Catheter-related Bloodstream Infections In Children Research Articles

Catheter salvage or removal in catheter-related bloodstream infections with Staphylococcus aureus in children with chronic intestinal failure receiving home parenteral nutrition and the use of prophylactic taurolidine catheter lock solution: A descriptive cohort study.

Children with chronic IF require long-term home parenteral nutrition (HPN), administered through a central venous catheter. Catheter-related bloodstream infection (CRBSI) with Staphylococcus aureus is known to be a serious infection with a high mortality rate and risk of complications. A standardized protocol on the management of S aureus CRBSIs in children receiving HPN is lacking. The aim of this study is to evaluate the effectiveness and safety of the current management in an HPN expertise center in the Netherlands. We performed a retrospective descriptive cohort study between 2013 and 2022 on children 0-18 years of age with chronic IF requiring long-term HPN. Our primary outcomes were the incidence of S aureus CRBSI per 1000 catheter days, catheter salvage attempt rate, and successful catheter salvage rate. Our secondary outcomes included complications and mortality. A total of 74 patients (39 male; 53%) were included, covering 327.8 catheter years. Twenty-eight patients (38%) had a total of 52 S aureus CRBSIs, with an incidence rate of 0.4 per 1000 catheter days. The catheter salvage attempt rate was 44% (23/52). The successful catheter salvage rate was 100%. No relapse occurred, and no removal was needed after catheter salvage. All complications that occurred were already present at admission before the decision to remove the catheter or not. No patients died because of an S aureus CRBSI. Catheter salvage in S aureus CRBSIs in children receiving HPN can be attempted after careful consideration by a multidisciplinary team in an HPN expertise center.

Risk factors for catheter-related bloodstream infections associated with home parental nutrition in children with intestinal failure: A prospective cohort study

Catheter-related bloodstream infection (CRBSI) is the most common, potentially life-threatening complication of long-term parenteral nutrition (PN). We prospectively assessed the incidence and risk factors for CRBSI in children receiving long-term home PN (HPN) for intestinal failure (IF) in a single IF rehabilitation center. Data regarding episodes and potential risk factors for CRBSI in children on HPN were prospectively recorded. Forty-one of 75 children were diagnosed with CRBSI. The overall CRBSI rate was 1.61 per 1000 catheter days. The indications for HPN were gastrointestinal motility disorders in 35%, short bowel syndrome (SBS) in 28% graft versus host disease (GvHD) post bone marrow transplant in 17%, congenital enteropathy in 15%, and severe neurodevelopmental impairment in 5%. Gastrointestinal motility disorders had significantly higher CRBSI rate compared to other groups (p<0.0005; 2.74 in motility group vs 1.54 in GvHD group vs 0.52 in congenital enteropathies vs 0.36 in SBS group vs 0.67 in severe neurodevelopmental delay). Multivariate analysis revealed that enterocutaneous distal stoma (ileostomy or colostomy) (HR 3.35 [95% CI, 1.63-6.86]; p<0.001), age <2 years (HR 0.28 [95% CI, 0.15-0.53]; p<0.0001), male sex (HR 2.28 [95% CI, 1.51-3.43]; p<0.0001), non-use of taurolidine citrate lock (HR 2.70 [95% CI, 1.72-4.11]; p<0.0001) and gastrointestinal motility disorder (HR 3.02 [95% CI, 1.81-4.91]; p<0.001) were independent risk factors for developing CRBSI. Extra care in managing PN connections and disconnections should be taken in children with an underlying gastrointestinal motility disorder, distal enterocutaneous stoma, male sex and those aged <2 years since they are at a significantly higher risk of CRBSI. Early introduction of taurolidine lock should be considered.

