Central-line-associated bloodstream infections in a surgical paediatric intensive care unit: Risk factors and prevention with chlorhexidine bathing

Cardiac output monitoring in children: a review

Cardiac output monitoring enables physiology-directed management of critically ill children and aids in the early detection of clinical deterioration. Multiple invasive techniques have been developed and have demonstrated ability to improve clinical outcomes. However, all require invasive arterial or venous catheters, with associated risks of infection, thrombosis and vascular injury. Non-invasive monitoring of cardiac output and fluid responsiveness in infants and children is an active area of interest and several proven techniques are available. Novel non-invasive cardiac output monitors offer a promising alternative to echocardiography and have proven their ability to influence clinical practice. Assessment of perfusion remains a challenge; however, technologies such as near-infrared spectroscopy and photoplethysmography may prove valuable clinical adjuncts in the future.

Effectiveness of Chlorhexidine-Impregnated Central Venous Catheter Dressing for Preventing Catheter-Related Bloodstream Infections in Pediatric Patients: A Systematic Review and Meta-Analysis Study

Objective The study's objective was to use meta-analysis to assess the effectiveness of a dressing impregnated with chlorhexidine in preventing catheter-related bloodstream infections (CRBSIs) in pediatric patients.

Methods The study was conducted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A comprehensive search of 18 databases was conducted up to 5 March 2020 to identify related studies. Following the evaluation of the methodological quality, 8 studies, 1,584 catheters in 1,556 patients were added to the meta-analysis. The odds ratio and Hedge's G effect size value were employed to analyze the data. Either a fixed-effects model or a random-effects model was used to compute the effect size value with 95% confidence intervals (CIs). The heterogeneity of effect sizes was investigated using Cochrane Q statistics, I 2, and Tau2 tests. To test for publication bias, funnel plot, Orwin's safe n number, Begg and Mazumdar rank correlation, Egger test, and Duval and Tweedie's trim and fill procedures were all utilized.

Results The catheter colonization risk was lowered by 50.7% by the chlorhexidine-impregnated (C-I) dressing (odds ratio [OR] = 0.493 [%95 CI: 0.360–0.675]; p < 0.001). The use of C-I dressing was associated with a trend toward a decrease in CRBSIs, while this association was not statistically significant (OR = 0.858 [%95 CI: 0.567–1.300]; p = 0.471).

Conclusion The use of C-I dressing can effectively reduce the risk of catheter colonization, and it is also a helpful tactic in lowering CRBSIs in pediatric patients with central venous catheters, according to the findings of this meta-analysis.

Enlisting Parents to Decrease Hospital-Acquired Central Line-Associated Infections in the Pediatric Intensive Care Unit

Hospital-acquired central line-associated bloodstream infections (CLABSIs) are the leading cause of infections in the pediatric intensive care unit. Bacteria responsible for CLABSIs are spread by health care workers, parents, and families and mitigated by scrupulous attention to hand hygiene and safety prevention strategies. Maintenance bundles are grouped elements, such as hand hygiene, standardized dressing and tubing changes, and aseptic technique for entering a central line, effective in preventing CLABSIs. Nurses can decrease the incidence of CLABSIs by using maintenance bundles and including parents and families in safety prevention strategies."