Culver DH, Gaynes RP (1999) Nosocomial infections in pediatric intensive care units in the United States. National Nosocomial Infections Surveillance System. Pediatrics 103:e39PubMedCrossRef
4.
go back to reference Edwards JR, Peterson KD, Andrus ML et al (2007) National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007. Am J Infect Control 35:290–301PubMedCrossRef Edwards JR, Peterson KD, Andrus ML et al (2007) National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007. Am J Infect Control 35:290–301PubMedCrossRef
5.
go back to reference O’Grady NP, Alexander M, Burns LA et al (2011) Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 52:e162–e193PubMedCrossRef O’Grady NP, Alexander M, Burns LA et al (2011) Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 52:e162–e193PubMedCrossRef
6.
go back to reference Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R, CDC, Healthcare Infection Control Practices Advisory Committee (2004) Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 53((RR-3)):1–36PubMed Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R, CDC, Healthcare Infection Control Practices Advisory Committee (2004) Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 53((RR-3)):1–36PubMed
7.
go back to reference Jarvis W, Edwards JR, Culver GH et al (1991) Nosocomial infection rates in adult and pediatric intensive care units in the United States. National Nosocomial Infections Surveillance System. Am J Med 91:185s–191sPubMedCrossRef Jarvis W, Edwards JR, Culver GH et al (1991) Nosocomial infection rates in adult and pediatric intensive care units in the United States. National Nosocomial Infections Surveillance System. Am J Med 91:185s–191sPubMedCrossRef
8.
go back to reference Venkatachalam V, Hendley JO, Wilson DF (2011) The diagnostic dilemma of ventilator-associated pneumonia in critically ill children. Pediatr Crit Care Med 12:286–296PubMedCrossRef Venkatachalam V, Hendley JO, Wilson DF (2011) The diagnostic dilemma of ventilator-associated pneumonia in critically ill children. Pediatr Crit Care Med 12:286–296PubMedCrossRef
10.
go back to reference Slonim AD, Kurtines HC, Sprague BM, Singh N (2001) The costs associated with nosocomial bloodstream infections in the pediatric intensive care unit. Pediatr Crit Care Med 2:170–174PubMedCrossRef Slonim AD, Kurtines HC, Sprague BM, Singh N (2001) The costs associated with nosocomial bloodstream infections in the pediatric intensive care unit. Pediatr Crit Care Med 2:170–174PubMedCrossRef
11.
go back to reference Bhutta A, Gilliam C, Honeycutt M et al (2007) Reduction of bloodstream infections associated with catheters in paediatric intensive care unit: stepwise approach. BMJ 334:362–365PubMedCrossRef Bhutta A, Gilliam C, Honeycutt M et al (2007) Reduction of bloodstream infections associated with catheters in paediatric intensive care unit: stepwise approach. BMJ 334:362–365PubMedCrossRef
12.
go back to reference Li S, Bizzarro MJ (2011) Prevention of central line associated bloodstream infections in critical care units. Curr Opin Pediatr 23:85–90PubMedCrossRef Li S, Bizzarro MJ (2011) Prevention of central line associated bloodstream infections in critical care units. Curr Opin Pediatr 23:85–90PubMedCrossRef
13.
go back to reference Elward AM, Hollenbeak CS, Warren DK, Fraser VJ (2005) Attributable cost of nosocomial primary bloodstream infection in pediatric intensive care unit patients. Pediatrics 115:868–872PubMedCrossRef Elward AM, Hollenbeak CS, Warren DK, Fraser VJ (2005) Attributable cost of nosocomial primary bloodstream infection in pediatric intensive care unit patients. Pediatrics 115:868–872PubMedCrossRef
14.
go back to reference Powers RJ, Wirtschafter DW (2010) Decreasing central line associated bloodstream infection in neonatal intensive care. Clin Perinatol 37:247–272PubMedCrossRef Powers RJ, Wirtschafter DW (2010) Decreasing central line associated bloodstream infection in neonatal intensive care. Clin Perinatol 37:247–272PubMedCrossRef
15.