Catheter-related bloodstream infections in children receiving parenteral nutrition: Experience of a single center with 178 patients

ObjectiveCatheter-related bloodstream infections are common in children who require parenteral nutrition and can have serious consequences, including mortality. This study aims to evaluate the frequency and nature of catheter-related bloodstream infections in children receiving parenteral nutrition. Materials and MethodsPatients between one month and 18 years of age who received parenteral nutrition within two years were evaluated for indications and complications by focusing on catheter-related bloodstream infections. ResultsTwenty-nine different catheter-related bloodstream infections were detected in 24 of 147 episodes in which parenteral nutrition was delivered via a catheter. The frequency of catheter-related bloodstream infections was 7.7 infections per 1000 catheter days. Coagulase-negative staphylococci, Gram-negative enteric bacilli, enterococci, and Candida species were the most common causative microorganisms. Five patients died. Infection frequency increased with increasing PN duration and receiving PN via a non-tunneled internal jugular catheter. Gender, age, and the number of catheter lumens were not associated with infection frequency. ConclusionCatheter-related bloodstream infection is a common complication in children receiving parenteral nutrition. Appropriate management is essential. Because parenteral nutrition duration is a risk for catheter-related bloodstream infections, the transition to enteral feeding should be considered as soon as possible.

Catheter-related bloodstream infections in children with intestinal failure: a 6-year review from an intestinal rehabilitation center in China.

Children with intestinal failure (IF) have frequent catheter-related bloodstream infections (CRBSIs). This study aimed to analyze the clinical presentation and laboratory parameters of CRBSIs in children with IF. This 6-year retrospective study was conducted among IF children with CRBSIs at an intestinal rehabilitation center in China. Clinical data were collected, including data of temperature and gastrointestinal symptoms. Blood/catheter culture, fecal tests, and calculation of inflammatory index were performed, which were obtained within 1 week since CRBSI onset. Fifty children with 87 CRBSIs were identified, of which there were 17 suspected and 70 confirmed cases. Seventy-two pathogens were cultured from 70 positive blood cultures: 63% were Gram-positive organisms, 23% were Gram-negative organisms, and 11% were fungal organisms. Overall, 48.6% were enteric organisms; 47.2% of bacterial pathogens were consistent between fecal and blood cultures. Moreover, 46.3% fecal routines showed abnormalities including increased white blood cells, occult blood positive and the presence of fat droplets. The consistent symptom at onset of CRBSIs was fever and gastrointestinal symptoms including increased stool output, abdominal distension, or both. C-reactive protein (CRP) and procalcitonin (PCT) were elevated, i.e., 16.5mg/L [interquartile range (IQR) 8.7-44.7] and 0.48ng/mL (IQR 0.2-1.76), respectively. IF children had a high rate of CRBSIs, of which larger proportions were due to Gram-positive and enteric organisms. Fever and/or gastrointestinal symptoms, combined with elevated CRP and PCT, is conducive to the early diagnosis of CRBSIs in IF patients.

1040 Evaluation of The Use of Biopatch In Haemodialysis Lines: Are We Reducing the Risk of Infection?

Abstract Aim Children who had the central venous lines inserted for prolonged vascular access usually experience the catheter-related blood stream infection (CRBSI). CRBSI is known to be associated with high morbidity which increases the cost of the healthcare and the chances of mortality. Clinical evidence suggests that the use of biopatch (chlorhexidine-impregnated dressing) is effective in reducing the rate of infection in central venous lines. The aim of our study was to evaluate whether the use of biopatch actually reduced the CRBSI in children who had had haemodialysis lines at our institution. Method Theatre logs and electronic records of 46 patients who had haemodialysis lines inserted between 2015-2019 were retrospectively reviewed. These patients were randomly selected. Results The total number of lines inserted in 46 patients were 104. The mean of line per patient was 2.2. Out of 104 lines, 22 lines (21%) had confirmed infection. Conclusions Infection of the central line is still a significant problem. Infections were more prevalent in cases which did not use biopatch according to the documentation. We believe the rate of infection can be reduced by encouraging the use of biopatch on regular basis for the haemodialysis lines and the proper documentation of its use in the operation notes.

