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Table 1 Overview of interventions in and effectiveness of CVC bundles in neonatal intensive care unit and pediatric intensive care unit settings

From: Implementation of a children’s hospital-wide central venous catheter insertion and maintenance bundle

Author (year) Setting Design Intervention Reduction of CA-BSI Level of evidence
Wirtschafter et al. (2010) NICU A Proper CVC insertion, hand hygiene promotion, closed tubing system, improved hub care From 4.32 to 3.22 per 1000 line-days 2-
Sannoh et al. (2010) NICU B Hand hygiene promotion, proper hub care using chloorhexedine with alcohol, glove use promotion, CVC documentation From 23 to 12 per 1000 line-days* 2++
Bizzarro et al. (2010) NICU B Proper CVC placement, promotion of hand hygiene, daily evaluation CVC need, infection surveillance, dressing replaced on indication From 8.40 to 1.28 cases per 1000 line-days* 2+
Andersen et al. (2005) NICU# B Hand hygiene promotion, maximum barrier during CVC insertion, daily evaluation need for CVC removal From 21% to 9% (P=0.05, confidence intervals 0.19–1.0)* 2+
Costello et al. (2008) PICU C Hand hygiene promotion, daily evaluation need for CVC removal, CVC insertion kid From 7.8 to 4.7 and to 2.3 per 1000 line-days 2-
McKee et al. (2008) PICU D Proper insertion and nursing care, empower nurses to stop the insertion procedure if guidelines were not followed, using a checklist to ensure adherence to the guidelines, providing weekly performance feedback, promotion of hand hygiene, chlorhexedine skin preparation, From 5.2 to 3.0 per 1000 line-days* 2+
Jeffries et al. (2009) PICU E Maximum sterile barrier during CVC insertion, hand hygiene promotion, apply transparent dressing, prepare skin with anti and/ or detergent chlorhexidine gluconate 2%, From 6.3 to 4.3 per 1000 line-days* 2+
Miller et al. (2010) PICU F Disinfect catheter site using chlorhexedine, maximum barrier, full barrier during pre-packages of the insertion tray, daily assess CVC need, gauze change every 2 days From 5.4 to 3.1 per 1000 line-days* 2+
Wheeler et al. (2011) Children’s hospital-wide D Full barrier precautions, chlorhexedine skin preparation with 2 minutes scrub and 1 minute air dry, use of insertion checklist, staff empowerment to stop the insertion procedure, daily assess CVC need, promotion of hand hygiene, chlorhexidine-impregnated sponge placed at insertion site, glove use for all CVC manipulations, change dressing every 7 day or on indication earlier, replace tubing sets no more than 72 hour, cap change every 7 day From 3 to <1 per 1000 line-days* 2+
Chuengchitraks et al. (2010) PICU G Promotion of hand hygiene, maximal barrier precautions, provide skin antiseptic, optimal catheter site selection From 2.6 to 2.4 per 1000 line-days 2-
  1. Design: A: multi center prospective pre-test posttest study; B: single center prospective pretest and posttest study; C: single center retrospective pretest and prospective posttest group, interrupted time series design; D: single center retrospective pretest and prospective posttest group, time series design; E: multicenter, prospective pretest and posttest group, time series; F: multicenter retrospective pretest and posttest group, interrupted time series; G: single center cohort study; 1++ High-quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias; 1+ Well-conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias; 1- Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of bias; 2++ High-quality systematic reviews of case–control or cohort studies, or high-quality case–control or cohort studies with a very low risk of confounding, bias, or chance and a high probability that the relationship is causal; 2+ Well-conducted case–control or cohort studies with a low risk of confounding, bias, or chance and a moderate probability that the relationship is causal; 2- Case–control or cohort studies with a high risk of confounding, bias or chance, and a significant probability that the relationship is not causal; 3 Non-analytic studies; for example, case reports, case series; 4 Expert opinion.
  2. CVC central venous catheter, BSI bloodstream infection, NICU neonatal intensive care unit, PICU pediatric critical care unit.
  3. #Premature born infants with birth weight < 1500 grams; and *indicate significant reduction of bloodstream infections per 1000 line-days.