INTERVENTIONS TO DECREASE CATHETER-ASSOCIATED BLOODSTREAM INFECTIONS IN NEWBORNS: AN INTEGRATIVE REVIEW

Curan, Gabriela Ramos Ferreira; Rossetto, Edilaine Giovanini

doi:10.1590/0104-07072017005130015

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LITERATURE REVIEWS • Texto contexto - enferm. 26 (1) • 2017 • https://doi.org/10.1590/0104-07072017005130015 copy

INTERVENTIONS TO DECREASE CATHETER-ASSOCIATED BLOODSTREAM INFECTIONS IN NEWBORNS: AN INTEGRATIVE REVIEW

MEDIDAS PARA LA REDUCCIÓN DE INFECCIÓN ASOCIADA A CATÉTER CENTRAL EN RECIÉN NACIDOS: REVISIÓN INTEGRATIVA

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to perform an integrative review of strategies presented in care bundles to decrease central catheter-associated bloodstream infection among newborns. .

Method

a search was conducted of the Cochrane Library, IBECS, PubMed, Lilacs, Medline and Scielo catalogues, using the terms "bundle", "catheter-related infection", "infection control", "prevention", "evidence-based nursing"," evidence-based medicine" and" central venous catheter". Inclusion criteria were: papers published from 2009 to April 2014; written in Portuguese, English or Spanish; addressing both neonatal and pediatric populations or just neonatal populations; describing the use and/or assessing care bundles or protocols to control central catheter-associated infection.

Results

fifteen studies published between 2009 and 2013 were selected. The main information extracted from the studies was systematized as: 1) measures adopted to prevent central catheter-associated bloodstream infection according to level of scientific evidence, and 2) strategies used to implement evidence into health practice.

Conclusion

there was a variety of practices adopted, some of which are consistent with scientific evidence and some of which are not. Systematization conducted in this study is expected to contribute to practice, facilitating the use of the best evidence in each context, and research indicating gaps in knowledge to be explored in future studies

DESCRIPTORS:
Catheter-related infections; Evidence-based nursing; Neonatal nursing; Patient care bundles; Catheters

Scientific evidence	Level
Placement of Central Venous Catheter
Hand hygiene^{9-10,19-20,22-24,26-27,29}	IA^*
Maximal barriers during central venous catheter insertion^{9,19-20,22-24,26, 29}	IA^*
Skin cleansing with chlorhexidine at 0.2% and air drying^{9-10,21,24, 29}	IA^*
Keep preassembled insertion kits ^{9-10,20,23,26}	IB^†
Establish a team with special training to exclusively provide care for the placement and maintenance of central lines^10,21,23,25	IB^†
Central Venous Catheter Maintenance
Hand hygiene ^{9-10,19-20,22-24,26-27, 29}	IA^*
Using sterile transparent semipermeable dressing or sterile gauze^9,22-23,27	IA^*
Dressing: rubbing the catheter site with chlorhexidine, alcohol at 70% or povidone-iodine and letting it air dry^9,23,26	IA^*
Rubbing the infusion system with alcohol or clorexidine^9,23,30	IA^*
Minimize infusions and multiple access routes^21-22	IA^*
Add 0.5ml of heparin in the total parenteral nutrition²¹	IA^*
Change infusion systems after 96 hours or before if there is blood or suspicion of infection²⁵	IA^*
Daily assess the need to keep catheter^{9,19-20,22-23,26,29}	IB^†
Daily observe signs of infection on the catheter site and the aspect of dressing^9-10,23,26	IB^†
Change dressing if dirty, wet, loose or constricting^10,21,25	IB^†
Standardize aseptic placement and change of infusion systems^{9,22- 24,30}	IB^†
Use a sponge impregnated with chlorhexidine on the insertion site at every change of dressing^20,22	IB^†
Dressing: change gauze every two days or before if dirty, wet or loose^20,25	II^‡
Keep the infusion system closed/use closed infusion system^{10,23,25,27,30}	II^‡

Intervention	Level
Rub the injector with chlorhexidine for different durations established for rubbing and drying^22,24-25	--
Use of glove procedure every time catheter is manipulated^20,23	--
Use sterile glove and mask to change sterile dressing^23-24	--
Use double or three-lumen catheters to ensure there is one that is exclusive to parenteral nutrition²⁴	--
Promote enteral nutrition to remove the central venous catheter early on²⁷	--
Avoid the use of dyed/colored solutions on stumps that may received a catheter later¹⁰	--
Insert umbilical catheters in pairs to checklist the catheter insertion¹⁰	--
Not placing patients with umbilical catheter in the prone positon¹⁰	--
Changes of fluids and infusions of umbilical catheters made by a medical staff¹⁰	--
Dressings: use preassembled dressing kits²⁰	--
Flush syringes are single use only²³	--
Use clean gloves to check the system if not using a closed system²⁶	--
Use sterile gloves to setup a closed system and at least clean gloves to install it²⁶	--
Use flush syringes previously aspired by the manufacturer or in the pharmacy using sterile technique²⁶	--
Comply with diagnostic criteria and measurement standards for nosocomial infections²⁷	--
Identify the catheter with date of insertion and infusion system and connections with the date they were changed³⁰	--
Avoid femoral site if possible/standardize the insertion sites^{10,19, 29}	≠
Clean the stump or site of the peripherally inserted central catheter with iodine-based solution¹⁰	≠
Dressing: change transparent dressings every seven days or before if dirty, wet or loose²²	≠
Change infusion systems within an interval between 72 and 96 hours, or before if there is blood or suspicion of infection³⁰	≠

Strategies
Education/training/workshops on the central venous catheter-associated blood stream infections concept^{9-10,19,23-24,26-27-29}
Meetings with the staff/teleconferences^{9,19-20,23,26,28-29}
Discussing infection rates in the unit^{19-20,24,26, 28-29}
Daily checklists to verify bundles compliance^{9 -10,20,23,28}
Feedback to the team concerning performance of bundles^{19-20,23-24,28-29}
Use of posters/reminders^{19-20,23-24,28-29}
Establish one or more leaders to prevent central venous catheter-associated blood stream infections^19,23-24,29
Goals to decrease infection rates and improve adherence to bundles^20,26
Autonomy to interrupt the insertion procedure if the team fails to observe any of a bundle's items^11,26
Anonymous and random nursing auditing²⁴
Applying tests or quizzes for the team²⁰
Provide training to workers²⁰
Ensure there is one antisepsis dispenser in every bed²⁴
Prohibit accessories below elbow, including sleeves and long nails²⁴
Establish a competition among employees to encourage their participation in the process²⁴
Promote commemorative celebrations on the project's aniversaries²⁴
Update practices by email and provide printed copies to staff²⁴
Visit facilities with good practices and rates²³
Involve other sectors that also use catheters (e.g., anesthesiology and radiology) ²³
Disseminate guidelines and tools²⁷

Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

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[1] Correspondence: Gabriela Ramos Ferreira Curan Rua Reverendo João Batista Ribeiro Neto, 75, ap 1903 86055-645 - Gleba Palhano, Londrina, PR, Brasil E-mail: gabrielacuran@yahoo.com.br