Decreasing Central Line Associated Bloodstream Infection in Neonatal Intensive Care

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Why does context matter?

Context refers to the complicated milieu that makes up the unique culture of each NICU. These units are complex workplaces in which hundreds of providers interact either directly or indirectly with large numbers of patients and their families, often for many days or even months. It is not surprising that this merging of various individuals' knowledge, experiences, attitudes, and languages produces many unique and even unstable combinations of these personal factors. The evolution of these

Microbiology

The distribution of organisms associated with neonatal BSIs has been reported by the NICHD (15 United States neonatal ICUs) and by the Israel Neonatal Network, representing 28 Israeli neonatal ICUs10, 47 (Table 1). Both large networks report a similar pattern of pathogens, with gram-positive organisms predominating. In both series the most common single organism associated with BSI was CONS (47% and 55% for Israel and the NICHD, respectively). This finding underscores the importance of

Summary

CLABSI results in increased mortality and adverse outcomes related to multiple systems with lifelong consequences. CLABSIs have come to be recognized as preventable adverse events that result from lapses in technique at multiple levels of care. This recognition is essential to instill the appropriate sense of personal accountability for individual health care workers necessary to motivate change. Strategies to reduce CLABSI have been described in the literature over the past decades. Successful

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      Standardization of processes related to central venous and arterial catheter insertion and maintenance, termed bundles, include the use of dedicated teams with expertise related to the selection of optimal insertion sites, the meticulous application of antisepsis, and the utilization of maximal barrier precautions for insertion and manipulation. Minimizing the numbers of ports, management of the catheter insertion site, timely removal when access is no longer needed and monitoring and reviewing local BSI data regularly facilitates reductions in rates of HAIs.59,60 A legal mandate passed in 2007 in New York state required surveillance and reporting of central line associated BSIs in all intensive care units.

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