Disclosures: Bryant reports being a principal investigator on clinical trials funded by Enanta, Gilead Sciences and Pfizer, with payments made to her institution, and serving as immediate past president of the Pediatric Infectious Diseases Society.
March 18, 2022
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SHEA publishes white paper on CLABSIs in NICU

Disclosures: Bryant reports being a principal investigator on clinical trials funded by Enanta, Gilead Sciences and Pfizer, with payments made to her institution, and serving as immediate past president of the Pediatric Infectious Diseases Society.
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The Society for Healthcare Epidemiology of America published a white paper that includes guidance on implementing strategies to prevent central line-associated bloodstream infections in infants in the NICU.

The paper was written in response to guidelines coauthored by the CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC).

Baby in the NICU
A new white paper addresses CLABSIs in the NICU. Source: Adobe Stock

Co-author Kristina A. Bryant, MD, of Norton Children’s Hospital and the University of Louisville, said the paper was “many years in preparation” and was meant to accompany HICPAC’s recommendations.

“The CDC guidelines identify areas for which we either don't have enough data for CDC to make firm recommendations, or, in some cases, CDC makes a recommendation based on published data but doesn't really provide implementation guidance,” Bryant told Healio.

Kristina A. Bryant

“The purpose of the white paper is really in recognition of the fact that people need to go to work every day and take care of patients, even when we don't necessarily have all of the data that we would like,” Bryant said.

Bryant was part of the HICPAC, which co-authored the CDC’s recent guidance. As a result, the authors of the white paper were able to solicit feedback from that group.

“Central line-associated bloodstream infections (CLABSIs) are among the most frequent invasive infections among infants in the NICU and contribute to substantial morbidity and mortality,” they wrote. “Infants who survive CLABSIs have prolonged hospitalization resulting in increased health care costs and suffer greater comorbidities including worse neurodevelopmental and growth outcomes. A bundled approach to central line care practices in the NICU has reduced CLABSI rates significantly, but challenges remain.”

The questions addressed by the white paper include which NICU patients are likely to benefit from chlorhexidine (CHG) skin antisepsis, how often central venous catheter dressings should be changed in NICU infants, which NICU patients should be given CHG-impregnated sponges or dressings, whether alcohol disinfectant caps should be used in the NICU, and at what point a NICU should be prompted to consider adding further preventative measures.

“I think pediatricians, neonatologists and other clinicians who care for patients in the NICU know that CLABSIs cause substantial morbidity and mortality in in NICU patients,” Bryant said. “This is not a review of risk factors and background information. This is really meant to be a practical document that clinicians on the frontline can use to prevent CLABSI from reaching these vulnerable patients.”