Table 1.
Overview of interventions in and effectiveness of CVC bundles in neonatal intensive care unit and pediatric intensive care unit settings
| Author (year) | Setting | Design | Intervention | Reduction of CA-BSI | Level of evidence |
|---|---|---|---|---|---|
| Wirtschafter et al. (2010) |
NICU |
A |
Proper CVC insertion, hand hygiene promotion, closed tubing system, improved hub care |
From 4.32 to 3.22 per 1000 line-days |
2- |
| Sannoh et al. (2010) |
NICU |
B |
Hand hygiene promotion, proper hub care using chloorhexedine with alcohol, glove use promotion, CVC documentation |
From 23 to 12 per 1000 line-days* |
2++ |
| Bizzarro et al. (2010) |
NICU |
B |
Proper CVC placement, promotion of hand hygiene, daily evaluation CVC need, infection surveillance, dressing replaced on indication |
From 8.40 to 1.28 cases per 1000 line-days* |
2+ |
| Andersen et al. (2005) |
NICU# |
B |
Hand hygiene promotion, maximum barrier during CVC insertion, daily evaluation need for CVC removal |
From 21% to 9% (P=0.05, confidence intervals 0.19–1.0)* |
2+ |
| Costello et al. (2008) |
PICU |
C |
Hand hygiene promotion, daily evaluation need for CVC removal, CVC insertion kid |
From 7.8 to 4.7 and to 2.3 per 1000 line-days |
2- |
| McKee et al. (2008) |
PICU |
D |
Proper insertion and nursing care, empower nurses to stop the insertion procedure if guidelines were not followed, using a checklist to ensure adherence to the guidelines, providing weekly performance feedback, promotion of hand hygiene, chlorhexedine skin preparation, |
From 5.2 to 3.0 per 1000 line-days* |
2+ |
| Jeffries et al. (2009) |
PICU |
E |
Maximum sterile barrier during CVC insertion, hand hygiene promotion, apply transparent dressing, prepare skin with anti and/ or detergent chlorhexidine gluconate 2%, |
From 6.3 to 4.3 per 1000 line-days* |
2+ |
| Miller et al. (2010) |
PICU |
F |
Disinfect catheter site using chlorhexedine, maximum barrier, full barrier during pre-packages of the insertion tray, daily assess CVC need, gauze change every 2 days |
From 5.4 to 3.1 per 1000 line-days* |
2+ |
| Wheeler et al. (2011) |
Children’s hospital-wide |
D |
Full barrier precautions, chlorhexedine skin preparation with 2 minutes scrub and 1 minute air dry, use of insertion checklist, staff empowerment to stop the insertion procedure, daily assess CVC need, promotion of hand hygiene, chlorhexidine-impregnated sponge placed at insertion site, glove use for all CVC manipulations, change dressing every 7 day or on indication earlier, replace tubing sets no more than 72 hour, cap change every 7 day |
From 3 to <1 per 1000 line-days* |
2+ |
| Chuengchitraks et al. (2010) | PICU | G | Promotion of hand hygiene, maximal barrier precautions, provide skin antiseptic, optimal catheter site selection | From 2.6 to 2.4 per 1000 line-days | 2- |
Design: A: multi center prospective pre-test posttest study; B: single center prospective pretest and posttest study; C: single center retrospective pretest and prospective posttest group, interrupted time series design; D: single center retrospective pretest and prospective posttest group, time series design; E: multicenter, prospective pretest and posttest group, time series; F: multicenter retrospective pretest and posttest group, interrupted time series; G: single center cohort study; 1++ High-quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias; 1+ Well-conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias; 1- Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of bias; 2++ High-quality systematic reviews of case–control or cohort studies, or high-quality case–control or cohort studies with a very low risk of confounding, bias, or chance and a high probability that the relationship is causal; 2+ Well-conducted case–control or cohort studies with a low risk of confounding, bias, or chance and a moderate probability that the relationship is causal; 2- Case–control or cohort studies with a high risk of confounding, bias or chance, and a significant probability that the relationship is not causal; 3 Non-analytic studies; for example, case reports, case series; 4 Expert opinion.
CVC central venous catheter, BSI bloodstream infection, NICU neonatal intensive care unit, PICU pediatric critical care unit.
#Premature born infants with birth weight < 1500 grams; and *indicate significant reduction of bloodstream infections per 1000 line-days.