Current Approach for the Prevention of Central Venous Catheter-related Bloodstream Infections in Children

Current Approach for the Prevention of Central Venous Catheter-related Bloodstream Infections in Children

Taurolidine lock solution for catheter-related bloodstream infections in pediatric patients: A meta-analysis.

Infection is one of the most commonly described complications, and a major cause of morbidity and mortality in pediatric patients treated using central venous catheters (CVCs). Taurolidine lock solutions have been used to decrease catheter-related bloodstream infections (CRBSIs) in both adult and pediatric patients. The purpose of this study was to systematically search the literature and conduct a meta-analysis to determine the efficacy of taurolidine in reducing CRBSI in children. We conducted an electronic search of the PubMed, EMBASE, Cochrane Library, TRIP Database, CINAHL, and Google Scholar databases for articles published up to 1st November 2019. Eligible studies included randomized controlled trials (RCTs) comparing the effects of taurolidine with control for preventing CRBSI in pediatric patients. Four studies were included. Our results indicated a statistical significant reduction in the total number of CRBSI with taurolidine as compared to control (RR: 0.23; 95% CI:0.13, 0.40; I2 = 0%; P<0.00001). The pooled analysis also indicated a statistical significant reduction in the incidence of CRBSI (defined as the number of CRBSI events/1000 catheter days) in the taurolidine group (MD: -1.12; 95% CI:-1.54, -0.71; I2 = 1%; P<0.00001). The number of catheters removed due to infection or suspected infection was not significantly different between the two groups (RR: 0.68; 95% CI:0.22, 2.10; I2 = 56%; P = 0.50) (Fig 5). The quality of the included studies was not high. The use of taurolidine as a catheter locking solution may significantly reduce CRBSI in pediatric patients. However, the quality of current evidence is not high and further high-quality large scale RCTs are needed to corroborate our results.

Central Catheter-related Bloodstream Infection Rates in Children on Home Parenteral Nutrition.

Reliable venous access is prerequisite for patients receiving long-term parenteral nutrition (PN). Central venous catheters are, however, an important risk factor for the development of potentially lethal complications, including catheter-related bloodstream infection (CRBSI). We have retrospectively assessed the incidence of CRBSIs in children on long-term PN who were treated at the Children's Hospital Zagreb from January 2011 until January 2019 and the cost effectiveness of the use of taurolidine line locks in children at home PN (HPN). During this period 48 children received long-term PN and 24 children were discharged to HPN. The rate of CRBSI 1.15/1000 catheter days in total; 2.35/1000 days in the hospital; and 0.48/1000 days at home. If taurolidine line lock was used every day of PN for children on HPN total costs would exceed existing CRBSI treatment costs >5 times.

P4.39: Citrate-taurolidine lock solution: impact on the incidence of catheter related bloodstream infections in children with intestinal failure receiving home parenteral nutrition

Introduction: The use of central venous catheters (CVC) for parenteral nutrition (PN) administration has increased survival rates and allowed patients with short bowel syndrome who are dependent on long-term PN to be discharged for home care. However, catheter related bloodstream infection (CRBSI) remains as a major complication of long-term PN and is associated to increased morbidity, mortality, length of stay and hospital costs. Several lock solutions have been used to prevent CVC contamination. Among them, the citrate-taurolidine solution (composed of 2% taurolidine and 4% citrate), which is unique by reducing the biofilm formation of bacterial cells and avoiding bacterial adhesion and clotting in the catheter. We aimed to identify the rates of CRBSI before and after the use of the citrate-taurolidine solution in de-hospitalized children receiving home PN. Methods: This was a prospective cohort study in 11 children with intestinal failure (IF), mean age 35.4 months (12.7), receiving home PN and followed-up at a center for intestinal rehabilitation between July 2015 and November 2018. The rate of CRBSI was calculated for each patient by the incidence density ratio, defined as number of infections per 1,000 catheter-days. The citrate-taurolidine solution began to be used from March 2017 onward. The primary outcome was the variation in the rate of CRBSI before and after use of citrate-taurolidine lock solution. Results: The median time on PN was 26.4 months (interquartile range 15.2 - 32.9). The mean number of catheter days per patient before and after taurolidine were 178 (interquartile range 32 - 85.5) and 238 (interquartile range 203 - 386) days, respectively. There were 13 episodes of CRBSI before and only one episode after the use of citrate-taurolidine line locks. The incidence density of pre-taurolidine CRBSI was 5.7 and of post-taurolidine was 0.3 per 1000 catheter days. The main microorganism identified was Staphylococcus epidermidis. Conclusion: The rate of CRBSI was greatly reduced after the citrate-taurolidine use; this lock solution should be the first choice in reducing CRBSI in children with IF receiving home PN.

