Critical Appraisal: Reducing Bloodstream Infections in Neonates

Holzmann-Pazgal et al.'s article "Utilizing a line maintenance team to reduce central line-associated bloodstream infections in a neonatal intensive care unit" discusses the issue of critically ill patients and their increased risk for developing central line-associated bloodstream infections. To better get a handle on increasing risk, the authors performed a study based on recommendations by the CDC and the Society of Healthcare Epidemiology of America. The specific recommendation was the implementation of a central venous catheter using chlorhexidine skin antisepsis for line insertion. Moreover, data appeared to be lacking or very minimal regarding the use of IV teams to minimize infections in the bloodstream. More specifically, the authors wanted to build on a prior study that had "incorporated the use of a central line team in a NICU as part of an intervention to decrease CLABSI" (pg.282).

In the study, CLABSIs notably decreased following the implementation of a line team. The sample size in the study was a "240 bed tertiary care pediatric hospital with a 118-bed level II to III NICU, with 300 nurses on staff" (Holzmann-Pazgal et al., 2012). Statistically, the rates for CLABSI in neonates "decreased from 4.5/1000 to 3.2/1000" (Holzmann-Pazgal et al., 2012) but the authors add that this was not necessarily a notable change. Overall, however, there was a significant shift in the introduction of line maintenance team and this falls in line with prior results that other studies, although minimal have found. The authors reasoned that there was a success in preventing or rather decreasing CLABSI in NICUs.

While the study was a definite improvement in the amount of information on the utilization of line maintenance teams in central line-associated bloodstream infections, the authors noted that there were limitations. Current practice, though, can benefit from the usage of evidence-based bundles to decrease CLABIs as long as there are effective implementation and a team of healthcare professionals that are dedicated to proper maintenance. In sum, this article was quite effective determining whether the implementation of insertion checklist policy, daily reviews of line and standardizing the practice of entering the line via sterile field technique being more effective in decreasing nosocomial infection and sepsis rates over a year than a non-standardizing practice and no insertion checklist documentations.

Reference

Holzmann-Pazgal, G., Kubanda, A., Davis, K., Khan, A. M., Brumley, K., & Denson, S. E. (2012). Utilizing a line maintenance team to reduce central-line-associated bloodstream infections in a neonatal intensive care unit. Journal of Perinatology, 32, 281-286.