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Proef ingediend met het oog op het behalen
van de graad van Master in de Geneeskunde
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
LEEMAN MARTINE
2017-2018
Promotor: Prof. Dr. Filip Cools
Researcher: Mevr. Brenda Van Delft
Geneeskunde & Farmacie
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
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TABLE OF CONTENTS
TABLE OF CONTENTS .................................................................................................................. 2
1. ABSTRACT ........................................................................................................................... 4
2. INTRODUCTION .................................................................................................................. 6
3. METHODOLOGY ..................................................................................................................... 8
3.1 LITERATURE STUDY ........................................................................................................... 8
3.2 DEVELOPMENT OF A CARE BUNDLE ................................................................................. 8
3.2.1 Recommendations regarding checklist and responsibility ............................................ 8
3.2.2 Recommendations regarding hand hygiene and aseptic technique ......................... 8
3.2.3 Recommendations regarding maximal sterile barrier precautions .............................. 8
3.2.4 Recommendations regarding skin preparation ......................................................... 9
3.2.5 Recommendations regarding disinfection of access ports ........................................... 9
3.2.6 Recommendations regarding CVC ................................................................................. 9
3.2.7 Recommendations regarding dressing .................................................................... 10
3.3 STUDY POPULATION ....................................................................................................... 10
3.4 OBSERVATIONS ............................................................................................................... 10
3.5 MEDICAL ETHICAL COMMITTEE...................................................................................... 11
3.6 STATISTICAL DATA ANALYSIS .......................................................................................... 11
4. RESULTS ............................................................................................................................ 12
4.1 GENERAL ......................................................................................................................... 12
4.2 CHARACTERISTICS ........................................................................................................... 12
4.3 CVC PLACEMENT ............................................................................................................. 15
4.3.1 Significant predictors in literature ........................................................................... 15
4.3.2 P value <0,05 (LR or Mann Whitney U test) ............................................................ 15
4.3.3 Checklist ................................................................................................................... 16
4.4 BANDAGE ........................................................................................................................ 18
5. DISCUSSION ...................................................................................................................... 19
6. CONCLUSION ........................................................................................................................ 21
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
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ACKNOWLEDGMENT ................................................................................................................ 22
REFERENCES ............................................................................................................................. 23
APPENDIX 1: LIST OF ABBREVIATIONS .................................................................................... 27
APPENDIX 2: APPROVAL MEDICAL ETHICAL COMMITTEE ...................................................... 28
APPENDIX 3: CHECKLIST .......................................................................................................... 30
APPENDIX 4: STATISTICAL DATA ANALYSIS CATEGORICAL VARIABLES ................................... 31
APPENDIX 5: STATISTICAL DATA ANALYSIS QUANTITATIVE VARIABLES ................................. 48
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
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1. ABSTRACT
AIM OF THE STUDY
Numerous studies described in evidence based literature demonstrate that the
implementation of insertion and maintenance bundles has a significant positive effect on the
incidence of central line associated bloodstream infection (CLABSI) in a neonatal intensive
care unit (NICU). This study aims to provide an answer to the following questions:
What are significant independent predictors of CLABSI in NICU patients?
What is the effect of the implementation of insertion and maintenance bundles on the
incidence of central line associated bloodstream infections in patients admitted in the
neonatal intensive care unit UZ Brussels?
METHODS
This prospective, observational, non-randomized, non-experimental trial with pretest posttest
design is executed in 3 phases.
Baseline measurement included collection of data in order to calculate the incidence of
catheter related bloodstream infections before implementation of care bundles.
Phase 2 included creation and implementation of care bundles. This was was proceeded by a
rigorous literature study focusing on insertion and maintenance bundles use in NICU.
Posttest measurement included collection of data in order to calculate the incidence of
catheter related bloodstream infections after implementation of care bundles.
Data was subjected to statistical analysis using SPSS 25. Univariate analysis was applied.
RESULTS
In the comparison of pretest to posttest period a significant result was achieved in the
category of birthweight <1500 grams (p=0,09). Univariate logistic regression confirmed this
result (p=0,028 OR=0,78 95% CI (0,08;0,765)).
Catheter dwell time shows to be a significant risk factor in the posttest period (p=0,045 OR=
1,27 95% CI (1,003;1,266)).
Analysis of PICC connection sterility as a risk factor showed a significant difference (p=0,006)
in pretest to posttest period comparison. This significant result was also visible in univariate
logistic regression (p=0,023 OR=0,079 95% BI (0,009;0,706)).
The number of times a dressing is reattached, is a significant risk factor in the pretest period
(p=0,013). This significance stays present after using univariate logistic regression (p=0,033
OR=8,039 95% CI (1,187;54,436))
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
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In the comparison of pretest to posttest period of birthweight as a risk factor, a significant
result was achieved in the category of birthweight <1500 grams (p=0,09). Univariate logistic
regression confirmed this (p=0,028 OR=0,78 95% CI (0,08;0,765))
Temperature of NICU in pretest period shows to be a significant predictor for CLABSI (p pretest period=0,025/p posttest period=0,076). Using univariate logistic regression, this significance is confirmed (p=0,033 OR=3,364 95% CI (1,102;10,267))
CONCLUSION
In the analysis of CLABSI predictors, no significant risk factors could be withheld. CLABSI rate
showed no significant difference in pretest and posttest population after implementation of
an insertion and maintenance bundle.
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
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2. INTRODUCTION
Newborn infants in critical conditions require a permanent intravenous line to allow for the
administration of fluids, parenteral nutrition and drugs. The use of a central catheter is
associated with an increased risk of morbidity and sepsis, leading to prolonged hospitalization
and increased hospitalization costs in Neonatal intensive care units. (1) Central line associated
bloodstream infection (CLABSI) is estimated to cause up to 70% of all hospital acquired
bloodstream infections in preterm infants. (2) The incidence of infectious complications varies
from a mean of 11.3 per 1000 catheter days in minus 1 kg infants to 6.9,4.0 and 3.8 per 1000
catheter days in 1001-1500g, 1501-2500 g and > 2500 g infants, respectively.(1)
CLABSI is a surveillance definition used by CDC and defined as follows: Recovery of a pathogen
from a blood culture (a single blood culture for organism not commonly present on the skin,
and two or more blood cultures for an organism commonly present on the skin) in a patient
who had a CVC at the time of infection or within 48 hours before development of infection.
The infection cannot be related to any other infection. (10)
Most common found organisms implicated in CLABSI are gram-positive cocci. More specifically, coagulase-negative Staphylococci (Co NS) are the leading cause. They were identified in 42,9% of CLABSI. The second leading cause was found to be Staphylococcus aureus. (9) In the presence of Staphylococcus aureus, fibronectin binding proteins facilitate attachment of Staphylococcus aureus to host cells and to fibronectin-coated biomaterials. Staphylococci also tend to colonize the catheter surface by the formation of a multilayered biofilm, which offers also some protection against antibiotics. Recently, there is a frequent detection of methicillin-resistant Staphylococcus aureus (MRSA), and extended spectrum B-lactamases (ESBL) and carbapenemases producing bacteria. Other less frequent pathogens are gram-negative bacilli (Enterobacter spp. Escherichia Coli, Pseudomonas aeruginosa, Klebsiella spp.) and Candida spp. However, it should be taken into consideration that the incidence of each pathogen isolated from catheters differs among NICU’s. Four distinct pathways in the infection process are possible; internal and external catheter surface colonization, intrinsic contamination and hematogenous spreading. External pathway surface infection occurs mostly after 7-10 days of placement of the central venous catheter. Micro-organisms of the skin flora migrate along the external surface of the catheter from the skin insertion site through the transcutaneous part of the dermal tunnel surrounding the catheter to the intravascular tip of the catheter. Non tunneled catheters are at higher risk for CLABSI.
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
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Internal surface pathway infections usually occur after 10 days and are caused by colonization of the hub and intraluminal surface of the catheter. Contamination mostly originates from health care provider’s hands when standard aseptic precautions to access the hub failed. After manipulation of the hub, the pathogens then migrate intraluminally with the potential of reaching the distal tip in the bloodstream. Less common mechanisms are the intrinsic and hematogenous contamination. In intrinsic contamination the source of infection is a contaminated infusate (fluids or drugs intravenously administered). In these circumstances, les common organisms such as Enterobacter spp. , Serratia Marcescens, Malasezia furfur or Candida parapsilosis can be identified. And finally, hematogenous seeding of the catheter during a bloodstream infection of any origin represents the last pathway. (1,2,3) In a study of independent risk factors for CLABSI in NICU patients, catheter hub colonization
was the strongest predictor of subsequent CLABSI followed by exit site colonization, weight at
the time of insertion lower than 1 kg, postnatal age over 7 days and days of total parenteral
nutrition (TPN). (4) NICU patient volume also correlated with CLABSI rate. Higher patient
volume NICU’s tended to have lower CLABSI rates (p=0,02 OR= 0,49 95% BI (0,27;0,90)). (14)
Catheter dwell time also poses an important risk for developing CLABSI. (7) Risk increases
during the first two weeks after catheter placement. The risk remains elevated afterwards as
long as the catheter stays in place. (6)
CLABSI was long thought to be an unavoidable complication of maintaining central venous
access in critically ill newborns. However, recent studies have proven that the use of insertion
and maintenance bundles significantly lowers the incidence of CLABSI. (5, 14, 15, 17, 18)
A bundle is defined as a group of evidence-based care practices that, when implemented
together, result in a better outcome than each individual component separately. (16)
Insertion bundles focus mainly on hand hygiene, use of maximal barrier precautions including
sterile gown, sterile gloves, surgical mask, hat and large sterile drape, proper disinfection, use
of the right dressing or gauze and use of a dedicated team with special training in insertion
and maintenance of central lines. (4)
Maintenance bundles focus mainly on proper hand hygiene, evaluation of catheter insertion
site, correct disinfection, removal of catheter when no longer necessary, addition of 0,5 U/ml
heparin to total parenteral nutrition and minimalization of catheter access ports. (4)
Fisher et. Al reported a 71% CLABI reduction rate from 3.94 infections per 1000 catheterdays
to 1,16 infections per 1000 catheterdays with sustained result one year after implementation
of an insertion and maintenance bundle in a collaboration of 13 neonatal intensive care units.
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
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3. METHODOLOGY
3.1 LITERATURE STUDY
Data collection was proceeded by a rigorous literature study focussing on insertion and
maintenance bundles use in NICU. The results of this literature study were used to develop a
tailor made insertion and maintenance care bundle for application in the NICU UZ Brussels.
