Outcomes of Using the Guideline of Central Line Care for Prevention of Central Line Associated Bloodstream Infection in Neonatal Surgical Intensive Care Unit at Queen Sirikit National Institute of Child Health

Abstract

Background: Management of neonatal patients with inserted central catheters can lead to complications, especially central line associated bloodstream infection (CLABSI).Objectives: The purpose of this research was to study outcomes of the CLABSI rate after using the revised guideline for CLABSI prevention and to evaluate the nursing processes along with the revised guideline at Neonatal Surgical Intensive Care Unit (NSICU).Methods: The first step was to revise the traditional guideline for prevention of CLABSI. Implementation of the new revised guideline was begun since 1st April 2019 including coaching for the nurses in NSICU and coordination with pediatric surgeons, anesthesiologists and nurses in the operative room. The second step was to collect data from 2 volunteer groups. The first group was neonatal patients, age 1-90 days, who were managed in NSICU with placement of central venous catheter (CVC) line. The patients were divided into 2 subgroups : 50 patients treated during the period of 1st April 2018 to 31st March 2019 and using the traditional guideline (subgroup 1 or control group) and 50 patients treated 1st April 2019 and 31st March 2020 and using the revised guideline (subgroup 2 or experiment group). The second volunteer group was 20 nurses who worked at the NSICU along with the revised guideline requirements for management of 50 neonatal patients.

Results: Demographic data of the patients in both groups were similar, except gender and birth weight. The ratios of male to female were 23:27 cases in control group and 35:15 cases in the experiment group. The ratios of low birth weight to normal birth weight were 60%: 40% in the control group and 32% : 68% in the experiment group (p = .034) Rate of CLABSI of the control group was higher than this rate of the experiment group with statistical significance (6.81 : 1.69 episodes per 1,000 indwelling CVC days : p=.025) The CLABSI did not occur in all of the patients with placement of the PICC line of both groups. Neonatal patients with intraabdominal operations and placement of central venous catheter tended to develop CLABSI, especially necrotizing enterocolitis and gastrointestinal obstruction. Risk factors for CLABSI included placement of catheter near the central vein, prolonged indwelling catheter days and patients with the problems of gastrointestinal operations. Evaluation of the NSICU nurses revealed the accuracy of all nursing processes along with requirement of the revised guideline for CLABSI prevention over than 90% (range 92% - 100%).Conclusion: Using the revised guideline for prevention of CLABSI could reduce the CLABSI occurrence approximately 4 folds in comparison with using the traditional guideline. The guideline influenced to increase the accuracy of all nursing processes of the NSICU nursed over than 90% of the guideline requirements.