The use of antibiotic line locks to reduce rates of catheter-related bloodstream infections in children with intestinal failure

Based on previous audit data, as of August 2010, antibiotic line locks have been routinely used in children under the age of 5 who require long-term parenteral nutrition (PN) and suffer with recurrent catheter-related bloodstream infection (CRBSI). We aim to quantify the rate of reduction in CRBSI

Is antibiotic lock therapy effective for the implantable longterm catheter-related bloodstream infections in children?

Tural Kara T, Özdemir H, Erat T, Yahşi A, Aysev AD, Taçyıldız N, Ünal E, İleri T, İnce E, Haskoloğlu Ş, Çiftçi E, İnce E. Is antibiotic lock therapy effective for the implantable long-term catheter-related bloodstream infections in children? Turk J Pediatr 2019; 61: 895-904. Catheter-related bloodstream infections (CRBSIs) are an important problem in pediatric patients with central venous catheters. This study aimed to determine the incidence of CRBSIs, responsible pathogens and outcomes of antibiotic lock treatment (ALT) in pediatric patients. Between January 2010 and November 2015 all hospitalized pediatric hematology, oncology and immunology patients diagnosed with CRBSIs were retrospectively analyzed. Seventy-eight CRBSI episodes were detected in 60 pediatric patients. The incidence of CRBSIs was 4.20/1000 catheter days. The most frequently detected pathogen was methicillin-resistant coagulase-negative Staphylococcus. Pseudomonas aeruginosa, Klebsiella spp., and Escherichia coli were other commonly isolated microorganisms. ALT was administered in 42 patients. The success rate of ALT was 81% (34/42). Catheter was removed without ALT in 36 episodes. Common reasons for catheter removal were sepsis and causative microorganisms which had high probability of biofilm formation. CRBSIs are an important cause of morbidity and mortality in pediatric patients. ALT is safe and effective. It is possible to obtain satisfactory results when ALT is used with intravenous systemic antibiotics for CRBSIs, though in some cases catheter removal is necessary. ALT helps to prevent unnecessary catheter removal in pediatric patients.

Epidemiology and Risk Factors for Outpatient-Acquired Catheter-Related Bloodstream Infections in Children Receiving Home Parenteral Nutrition.

Few studies have examined the epidemiology and risk factors for the development of outpatient-acquired catheter-related bloodstream infections (CRBSIs) in children receiving home parenteral nutrition. This study aimed to (1) characterize the incidence, clinical presentation, and epidemiology of CRBSIs and (2) identify risk factors for CRBSIs in children receiving home parenteral nutrition. A longitudinal database approved by our Institutional Review Board was created to prospectively track CRBSIs in the UCLA pediatric population from January to December 2012. Eligible patients included those < 18 years old receiving home parenteral nutrition. Thirty of 60 patients (50%) were diagnosed with 66 CRBSIs, for an overall CRBSI rate of 3.6 per 1000 catheter days. Of the CRBSIs, 73% were due to single microorganisms and 27% were polymicrobial. There was a significant difference in median (range) time for blood cultures to turn positive depending on type of CRBSIs (p = 0.03), with polymicrobial infections detected at 13.4 (8.7-24.3) hours, gram-negative infections at 16.5 (9-30.8) hours, and gram-positive infections at 18.9 (8.4-37.1) hours. The most common presenting symptom was fever (82%), followed by gastrointestinal symptoms (42%) and chills (29%). The only significant multivariate risk factor for CRBSIs was presence of a feeding tube (2.3-fold increase in CRBSI risk, p = 0.04). Outpatient-acquired CRBSIs are common in children receiving home parenteral nutrition. CRBSIs typically present with fever, but are also associated with gastrointestinal and/or respiratory symptoms. The presence of feeding tubes may predispose children on home parenteral nutrition to developing CRBSIs.