This study and development took place in collaboration with the VIKA (vragen incidenten
klachten aanbevelingen) task force.
3.2 DEVELOPMENT OF A CARE BUNDLE
The CVC care bundle developed by the VIKA task force consists of evidence based guidelines
to improve quality of care and to prevent infection. These guidelines are based on the CDC,
NHS and IHI guidelines regarding central vascular catheters (CVC), and articles. (11,12,13)
3.2.1 Recommendations regarding checklist and responsibility
To improve patient security, to comply with regulations of the local healthcare department, and to induce a change in habits, a checklist should be filled out. (Appendix)
Healthcare personnel should be educated regarding the indications for CVC use and proper procedures for the insertion and maintenance of CVC.
Only trained persons are allowed to place a CVC, in any other case they should be supervised by an expert.
Use of an intravenous (IV) team reduces the risk to develop CLABSI.
3.2.2 Recommendations regarding hand hygiene and aseptic technique
Hand hygiene should be performed according to regulations of the UZ Brussels.
Hand hygiene procedures should be performed, either by washing hands with soap and water or with alcohol-based hand rubs.
Hand hygiene should be performed before and after palpating catheter insertion site as well as before and after inserting, replacing, or rinsing the CVC.
Two pairs of sterile gloves should be used, one before disinfection of the insertion site, one before CVC placement.
Sterile gloves should always be used when manipulating a CVC.
3.2.3 Recommendations regarding maximal sterile barrier precautions
Sterile gloves, a mouth mask, a medical hat and a sterile full body drape should be used for the insertion of a CVC.
A sterile field must cover the complete insertion site.
An adherable sterile sleeve should be used to protect any other invasive catheters.
Two pairs of sterile gloves should be used.
The patient’s environment should be protected by placing panels. This will also give a warning to other persons.
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
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3.2.4 Recommendations regarding skin preparation
In case of newborns < 1000 grams, Hibidil should be used.
In case of newborns > 1000 grams, or after two weeks in case of newborns with birth weight < 1000 grams, Cedium Chlorhexidin should be used.
One should be carefull with heat radiation, eg. phototherapy or an incubator with heat radiation. The effect of the antiseptic will increase and chemical burns are possible.
It should be ensured that dressings are not soaked. Body temperature of the newborn or radiation heat can increase the effect of the antiseptic and cause chemical burns.
A large area has to be disinfected.
A drying time of 30 seconds should be respected when using Cedium Chlorhexidin.
When using Hibidil, which doesn’t dry spontaneously, excess antiseptic can be removed using a sterile gauze.
3.2.5 Recommendations regarding disinfection of access ports
All claves, needleless valves and other intravascular access ports should be disinfected with an appropriate antiseptic before use, change or administration of perfusion.
Access ports should be disinfected during 15 seconds after which a drying time of 30 seconds is imposed.
When manipulating access ports, hand hygiene should be performed. Gloves should be used every time when manipulating an IV system.
Every member of the staff should be informed or trained regarding standard protocol in disinfecting catheter hubs, needleless connectors and access ports before and after every catheter manipulation.
Every member of the staff should be informed regarding the consequences of applying a bad technique while refreshing the correct technique.
Sampling should be performed to supervise disinfection procedures before and after use of CVC. The results should be reported and taken into account.
Every process should be evaluated and new techniques investigated.
A multimodal quality control infection prevention program should be implemented in order to achieve compliance to guidelines and recommendations during all actions.
3.2.6 Recommendations regarding CVC
The need for use of a CVC should be evaluated.
Catheter type should be evaluated, preferably UVC should be used if possible.
Before start of the procedure, distance for UVC and PICC should be measured.
In case of a umbilical venous catheter (UVC), a double lumen catheter should be used. In case of a peripherally inserted central venous catheter (PICC), the necessity of a double lumen catheter should be evaluated.
In case of a double lumen PICC, two bags of total TPN should be ordered.
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
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A chest x-ray should be performed afterwards to check position.
Necessity of the CVC should be evaluated daily.
Replacement of the CVC should only happen in case of malfunctioning.
3.2.7 Recommendations regarding dressing
A dressing that is applied correctly will limit the need to replace the dressing to a minimum.
A dressing that is applied correctly will minimalize the risk of loosening of the dressing, displacement of the catheter and infection.
Application and replacement of the dressing should always be executed by two nurses in a sterile environment.
Replacement is only recommended in case of loosening, moist or visibly soiled dressing. (dry bloody dressing excluded)
Replacement of the dressing should be executed with care and enough time should be provided.
Before starting the procedure, all steps should be evaluated.
The dressing should be adjusted to the shape of the hand, fingers and joints by cutting the Tegaderm.
This care bundle was implemented between pretest and posttest period.
3.3 STUDY POPULATION
Pretest period extended from 01/12/2016 until 30/06/2017. During this period, catheter
placement was executed in a population of 92 patients. Of this 92 cases, 36 were not included
in the study due to unsigned informed consent or other reasons. 56 cases provided a signed
informed consent and data was collected. Of this 56 cases 13 were excluded based on
congenital malformation (6), early onset infection (EOS) (5) and catheter placement failure
(2). Data of 43 cases was effectively used in data processing.
Posttest period extended from 01/10/2017 until 28/02/2018. 27 patients who had a catheter
placement during this period were not included in the study, due to unsigned informed
consent or other reasons. Data was gathered of 33 cases. After evaluation, 6 cases were
excluded based on congenital malformation (2), EOS (3) and catheter placement failure(1).
Data of the remaining 27 cases was effectively used in the analysis.
3.4 OBSERVATIONS
During the pretest and posttest period, several forms had to be filled out at every procedure: checklist (implemented in care bundle), observation form UVC placement, observation form PICC placement, observation form dressing, observation form manipulations.
CLABSI rate was also monitored. A CLABSI was defined as a culture proven infection or a
clinically documented infection. Clinically documented infection was defined as a combination
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
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of CRP > 10 occurring > 48u and signs of illness, when this could not be attributed to any other
cause.
3.5 MEDICAL ETHICAL COMMITTEE
Approval was granted by the medical ethical committee of the UZ (Universitair Ziekenhuis)
Brussels on November 23th 2016.
3.6 STATISTICAL DATA ANALYSIS
All data gathered from the checklist and observation forms in pretest and posttest period were
collected in one excel file, which was implemented in SPSS 25. Missing data were coded as
missing values. In case an action was reported as not executed, this was coded as value 0.
A descriptive statistical analysis was then executed. Variables were all coded as categorical or
quantitative.
For categorical variables, frequencies, mode and missing values were summarized.
Since data distribution of quantitative variables tended to be skewed or not normal, median
was reported as a measure of centre of data distribution. Range and interquartile range were
reported as a measure of variability of the data. Frequencies and missing values were also
accounted for. In the pretest and posttest population of patients having CLABSI, interquartile
range was not reported since there were not enough values.
After general summarization of the data, an analysis was made of pretest and posttest data
separately in order to discover predictors for CLABSI.
Given the use of unpaired data, and small expected counts in the crosstabs, Likelihood ratio
(LR) was used to compare two categorical variables.
In order to compare quantitative not normally distributed data, the Mann Whitney U test was
applied.
In case of significance (P < 0,05) , these variables were further submitted to univariate logistic
regression to calculate the odds ratio (OR). Multivariate logistic regression had no place in this
study. The data model didn’t lend itself to this. The OR expresses the risk to develop CLABSI
when exposed to a certain risk factor. An OR smaller than 1 means the risk to develop CLABSI
decreases. On the contrary, an OR >1 expresses an increased risk.
Significant predictors or predictors that showed to be significant in literature research were
then submitted to a pretest posttest comparison in order to analyse whether there was a
difference in CLABSI rate between the pre and post test period. Any significant results were
then again included in a univariate logistic regression analysis.
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
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4. RESULTS
All entries in the checklist and observation forms provided a huge amount of data that could
be divided into categories: checklist, data baby, data NICU, catheter placement general, period
before catheter placement, period during catheter placement, preparation perfusion lines,
dressing, RX check, manipulations, infection, extra.
General characteristics, variables that showed to be significant predictors in literature,
variables for which a significant result was achieved in the analysis, and checklist data are
discussed in detail.
All other results can be consulted in appendix 4 (statistical data analysis categorical variables)
and in appendix 5 (statistical data analysis quantitative variables).
4.1 GENERAL
3 CLABSI (6,98%) were diagnosed in the pretest period. 6 CLABSI (22,22%) were diagnosed in the posttest period (p=0,067). Total dwell time in the pretest period consisted of 317 days what resulted in a CLABSI rate of 9,5/1000 central-line days. Total dwell time in the posttest period consisted of 351 days, what resulted in a CLABSI rate of 17/1000 central-line days. Microbiological criteria were possible for most clinical infections. Except for 1 clinically
documented infection, all organisms were coagulase negative Staphylococcus (CNS), with a
majority of Staphylococcus Capitis.
In the pretest period 2 cases of culture proven S. Capitis CLABSI were confirmed. 1 case was a
clinically documented infection.
In the posttest period culture proven S. Capitis CLABSI was confirmed in 2 cases, culture
proven S. Epidermis CLABSI in 1 case and the last case showed a culture proven S. Capitis in
combination with a culture proven S. Epidermis CLABSI.
4.2 CHARACTERISTICS
Pretest population consisted of 19 (44,2%) male and 24 (55,8%) female patients. Posttest
population consisted of 16 (59,3%) male and 11 (40,7%) female patients. (table 1)
Gestational age range in the pretest period extended from 24,0 weeks to 40,2 weeks. In the
posttest period we see a comparable range from 24 weeks to 39,4 weeks. (table1) However,
in the pretest period, 30,2% of patients had a gestational age <29 weeks as compared to 44,4%
in the posttest period. Gestational age does not seem to be a significant predictor
(p=0,664/p=0,122). In the comparison of pretest to posttest period a significant result is visible
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
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in the category 25-28,6 weeks (p=0,034). However, univariate logistic regression refutes this.
(p=0,057)
Birth weight was divided in two categories; < 1500 gram and > 1500 gram. (table 1) In the
pretest period one out of 3 CLABSI (33,3%) occurred in the first category. In the posttest period
all 6 cases of CLABSI (100%) were reported in the first category. Adjusted to the population
size for the first category, there is CLABSI rate of 1/18 (5,56%) in the pretest period and a
CLABSI rate of 6/14 (42,86%) in the posttest period. Evaluation of birth weight as a predictor
value shows a significant result in the posttest period (p=0,754/p=0,002). However no
significance is shown in univariate logistic regression (p=0,076). In the comparison of pretest
to posttest period a significant result was achieved in the first category (p=0,09). Univariate
logistic regression confirms this (p=0,028; OR=0,78; 95% CI 0,08;0,765).