go back to reference Klevens RM, Edwards JR, Richards CL et al (2007) Estimating health care-associated infections and death in US hospitals, 2002. Public Health Rep 122:160–166PubMed Klevens RM, Edwards JR, Richards CL et al (2007) Estimating health care-associated infections and death in US hospitals, 2002. Public Health Rep 122:160–166PubMed
17.
go back to reference Morris AC, Hay AW, Swann DG et al (2011) Reducing ventilator-associated pneumonia in intensive care: impact of implementing a care bundle. Crit Care Med 39:2218–2224PubMedCrossRef Morris AC, Hay AW, Swann DG et al (2011) Reducing ventilator-associated pneumonia in intensive care: impact of implementing a care bundle. Crit Care Med 39:2218–2224PubMedCrossRef
18.
go back to reference Lachman P, Yuen S (2009) Using care bundles to prevent infection in neonatal and paediatric ICUs. Curr Opin Infect Dis 22:224–228PubMedCrossRef Lachman P, Yuen S (2009) Using care bundles to prevent infection in neonatal and paediatric ICUs. Curr Opin Infect Dis 22:224–228PubMedCrossRef
19.
go back to reference Winters B, Dorman T (2006) Patient-safety and quality initiatives in the intensive-care unit. Curr Opin Anaesthesiol 19:140–145PubMedCrossRef Winters B, Dorman T (2006) Patient-safety and quality initiatives in the intensive-care unit. Curr Opin Anaesthesiol 19:140–145PubMedCrossRef
20.
go back to reference Shuman EK, Washer LL, Arndt JL et al (2010) Analysis of central line-associated bloodstream infections in the intensive care unit after implementation of central line bundles. Infect Control Hosp Epidemiol 31:551–553PubMedCrossRef Shuman EK, Washer LL, Arndt JL et al (2010) Analysis of central line-associated bloodstream infections in the intensive care unit after implementation of central line bundles. Infect Control Hosp Epidemiol 31:551–553PubMedCrossRef
21.
go back to reference Pronovost P, Needham D, Bernholtz S et al (2006) An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 355:2725–2732PubMedCrossRef Pronovost P, Needham D, Bernholtz S et al (2006) An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 355:2725–2732PubMedCrossRef
22.
go back to reference Bonello RS, Fletcher CE, Becker WK et al (2008) An intensive care unit quality improvement collaborative in nine Department of Veterans Affairs hospitals: reducing ventilator-associated pneumonia and catheter-related bloodstream infection rates. Jt Comm J Qual Patient Saf 34:639–645PubMed Bonello RS, Fletcher CE, Becker WK et al (2008) An intensive care unit quality improvement collaborative in nine Department of Veterans Affairs hospitals: reducing ventilator-associated pneumonia and catheter-related bloodstream infection rates. Jt Comm J Qual Patient Saf 34:639–645PubMed
23.
go back to reference Furuya EY, Dick A, Perencevich EN, Pogorzelska M, Goldmann D, Stone PW (2011) Central line bundle implementation in US intensive care units and impact on bloodstream infections. PLoS One 6:e15452PubMedCrossRef Furuya EY, Dick A, Perencevich EN, Pogorzelska M, Goldmann D, Stone PW (2011) Central line bundle implementation in US intensive care units and impact on bloodstream infections. PLoS One 6:e15452PubMedCrossRef
24.
go back to reference Galpern D, Guerrero A, Tu A, Fahoum B, Wise L (2008) Effectiveness of a central line bundle campaign on line-associated infections in the intensive care unit. Surgery 144:492–495PubMedCrossRef Galpern D, Guerrero A, Tu A, Fahoum B, Wise L (2008) Effectiveness of a central line bundle campaign on line-associated infections in the intensive care unit. Surgery 144:492–495PubMedCrossRef
25.
go back to reference Venkatram S, Rachmale S, Kanna B (2010) Study of device use adjusted rates in health care-associated infections after implementation of “bundles” in a closed-model medical intensive care unit. J Crit Care 25:174.e11–174.e18CrossRef Venkatram S, Rachmale S, Kanna B (2010) Study of device use adjusted rates in health care-associated infections after implementation of “bundles” in a closed-model medical intensive care unit. J Crit Care 25:174.e11–174.e18CrossRef
26.