Strategies to Reduce Catheter-Related Bloodstream Infections in Pediatric Patients Receiving Home Parenteral Nutrition: The Efficacy of Taurolidine-Citrate Prophylactic-Locking.

Catheter-related bloodstream infections (CRBSIs) remain a major issue in patients who are receiving home parenteral nutrition (HPN). The aim of this interventional study was to assess the impact of a new strategy using taurolidine-citrate (T-C) prophylactic locks on the CRBSI rate in children with intestinal failure who are receiving HPN. The rate of CRBSIs was monitored every calendar year in a prospective cohort of 195 children with intestinal failure. T-C locks were initiated from October 2011 in children with recurring CRBSIs (≥2 episodes per year). In the whole cohort, the median annual CRBSI rate per 1000 catheter days decreased significantly from 2.07 in 2008 to 2010 to 1.23 in 2012 to 2014 (P < .05). T-C locks were used in 40 patients. No adverse events were reported. In taurolidine-treated patients, the CRBSI rate per 1000 catheter days decreased from 4.16 to 0.25 (P < .0001). The cumulative percentage of patients free of CRBSI at 18 months was 92% (95% confidence interval [CI]: 71-98) on T-C lock vs 61% (95% CI: 49-72) in controls (P = .01). In multivariate analysis, factors associated with CRBSI were immune deficiency (adjusted hazard ratio 3.49; 95% CI: 1.01-12.17) and the young age of the parents (adjusted hazard ratio 4.79, 95% CI: 2.16-10.62), whereas T-C locks were protective (adjusted hazard ratio 0.22, 95% CI: 0.06-0.74). This study confirms the efficacy of T-C catheter locks in decreasing the incidence of CRBSIs in children with intestinal failure who are receiving HPN.

Antibiotic-Impregnated Central Venous Catheters for the Prevention of Catheter-Related Bloodstream Infection in Children: A Meta-Analysis

Antibiotic-Impregnated Central Venous Catheters for the Prevention of Catheter-Related Bloodstream Infection in Children: A Meta-Analysis

Taurolidine Lock vs Heparin Lock in Children and Adolescents on Chronic Parenteral Nutrition

Introdution: Patients with intestinal failure (IF) requiring central venous catheters (CVCs) are at risk for frequent catheter-related bloodstream infections (CRBSIs).[1] Taurolidine is a catheter lock solution used for CRBSI prevention, however only few studies showed efficacy in pediatric patients. This study aimed to compare the use of taurolidine lock versus heparin lock to prevent CRBSI and catheter replacement in pediatric IF patients with chronic parenteral nutrition dependence. Methods: During a study period of 52 months, 28 patients (22 male, 6 female, median age 30 months (range 1-165 months) were enrolled. Inclusion criteria were: a) patients from 2 months through 8 years old; b) who had intestinal failure on PN by tunelled CVC for at least 8 weeks; c) on cyclic PN for at least 2 hours. The exclusion criteria were acquired or primary immunodeficiency or associated diseases requiring recurrent use of antibiotics such as cystic fibrosis. All patients were randomly assigned to one of 2 groups: taurolidine lock + citrate 4% (group A) and control with heparin lock 50 UI/ml (group B) and patients were observed for CRBSIs. Blood cultures were collected at the same time from peripheral and from CVC whenever infection was suspected. The main endpoint was the number of CRBSI/1,000 catheter days and also the number of catheter replacement/patient. Statistical analysis employed Student's t test and X2 for categorical variables. Trial registration ClinicalTrials.gov NCT02515201. Results: The total number of catheter days was 8,260 days, with the following number of days per group: group A=4,371 days; group B=3,889 days. CRBSI infection rate during the hospitalization period was 7.1/1000 on taurolidine and 7.9/1000 on heparin, with no significant difference among them. CRBSI infection rate during home PN period was 0.9/1000 on taurolidine and 2.6/1000 on heparin, with no significant difference among them. The number of catheter replacement during the hospitalization period was 27 on taurolidine and 32 on heparin, with no significant difference among them. Number of catheter replacement on home PN period was 6 on taurolidine and 5 on heparin, with no significant difference among them. Conclusion: In conclusion, our study showed that there was no difference between the incidence of CRBSI in pediatric home PN patients when comparing with heparin lock solution. Reference: 1. Chu HP, Brind J, Tomar R, Hill S. Significant reduction in central venous catheter-related bloodstream infections in children on HPN after starting treatment with taurolidine line lock. J Pediatr Gastroenterol Nutr. 2012;55(4):403–7.