Reason of admission was mostly comparable in pretest and posttest period. (table1) Main indication was prematurity; 58,1% in pretest period, 51,9% in posttest period. Second main cause was premature rupture of membranes (PROM). Reason of admission shows no significance as a predictor value (p=0,650/p=0,378). In both pretest and posttest period the majority of patients received respiratory support; 79,1% in pretest period, 88,5 % in posttest period. (table1) In neither population, respiratory support was a significant risk factor for CLABSI (p=0,226/p=0,194). When comparing different types of mechanical ventilation, there was also no significant result (p=0,738/p=0,620). In both populations, TPN was the main indication for placement of a CVC; 93% in pretest period, 100 % in posttest period. (table 1) In the pretest period all 3 CLABSI (100%) occurred in the patients with TPN. In the posttest period 6 CLABSI (100%) were reported in the TPN group. When adjusting to population size a rate of 7,5% (3/40) was reported in the pretest period versus a rate of 24% (6/25) in posttest period. In this study, TPN as a risk factor shows no significance (p=0,816/p=0,696). Catheter period range extended from 1-42 days in the pretest period, and from 2-65 days in the posttest period. (table1) A duration of > 9 catheterdays is present in 11,6 % of the pretest population. However, in the posttest population, this number increases to 40,7% of the population. An explanation could possibly be the presence of a large number of patients with very low birth weight (VLBW) <1000 grams in the posttest population (40,7% in posttest vs 26,6% in pretest). In the pretest period, 33,33% of total CLABSI is situated in the patient group with dwell time >9 days. In the posttest period the incidence rises to 100%. Dwell time seems to have a significant effect in pretest and posttest period (p=0,028/p=0,003). When applying univariate logistic regression, significance in the pretest period is no longer present (p=0,093). However, significance in posttest period remains valid. (p=0,045 OR= 1,27 95% CI (1,003;1,266)). Between pretest and posttest period, a significant difference could not be confirmed.
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
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TABLE 1: Characteristics
PRE PERIOD
(n=43) POST PERIODE
(n=27)
Gender (N(%)) Male 24 (55,8) 11 (40,7)
Female 19 (44,2) 16 (59,3)
Gestational Age (weeks) (N(%))
modus (range) <25 weeks 25 - 28,6 29 - 32,6 weeks 33 - 36,6 >37 weeks
32,6 (24 - 40,2) 1 (2,3)
12 (28,0) 9 (21,0)
16 (37,2) 5 (11,6)
29,6 (24 _ 39,4) 4 (14,8) 8 (29,6) 9 (33,3) 3 (11,1) 5 (18,1)
Birthweight (grams) modus(range)
1770 (695 - 4663)
1463,5 (667 - 4370)
Reason of admission NICU Prematurity 25 (58,1) 14 (52,0)
N(%) PPROM 5 (11,6) 6 (22,2)
Asphyxia 2 (4,6) 2 (7,4)
Infection 5 (11,6) 0
Respiratory 4 (9,3) 2 (7,4)
Other 2 (4,6) 3 (11,1)
Respiratory support: Yes (N(%)) 34 (79,1) 23 (85,2)
Indication catheter (N(%)) TPN 37 (86,0) 22 (81,5)
Long term medication 2 (4,7) 0
Impossible Peripheral infusion 1 (2,3) 0
TPN + medication 3 (7,0) 3 (11,1)
Catheter type (N(%)) PICC 18 (41,9) 14 (52,0)
UVC 25 (58,1) 13 (48,1)
Duration Catheter (days) modus (range)
6 (1 - 42) 7 (2 - 65)
Duration procedure (minutes) modus (range)
45 (15 - 78) 32,5 (15 - 20)
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4.3 CVC PLACEMENT
4.3.1 Significant predictors in literature
In the pretest period, weight at the moment of insertion extended from 695 to 4663 grams,
in the posttest period a comparable range from 667 to 4370 grams was noted. Analysis
showed a significance in the posttest period (p=0,371/p=0,046). This significance could not be
withheld using univariate logistic regression (p=0,076).
Analysis of age at the moment of catheter insertion showed a range from 0-12 days in the
pretest period and a range of 0-98 days in the posttest period. It could not be identified as a
significant risk factor for CLABSI both in pretest and posttest period (p=0,875/p=0,533).
4.3.2 P value <0,05 (LR or Mann Whitney U test)
NICU temperature ranges from 25,1°C tot 29,7°C in pretest period with a median temperature
of 27°C and ranges from 26,2°C to 28,3°C in posttest period with a median temperature of
27,1°C. First analysis of the data showed significance for temperature of NICU as a risk factor
in pretest period (p=0,025/p=0,076). Using univariate logistic regression, this significance is
confirmed (p=0,033 OR=3,364 95% CI (1,102;10,267)).
PICC connection piece sterility showed to be significant as a risk factor during pretest period
(p=0,01/-). During posttest period sterility was always achieved, so calculation of the LR was
impossible. Significance in the pretest period could not be maintained using univariate logistic
regression (p=1). However, analysis of PICC connection sterility as a risk factor showed a
significant difference when comparing pretest versus posttest period (p=0,006). This
significant result was also visible in univariate logistic regression (p=0,023 OR=0,079 95% CI
(0,009;0,706)). Analysis of PICC connection sterility as a risk factor showed a significant
difference
Mechanism of umbilical disinfection in the pretest period showed to be a significant risk factor
(p= 0,044/p=0,271). This result was rejected by univariate logistic regression (p=0,998). When
comparing pretest with posttest period, a significant result is noted in case of disinfection of
insertion place by doctor (p=0,017) and disinfection of insertion place by nurse, without
disinfection by doctor when he or she proceeds (p=0,045). These results are not confirmed in
univariate logistic regression (p=0,999). (table 2)
Use of a medical hat by doctor 2 shows significance as a predictor in the pretest period
(p=0,030/-). In the posttest period doctor 2 always wears a medical hat so no comparison is
possible. This result is not confirmed by univariate logistic regression (p=0,998).
The presence of the baby in a bag shows to be significant in posttest period
(p=0,216/p=0,022). Again this result is not confirmed by univariate logistic regression
(p=0,999).
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4.3.3 Checklist
A comparison of pretest period with posttest period was executed based on the checklist.
Data are summarized in table 2. None of the observed variables showed significance in
univariate logistic regression analysis.
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TABLE 2: Procedure placement of central venous catheter based on the checklist and proven
catheter infection compared in pre (N=43) and post period (N=27), comparison pretest
period with posttest period
PRE PERIOD (N/N(%))
POST PERIOD (N/N(%))
P-value
P-value Log Regression
Moment of the day (N=70) Morning 1/12 (8,3%) 2/11 (18,2%) 0,481
Afternoon 1/22 (4,5%) 4/13 (30,8%) 0,033 0,06
Evenning 1/9 (11,1%) 0/2 (0%) 0,515
Catheter type (N=70) PICC 1/18 (5,6%) 4/14 (28,6%) 0,071
UVC 2/25 (8%) 2/13 (15,4%) 0,592
Use of 2nd pair of sterile gloves (n=64) No 1/23 (4,3%) 6/27 (22,2%) 0,535
Yes 2/14 (66,7%)
Desinfection region mechanism (N=62) Only doctor 0/6 (0%) 2/3 (66,7%) 0,017 0,999
Nurse 0/12 (0%) 2/8 (25%) 0,045 0,999
Nurse and doctor 2/21 (9,5%) 1/9 (11,1%) 0,95
Nurse hold umbilical or arm or leg 1/1 (100%) 1/2 (50%)
0,306
Drying time 30 sec. (N=57) Yes 2/32 (6,3%) 5/24 (20,8%) 0,102
Sterile enviremont (N=61) Yes 2/35 (5,7%) 6/25 (24%) NA
Massage when moving catheter (N=50) No 2/21 (9,5%) 4/18 (22,2%) 0,270
Yes 0/7 (0%) 2/4 (50%) 0,027 0,999
Bandage according to regulations (N=64) Yes 3/40 (7,5%) 6/23 (26,1%) 0,047
Type of bandage for UVC (N=31) Bridging 0/8 (0%) 0/3 (0%) NA
Bridging & Steristrip 2/12 (16,7%) 2/7 (28,6%) 0,544
Steristrip 0/1 (0%) 0/0 (0%) NA
Bloody bandage (N=56) No 1/25 (4%) 4/20 (20%) 0,084
Yes 1/8 (12,5%) 2/3 (66,7%) 0,081
Who placed the CVC (N=67) Neonatologist 1/13 (7,7%) 5/17 (29,4% 0,123
Student doctor 2/22 (9,1%) 4 /15 (26,7%) 0,157
Catheter repositioning (N=67) No 2/18 (11,1%) 5/14 (35,7%) 0,093
Yes 1/24 (4,2%) 1/11 (9,1%) 0,574
Catheter repositioning mechanism (N=29)
Doctor still sterile 0/11 (0%) 0/3 (0%) NA
HH & steril gloves 1/7 (14,3%) 0/5 (0%) 0,285
Sterile gloves & no HH 0/2 (0%) 1/1 (0%) 0,051
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4.4 BANDAGE
All manipulations of the CVC were documented in an observation form. Table 3
(manipulations of CVC in pre and posttest period and catheter infection) was based on this
data.
The number of times a dressing is reattached, is a significant risk factor in the pretest period
(p=0,013). This significance stays present after using univariate logistic regression (p=0,033
OR=8,039 95% CI (1,187;54,436)).
Of the other variables, a significance is present in some cases; number of times rinsing clave
in posttest period (p=0,015), number of times administration medication in posttest period
(p=0,028), number of times disinfection clave in posttest period (p=0,015) and number of
times connecting the line (p=0,012). These results are not confirmed by univariate logistic
analysis regression.
