Catheter Dwell Time and Risk of Bloodstream Infections in Hospitalized Neonates

住院新生儿的导管停留时间和血流感染风险

• 批准号: 8034164
• 负责人: AARON M MILSTONE
• 金额: $ 11.2万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2012-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8034164
• 关键词: Catheter; Dwell; Time; Risk; Bloodstream

DESCRIPTION (provided by applicant): Intravenous (IV) access is essential to provide fluids, medications and nutrition to hospitalized neonates. Since the 1980s, peripherally inserted central venous catheters (PICC) have been increasingly used to provide IV access. PICCs can be placed at the bedside without general anesthesia and can remain in place for days or weeks with seemingly minimal mechanical complications. However, complications do occur, including central-line associated bloodstream infections (CLA-BSI), phlebitis, cellulitis, and thrombosis. CLA-BSIs have a significant attributable cost and an associated mortality of up to 20%. The long-term objective of this research is to further develop evidence-based strategies to prevent central-line associated bloodstream infections (CLA-BSI) among infants hospitalized in the neonatal intensive care unit. This proposal builds a multicenter pediatric collaborative to examine the association between catheter dwell time and CLA-BSI in this unique population. Many studies have shown that the longer a catheter remains in the place, the greater the risk of complication. However, healthcare providers assume that the risk of a complication is constant from day to day. We hypothesize that 1) the daily risk of PICC-associated CLA-BSI in children hospitalized in the neonatal intensive care unit (NICU) is not constant, and 2) approximately one month after PICC insertion, a threshold exists beyond which time the daily risk of CLA-BSI significantly increases. This proposal will determine if the risk of PICC- associated CLA-BSI is constant over catheter dwell time, and identify whether a threshold exists beyond which the daily risk of CLA-BSI significantly increases. To complete this project we will perform a multicenter retrospective cohort study to collect and characterize data from seven tertiary care NICUs. We will evaluate risk factors for PICC-associated CLA-BSI, focusing on catheter dwell time as a non-linear independent predictor of CLA-BSI. PICCs are essential to the care of hospitalized neonates, but CLA-BSI have significant mortality and associated financial costs. Neonates may face unnecessary risk from prolonged PICC duration if the risk of CLA-BSI over time is not constant. As PICCs continue to be used widely in other healthcare settings and populations, findings from this collaborative project should stimulate additional studies to improve quality of care and prevent healthcare-associated infections. Our long-term goal is to provide evidence-based justification for instituting preventive measures which could save lives and reduce healthcare costs. PUBLIC HEALTH RELEVANCE: Bloodstream infections are a significant cause of morbidity and financial costs. This project will help to develop evidence-based strategies to prevent bloodstream infections among vulnerable infants hospitalized in the neonatal intensive care unit.

描述（由申请人提供）：静脉 (IV) 通路对于为住院新生儿提供液体、药物和营养至关重要。自 20 世纪 80 年代以来，外周插入中心静脉导管 (PICC) 越来越多地用于提供静脉通路。 PICC 可以放置在床边，无需全身麻醉，并且可以保留在原位数天或数周，机械并发症似乎很少。然而，并发症确实会发生，包括中心静脉相关血流感染 (CLA-BSI)、静脉炎、蜂窝织炎和血栓形成。 CLA-BSI 具有显着的可归因成本和高达 20% 的相关死亡率。这项研究的长期目标是进一步制定基于证据的策略，以预防新生儿重症监护室住院婴儿的中心静脉相关血流感染（CLA-BSI）。该提案建立了一个多中心儿科协作机构，以研究这一独特人群中导管停​​留时间与 CLA-BSI 之间的关联。 许多研究表明，导管留在原处的时间越长，发生并发症的风险就越大。然而，医疗保健提供者认为并发症的风险每天都是恒定的。我们假设 1) 在新生儿重症监护病房 (NICU) 住院的儿童中，PICC 相关 CLA-BSI 的每日风险不是恒定的，2) 在 PICC 置入后大约一个月，存在一个阈值，超过该时间后，CLA-BSI 的每日风险显着增加。该提案将确定 PICC 相关 CLA-BSI 的风险在导管停留时间内是否恒定，并确定是否存在阈值，超过该阈值，CLA-BSI 的每日风险会显着增加。为了完成这个项目，我们将进行一项多中心回顾性队列研究，以收集和表征来自七个三级护理新生儿重症监护室的数据。我们将评估 PICC 相关 CLA-BSI 的危险因素，重点关注导管停留时间作为 CLA-BSI 的非线性独立预测因子。 PICC 对于住院新生儿的护理至关重要，但 CLA-BSI 具有很高的死亡率和相关的财务成本。如果 CLA-BSI 风险随时间变化不恒定，新生儿可能会因 PICC 持续时间延长而面临不必要的风险。随着 PICC 继续在其他医疗机构和人群中广泛使用，该合作项目的研究结果应该会刺激更多的研究，以提高护理质量并预防医疗相关感染。我们的长期目标是为采取预防措施提供基于证据的理由，从而挽救生命并降低医疗费用。 公共卫生相关性：血流感染是发病率和经济成本的重要原因。该项目将有助于制定基于证据的策略，以预防新生儿重症监护病房住院的弱势婴儿的血流感染。