The impact of central line-specific dwell-times for neonatal central line associated bloodstream infections.

Background: Central line-associated bloodstream infections (CLABSIs) are among the most serious infectious complications associated with central lines in neonates. CLABSIs can be prevented by healthcare workers using "bundles" when inserting and managing central lines. These include prompt removal of the central line when it is no longer needed. The aim of this study was to describe and analyze neonatal CLABSIs, focusing on a minimal data set including specific catheter types and dwell times.

Methods: A retrospective descriptive study reviewing the management and outcome of neonates with CLABSI admitted to the Department of Neonatology and Neonatal Intensive Care at the Children's Hospital of Central Switzerland in Lucerne from 1 January 2020 to 31 December 2023.

Results: In this four-year period, a total of 27,636 neonates were born in the catchment area and 2599 neonates (9.4%) were admitted to our hospital. In total, 615 neonates (23.7%) had at least one central line with a total of 4940 catheter days. We observed an overall neonatal CLABSI rate of 2.9 per 1,000 catheter days. The rate varied significantly by catheter type: 0 per 1,000 catheter days for umbilical artery catheters (UACs), 0.9 per 1,000 catheter days for peripherally inserted central lines (PICCs), 5.6 per 1,000 catheter days for umbilical venous catheters (UVCs), and 17.9 per 1,000 catheter days for centrally inserted venous catheters (CVCs). All episodes of CLABSI were observed after a dwell time of 5 days, with increasing rates after 9 days.

Conclusions: We observed a pronounced variation in CLABSI rates between different catheter types. All episodes of CLABSI were observed after a dwell time of 5 days, with increasing rates after 9 days, and the rate of CLABSI increased with longer dwell times for UVCs and CVCs. This suggests a reduction in dwell time as a potential strategy for future quality improvement programs aiming for a zero CLABSI rate and underlines the importance of reporting central-line specific dwell-times for future publications.