TABLE 3: Manipulations of CVC in pre and postest period and catheter infection
No CLABSI
Yes: CLABSI P
P log Reg OR 95% BI
N
Median Min Max
N
Median Min Max
Valid Valid
N Rinsing clave Prestest 37 6 0 123 3 10 3 60 0,461
Posttest 21 8 0 195 5 53 23 254 0,015 0,071
N Administration of medication
Pretest 37 4 0 31 3 4 2 17
0,401 Posttest 21 2 0 58 5 22 3 63
0,028 0,076
N Disinfection clave
Prestest 37 7 0 93 3 6 3 66 0,847
Posttest 21 13 3 165 5 54 35 272 0,015 0,090
N Connecting line
Pretest 37 4 0 61 3 2 2 46 0,809
Posttest 21 10 4 160 5 35 29 228 0,012 0,110
N deconnecting line
Prestest 37 1 0 57 2 22 2 42
0,243 Posttest 21 9 1 161 4 28 18 223
0,057
Duration catheter period (days)
Pretest 40 6 1 42 3 8 8 31
0,028 0,093
Posttest 21 7 2 29 6 18 10 65 0,003 0,045
1,127 1,003-1,266
Reattaching bandage
Pretest 3 (9,4%) _ _ _
2 (6,25%) _ _ _ 0,013 0,033 8,039
1,187-54,436
posttest
0 _ _ _ 0 _ _ _ _
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5. DISCUSSION
In literature, the use of respiratory support was found to be a risk factor for CLABSI determined
by univariate logistic regression (p=0,02). (8) Although no significance could be proven in this
study, data nevertheless show that all CLABSI occurred in the population receiving respiratory
support, both in pretest as well as in posttest period.
Indication for placement of the CVC and more specifically indication for TPN , is in literature
described as a factor independently associated with CLABSI; duration of parenteral nutrition
(OR=1.04, 95 % CI (1.0;1.08)). (7) In this study, TPN as a risk factor shows no significance.
(p=0,816/p=0,696). All CLABSI do occur in the population with TPN, however, this is the main
indication so no conclusions can be made.
Literature indicates that dwell time is a significant predictor. The risk of catheter related
infections increases during the 2 weeks after central line insertion and remains elevated for
the catheter duration, with a predicted CLABSI rate over catheter dwell time of about 4/1000
central line days. (6) In this study, a significant result is visible only in posttest period (p=0,045
OR= 1,27 95% CI (1,003;1,266)). This can possibly be explained by the large number of patients
with very low birth weight (VLBW) <1000 grams in the posttest population. These patients are
more often in need of intravenous access.
Weight at the time of catheter insertion is proven to be a significant risk factor for CLABSI in
literature; extremely low weight (<1000g) at time of catheter insertion (OR=5.13 95% CI (2.1
;12.5)). (7) No significance could be withheld in this study.
There is evidence in literature that age at moment of insertion is a determining risk factor;
catheter insertion after first week of life (OR=2.7 95% CI (1.1;6.7)).(7) However, no significance
for age at moment at insertion catheter can be proven in this study.
Catheter hub colonization (OR=44.1 95% CI14.5;134.4)) (7), exit site colonization (OR=14.4 95
% CI (4.8;42.6)) (7), and luminal care are also important predictors for CLABSI. In this study,
PICC connection sterility showed a significant difference (p=0,006) in pretest with posttest
period comparison. This significant result was also visible in univariate logistic regression
(p=0,023 OR=0,079 95% CI (0,009;0,706)). When using a sterile PICC connection the risk of
infection is lower in the posttest period with a factor 0,079 compared to pretest period risk.
This difference can possibly be attributed to implementation of the care bundle in which
manipulation of the PICC catheter is extendedly documented.
The number of times a dressing is reattached, is a significant risk factor in the pretest period
(p=0,013). This significance stays present after using univariate logistic regression (p=0,033
OR=8,039 95% CI (1,187;54,436)). A comparison of pretest period with posttest period is not
possible since the implementation of the care bundle documented only to change dressings
in case of loosening, moist or visibly soiled dressing. (dry bloody dressing excluded). Hence
this was almost never executed in the posttest period. The elevated risk of developing
infection caused by reattaching the dressing is thus no longer present in the posttest period.
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In the comparison of pretest to posttest period, a significant result was achieved in the
category of birthweight <1500 grams (p=0,09). Univariate logistic regression confirmed this
(p=0,028 OR=0,78 95% CI (0,08;0,765)). The risk of developing a CLABSI was higher in posttest
than pretest period. Pretest population contained less patients with a VLBW. Literature shows
that infants admitted to NICU are at increased risk to developing CLABSI. In particular, very
low birth weight infants (<1500g) are at risk due to their compromised immunological defense
system and multiple invasive procedures. (5)
Temperature of NICU in pretest period shows to be a significant predictor (p=0,025/p=0,076).
Using univariate logistic regression, this significance is confirmed (p=0,033 OR=3,364 95% CI
(1,102;10,267)). This result is not confirmed in literature and can be explained by the period.
Pretest study took place in summer and temperature ranged from 25,1°C To 29,7°C.
Temperatures raising so high are not favorable.
There are several limitations regarding this study. Data of 43 cases in the pretest period and
27 cases in the posttest period are used to perform tests on 135 variables. The risk of
producing a type 1 error (false positive result) cannot be ignored.
Given the introduction of a checklist and observation form in the pretest period, it is possible
that some health care workers already gave more attention to these points and that a bias
was created.
Multivariate logistic analysis could not be executed because there were not enough patients
included in the study to test the variables in a model. Independent significance cannot be
reported.
During pretest period, a total of 37 cases was not included in the study. 361 catheterdays were
not monitored. During posttest period, a total of 27 cases was not included in the study. 291
catheterdays were not monitored.
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
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6. CONCLUSION
Given the fact that the studied sample size was too small, no significant results can be
displayed here. To evaluate this properly, a new study involving a bigger sample size and
extending over a longer period of time should be instated. However, it might be appropriate
to take some points into consideration. Although not significant, the fact that infection risk
decreases in posttest period when PICC connection is sterile shows that there might be a
positive effect of the implementation of the care bundle. This result in combination with
numerous significant results reported in literature should be an encouragement to keep using
the checklist and care bundle. The same conclusion can be made regarding the reattachment
of the dressing. Although not significant, there was an elevated risk to develop CLABSI in the
pretest period associated with the number of times a dressing was replaced. Due to
implementation of the care bundle, this action became almost obsolete in the posttest period,
thereby reducing the risk factor to develop CLABSI. In literature, catheter manipulation has
shown to be a main predictor for developing CLABSI. It is therefore worthwhile to maintain
the efforts to use the checklist and care bundle.
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
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ACKNOWLEDGMENT
I I’m very grateful to my promoter Prof.Dr. Filip Cools, Diensthoofd Neonatology UZ Brussels, for providing me with this subject and for guiding me through the preparation of my master’s thesis. I would also like to thank Mrs. Van Delft, Adjunct Head Nurse Neonatology UZ Brussels, for collecting all the data, development of the care bundle in collaboration with VIKA task force and for answering all of my numerous questions, even in her spare time. My special thanks also goes to my stepfather, François De Vos, for his advice on data processing. Further, I would like to thank my family and children for their patience and understanding.
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
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REFERENCES
1. Elisabetta Dioni, Renata Franceschini, Roberto Marzollo, Daniela Oprandi, Gaetano Chirico. Central vascular catheters and infections Early Human Development 90S1 (2014) S51-53
2. Lee JH. Catheter-related bloodstream infections in neonatal intensive care units Korean J Pediatr. 2011;54(9):363–367
3. Curry S., Honeycutt M., Goins G., Gilliam C. Catheter-associated bloodstream infections in the NICU: getting to zero Neonatal netw. 2009; 28:151)5
4. Thimothy P. Stevens, Joseph Schulman. Evidence-based aproach to preventing central-line associated bloodstream infection in the NICU. Acta Paediatrica 2012 101 (suppl.464), pp 11-16
5. Erwin Ista, Ben van der Hoven, René F. Kornelisse, Cynthia van der Starre, Margreet
C. Vos, Eric Boersma, Onno K. Helder. Effectiveness of insertion and maintenance bundles to prevent central-line-associated bloodstream infections in critically ill patients of all ages: a systematic review and meta-analysis. Published online February 18, 2016 The Lancet
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(6):e1609-15
7. L.M.Mahieuaf1A.O.De MuynckbM.M.IevencJ.J.De DooyaH.J.GoossenscP.J.Van Reemptsa
Catheter dwell time and CLABSI in neonates with PICC: A multicenter Cohort Study Journal of Hospital Infection Volume 48, Issue 2, June 2001, Pages 108-116
8. Silva Resende, Jacqueline Moreira do Ó, Denise von Dolinger de Brito, Vânia Olivetti,
Steffen Abdallah and Paulo Pinto Gontijo Filho Reduction of catheter-associated bloodstream infections through procedures in newborn abies admitted in a university hospital intensive care unit in Brazil Revista da Sociedade Brasileira de Medicina Tropical 44(6):731-734,nov-dez, 2011
9. Thomas A. Hooven, Richard A. Polin
Healthcare associated infections in the hopitalized neonate: a review Early human development90S1 (2014) S4-S6
10. CDC Strategies for prevention of catheter-related infections in adult and pediatric
patients.
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
Pagina 24 van 49
11. Fluhr, J. W., Darlenski, R., Taieb, A., Hachem, J. P., Baudou in, C., Msika, P.,Berardesca,
E. Functional skin adaptation in infancy - almost complete but not fully competent Exp Dermatol,(2010) 19 (6), 483-492. doi:10.1111/j.1600-0625.2009.01023.x
12. Oranges, T., Dini, V., & Romanelli, M. (2015). Skin Physiology of the Neonate and Infant: Clinical Implications. Adv Wound Care (New Rochelle), 4 (10), 587-595. doi:10.1089/wound.2015.0642
13. Wilder, K. A., Wall, B., Haggard, D., & Epperson, T. (2016). CLABSI Reduction Strategy: A Systematic Central Line Quality Improvement Initiative Integrating Line-Rounding Principles and a Team Approach. Adv Neonatal Care, 16 (3), 170-177. doi:10.1097/ANC.0000000000000259
14. Joseph Schulman, Rachel Stricof, Timothy P. Stevens, Michael Horgan, Kathleen Gase, Ian R. Holzman, Robert I. Koppel, Suhas Nafday, Kathleen Gibbs, Robert Angert, Aryeh Simmonds, Susan A. Furdon, Lisa Saiman, the New York State Regional Perinatal Care Centers Statewide NICU Central-Line-Associated Bloodstream Infection Rates Decline After Bundles and Checklists Pediatrics, March 2011, VOLUME 127 / ISSUE 3 From the American Academy of Pediatrics
15. Fisher D1, Cochran KM, Provost LP, Patterson J, Bristol T, Metzguer K, Smith B, Testoni D, McCaffrey MJ. Reducing central line-associated bloodstream infections in North Carolina NICUs. Pediatrics. 2013 Dec;132(6):e1664-71. doi: 10.1542/peds.2013-2000. Epub 2013 Nov
16. Simon Li, Edward Vincent S Faustino, Sergio G. Golombek Reducing Central Line Infections in Pediatric and Neonatal Patients Article in Current Infectious Disease Reports 15(3) · April 2013 DOI: 10.1007/s11908-013-0336-2 ·
17. Helder O1, van den Hoogen A, de Boer C, van Goudoever J, Verboon-Maciolek M, Kornelisse R. Effectiveness of non-pharmacological interventions for the prevention of bloodstream infections in infants admitted to a neonatal intensive care unit: A systematic review. Int J Nurs Stud. 2013 Jun;50(6):819-31. doi: 10.1016/j.ijnurstu.2012.02.009. Epub 2012 Mar .
