Abstract
BackgroundCentral line-associated bloodstream infections (CLABSI) are a main focus of infection prevention and control initiatives in neonatal care. Standardised surveillance of neonatal CLABSI enables intra- and interfacility comparisons which can contribute to quality improvement. To date, there is no national registration system for CLABSI in neonatal care in the Netherlands and several criteria are used for local monitoring of CLABSI incidence rates. To achieve standardised CLABSI surveillance we conducted a consensus procedure with regard to nationwide neonatal CLABSI surveillance criteria (SC).MethodsA modified Delphi consensus procedure for the development of nationwide neonatal CLABSI SC was performed between January 2016 and January 2017 in the Netherlands. An expert panel was formed by members of the Working Group on Neonatal Infectious Diseases of the Section of Neonatology of the Dutch Paediatric Society. The consensus procedure consisted of three expert panel rounds.ResultsThe expert panel achieved consensus on Dutch neonatal CLABSI SC. Neonatal CLABSI is defined as a bloodstream infection occurring more than 72 h after birth, associated with an indwelling central venous or arterial line and laboratory confirmed by one or more blood cultures. In addition, the blood culture finding should not be related to an infection at another site and one of the following criteria can be applied: 1. a bacterial or fungal pathogen is identified from one or more blood cultures; 2. the patient has clinical symptoms of sepsis and 2A) a common commensal is identified in two separate blood cultures or 2B) a common commensal is identified by one blood culture and C-reactive protein level is above 10 mg/L in the first 36 h following blood culture collection.ConclusionsThe newly developed Dutch neonatal CLABSI SC are concise, specified to the neonatal population and comply with a single blood culture policy in actual neonatal clinical practice. International agreement upon neonatal CLABSI SC is needed to identify best practices for infection prevention and control.
Highlights
Central line-associated bloodstream infections (CLABSI) are a main focus of infection prevention and control initiatives in neonatal care
A subsequent iterative process of consultation with the expert panel in Round II and revision of the concept resulted in consensus concerning Dutch neonatal CLABSI surveillance criteria (SC) in Round III
Neonatal CLABSI is defined as the occurrence of a laboratory confirmed bloodstream infection occurring more than 72 h after birth that was associated with an indwelling central line
Summary
Central line-associated bloodstream infections (CLABSI) are a main focus of infection prevention and control initiatives in neonatal care. There is no national registration system for CLABSI in neonatal care in the Netherlands and several criteria are used for local monitoring of CLABSI incidence rates. Neonatal central line-associated bloodstream infections (CLABSI) are associated with significant morbidity and mortality and burden the healthcare system with substantial costs [1]. Across Dutch neonatal intensive care units (NICUs), several different sets of CLABSI criteria and surveillance methods are used for local monitoring of CLABSI incidence rates resulting in considerable variation in incidence numbers impeding accurate interfacility comparison [10]. The NEO-KISS surveillance system includes very low birthweight (VLBW)
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