go back to reference Wip C, Napolitano L (2009) Bundles to prevent ventilator-associated pneumonia: how valuable are they? Curr Opin Infect Dis 22:159–166PubMedCrossRef Wip C, Napolitano L (2009) Bundles to prevent ventilator-associated pneumonia: how valuable are they? Curr Opin Infect Dis 22:159–166PubMedCrossRef
27.
go back to reference National Nosocomial Infections Surveillance System (2004) National Nosocomial Infections Surveillance System (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 32:470–485CrossRef National Nosocomial Infections Surveillance System (2004) National Nosocomial Infections Surveillance System (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 32:470–485CrossRef
28.
go back to reference Huskins WC (2012) Quality improvement interventions to prevent healthcare-associated infections in neonates and children. Curr Opin Pediatr 24:103–112PubMedCrossRef Huskins WC (2012) Quality improvement interventions to prevent healthcare-associated infections in neonates and children. Curr Opin Pediatr 24:103–112PubMedCrossRef
29.
go back to reference Bizzarro MJ, Sabo B, Noonan M et al (2010) A quality improvement initiative to reduce central line-associated bloodstream infections in a neonatal intensive care unit. Infect Control Hosp Epidemiol 31:241–248PubMedCrossRef Bizzarro MJ, Sabo B, Noonan M et al (2010) A quality improvement initiative to reduce central line-associated bloodstream infections in a neonatal intensive care unit. Infect Control Hosp Epidemiol 31:241–248PubMedCrossRef
30.
go back to reference Schulman J, Stricof R, Stevens TP et al (2011) Statewide NICU central-line-associated bloodstream infection rates decline after bundles and checklists. Pediatrics 127:436–444PubMedCrossRef Schulman J, Stricof R, Stevens TP et al (2011) Statewide NICU central-line-associated bloodstream infection rates decline after bundles and checklists. Pediatrics 127:436–444PubMedCrossRef
31.
go back to reference Costello JM, Morrow DF, Graham DA, Potter-Bynoe G, Sandora TJ, Laussen PC (2008) Systematic intervention to reduce central line-associated bloodstream infection rates in a pediatric cardiac intensive care unit. Pediatrics 121:915–923PubMedCrossRef Costello JM, Morrow DF, Graham DA, Potter-Bynoe G, Sandora TJ, Laussen PC (2008) Systematic intervention to reduce central line-associated bloodstream infection rates in a pediatric cardiac intensive care unit. Pediatrics 121:915–923PubMedCrossRef
32.
go back to reference Jeffries HE, Mason W, Brewer M et al (2009) Prevention of central venous catheter-associated bloodstream infections in pediatric intensive care units: a performance improvement collaborative. Infect Control Hosp Epidemiol 30:645–651PubMedCrossRef Jeffries HE, Mason W, Brewer M et al (2009) Prevention of central venous catheter-associated bloodstream infections in pediatric intensive care units: a performance improvement collaborative. Infect Control Hosp Epidemiol 30:645–651PubMedCrossRef
33.
go back to reference McKee C, Berkowitz I, Cosgrove SE et al (2008) Reduction of catheter-associated bloodstream infections in pediatric patients: experimentation and reality. Pediatr Crit Care Med 9:40–46PubMedCrossRef McKee C, Berkowitz I, Cosgrove SE et al (2008) Reduction of catheter-associated bloodstream infections in pediatric patients: experimentation and reality. Pediatr Crit Care Med 9:40–46PubMedCrossRef
34.
go back to reference Miller MR, Niedner MF, Huskins WC et al (2011) Reducing PICU central line-associated bloodstream infections: 3-year results. Pediatrics 128:e1077–e1083PubMedCrossRef Miller MR, Niedner MF, Huskins WC et al (2011) Reducing PICU central line-associated bloodstream infections: 3-year results. Pediatrics 128:e1077–e1083PubMedCrossRef
35.
go back to reference Miller-Hoover S (2011) Pediatric central line: bundle implementation and outcomes. J Infus Nurs 34:36–48PubMedCrossRef Miller-Hoover S (2011) Pediatric central line: bundle implementation and outcomes. J Infus Nurs 34:36–48PubMedCrossRef
36.