18. Bizzarro MJ1, Sabo B, Noonan M, Bonfiglio MP, Northrup V, Diefenbach K; Central Venous Catheter Initiative Committee A quality improvement initiative to reduce central line-associated bloodstream infections in a neonatal intensive care unit. Infect Control Hosp Epidemiol. 2010 Mar;31(3):241-8. doi: 10.1086/650448
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
Pagina 25 van 49
19 Huang EY1, Chen C, Abdullah F, Aspelund G, Barnhart DC, Calkins CM, Cowles RA, Downard CD, Goldin AB, Lee SL, St Peter SD, Arca MJ; 2011 American Pediatric Surgical Association Outcomes and Clinical Trials Committee. Strategies for the prevention of central venous catheter infections: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review. J Pediatr Surg. 2011 Oct;46(10):2000-11. doi: 10.1016/j.jpedsurg.2011.06.017.
20 Suresh GK1, Edwards WH. Am J Perinatol. 2012 Jan;29(1):57-64. doi: 10.1055/s-0031-1286182. Epub 2011 Aug 30. Central line-associated bloodstream infections in neonatal intensive care: changing the mental model from inevitability to preventability. Am J Perinatol. 2012 Jan;29(1):57-64. doi: 10.1055/s-0031-1286182. Epub 2011 Aug 30.
21 Freeman JJ1, Gadepalli SK2, Siddiqui SM2, Jarboe MD2, Hirschl RB2. Improving central line infection rates in the neonatal intensive care unit: Effect of hospital location, site of insertion, and implementation of catheter-associated bloodstream infection protocols. Freeman JJ1, Gadepalli SK2, Siddiqui SM2, Jarboe MD2, Hirschl RB2. J Pediatr Surg. 2015 May;50(5):860-3. doi: 10.1016/j.jpedsurg.2015.02.001. Epub 2015 Feb 7.
22 Resende DS1, Peppe AL2, dos Reis H3, Abdallah VO3, Ribas RM4, Gontijo Filho PP4.
Late onset sepsis in newborn babies: epidemiology and effect of a bundle to prevent central line associated bloodstream infections in the neonatal intensive care unit. Resende DS1, Peppe AL2, dos Reis H3, Abdallah VO3, Ribas RM4, Gontijo Filho PP4. Braz J Infect Dis. 2015 Jan-Feb;19(1):52-7. doi: 10.1016/j.bjid.2014.09.006. Epub 2014 Dec 15.
23 Helder OK1, Brug J, Looman CW, van Goudoever JB, Kornelisse RF.
The impact of an education program on hand hygiene compliance and nosocomial infection incidence in an urban neonatal intensive care unit: an intervention study with before and after comparison. Int J Nurs Stud. 2010 Oct;47(10):1245-52. doi: 10.1016/j.ijnurstu.2010.03.005. Epub 2010 Apr 9.
24 Smulders CA1, van Gestel JP, Bos AP
Are central line bundles and ventilator bundles effective in critically ill neonates and children? Intensive Care Med. 2013 Aug;39(8):1352-8. doi: 10.1007/s00134-013-2927-7. Epub 2013 Apr25.
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25 Borghesi A1, Stronati M. Strategies for the prevention of hospital-acquired infections in the neonatal intensive care unit. J Hosp Infect. 2008 Apr;68(4):293-300. doi: 10.1016/j.jhin.2008.01.011. Epub 2008 Mar 7.
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APPENDIX 1: LIST OF ABBREVIATIONS
CLABSI Central line associated bloodstream infection NICU Neonatal intensive care unit VIKA Vragen incidenten klachten aanbevelingen task force (questions, incidents,
complaints recommendations) CVC Central venous catheter CDC Centers of diseases and prevention NHS National health service IHI Institute for healthcare improvement IV Intravenous UVC Umbilical venous catheter PICC Peripherally inserted central venous catheter TPN Total parenteral nutrition EOS Early onset infection SPSS 25 Statistical package for the social sciences version 25 CNS Coagulase negative Staphylococcus PROM Premature rupture of membranes VLBW Very low birth weight
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APPENDIX 2: APPROVAL MEDICAL ETHICAL COMMITTEE
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APPENDIX 3: CHECKLIST
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APPENDIX 4: STATISTICAL DATA ANALYSIS CATEGORICAL VARIABLES
Seq Variable description Test type Variable value CLABSI Total n missing
values
% missing
values
Mode Total P
No Yes
N Row % Column % N Row % Column % N %
CHECKLIST
1 Gender Pretest Female 23 95,8 57,7 1 4,2 33,3 24 55,8% 0 0,0 Female 0,416
Male 17 89,5 42,3 2 10,5 66,7 19 44,2%
Posttest Female 10 90,9 47,6 1 9,1 16,7 11 40,7% 0 0,0 Male 0,154
Male 11 68,8 52,4 5 31,2 83,3 16 59,3%
2 Catheter type Pretest PICC single lumen 13 92,9 32,5 1 7,1 33,3 14 32,6% 0 0,0 UVC Umbilical venous catheter 0,734
PICC double lumen 4 100 10 0 0 0 4 9,3%
UVC Umbilical venous
catheter
23 92 57,5 2 8 66,7 25 58,1%
Posttest PICC single lumen 7 77,8 33,3 2 22,2 33,3 9 33,3% 0 0,0 UVC Umbilical venous catheter 0,555
PICC double lumen 3 60 14,3 2 40 33,3 5 18,5%
UVC Umbilical venous
catheter
11 84,6 52,4 2 15,4 33,3 13 48,1%
3 Use of sterile gloves by doctor Pretest Yes 39 92,9 100 3 7,1 100 42 100,0% 1 2,3 Yes
Posttest Yes 21 77,8 100 6 22,2 100 27 100,0% 0 0,0 Yes
4 Use of 2nd pair of sterile
gloves by doctor
Pretest No 22 95,7 64,7 1 4,3 33,3 23 62,2% 6 14,0 No 0,291
Yes 12 85,7 35,3 2 14,3 66,7 14 37,8%
Posttest Yes 21 77,8 100 6 22,2 100 27 100,0% 0 0,0 Yes
5 Drying time 30 sec Pretest Yes 30 93,8 100 2 6,3 100 32 100,0% 11 25,6 Yes
Posttest No 1 100 5 0 0 0 1 4,0% 2 7,4 Yes 0,499
Yes 19 79,2 95 5 20,8 100 24 96,0%
6 Sterile environment during
procedure
Pretest Yes 33 94,3 100 2 5,7 100 35 100,0% 8 18,6 Yes
Posttest No 1 100 5 0 0 0 1 3,8% 1 3,7 Yes 0,464
Yes 19 76 95 6 24 100 25 96,2%
7 Massage when moving katheter Pretest No 19 90,5 73,1 2 9,5 100 21 75,0% 15 34,9 No 0,273
Yes 7 100 26,9 0 0 0 7 25,0%
Posttest No 14 77,8 87,5 4 22,2 66,7 18 81,8% 5 18,5 No 0,280
Yes 2 50 12,5 2 50 33,3 4 18,2%
8 Bandage according to regulations Pretest Yes 37 92,5 100 3 7,5 100 40 100,0% 3 7,0 Yes
Posttest No 1 100 5,6 0 0 0 1 4,2% 3 11,1 Yes 0,443
Yes 17 73,9 94,4 6 26,1 100 23 95,8%
9 Bloody bandage Pretest No 24 96 77,4 1 4 50 25 75,8% 10 23,3 No 0,415
Yes 7 12,5 22,6 1 87,5 50 8 24,2%
Posttest No 16 80 94,1 4 20 66,7 20 87,0% 4 14,8 No 0,109
Yes 1 33,3 5,9 2 66,7 33,3 3 13,0%
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
Pagina 32 van 49
Seq Variable description Test type Variable value CLABSI Total n missing
values
% missing
values
Mode Total P
No Yes
N Row % Column % N Row % Column % N %
DATA BABY
10 Reason of admission to NICU Prestest PROM 5 100 12,5 0 0 0 5 11,6% 0 0 Prematurity 0,945
Prematurity 19 90,5 47,5 2 9,5 66,7 21 48,8%
Bad start 2 100 5 0 0 0 2 4,7%
IRDS 3 75 7,5 1 25 33,3 4 9,3%
Maternal herpes
infection
3 100 7,5 0 0 0 3 7,0%
Asphyxia 2 100 5 0 0 0 2 4,7%
IUGR 1 100 2,5 0 0 0 1 2,3%
Unstoppable labour 1 100 2,5 0 0 0 1 2,3%
Hyperbilirubinemia 2 100 5 0 0 0 2 4,7%
Suspicion colitis 1 100 2,5 0 0 0 1 2,3%
Chorio-amnionitis 1 100 2,5 0 0 0 1 2,3%
