Higher CRBSI in Peds and NICU?

[WildcatFanRN, BSN, RN]

At a local AACN meeting the topic was catheter related blood stream infection prevention, using Chlorhexidine and the biopatch. During the presentation the presenter showed that there are higher rates of these kinds of infections in pediatric and NICU populations, but didn't go into detail as the topic was adults mainly. Have any of you seen or experienced this. I'm looking up information as I post this, but find it interesting that this could be the case. Do the bundles that are preached for adult ICU's comparable to what is done in peds and neonatal populations?

The preventative given was to give daily baths with chlorhexidine as well as use the proper prep techniques. Chlorhexidine is known to be very drying to the skin, how do you keep neonatal skin healthy with that kind of guideline?

I don't yet work in a NICU, but I am very curious about this.

[prmenrs, RN]

You have to be careful putting solutions like Chlorhexidine on neonatal/premie skin, as it's more permeable than grown-up skin. I'd be very interested in current practices in Level 3 nurseries.

[umcRN, BSN, RN]

Chlorehexadine baths are NOT done in my NICU and in the peds cardiac icu I work in the wipes are not to be used on any baby under 36wks gestation until they are a month old.

All dressing changes are done sterile, once a week or when soiled/wet, the biopatch is not used on premature infants. All our ICU's have won awards for reduction in CLBSI's so I suppose we're doing something right. In the NICU babies get soap & water baths as well and we haven't had any issues with that however in the PICU/CICU they do not do soap/water baths on pts with central lines.

[NicuGal, MSN, RN]

We don't bath kids in chlorhex. We will use bactistat once a week on our MRSA+ kids. We use chlorhex in kids over a kilo and betadine on the ones below. We also use biopatches on our kids over 28 weeks gestation with intact skin. We have a Central line bundle we follow and we have little to no infections. We are looking at using a transparent dressing that is impregnated with chlorhex, easier to see the insertion site! We change dressing once a week unless soiled or loose. We have a high number of them in the groin since that is where IR likes to put them, and since we went to biopatches it has greatly reduced our infection, esp within this site!

[WildcatFanRN, BSN, RN]

One thing the presenter mentioned was using PICC's impregnated with chlorhexidine. She did say soap and water baths are better than nothing. None of the articles I've found say anything about chlorhex baths for neonates. My guess is following the central line bundle.

Why would biopatches not be used with neonates? Skin permiability?

[prmenrs, RN]

re: soap. Soap is very alkaline and destroys the acid mantle that acts as a microbial barrier on skin. Baby bath is pH neutral and does not do that. It's better to use baby bath on babies when they are mature enough to have a bath other than sterile water.

[NicuGal, MSN, RN]

The biopatches release the chlorhex constantly and when their skin isn't fully developed they can absorb the chlorhex. We are also very careful with betadine use and make sure it is washed off asap as they can absorb the iodine in it and it will also cause burns if left on, as will the chlorhex. You have to remember that the skin of a preemie is so thin, transparent as the epidermis is not fully developed.

[WildcatFanRN, BSN, RN]

The biopatches release the chlorhex constantly and when their skin isn't fully developed they can absorb the chlorhex. We are also very careful with betadine use and make sure it is washed off asap as they can absorb the iodine in it and it will also cause burns if left on, as will the chlorhex. You have to remember that the skin of a preemie is so thin, transparent as the epidermis is not fully developed.

Thanks, that's what I was thinking. I was shocked when she put up that chart saying how high the CRBSI rates were compared to adult ICU's. Especially since NICU's are so on top of anything infection-wise, at least the one I did my RNA time on was. I wonder if the researchers take into consideration skin type when making recomendations?

[NicuGal, MSN, RN]

Did she site her references? There are nicus with high numbers, just as I am sure there are adult icus with high numbers. Our kids can also get sepsis from other sources besides their lines since they are so immunocompromised. We get kids with sepsis from having a sick gut because their gut wall is so fragile and they don't have a protective coating in the lining yet, ecoli loves to travel when it can. That is just one example. the most common sepsis from a line is staph, which has dropped dramatically with the new central line bundles that most places have put into effect. Better skin prep, better maintainence of lines, better understanding of how to access lines and the use of closed systems. Things like this have made our numbers better.

[WildcatFanRN, BSN, RN]

Did she site her references? There are nicus with high numbers, just as I am sure there are adult icus with high numbers. Our kids can also get sepsis from other sources besides their lines since they are so immunocompromised. We get kids with sepsis from having a sick gut because their gut wall is so fragile and they don't have a protective coating in the lining yet, ecoli loves to travel when it can. That is just one example. the most common sepsis from a line is staph, which has dropped dramatically with the new central line bundles that most places have put into effect. Better skin prep, better maintainence of lines, better understanding of how to access lines and the use of closed systems. Things like this have made our numbers better.

She didn't site them off hand, I'll have to look at the handout. I think she was going by the research she was the researcher in. One thing she was big on talking about was biofilms and where they can grow and be found. I honestly felt I was in a microbiology class. Scarey where you can find them.