The study examines how the replacement frequency of external infusion connection devices impacts the incidence of catheter-related bloodstream infections (CRBSI) among critically ill pediatric patients.
Research conducted by the team at Fudan University Children’s Hospital over about 15 months has revealed compelling insights about the relationship between external infusion connection device replacement and the risk of CRBSI. The findings also find relevance amid increasing concerns about infection management related to vascular access devices.
Central venous catheters (CVCs) are commonly used for vascular access, particularly among critically ill pediatric patients. These devices enable rapid interventions and the delivery of medications efficiently; unfortunately, they also pose significant risks, including the development of infections. CRBSI happen when pathogens enter the bloodstream through the central catheter, leading to potentially dangerous complications.
Catheter-related bloodstream infections have serious consequences, extending hospital stays and incurring significant costs—reported to add £29,909 per catheter incident and prolong stays by approximately seven days. Despite the well-established risks, guidelines on how frequently to replace external infusion connection devices—critical for CRBSI prevention—are not succinctly defined.
The aim of the latest investigation was to explore whether the frequency of changing these external devices influences the occurrence of CRBSI. The research team enrolled 304 pediatric patients between September 2021 and December 2022, all receiving treatment with CVCs. Notably, the evaluation took place at two intensive care units at Fudan University Children’s Hospital, which consists of advanced pediatric care facilities.
According to the study, no statistically significant differences emerged related to CRBSI rates when varying the replacement frequency of external infusion connection devices. Specifically, changing these devices every two to six days did not heighten infection risk. The predominant infecting bacteria identified were coagulase-negative staphylococci, particularly Staphylococcus epidermidis, underscoring the importance of continual aseptic technique application during device handling.
One noteworthy aspect is the role strict adherence to aseptic principles played. "Timely and effective rescue of critically ill children no longer solely relies on advanced medical technology; vascular access plays a pivotal role," the authors pointed out. This emphasizes the importance of skilled nursing practices and standardized protocols to minimize infection risks.
Current literature suggests various protocols around catheter and device maintenance, with recommendations from the Society for Healthcare Epidemiology of America (SHEA) and other bodies indicating intervals of replacement from every 96 hours to every seven days. The study sought to refine these guidelines by evaluating real-world practices lacking standardization.
The findings suggest significant potential benefits to reducing the frequency of device replacements. Not only can this improve patient experience by minimizing unnecessary changes, but it could also lead to cost savings by reducing the wastage of medical supplies and labor costs associated with frequent replacements.
The research methodology included careful monitoring and documentation of patient conditions, catheter use, and all device replacements. Rigorous planning ensured comprehensive follow-up leading to insightful findings on the efficacy of existing practices. The methodology was approved by the ethics committee and adhered to international ethical guidelines throughout the process.
Results highlighted the average catheter indwelling time, which stood at roughly nine days, with 7.89% of those patients developing CRBSI. The data did not find meaningful differences among those who utilized varying numbers of devices, which indicates adherence to stringent aseptic techniques appeared far more favorable for avoiding infections than simply replacing devices at higher frequencies.
Given these insights, the authors conclude with proffering recommendations for nursing practices concerning the replacement of infusion devices; stressing the need for consistent adherence to aseptic principles over rigid stipulations on replacement intervals. This highlights the importance of preparing health professionals to respond flexibly to the nuanced needs of critically ill patients.
Adherence to evidence-based protocols and improved education around CVC maintenance—both for medical staff and patients—will be pivotal moving forward. This study hopes to act as the catalyst for future research revolutions, contributing broader knowledge to the domain of infection control within pediatric intensive care settings.
Future investigations may leverage these findings to explore varied external device configurations or protocols across diverse healthcare settings to validate the results on larger populations. The exploration of such effective practices can redefine catheter maintenance strategies, ensuring safer outcomes for vulnerable patients dependent on intravenous therapies.