Reduction of bloodstream infections associated with catheters in paediatric intensive care unit: stepwise approachBMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39064.457025.DE (Published 15 February 2007) Cite this as: BMJ 2007;334:362
All rapid responses
While it is, as always, commendable that the authors of this paper
took clearly effective steps to remedy what was a significant local
problem, the results don't/shouldn't show us anything new in terms of the
procedure of insertion of CVCs. The impact of the interventions on the
results lead to the obvious question; what was practice like beforehand if
they had such an effect?
The interventions cited, other than the use of antibiotic-impregnated
CVCs, would be regarded as routine practice in the majority of ICUs in
this country. The implication that this wasn't the case prior to their
formal introduction in the unit in question would account for their high
rates of infection at the outset. The changes in infection rates
immediately following antibiotic impregnated CVCs introduction on the
graph in the article might be an accurate reflection of their clinical
impact on the shopfloor i.e minimal in comparison to the other measures.
The design of physical barriers between patients beds is highlighted, but
the crucial feature in this intervention is surely the 5-fold increase in
both handwashing stations and alcohol gel dispensers on the unit?
It is interesting to note that the rates of infection begin to show a slow
rise approximately 18 months to 2 years after the introduction of
impregnated CVCs & handwashing campaign, and then again the same
period after introduction of chlorhexidine. This could reflect the
diminished impact of an intervention as both its novelty, ad strict
adherence to it, wears off.
There is a relatively high rate of infection even after the interventions
are all in place, suggesting that there is still room for improvement, a
feature no doubt not limited purely to this unit.
Competing interests: No competing interests