Evaluating central venous catheter care in a pediatric intensive care unit.

BACKGROUND: Catheter-related bloodstream infection remains an important health problem for hospitalized children. Although placement of a central venous catheter is a life-saving intervention for critically ill children, these same central catheters are a potential source of infection.

OBJECTIVES: Few studies that directly address care of central venous catheters for children in intensive care units have been reported. This evaluation was designed to describe the extent of evidence-based practices for care of insertion sites of central venous catheters in the pediatric intensive care unit of an urban tertiary care center. Another goal was to determine the influence of 2 different regimens for dressing changes on rates of catheter-related bloodstream infections and costs.

METHODS: A convenience sample and an exploratory design were used to collect data in 2 phases, including 30 days to establish baseline information and 30 days each during which patients received dressing care for a central venous catheter with a transparent dressing alone and with a transparent dressing plus a chlorhexidine-impregnated dressing. Nurses also participated in a survey of knowledge about infection control practices related to central catheters.

RESULTS: Few differences were found between the transparent dressing alone and a chlorhexidine-impregnated dressing plus the transparent dressing. A serendipitous finding was the number of times that central catheters were accessed daily.

CONCLUSIONS: The results of this project suggest that infection control efforts may be most appropriately focused on processes rather than on products.