Can procalcitonin be a diagnostic marker for catheter‐related blood stream infection in children?

ObjectiveThe potential role of procalcitonin (PCT) in the diagnosis of catheter‐related bloodstream infection (CRBSIs) is still unclear and requires further research. The diagnostic value of serum PCT for the diagnosis of CRBSI in children is evaluated here. MethodThis study was conducted between October 2013 and November 2014, and included patients with suspected CRBSI from 1 month to 18 years of age who were febrile, with no focus of infection, and had a central venous catheter. Levels of PCT and other serum markers were measured, and their utility as CRBSI markers was assessed. Additionally, the clinical performance of a new, automated, rapid, and quantitative assay for the detection of PCT was tested. ResultsAmong the 49 patients, 24 were diagnosed with CRBSI. The PCT‐Kryptor and PCT‐RTA values were significantly higher in proven CRBSI compared to those in unproven CRBSI (p=0.03 and p=0.03, respectively). There were no differences in white blood cell count and C‐reactive protein (CRP) levels between proven CRBSI and unproven CRBSI. Among the 24 patients with CRBSI, CRP was significantly higher among those with Gram‐negative bacterial infection than in those with Gram‐positive bacterial infections. PCT‐Kryptor was also significantly higher among patients with Gram‐negative bacterial infection than in those with Gram‐positive bacterial infections (p=0.01 and p=0.02, respectively). ConclusionsThe authors suggest that PCT could be a helpful rapid diagnostic marker in children with suspected CRBSIs.

Can procalcitonin be a diagnostic marker for catheter-related blood stream infection in children?

ObjectiveThe potential role of procalcitonin (PCT) in the diagnosis of catheter-related bloodstream infection (CRBSIs) is still unclear and requires further research. The diagnostic value of serum PCT for the diagnosis of CRBSI in children is evaluated here. MethodThis study was conducted between October 2013 and November 2014, and included patients with suspected CRBSI from 1 month to 18 years of age who were febrile, with no focus of infection, and had a central venous catheter. Levels of PCT and other serum markers were measured, and their utility as CRBSI markers was assessed. Additionally, the clinical performance of a new, automated, rapid, and quantitative assay for the detection of PCT was tested. ResultsAmong the 49 patients, 24 were diagnosed with CRBSI. The PCT-Kryptor and PCT-RTA values were significantly higher in proven CRBSI compared to those in unproven CRBSI (p=0.03 and p=0.03, respectively). There were no differences in white blood cell count and C-reactive protein (CRP) levels between proven CRBSI and unproven CRBSI. Among the 24 patients with CRBSI, CRP was significantly higher among those with Gram-negative bacterial infection than in those with Gram-positive bacterial infections. PCT-Kryptor was also significantly higher among patients with Gram-negative bacterial infection than in those with Gram-positive bacterial infections (p=0.01 and p=0.02, respectively). ConclusionsThe authors suggest that PCT could be a helpful rapid diagnostic marker in children with suspected CRBSIs.