Posttest PROM 4 66,7 19 2 33,3 33,3 6 22,2% 0 0,0 Prematurity 0,583
Prematurity 9 75 42,9 3 25 50 12 44,4%
IRDS 2 100 9,5 0 0 0 2 7,4%
Asphyxia 2 100 9,5 0 0 0 2 7,4%
HELLP 1 50 4,8 1 50 17,7 2 7,4%
Esophageal fistula 2 9,5 7,4 0 0 0 2 7,4%
Hypoglycemia 1 100 4,8 0 0 0 1 3,7%
11 Respiratory support Pretest No 9 100 22,5 0 0 0 9 20,9% 0 0,0 Yes 0,226
Yes 31 91,2 77,5 3 8,8 100 34 79,1%
Posttest No 3 100 15 0 0 0 3 11,5% 1 3,7 Yes 0,194
Yes 17 26,1 85 6 73,9 100 23 88,5%
12 Respiratory support type Pretest Optiflow 5 100 16,1 0 0 0 5 14,7% 9 20,9 BCPAP 0,738
BCPAP 18 90 58,1 2 10 66,7 20 58,8%
NIV-NAVA 7 87,5 22,6 1 12,5 33,3 8 23,5%
VDR 1 100 3,2 0 0 0 1 2,9%
Posttest Optiflow 3 100 17,6 0 0 0 3 13,0% 4 14,8 BCPAP 0,620
BCPAP 7 77,8 41,2 2 22,2 33,3 9 39,1%
NIV-NAVA 2 66,7 11,8 1 33,3 16,7 3 13,0%
Invasive NAVA 4 66,7 23,5 2 33,3 33,3 6 26,1%
VDR 1 50 5,9 1 50 16,7 2 8,7%
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
Pagina 33 van 49
Seq Variable description Test type Variable value CLABSI Total n missing
values
% missing
values
Mode Total P
No Yes
N Row % Column % N Row % Column % N %
DATA NICU
13 Number of patiënts A side Pretest 4 4 100 10,3 0 0 0 4 9,5% 1 2,3 6 0,153
5 3 75 7,7 1 25 33,3 4 9,5%
6 15 100 38,5 0 0 0 15 35,7%
7 9 81,8 23,1 2 18,2 66,7 11 26,2%
8 8 100 20,5 0 0 0 8 19,0%
Posttest 5 1 50 5,9 1 50 25 2 9,5% 6 22,2 8 0,316
6 4 66,7 23,5 2 33,3 50 6 28,6%
7 3 100 17,6 0 0 0 3 14,3%
8 9 90 52,9 1 10 25 10 47,6%
14 Number of patiënts B side Pretest 2 3 100 7,7 0 0 0 3 7,1% 1 2,3 7 0,729
3 1 100 2,6 0 0 0 1 2,4%
4 3 100 2,6 0 0 0 3 7,1%
5 5 83,3 12,8 1 16,7 33,3 6 14,3%
6 11 100 28,2 0 0 0 11 26,2%
7 13 86,7 33,3 2 13,3 66,7 15 35,7%
8 2 100 5,1 0 0 0 2 4,8%
9 1 100 2,6 0 0 0 1 2,4%
Posttest 3 1 100 5,9 0 0 0 1 4,5% 5 18,5 6 0,457
5 4 66,7 23,5 2 33,3 40 6 27,3%
6 7 77,8 41,2 2 22,2 40 9 40,9%
7 1 50 5,9 1 50 22 2 9,1%
8 4 100 23,5 0 0 0 4 18,2%
15 Number of nurses Pretest 2 1 100 2,6 0 0 0 1 2,4% 1 2,3 5 0,861
4 3 100 7,7 0 0 0 3 7,1%
5 14 93,3 35,9 1 6,7 33,3 15 35,7%
6 14 93,3 35,9 1 6,7 33,3 15 35,7%
7 4 80 10,3 1 20 33,3 5 11,9%
8 3 100 7,7 0 0 0 3 7,1%
Posttest 3 2 66,7 12,5 1 33,3 20 3 14,3% 6 22,2 5 0,583
4 1 100 6,3 0 0 0 1 4,8%
5 7 77,8 43,8 2 22,2 40 9 42,9%
6 4 80 25 1 20 10 5 23,8%
7 0 0 0 1 100 20 1 4,8%
8 1 100 6,3 0 0 0 1 4,8%
9 1 100 6,3 0 0 0 1 4,8%
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
Pagina 34 van 49
Seq Variable description Test type Variable value CLABSI Total n missing
values
% missing
values
Mode Total P
No Yes
N Row % Column % N Row % Column % N %
16 Moment of the day Pretest 07:00-11:59 11 91,7 27,5 1 8,3 33,3 12 27,9% 0 0,0 14:00-16:59 0,466
12:00-13:59 6 100 15 0 0 0 6 14,0%
14:00-16:59 15 93,8 37,5 1 6,3 33,3 16 37,2%
17:00-20:59 2 66,7 5 1 33,3 33,3 3 37,2%
21:00-06:59 6 100 15 0 0 0 6 14,0%
Posttest 07:00-11:59 9 81,8 45 2 18,2 33,3 11 42,3% 1 3,7 07:00-11:59 0,587
12:00-13:59 3 60 15 2 40 33,3 5 19,2%
14:00-16:59 6 75 30 2 25 33,3 8 30,8%
17:00-20:59 2 100 10 0 0 0 2 7,7%
17 Number of Neonatologists present Pretest 0 11 100 27,5 0 0 0 11 25,6% 0 0,0 1 0,557
1 17 94,4 42,5 1 5,6 33,3 18 41,9%
2 7 87,5 17,5 1 12,5 33,3 8 18,6%
3 4 80 10 1 20 33,3 5 11,6%
4 1 100 2,5 0 0 0 1 2,3%
Posttest 0 1 100 5,6 0 0 0 1 4,2% 3 11,1 1 0,114
1 12 85,7 66,7 2 14,3 33,3 14 58,3%
2 3 42,9 16,7 4 57,1 66,7 7 29,2%
3 2 100 11,1 0 0 0 2 8,3%
18 Number of fellows present Pretest 0 20 90,9 50 2 9,1 66,7 22 51,2% 0 0,0 0 0,574
1 20 95,2 50 1 4,8 33,3 21 48,8%
Posttest 0 18 75 100 6 25 100 24 100,0% 3 11,1 0
19 Number of residents present Pretest 0 5 100 12,5 0 0 0 5 11,6% 0 0,0 2 0,735
1 15 93,8 37,5 1 6,3 33,3 16 37,2%
2 18 90 45 2 10 66,7 20 46,5%
3 2 100 5 0 0 0 2 4,7%
Posttest 0 1 100 5,6 0 0 0 1 4,2% 3 11,1 2 0,343
1 5 83,3 27,8 1 16,7 16,7 6 25,0%
2 9 64,3 50 5 35,7 83,3 14 58,3%
3 3 100 16,7 0 0 0 3 12,5%
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
Pagina 35 van 49
Seq Variable description Test type Variable value CLABSI Total n missing
values
% missing
values
Mode Total P
No Yes
N Row % Column % N Row % Column % N %
CATHETER PLACEMENT
20 Reason placement CVC Pretest First catheter 3 100 17,6 0 0 0 3 16,7% 25 58,1 Elective replacement 0,771
Elective replacement 13 92,9 76,5 1 7,1 100 14 77,8%
Bad position UVC 17 94,4 5,6 1 0 0 18 5,6%
Posttest First catheter 2 100 28,6 0 0 0 2 18,2% 16 59,3 Elective replacement 0,227
Replacement for the
sake of malfunction
1 33,3 14,3 2 66,7 50 3 27,3%
Elective replacement 4 66,7 57,1 2 33,3 50 6 54,4%
21 Indication Pretest TPN 34 91,9 85 3 8,1 100 37 86,0% 0 0,0 TPN 0,816
Long-term medication 2 100 5 0 0 0 2 4,7%
Peripheral infusion
impossible 1 100 2,5 0 0 0 1 2,3%
TPN + medication 3 100 7,5 0 0 0 3 7,0%
Posttest TPN 17 77,3 89,5 5 22,7 83,3 22 88,0% 2 7,4 TPN 0,696
TPN + medication 2 66,7 10,5 1 33,3 16,7 3 12,0%
22 Blood culture Pretest No 25 96,2 64,1 1 3,8 33,3 26 61,9% 1 2,3 No 0,298
Yes 14 87,5 35,9 2 12,5 66,7 16 38,1%
Posttest No 9 81,8 47,4 2 18,2 33,3 11 44,0% 2 7,4 Yes 0,542
Yes 10 71,4 52,6 4 28,6 66,7 14 56,0%
23 Blood culture result Pretest Negative 13 86,7 100 2 13,3 100 15 100,0% 28 65,1 Negative
Posttest Negative 10 71,4 100 4 28,6 100 14 100,0% 13 48,1 Negative
24 Lumbar punction performed Pretest No 38 92,7 97,4 3 7,3 100 41 97,6% 1 2,3 No 0,698
Yes 1 100 2,6 0 0 0 1 2,4%
Posttest No 19 76 100 6 24 100 25 100,0% 2 7,4 No
25 Lumbar punction result Pretest Negative 1 100 100 1 100,0% 42 97,7 Negative
Posttest
26 Catheter placement by a
neonatologist
Pretest No 27 93,1 69,2 2 6,9 66,7 29 69,0% 1 2,3 No 0,927
Yes 12 7,7 30,8 1 92,3 33,3 13 31,0%
Posttest No 7 87,5 36,8 1 12,5 16,7 8 32,0% 2 7,4 Yes 0,335
Yes 12 70,6 63,2 5 29,4 83,3 17 68,0%
27 Catheter placement by a fellow Pretest No 28 90,3 71,8 3 9,7 100 31 73,8% 1 2,3 No 0,168
Yes 11 100 28,2 0 0 0 11 26,2%
Posttest No 19 76 100 6 24 100 25 100,0% 2 7,4
28 Catheter placement by a resident Pretest No 19 95 48,7 1 5 33,3 20 47,6% 1 2,3 Yes 0,603
Yes 20 90,9 51,3 2 9,1 66,7 22 52,4%
Posttest No 8 80 42,1 2 20 33,3 10 40,0% 2 7,4 Yes 0,700
Yes 11 73,3 57,9 4 26,7 66,7 15 60,0%
29 Number of attempts neonatologist Pretest 0 18 90 60 2 10 66,7 20 60,6% 10 23,3 0 0,896
1 11 91,7 36,7 1 8,3 33,3 12 36,4%
4 1 100 3,3 0 0 0 1 3,0%
Posttest 0 7 77,8 36,8 2 22,2 33,3 9 36,0% 2 7,4 1 0,578
1 9 69,2 47,4 4 30,8 66,7 13 52,0%
2 2 100 10,5 0 0 0 2 8,0%
3 1 100 5,3 0 0 0 1 4,0%
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
Pagina 36 van 49
Seq Variable description Test type Variable value CLABSI Total n missing
values
% missing
values
Mode Total P
No Yes
N Row % Column % N Row % Column % N %
30 Number of attempts fellow Pretest 0 15 88,2 57,7 2 11,8 100 17 60,7% 15 34,9 0 0,351
1 8 100 30,8 0 0 0 8 28,6%
2 3 100 11,5 0 0 0 3 10,7%
Posttest 0 19 76 100 6 24 100 25 100,0% 2 7,4
