Bundle implementation for reduction of central venous catheter associated bloodstream infections in pediatric intensive care unit - A systematic review.

BACKGROUND

Catheter associated bloodstream infections (CLABSI) are the most frequently reported healthcare-associated infections in pediatric intensive care units (PICUs). Largely preventable, CLABSI have prompted the global implementation of care bundles aimed at reducing infection rates, healthcare costs, length of stay, and mortality. Objective - To evaluate and compare the effectiveness of various care bundles in reducing CLABSI rates per 1000 catheter-days in PICUs.

METHODS

A systematic review of 23 original studies identified through PubMed, Embase, SciELO, BVS, and Scopus databases, selected in accordance with PRISMA guidelines. For each study, CLABSI rates before and after bundle implementation were extracted, and percentage reductions were calculated.

RESULTS

Baseline CLABSI rates ranged from 2.0 to 25.2 per 1000 catheter-days. Intervention durations varied from 3 months to 9 years. Post-intervention rates ranged from 0.7 to 14.3 per 1000 catheter-days. No study achieved a zero CLABSI rate although positively, over half of the studies reported a reduction superior to 50%. Methodological weaknesses significantly limited the reliability of effect estimates.

CONCLUSION

Care bundles are associated with meaningful reductions in CLABSI rates in PICUs. Although most studies lack rigorous design, the consistent improvements observed support their effectiveness. Randomized controlled trials would be needed to determine the effect size of individual bundle components.