Impact of New Practice Guideline to Prevent Catheter-related Blood Stream Infection (CRBSI): Experience at the Pediatric Intensive Care Unit of Phramongkutklao Hospital

Objective: To demonstrate the incidence of catheter-related blood stream infection (CRBSI) of patients in the pediatric intensive care unit (PICU) after implementing the new guideline to prevent CRBSI.

Methods: All patients who were admitted to PICU at Phramongkutklao Hospital between January and December 2006 and had central venous catheter (CVC) inserted from the operation room before admission or CVC placed in the PICU were included in a cohort study with longitudinal assessment of an overall catheter care policy targeted at the reduction of vascular access infection. The guideline included five key components (hand hygiene, maximal barrier precautions, povidine skin antiseptic, optimal catheter site selection, daily review of line necessity with prompt removal of unnecessary lines) called "central line bundle". All nursing staffs in the PICU were asked to attend an educational meeting in order to review the scientific data on vascular access insertion, device use and care. Data regarding age, underlying disease, location of insertion, duration, and complication were recorded.

Results: A total of 61 patients were recruited. Average duration of catheterization was 8.7 days. Complications were found in 8 cases (13.1%). Hematoma was the most common complication (6.6%) followed by infection (3.3%). Rate of CRBSI was reduced from 2.6 per 1000 catheter days to 2.4 per 1000 catheter days after implementing the new practice guideline.

Conclusion: Rate of CRBSI was reduced after implementing the new "central line bundle" guideline to prevent CRBSI.