Background: According to the Centres for Disease Control and Prevention, central line-associated bloodstream infection (CLABSI) is a laboratory-confirmed bloodstream infection not related to an infection at another site that develops within 48 h of central line placement. Central line-associated bloodstream infection in the Neonatal Intensive Care Unit contributes to increased morbidity and hospital mortality. This study aimed to prove the relationship between peripherally inserted central catheter dwell time and the incidence of CLABSI among neonates at our tertiary center hospital in Bali, Indonesia. Methods: This study was conducted based on a prospective cohort study design. The subjects were neonates admitted in levels 2 and 3 of the neonatology wards of Sanglah Hospital, Bali, Indonesia, between November 2018 to December 2020. The cases were followed during the insertion of a central catheter. Statistical analysis was performed using the Chi-square test and logistic regression with a p-value of < 0.05. Results: Subjects were recruited consecutively and fulfilled the research criteria as many as 114 people. A total of 63 subjects were excluded, and none of the cases was lost for follow-up. The incidence rate of CLABSI was obtained at 19.2‰ among the 114 subjects. The patients with a catheter dwell time of ˃ 14 days, compared to those with a catheter dwell time of ≤ 14 days, had a 2.9-fold risk of experiencing CLABSI (95% confidence interval: 1.191-7.497, P=0.02). No other risk factors were found for CLABSI development. Conclusion: The results of this study demonstrated that the risk of CLABSI in subjects with a catheter dwell time of ˃ 14 days was 2.9. Therefore, the implementation of the CLABSI bundle is necessary to decrease CLABSI incidence in neonates.
Zingg W, Posfay-Barbe KM, Pfister RE, Touveneau S, Pittet D. Individualized catheter surveillance among neonates: a prospective, 8-year, single-center experience. Infect Control Hosp Epidemiol. 2011;32:42-9.
O’Grady NP, Alexander M, Burn LA, Dellinger PE, Garland J, Heard S, Lipsett PA, Maur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S. Guidelines for the prevention of intravascular catheter-related infections; 2011.
Bashir RA, Swarnam K, Vayalthrikkovil S, Yee W, Soraisham AS. Association between peripherally inserted central venous catheter insertion site and complication rates in preterm infants. Am J Perinatol. 2016;33(10):945-50.
Hoang V, Sills J, Chandler M, Busalani E, Clifton-Koeppel R, Modanlou HD. Percutaneously inserted central catheter for total parenteral nutrition in neonates: complications rates related to upper versus lower extremity insertion. Pediatrics. 2008;121(5):e1152-9.
Cartwright D. Central venous lines in neonates: a study of 2186 catheters. Arch Dis Child Fetal Neonatal Ed. 2004;89(6):F504–8.
Casner M, Hoesli SJ, Slaughter JC, Hill M, Weitkamp JH. Incidence of catheter-related bloodstream infections in neonates following removal of peripherally inserted central venous catheters. Pediatr Crit Care Med. 2013;15(1):1-7.
Dubbink-Verheij GH, Bekker V, Pelsma ICM, van Zwet EW, Smits-Wintjens VE, Steggerda SJ, TePas AB, Lopriore E. Bloodstream infection incidence of different central venous catheters in neonates: a descriptive cohort study. Front Pediatr. 2017; 20:5:142-7.
Malek AM, Abouseif HA, Abd Elaziz KH, Allam MF, Fahim HI. Incidence of central line-associated bloodstream infections in intensive care units in a private hospital (Cairo, Egypt). Open Public Health J. 2018;11:562-72.
Abdullah NA. Epidemiology of central line-associated bloodstream infection (CLABSI) among patients in intensive care units (ICUs) at a teaching hospital in Saudi Arabia from year 2011-2016. J Crit Care. 2018;4(12):1-6.
Dahan M, O'Donnell S, Hebert J, Gonzales M, Lee B, Chandran AU. CLABSI Risk factors in the NICU: potential for prevention: a PICNIC study. Infect Control Hosp Epidemiol. 2014;37:1446-52.
