Rachel G Greenberg1, Keith M Cochran2, P Brian Smith1, Barbara S Edson3, Joseph Schulman4, Henry C Lee5, Balaji Govindaswami6, Alfonso Pantoja7, Doug Hardy8, John Curran9, Della Lin10, Sheree Kuo11, Akihiko Noguchi12, Patricia Ittmann13, Scott Duncan14, Munish Gupta15, Alan Picarillo16, Padmani Karna17, Morris Cohen18, Michael Giuliano19, Sheri Carroll20, Brandi Page20, Judith Guzman-Cottrill21, M Whit Walker22, Jeff Garland23, Janice K Ancona23, Dan L Ellsbury24, Matthew M Laughon2, Martin J McCaffrey25. 1. Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; 2. Department of Pediatrics, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina; 3. American Hospital Association, Chicago, Illinois; 4. California Department of Health Care Services, Sacramento, California; 5. Department of Pediatrics, Stanford University School of Medicine, Stanford, California; 6. Santa Clara Valley Health and Hospital System, San Jose, California; 7. St Joseph's Hospital, Denver, Colorado; 8. Winnie Palmer Children's Hospital, Orlando, Florida; 9. USF Health, University of South Florida, Tampa, Florida; 10. On the CUSP-Stop BSI Initiative, Honolulu, Hawaii; 11. Department of Pediatrics, University of Hawaii and Kapiolani Medical Center, Honolulu, Hawaii; 12. Department of Pediatrics, Saint Louis University School of Medicine, St Louis, Missouri; 13. Rockford Memorial Hospital, Rockford, Illinois; 14. Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky; 15. Beth Israel Deaconess Hospital, Boston, Massachusetts; 16. Department of Pediatrics, University of Massachusetts, Worcester, Massachusetts; 17. Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, East Lansing, Michigan; 18. Children's Hospital of New Jersey, Newark, New Jersey; 19. Hackensack University Medical Center, Hackensack, New Jersey; 20. Betty H. Cameron Women's and Children's Hospital, Wilmington, North Carolina; 21. Department of Pediatrics, Oregon Health and Science University School of Medicine, Portland, Oregon; 22. Greenville Health System, Greenville, South Carolina; 23. Wheaton Franciscan Healthcare-St Joseph, Milwaukee, Wisconsin; and. 24. Pediatrix Medical Group, Des Moines, Iowa. 25. Department of Pediatrics, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina; mjmcaff@email.unc.edu.
Abstract
BACKGROUND AND OBJECTIVE: Central venous catheters in the NICU are associated with significant morbidity and mortality because of the risk of central line-associated bloodstream infections (CLABSIs). The purpose of this study was to determine the effect of catheter dwell time on risk of CLABSI. METHODS: Retrospective cohort study of 13,327 infants with 15,567 catheters (93% peripherally inserted central catheters [PICCs], 7% tunneled catheters) and 256,088 catheter days cared for in 141 NICUs. CLABSI was defined using National Health Surveillance Network criteria. We defined dwell time as the number of days from line insertion until either line removal or day of CLABSI. We generated survival curves for each week of dwell time and estimated hazard ratios for CLABSI at each week by using a Cox proportional hazards frailty model. We controlled for postmenstrual age and year, included facility as a random effect, and generated separate models by line type. RESULTS: Median postmenstrual age was 29 weeks (interquartile range 26-33). The overall incidence of CLABSI was 0.93 per 1000 catheter days. Increased dwell time was not associated with increased risk of CLABSI for PICCs. For tunneled catheters, infection incidence was significantly higher in weeks 7 and 9 compared with week 1. CONCLUSIONS: Clinicians should not routinely replace uninfected PICCs for fear of infection but should consider removing tunneled catheters before week 7 if no longer needed. Additional studies are needed to determine what daily maintenance practices may be associated with decreased risk of infection, especially for tunneled catheters.
