Short summary

The purpose of this project is to describe the incidence of centrale-line-associated bloodstream infections (CLABSI) at Odense University Hospital neonatal intensive care unit (H1 and H56) during the past 5 years and to compare these results with high-income countries benchmarks on CLABSI. Further, the daily nursing care practice related to central vascular catheters will be described. This will be used to evaluate our practice and consumption of guidelines, and if possible to decrease our infection rates.

Rationale

Central vascular catheters (CVCs) are widely used in neonatal intensive care units (NICU). They include umbilical catheters (UVCs) and peripherally inserted CVCs (PCVCs). Vascular access is necessary for several infants in the NICU. They provide nutrition, intravenous fluids and medications. Hospitalized acquired bloodstream infections represent a significant and largely preventable cause of disease. Central-line-associated bloodstream infections (CLABSI) are associated with serious morbidity and mortality in NICUs. It is associated with Prolonged hospitalization and is some of the most expensive hospital-acquired infections. It is also associated with increased risk of neurodevelopment impairment and cerebral palsy. Extremely premature neonates have an increased risk of infections due to biological immaturity, frequent invasive procedures and prolonged requirement for respiratory support and parenteral nutrition. The incidence of CLABSI varies widely within the populations studied and according to the definition: 1.2-20 per 1,000 central line-days in the NICUs in high income countries.

The daily nursing care related to CVCs have an impact on the development of CLABSI. The risk of CLABSI can be reduced 50-60% by implementing cost-effective and evidence-based interventions such as care bundles elements. This includes e.g. dressing protocols, skin preparation and daily CVC need assessment. Moreover, it includes professional elements such as education and training of healthcare professionals as well as guidelines, which is shown to be the most commonly used for managing CVCs in clinical practice. However approximately 50% of the intensive care units worldwide, including NICUs, report challenges with best practice related to CVC management, even though 80% of the healthcare professionals are aware of the existence of CLABSI prevention guidelines. Overall, middleincome countries possess a higher consumption of clinical guidelines compared to highincome countries.

Description of the cohort

All children with CVC admitted in the NICU at OUH within the first year of living.

Data and biological material

Data will be collected in patient medical records.

Publications associated with the project

Department of Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark

• RN, PhD, post.doc., Kristina Garne Holm
• MD, PhD, associated professor, Gitte Zachariassen