Mobley RE and Bizzarro MJ. Central line-associated bloodstream infections in the NICU: successes and controversies in the quest for zero. Semin Perinatol. 2017;41:166-74.
Kusek L, Soule BM, Kupka N, William S, Koss R, Loeb J. Preventing central line associated bloodstream infection: a global challenge, a global perspective. Oakbrook Terrace, IL: Joint Commission Resources; 2012. 3-11.
Fontela PS, Platt RW, Rocher I, Frenette C, Moore D, Fortin, Quach C. Epidemiology of central line–associated bloodstream infections in Quebec Intensive Care Units: a 6-year review. Am J Infect Control. 2012;40:221-6.
Milstone AM, Reich NG, Advani S, Yuan G, Bryant K, Coffin SE, et al. Catheter dwell time and CLABSI in neonates with PICC: a multicenter cohort study. Pediatrics. 2013;132:e1609-15.
Greenberg RG, Cochran KM, Smith PB, Edson BS, Schulman J, Lee HC, Govindaswami B, Pantoja A, Ittmann P, Duncan S, Gupta M, Picarillo A, Karna P, Cohen M, Giuliano M, Caroll S, Page B, Walker MW, Garland J, Ancona JK, Laughon MW, McCaffrey MJ. Effect of catheter dwell time on risk of central line–associated bloodstream infection in infants. Pediatrics. 2015;136(6):1080-6.
Sengupta A, Lehmann C, Diener-West M, Peri TM, Milestone AM. Catheter duration and risk of central line-associated bloodstream infection in neonates with PICC. Pediatrics, 2010;124:648-53.
de Brito CS, de Brito DVD, Abdallah VO, Gontijo Filho PP. Occurrence of bloodstream infection with different types of central vascular catheter in critically neonates. J Infect. 2010;60:128‐32.
Hsu JF, Tsai MH, Huang HR, Lien R, Chu SM, Huang CB. Risk factors of catheter-related bloodstream infection with percutaneously inserted central venous catheters in very low birth weight infants: a center's experience in Taiwan. Pediatr Neonatol. 2010;51:336-42.
Ekaputri, D., Sukmawati, M., Sidiartha, I. G. L., Nilawati, G. A. P., Utama, I. M. G. D. L., & Gustawan, I. W. (2022). Peripherally Inserted Central Catheter Dwell Time as a Risk Factor of Central Line-Associated Bloodstream Infection in Neonates. Iranian Journal of Neonatology IJN, 13(2), 39-45. doi: 10.22038/ijn.2022.60748.2157
Dian Sulistya Ekaputri; Made Sukmawati; I Gusti Lanang Sidiartha; Gusti Ayu Putu Nilawati; I Made Gde Dwi Lingga Utama; I Wayan Gustawan. "Peripherally Inserted Central Catheter Dwell Time as a Risk Factor of Central Line-Associated Bloodstream Infection in Neonates". Iranian Journal of Neonatology IJN, 13, 2, 2022, 39-45. doi: 10.22038/ijn.2022.60748.2157
Ekaputri, D., Sukmawati, M., Sidiartha, I. G. L., Nilawati, G. A. P., Utama, I. M. G. D. L., Gustawan, I. W. (2022). 'Peripherally Inserted Central Catheter Dwell Time as a Risk Factor of Central Line-Associated Bloodstream Infection in Neonates', Iranian Journal of Neonatology IJN, 13(2), pp. 39-45. doi: 10.22038/ijn.2022.60748.2157
Ekaputri, D., Sukmawati, M., Sidiartha, I. G. L., Nilawati, G. A. P., Utama, I. M. G. D. L., Gustawan, I. W. Peripherally Inserted Central Catheter Dwell Time as a Risk Factor of Central Line-Associated Bloodstream Infection in Neonates. Iranian Journal of Neonatology IJN, 2022; 13(2): 39-45. doi: 10.22038/ijn.2022.60748.2157