31 Number of attempts resident Pretest 0 11 100 35,5 0 0 0 11 33,3% 10 23,3 1 0,282
1 16 88,9 51,6 2 11,1 100 18 54,5%
2 4 100 12,9 0 0 0 4 12,1%
Posttest 0 8 80 44,4 2 20 33,3 10 41,7% 3 11,1 1 0,322
1 9 75 50 3 25 50 12 50,0%
2 1 100 5,6 0 0 0 1 4,2%
3 0 0 0 1 100 16,7 1 4,2%
32 Total number of attempts Pretest 1 28 90,3 71,8 3 9,7 100 31 73,8% 1 2,3 1 0,593
2 9 100 23,1 0 0 0 9 21,4%
3 1 100 2,6 0 0 0 1 2,4%
4 1 100 2,6 0 0 0 1 2,4%
Posttest 1 12 80 66,7 3 20 50 15 62,5% 3 11,1 1 0,666
2 4 66,7 22,2 2 33,3 33,3 6 25,0%
3 1 50 5,6 1 50 16,7 2 8,3%
4 1 100 5,6 0 0 0 1 4,2%
33 Use of a new needle during second Pretest
attempt
No 5 100 50 5 50,0% 33 76,7 No = Yes
Yes 5 100 50 5 50,0%
Posttest No 18 75 100 6 25 100 24 100,0% 3 11,1 No
34 Reason use of new needle Pretest Not mentionned 1 100 33,3 1 33,3% 40 93,0 Not mentionned = Mandrin
first catheter broken
Mandrin 1st catheter
broken 1 100 33,3
1 33,3%
Guide bent 1 100 33,3 1 33,3%
34 Reason use of new needle Posttest 27 100,0
35 Catheter placement succesfull Pretest Yes 17 94,4 100 1 5,6 100 18 100,0% 25 58,1 Yes
Posttest Yes 8 66,7 100 4 33,3 100 12 100,0% 15 55,6 Yes
36 Place catheter Pretest Vena cephalica hand 1 100 5,9 0 0 0 1 5,6% 25 58,1 Other vena back of hand 0,836
Other vena back of hand 8 88,9 47,1 1 100 5,6 9 50,0%
Vena cephalica lower
arm 4 100 23,5 0 0 0 4 22,2%
Vena dorsalis pedis 2 100 11,8 0 0 0 2 11,1%
Vena saphena leg 2 100 11,8 0 0 0 2 11,1%
Posttest Vena cephalica hand 2 100 25 0 0 0 2 16,7% 15 55,6 Vena saphena leg 0,325
Other vena back of hand 1 100 12,5 0 0 0 1 8,3%
Vena axillaris upper arm 1 50 12,5 1 50 25 2 16,7%
Vena dorsalis pedis 0 0 0 1 100 25 1 8,3%
Vena saphena leg 2 50 25 2 50 50 4 33,3%
Vena temporalis head 1 100 12,5 0 0 0 1 8,3%
Vena cubitalis 1
100 12,5 0 0 0 1 8,3%
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
Pagina 37 van 49
Seq Variable description Test type Variable value CLABSI Total n missing
values
% missing
values
Mode Total P
No Yes
N Row % Column % N Row % Column % N %
PERIOD BEFORE PLACEMENT CATHETER
37 Number of doctors
assisting placement
Pretest 0 4 80 13,3 1 20 33,3 5 15,2% 10 23,3 1 0,838
1 13 92,9 43,3 1 7,1 33,3 14 42,4%
2 12 92,3 40 1 7,7 33,3 13 39,4%
3 1 100 3,3 0 0 0 1 3,0%
Posttest 0 10 83,3 52,6 2 16,7 33,3 12 48,0% 2 7,4 1 0,405
1 9 69,2 47,4 4 30,8 66,7 13 52,0%
38 Doctor 1 medical hat Pretest Yes 40 93 100 3 7 100 43 100,0% 0 0,0 Yes
Posttest Yes 19 76 100 6 24 100 25 100,0% 2 7,4 Yes 0,453
39 Doctor 2 medical hat Pretest No 1 50 6,7 1 50 100 2 12,5% 27 62,8 Yes 0,030
Yes 14 100 93,3 0 0 0 14 87,5%
Posttest Yes 9 69,2 100 4 30,8 100 13 100,0% 14 51,9 Yes
40 Doctor 3 medical hat Pretest Yes 1 100 100 1 100,0% 42 97,7 Yes
Posttest 0 27 100,0
41 Doctor 1 mouth mask Pretest Yes 40 93 100 3 7 100 43 100,0% 0 0,0 Yes
Posttest Yes 19 76 100 6 24 100 25 100,0% 2 7,4 Yes
42 Doctor 2 mouth mask Pretest Yes 15 93 100 1 6,3 100 16 100,0% 27 62,8 Yes
Posttest Yes 9 69,2 100 4 30,8 100 13 100,0% 27 100,0 Yes
43 Doctor 3 mouth mask Pretest Yes 1 100 100 1 100,0% 42 97,7 Yes
Posttest 0 27 100,0
44 Doctor 1 hand hygiene Pretest Yes 39 92,9 97,5 3 7,1 100 42 97,7% 0 0,0 Yes 0,702
Unknown 1 100 2,5 0 0 0 1 2,3%
Posttest Yes 19 76 100 6 24 100 25 100,0% 2 7,7 Yes
45 Doctor 2 hand hygiene Pretest No 1 100 6,3 1 6,3% 27 62,8 Yes
Yes 14 100 87,5 14 87,5%
Unknown 16 100 6,3 16 6,3%
Posttest Yes 9 75 100 3 25 75 12 92,3% 14 51,9 Yes 0,110
Unknown 0 0 0 1 100 25 1 7,7%
46 Doctor 3 hand hygiene Pretest Yes 1 100 100 1 100,0% 42 97,7 Yes
Posttest 0 27 100,0
47 Doctor 1 hand hygiene type Pretest Water and soap 3 100 7,7 0 0 0 3 7,1% 1 2,3 Hand alcohol 0,123
Hand alcohol 21 100 53,8 0 0 0 21 50,0%
Unknown 1 100 2,6 0 0 0 1 2,4%
Water + soap + hand
alcohol
14 82,4 35,9 3 17,6 100 17 40,5%
Posttest Water and soap 0 0 0 1 100 16,7 1 4,0% 2 7,4 Hand alcohol= Water + soap + hand
alcohol
0,197
Hand alcohol 9 75 47,4 3 25 50 12 48,0%
Water + soap + hand
alcohol
10 83,3 52,6 2 16,7 33,3 12 48,0%
48 Doctor 2 hand hygiene type Pretest Water and soap 3 100 20 3 20,0% 28 65,1 Hand alcohol
Hand alcohol 6 100 40 6 40,0%
Unknown 2 100 13,3 2 13,3%
Water + soap + hand
alcohol
4 100 26,7 4 26,7%
Posttest Water and soap 0 0 0 1 100 25 1 7,7% 14 51,9 Hand alcohol 0,053
Hand alcohol 5 71,4 55,6 2 28,6 50 7 53,8%
Unknown 0 0 0 1 100 25 1 7,7%
Water + soap + hand
alcohol
4 100 44,4 0 0 0 4 30,8%
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
Pagina 38 van 49
Seq Variable description Test type Variable value CLABSI Total n missing
values
% missing
values
Mode Total P
No Yes
N Row % Column % N Row % Column % N %
49 Doctor 3 hand hygiene type Pretest Water + soap + hand
alcohol
1 100 100 1 100,0% 42 97,7 Water + soap + hand alcohol
Posttest 0 27 100,0
50 Duration hand hygiene doctor 1
(min)
Pretest 1,5 5 100 14,7 0 0 0 5 13,5% 6 14,0 2,0 0,625
2 25 89,3 73,5 3 10,7 100 28 75,5%
2,5 2 100 5,9 0 0 0 2 5,4%
3 2 100 5,9 0 0 2 5,4%
Posttest 1 1 50 5,9 1 50 20 2 9,1% 5 18,5 2,0 0,421
1,5 2 100 11,8 0 0 0 2 9,1%
2 12 75 70,6 4 25 80 16 72,7% 2,0
3 2 100 11,8 0 0 0 2 9,1%
51 Duration hand hygiene doctor 2
(min)
Pretest 1 1 100 9,1 1 9,1% 32 74,4 2,0
1,5 3 100 27,3 3 27,3%
2 7 100 63,6 7 63,6%
Posttest 1 0 0 0 1 100 50 1 14,3% 20 74,1 2,0 0,085
2 5 83,3 100 1 16,7 50 6 85,7%
52 Duration hand hygiene doctor 3
(min)
Pretest 1 1 100 100 1 100,0% 42 97,7 1,0
Posttest 0 27 100,0
53 Sterile apron doctor 1 Pretest Yes 40 93 100 3 7 100 43 100,0% 0 0,0 Yes
Posttest Yes 19 76 100 6 24 100 25 100,0% 2 7,4 Yes
54 Sterile apron doctor 2 Pretest No 2 66,7 14,3 1 33,3 100 3 20,0% 28 65,1 Yes 0,060
Yes 12 100 85,7 0 0 0 12 80,0%
Posttest Yes 9 69,2 100 4 30,8 100 13 100,0% 14 51,9 Yes
55 Sterile apron doctor 3 Pretest Yes 1 100 100 1 100,0% 42 97,7 Yes
Posttest 0 27 100,0
56 Number of people surrounding
patient, except doctors placing
catheter
Pretest 1 15 100 53,6 0 0 0 15 50,0% 13 30,2 1 0,203
2 9 90 32,1 1 10 50 10 33,3%
3 4 80 14,3 1 20 50 5 16,7%
Posttest 1 8 80 44,4 2 20 33,3 10 41,7% 3 11,1 1 0,115
2 3 42,9 16,7 4 57,1 66,7 7 29,2%
3 5 100 27,8 0 0 0 5 20,8%
4 1 100 5,6 0 0 0 1 4,2%
5 1 100 5,6 0 0 1 1 4,2%
57 Mouth mask surrounding people Pretest Yes 30 93,8 100 2 6,3 100 32 100,0% 11 25,6 Yes
Posttest No 1 100 5,6 0 0 0 1 4,2% 3 11,1 Yes 0,443
Yes 17 73,9 94,4 6 26,1 100 23 95,8% Yes
58 Hand hygiene nurse Pretest Yes 38 92,7 100 3 7,3 100 41 100,0% 2 4,7 Yes
Posttest Yes 19 76 100 6 24 100 25 100,0% 2 7,4 Yes
59 Hand hygiene nurse type Pretest Water and soap 2 66,7 5,4 1 33,3 33,3 3 7,5% 3 7,0 Hand alcohol 0,075
Hand alcohol 20 100 54,1 0 0 0 20 50,0%
Water + soap + hand
alcohol
15 88,2 40,5 2 11,8 66,7 17 42,5%
Posttest Water and soap 1 100 5,6 0 0 0 1 4,3% 4 14,8 Water + soap + hand alcohol 0,590