BACKGROUND AND OBJECTIVE: Central venous catheters in the NICU are associated with significant morbidity and mortality because of the risk of central line-associated bloodstream infections (CLABSIs). The purpose of this study was to determine the effect of catheter dwell time on risk of CLABSI. METHODS: Retrospective cohort study of 13,327 infants with 15,567 catheters (93% peripherally inserted central catheters [PICCs], 7% tunneled catheters) and 256,088 catheter days cared for in 141 NICUs. CLABSI was defined using National Health Surveillance Network criteria. We defined dwell time as the number of days from line insertion until either line removal or day of CLABSI. We generated survival curves for each week of dwell time and estimated hazard ratios for CLABSI at each week by using a Cox proportional hazards frailty model. We controlled for postmenstrual age and year, included facility as a random effect, and generated separate models by line type. RESULTS: Median postmenstrual age was 29 weeks (interquartile range 26-33). The overall incidence of CLABSI was 0.93 per 1000 catheter days. Increased dwell time was not associated with increased risk of CLABSI for PICCs. For tunneled catheters, infection incidence was significantly higher in weeks 7 and 9 compared with week 1. CONCLUSIONS: Clinicians should not routinely replace uninfected PICCs for fear of infection but should consider removing tunneled catheters before week 7 if no longer needed. Additional studies are needed to determine what daily maintenance practices may be associated with decreased risk of infection, especially for tunneled catheters.
Authors: Daniel K Benjamin; Barbara J Stoll; Marie G Gantz; Michele C Walsh; Pablo J Sánchez; Abhik Das; Seetha Shankaran; Rosemary D Higgins; Kathy J Auten; Nancy A Miller; Thomas J Walsh; Abbot R Laptook; Waldemar A Carlo; Kathleen A Kennedy; Neil N Finer; Shahnaz Duara; Kurt Schibler; Rachel L Chapman; Krisa P Van Meurs; Ivan D Frantz; Dale L Phelps; Brenda B Poindexter; Edward F Bell; T Michael O'Shea; Kristi L Watterberg; Ronald N Goldberg Journal: Pediatrics Date: 2010-09-27 Impact factor: 7.124
Authors: Aaron M Milstone; Nicholas G Reich; Sonali Advani; Guoshu Yuan; Kristina Bryant; Susan E Coffin; W Charles Huskins; Robyn Livingston; Lisa Saiman; P Brian Smith; Xiaoyan Song Journal: Pediatrics Date: 2013-11-11 Impact factor: 7.124
Authors: S B Brodie; K E Sands; J E Gray; R A Parker; D A Goldmann; R B Davis; D K Richardson Journal: Pediatr Infect Dis J Date: 2000-01 Impact factor: 2.129
Authors: Arnab Sengupta; Christoph Lehmann; Marie Diener-West; Trish M Perl; Aaron M Milstone Journal: Pediatrics Date: 2010-03-15 Impact factor: 7.124
Authors: Naomi P O'Grady; Mary Alexander; E Patchen Dellinger; Julie L Gerberding; Stephen O Heard; Dennis G Maki; Henry Masur; Rita D McCormick; Leonard A Mermel; Michele L Pearson; Issam I Raad; Adrienne Randolph; Robert A Weinstein Journal: MMWR Recomm Rep Date: 2002-08-09
Authors: P Brian Smith; Daniel K Benjamin; C Michael Cotten; Eric Schultz; Rose Guo; Lisa Nowell; Mary Laura Smithwick; Courtney D Thornburg Journal: Infect Control Hosp Epidemiol Date: 2008-08 Impact factor: 3.254
Authors: C M Beck-Sague; P Azimi; S N Fonseca; R S Baltimore; D A Powell; L A Bland; M J Arduino; S K McAllister; R S Huberman; R L Sinkowitz Journal: Pediatr Infect Dis J Date: 1994-12 Impact factor: 2.129
Authors: A J Vachharajani; N A Vachharajani; H Morris; A Niesen; A Elward; D A Linck; A M Mathur Journal: J Perinatol Date: 2017-01-12 Impact factor: 2.521
Authors: L Dupree Hatch; Peter H Grubb; Melinda H Markham; Theresa A Scott; William F Walsh; James C Slaughter; Ann R Stark; E Wesley Ely Journal: Am J Perinatol Date: 2017-05-11 Impact factor: 1.862
Authors: Will S Lindquester; C Matthew Hawkins; Eric J Monroe; Anne E Gill; Giridhar M Shivaram; F Glen Seidel; Matthew P Lungren Journal: Pediatr Radiol Date: 2017-07-18
Authors: Maziar M Nourian; Angelina L Schwartz; Austin Stevens; Eric R Scaife; Brian T Bucher Journal: J Pediatr Surg Date: 2017-12-24 Impact factor: 2.545