Antibiotic-Lock Therapy in Pediatric Oncology Patients

The use of long-term central venous catheters (CVCs) has increased over the past decade. There is, however, a risk of complications associated with the use of these catheters. Catheter-related bloodstream infection (CRBSI) is a common complication with a mortality rate that can be in excess of 25%. Antibiotic-lock therapy consists of filling the catheter lumen with antibiotics and allows them to dwell for a period of time, to rid the lumen from the organisms that are there and allowing the life of the catheter to be extended. The objective of this study is to evaluate the treatment of uncomplicated long-term CRBSI using lock therapy associated with systemic antibiotics among a hematology-oncology pediatric population. This is a noncomparative retrospective and descriptive cohort study. CRBSIs in patients with long-term CVCs who were treated with antibiotic-lock therapy and systemic antibiotics in oncology ward at Hospital de Ninos de Cordoba between January 2005 and December 2011 were analyzed. A total of 174 noncomplicated CRBSIs were identified during this period. A total of 123 uncomplicated CRBSIs occurred in 90 patients; all of them were treated with both systemic and lock therapy. The CRBSI rate observed in 7 years was 0.57 episodes per 1000 days/catheter. Out of the 90 patients, 68 (75.56%) had acute lymphoblastic leukemia. A total of 118 episodes were monomicrobial. Gram-negative bacilli accounted for 76/123 (59%). All Klebsiella spp and Escherichia coli responded to conservative treatment. Total therapeutic success rate was achieved in 87.89%. This study suggests that antibiotic-lock therapy along with systemic therapy is an effective and reasonable alternative for the treatment of uncomplicated long-term CRBSIs in children with oncologic diseases.

Aseptic non-touch technique and catheter-related bloodstream infection in children receiving parenteral nutrition at home.

Parenteral nutrition (PN) at home is an acceptable form of delivering long-term PN for children with intestinal failure. Catheter-related bloodstream infection (CRBSI) is one of the serious complications of long-term PN and can lead to increasing morbidity and mortality. Using aseptic non-touch technique (ANTT) was proven to decrease the incidence of CRBSI in hospital patients. In this study we aimed to review the incidence of CRBSI in children receiving PN at home in our institution using the ANTT and a simplified training programme for parents and carers. We retrospectively collected clinical and microbiological data on all children with intestinal failure (IF) who were on treatment with PN at home under our specialist IF rehabilitation service between November 2012 and November 2013. Thirty-five children were included, 16 of whom did not have any infection recorded during the study period. The overall CRBSI rate was 1.3 infections per 1000 line-days, with Staphylococcus being the commonest organism. Twenty-one children did not require catheter change and the overall catheter changes were 1.8 per 1000 line-days. In this article, we report a low incidence of CRBSI in a single institution by using the principle of ANTT for accessing central venous catheters combined with a simplified, nurse-led, two-week standardised training programme for parents of children going home on PN.

Closed Blood Conservation Device for Reducing Catheter-Related Infections in Children After Cardiac Surgery

Arterial catheters are potential sources of nosocomial infection. To investigate use of a closed blood conservation device in preventing catheter-related bloodstream infections in children after cardiac surgery. Children with an indwelling arterial catheter after cardiac surgery were randomly assigned to 2 groups: a control group with a conventional 3-way stopcock in the catheter system and an interventional group with the conservation device in the catheter system. Catheter tips, catheter intraluminal fluid, and blood samples obtained from the catheter and peripherally were cultured for microbiological analysis. RESULTS Intraluminal fluid contamination was significantly lower (P = .03) in the interventional group (3 of 147 catheters) than in the control group (10 of 137 catheters). The 2 groups did not differ significantly in the rate of tip colonization (9 of 147 vs 12 of 137; P = .40) or in the number of catheter-related bloodstream infections (0 of 147 vs 2 of 137; P = .21). Use of a closed blood conservation device could decrease the incidence of catheter-related contamination of intraluminal fluid.