Catheter Dwell Time and Risk of Bloodstream Infections in Hospitalized Neonates

描述(由申请人提供)：静脉途径(IV)对于向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，经外周静脉插入的中心静脉导管(PICC)越来越多地被用于提供静脉通道。PICCs可以在没有全身麻醉的情况下放置在床边，并可以在似乎最小的机械并发症的情况下保留几天或几周。然而，并发症确实会发生，包括中心线相关性血流感染(CLA-BSI)、静脉炎、蜂窝织炎和血栓形成。CLA-BSI具有显著的归属成本和高达20%的相关死亡率。这项研究的长期目标是进一步开发循证策略，以预防在新生儿重症监护病房住院的婴儿中的中心线相关性血流感染(CLA-BSI)。这项建议建立了一个多中心儿科协作性研究，以在这一独特的人群中检查导管停留时间和CLA-BSI之间的关联。许多研究表明，导管在该位置停留的时间越长，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)住院的儿童发生PICC相关的CLA-BSI的每日风险不是恒定的，2)PICC置入后大约一个月，存在一个阈值，超过该阈值后，CLA-BSI的日常风险显著增加。这项建议将确定PICC相关的CLA-BSI的风险是否随着导管停留时间的延长而恒定，并确定是否存在一个阈值，超过该阈值，CLA-BSI的日常风险显著增加。为了完成这个项目，我们将进行一项多中心回溯性队列研究，以收集和描述来自七个三级护理NICU的数据。我们将评估PICC相关CLA-BSI的危险因素，重点是导管停留时间作为CLA-BSI的非线性独立预测因素。PICC对于住院新生儿的护理是必不可少的，但CLA-BSI具有显著的死亡率和相关的经济成本。如果随着时间的推移CLA-BSI的风险不是恒定的，新生儿可能会面临延长PICC持续时间的不必要风险。随着PICCs继续在其他医疗保健环境和人群中广泛使用，这个合作项目的发现应该会刺激更多的研究，以提高护理质量和预防与医疗保健相关的感染。我们的长期目标是为制定能够挽救生命和降低医疗成本的预防措施提供循证的理由。 公共卫生相关性：血液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循证战略，以预防在新生儿重症监护病房住院的脆弱婴儿发生血流感染。

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.