CENTRAL VENOUS CATHETER-RELATED BACTEREMIA IN CRITICALLY ILL NEONATES- RISK-FACTORS AND IMPACT OF A PREVENTION PROGRAM

Risk factors for central venous catheter (CVC)-related bacteraemia amo ng infants admitted to a neonatal intensive care unit (NICU) were anal ysed and the impact of surveillance and continuing education on the in cidence of this complication investigated. Among patients admitted to a NICU, CVC-related bacteraemia increased from 1/15 (7%) in 1987 to 11 /26 (42%) in 1988 (P=0.01). Coagulase-negative staphylococci isolated from bacteraemia patients showed clonal diversity by plasmid and chrom osomal fingerprinting. A review of CVC care procedures suggested breac hes in aseptic techniques. Catheter-care technique was revised to ensu re maximal aseptic precautions, including the use of sterile gloves, g own and drapes. The new policy was promoted by a continuing education programme and regular feed-back of CVC-related bacteraemia incidence t o NICU staff. In the four-year follow-up period, the attack-rate of CV C-related bacteraemia decreased to 18/156 (12%) patients [relative ris k (RR): 0.27, 95% confidence interval (CI); 0.15-0.51; P<0.001 vs the previous period]. By using the Cox's model proportional hazards, very low birthweight and the period before use of strict aseptic CVC care w ere found to be predictors of increased risk of catheter-related bacte raemia after adjustment for duration of catheterization. These data pr ovide further evidence that strict aseptic precautions during the main tenance and utilization of CVC can contribute to lower the risk of cat heter infection in critically ill neonates. Regular feedback of survei llance data was associated with a progressive decrease in incidence of infection, suggesting that it improved staff compliance with aseptic precautions.