Utrecht University, Utrecht, The Netherlands.
Intensive Care Med. 2013 Aug;39(8):1352-8. doi: 10.1007/s00134-013-2927-7. Epub 2013 Apr 25.
Central line-associated bloodstream infections (CLABSI) and ventilator-associated pneumonia (VAP) are common problems in adult, pediatric (PICU) and neonatal (NICU) intensive care unit patients. Care bundles have been developed to prevent these hospital-acquired infections and to provide best possible care. Studies in adults have proven that care bundles contribute to a decrease in CLABSI and VAP rates. The purpose of this literature review was to critically appraise the known evidence of the effectiveness of central line bundles and ventilator bundles in PICU and NICU patients. The number of publications of central line bundles and ventilator bundles in PICU and NICU patients is limited compared to adults. Ten studies in PICU patients demonstrated a significant decrease in the CLABSI or VAP rate after implementation of the bundle. Two studies in neonates demonstrated a reduction in the CLABSI rate after implementation of the central line bundle. No studies on the effectiveness of the ventilator bundle in neonates were found. Bundle elements differed between studies, and their scientific basis was not as robust as in adults. Monitoring of compliance to bundle elements seems required for optimal reduction of CLABSI and VAP. Bundle components that focus on maintenance of a central line probably are important to prevent CLABSI in children.
中心静脉导管相关性血流感染（CLABSI）和呼吸机相关性肺炎（VAP）是成人、儿科（PICU）和新生儿（NICU）重症监护病房患者常见的问题。已经开发了护理包来预防这些医院获得性感染并提供最佳护理。成人研究已证明护理包有助于降低 CLABSI 和 VAP 发生率。本文献复习的目的是批判性评估已知的中心静脉导管套件和呼吸机套件在 PICU 和 NICU 患者中的有效性证据。与成人相比，PICU 和 NICU 患者的中心静脉导管套件和呼吸机套件的出版物数量有限。十项 PICU 患者的研究表明，在实施套件后，CLABSI 或 VAP 发生率显著降低。两项关于新生儿的研究表明，在实施中心静脉导管套件后，CLABSI 发生率降低。未发现关于新生儿呼吸机套件有效性的研究。研究之间的套件元素不同，其科学基础不如成人牢固。为了最佳降低 CLABSI 和 VAP，似乎需要监测对套件元素的依从性。关注中心静脉维护的套件组件可能对预防儿童 CLABSI 很重要。