go back to reference Morgan LM, Thomas DJ (2007) Implementing evidence-based nursing practice in the pediatric intensive care unit. J Infus Nurs 30:105–112PubMedCrossRef Morgan LM, Thomas DJ (2007) Implementing evidence-based nursing practice in the pediatric intensive care unit. J Infus Nurs 30:105–112PubMedCrossRef
37.
go back to reference Wheeler DS, Giaccone MJ, Hutchinson N et al (2011) A hospital-wide quality-improvement collaborative to reduce catheter-associated bloodstream infections. Pediatrics 128:e995–e1004PubMedCrossRef Wheeler DS, Giaccone MJ, Hutchinson N et al (2011) A hospital-wide quality-improvement collaborative to reduce catheter-associated bloodstream infections. Pediatrics 128:e995–e1004PubMedCrossRef
38.
go back to reference Bigham MT, Amato R, Bondurrant P et al (2009) Ventilator-associated pneumonia in the pediatric intensive care unit: characterizing the problem and implementing a sustainable solution. J Pediatr 154:582–587PubMedCrossRef Bigham MT, Amato R, Bondurrant P et al (2009) Ventilator-associated pneumonia in the pediatric intensive care unit: characterizing the problem and implementing a sustainable solution. J Pediatr 154:582–587PubMedCrossRef
39.
go back to reference Brierley J, Highe L, Hines S, Dixon G (2012) Reducing VAP by instituting a care bundle using improvement methodology in a UK paediatric intensive care unit. Eur J Pediatr 171:323–330PubMedCrossRef Brierley J, Highe L, Hines S, Dixon G (2012) Reducing VAP by instituting a care bundle using improvement methodology in a UK paediatric intensive care unit. Eur J Pediatr 171:323–330PubMedCrossRef
40.
go back to reference Brilli RJ, Sparling KW, Lake MR et al (2008) The business case for preventing ventilator-associated pneumonia in pediatric intensive care unit patients. Jt Comm J Qual Patient Saf 34:629–638PubMed Brilli RJ, Sparling KW, Lake MR et al (2008) The business case for preventing ventilator-associated pneumonia in pediatric intensive care unit patients. Jt Comm J Qual Patient Saf 34:629–638PubMed
41.
go back to reference Chittick P, Sherertz RJ (2010) Recognition and prevention of nosocomial vascular device and related bloodstream infections in the intensive care unit. Crit Care Med 38(8 Suppl):363–372CrossRef Chittick P, Sherertz RJ (2010) Recognition and prevention of nosocomial vascular device and related bloodstream infections in the intensive care unit. Crit Care Med 38(8 Suppl):363–372CrossRef
42.
go back to reference Marwick C, Davey P (2009) Care bundles: the holy grail of infectious risk management in hospital? Curr Opin Infect Dis 22:364–369PubMedCrossRef Marwick C, Davey P (2009) Care bundles: the holy grail of infectious risk management in hospital? Curr Opin Infect Dis 22:364–369PubMedCrossRef
43.
go back to reference Miller MR, Griswold M, Harris JM et al (2010) Decreasing PICU catheter-associated bloodstream infections: NACHRI’s quality transformation efforts. Pediatrics 125:206–213PubMedCrossRef Miller MR, Griswold M, Harris JM et al (2010) Decreasing PICU catheter-associated bloodstream infections: NACHRI’s quality transformation efforts. Pediatrics 125:206–213PubMedCrossRef
44.
go back to reference Kilo CM, Kabcenell RN, Berwick DM (1998) Beyond survival: toward continuous improvement in medical care. New Horiz 6:3–11PubMed Kilo CM, Kabcenell RN, Berwick DM (1998) Beyond survival: toward continuous improvement in medical care. New Horiz 6:3–11PubMed
Metadata
Title
Are central line bundles and ventilator bundles effective in critically ill neonates and children?
Authors
Charlotte A. Smulders
Josephus P. J. van Gestel
Albert P. Bos
Publication date
01-08-2013
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 8/2013
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-013-2927-7

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