Hand alcohol 7 70 38,9 3 30 60 10 43,5%
Water + soap + hand
alcohol
10 83,3 55,6 2 16,7 40 12 52,2%
60 Mouth mask nurse Pretest Yes 39 92,9 100 3 7,1 100 42 100,0% 1 2,3 Yes
Posttest Yes 18 75 100 6 25 100 24 100,0% 3 11,1 Yes
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
Pagina 39 van 49
Seq Variable description Test type Variable value CLABSI Total n missing
values
% missing
values
Mode Total P
No Yes
N Row % Column % N Row % Column % N %
61 Cleaning medical table Pretest Yes 38 92,7 100 3 7,3 100 41 100,0% 2 4,7 Yes
Posttest Yes 19 79,2 100 5 20,8 100 24 100,0% 3 11,1 Yes
62 Cleaning medical table: product Pretest Incidin foam 36 92,3 94,7 3 7,7 100 39 95,1% 2 4,7 Incidin foam 0,856
Chlorhexidine 1 100 2,6 0 0 0 1 2,4%
Incidin wipes 1 100 2,6 0 0 0 1 2,4%
Posttest Incidin foam 18 85,7 94,7 3 14,3 60 21 87,5% 3 11,1 Incidin foam 0,102
Chlorhexidine 0 0 0 1 100 20 1 4,2%
Incidin wipes 1 50 5,3 1 50 20 2 8,3%
63 Medical table setup: place Pretest Desk 14 100 35 0 0 0 14 32,6% 0 0,0 Patiënt 0,206
Patiënt 23 88,5 57,5 3 11,5 100 26 60,5%
Bath 3 100 7,5 0 0 0 3 7,0%
Posttest Desk 10 76,9 52,6 3 23,1 60 13 54,2% 3 11,1 Desk 0,467
Patiënt 6 75 31,6 2 25 40 8 33,3%
Bath 3 100 15,8 0 0 0 3 12,5%
64 Medical table desterilisation Pretest No 34 91,9 94,4 3 8,1 100 37 94,9% 4 9,3 No 0,566
Unknown 2
17
100
77,3
5,6 0
100 5
0
22,7
0 2
100 22
5,1%
100,0%
Posttest No 5 18,5 No
65 Medical table desterilisation: type Pretest 0 43 100,0
Posttest 0 27 100,0
66 Medical table desterilisation:
mechanism
Pretest
0 43 100,0
Posttest 0 27 100,0
67 Disturbance during medical table
setup
Pretest No 34 94,4 89,5 2 5,6 66,7 36 87,8% 2 4,7 No 0,333
Yes 2 66,7 5,3 1 33,3 33,3 3 7,3%
Unknown 2 100 5,3 0 0 0 2 4,9%
Posttest No 16 76,2 88,9 5 23,8 100 21 91,3% 4 14,8 No 0,310
Yes 2 100 11,1 0 0 0 2 8,7%
68 Disturbance during medical table
setup: type
Pretest Microclave missing 1 100 50 0 0 0 1 33,3% 40 93,0 Conversation colleague 0,306
Conversation colleague 1 50 50 1 50 100 2 66,7%
Posttest Material missing 1 100 50 1 50,0% 25 92,6 Material missing = Passage
transportshuttle
Pasage transportshuttle 2 100 50 2 100,0%
69 Hand hygiene after interruption Pretest No 1 50 25 1 50 100 2 40,0% 38 88,4 No= Unknown 0,328
Yes 1 100 25 0 0 0 1 20,0%
Unknown 2 100 50 0 0 0 2 40,0%
Posttest Yes 2 100 100 2 100,0% 25 92,6 Yes
70 Hand hygiene after interruption:
type
Pretest Hand alcohol 1 100 100 1 42 97,7 Hand alcohol
Posttest Hand alcohol 2 100 100 2 25 92,6 Hand alcohol
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
Pagina 40 van 49
Seq Variable description Test type Variable value CLABSI Total n missing
values
% missing
values
Mode Total P
No Yes
N Row % Column % N Row % Column % N %
PERIOD DURING CATHETER PLACEMENT
71 Baby in bag Pretest No 14 87,5 66,7 2 12,5 100 16 69,6% 20 46,5 No 0,216
Yes 7 100 33,3 0 0 0 7 30,4%
Posttest No 8 100 80 0 0 0 8 66,7% 15 55,5 No 0,022
Yes 2 50 20 2 50 100 4 33,3%
72 Umbilical opening widened Pretest No 1 100 14,3 1 14,3% 36 83,7 Yes
Yes 5 100 41,4 5 41,4%
Unknown 1 100 14,3 1 14,3%
Posttest Yes 1 33,3 100 2 66,7 100 3 100,0% 24 88,9 Yes
73 Disinfection umbilical region:
product
Pretest Chlorhexidine 0,5% 30 90,9 78,9 3 9,1 100 33 80,5% 2 4,7 Chlorhexidine 0,5% 0,244
Hibidil 8 100 21,1 0 0 0 8 19,5%
Posttest Chlorhexidine 0,5% 16 80 88,9 4 20 66,7 20 83,3% 3 11,1 Chlorhexidine 0,5% 0,232
Hibidil 2 50 11,1 2 50 33,3 4 16,7%
74 Disinfection umbilical region:
mechanism
Pretest Doctor disinfects
insertion place
6 100 16,2 0 0 0 6 15,0% 3 7,0 Nurse disinfects insertion
place, doctor proceeds and
disinfects again
0,044
Nurse disinfects insertion
place, doctor proceeds
12 100 32,4 0 0 0 12 30,0%
Nurse disinfects insertion
place, doctor proceeds
and disinfects again
19 90,5 51,4 2 9,5 66,7 21 52,5%
Nurs holds limb, doctor
disinfects and proceeds
0 0 0 1 100 33,3 1 2,5%
Posttest Doctor disinfects
insertion place
1 33,3 6,3 2 66,7 33,3 3 13,6% 5 18,5 Nurse disinfects insertion
place, doctor proceeds and
disinfects again
0,271
Nurse disinfects insertion
place, doctor proceeds
6 75 37,5 2 25 33,3 8 36,4%
Nurse disinfects insertion
place, doctor proceeds
and disinfects again
8 88,9 50 1 11,1 16,7 9 40,9%
Nurs holds limb, doctor
disinfects and proceeds
1 50 6,3 1 50 16,7 2
75 New pair of sterile gloves
after disinfection insertion place
Pretest No 23 95,8 62,2 1 4,2 33,3 24 60,0% 3 7,0 No 0,332
Yes 14 87,5 37,8 2 12,5 66,7 16 40,0%
Posttest No 3 75 18,8 1 25 16,7 4 18,2% 5 18,5 Yes 0,255
Yes 13 76,5 81,3 4 23,5 66,7 17 77,3%
Unknown 0 0 0 1 100 16,7 1 4,5%
76 Sterile field: size Pretest Completely sealed,
attached to skin
4 100 11,1 0 0 0 4 10,3% 4 9,3 Completely sealed, not
attached to skin
0,394
Completely sealed, not
attached to skin
26 89,7 72,2 3 100 7,7 29 74,4%
Not sealed around limb,
non sterile surface
underneath not visible
6 100 16,7 0 0 0 6 15,4%
Posttest Completely sealed,
attached to skin
4 100 23,5 0 0 0 4 17,4% 4 14,8 Completely sealed, not
attached to skin
0,077
Completely sealed, not
attached to skin
13 72,2 76,5 5 27,8 83,3 18 78,3%
Not sealed around limb,
non sterile surface
underneath not visible
0 0 0 1 100 16,7 1 4,3%
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
Pagina 41 van 49
Seq Variable description Test type Variable value CLABSI Total n missing
values
% missing
values
Mode Total P
No Yes
N Row % Column % N Row % Column % N %
77 Number of catheter reinstatements Pretest 0 18 94,7 58,1 1 5,3 33,3 19 55,9% 9 20,9 0 0,731
1 9 81,8 29 2 18,2 66,7 11 32,4%
2 1 100 3,2 0 0 0 1 2,9%
3 2 100 6,5 0 0 0 2 5,9%
5 1 100 3,2 0 0 0 1 2,9%
Posttest 0 7 77,8 50 2 22,2 40 9 47,4% 8 29,6 0 0,410
1 5 62,5 35,7 3 37,5 60 8 42,1%
2 2 100 14,3 0 0 0 2 10,5%
78 Number of catheter purging Pretest 0 1 100 7,7 0 0 0 1 7,1% 29 67,4 1 0,759
1 7 87,5 53,8 1 12,5 100 8 57,1%
2 3 100 23,1 0 0 0 3 21,4%
4 2 100 15,4 0 0 0 2 14,3%
Posttest 0 3 60 37,5 2 40 50 5 41,7% 15 55,6 0 0,391
1 1 100 12,5 0 0 0 1 8,3%
2 2 50 25 2 50 50 4 33,3%
4 2 100 25 0 0 0 2 16,7%
79 Catheter movement flawless Pretest No 8 100 25 0 0 0 8 22,9% 8 18,6 Yes 0,391
Yes 23 88,5 71,9 3 11,5 100 26 74,3%
Unknown 1 100 3,1 0 0 0 1 2,9%
Posttest No 4 80 26 1 20 20 5 25,0% 7 25,9 Yes 0,762
Yes 11 73,3 73,3 4 26,7 80 15 75,0%
80 Problems when moving catheter Pretest Bumps against liver 2 100 25 2 25,0% 35 81,4 No reflu = unknown
No reflu 3 100 37,5 3 37,5%
Unknown 3 100 37,5 3 37,5%
Posttest Moved, slipped back 0 0 0 1 100 100 1 25,0% 23 85,2 Difficult to move forward 0,105
Difficult to move forward 2 100 66,7 0 0 0 2 50,0%
Replacement Seldinger 1 100 33,3 0 0 0 1 25,0%
81 Massage during catheter Pretest
movement
No 7 87,5 46,7 1 12,5 100 8 50,0% 27 62,8 No 0,484
Yes 7 100 46,7 0 0 0 7 43,8%
Unknown 1 100 6,7 0 0 0 1 6,3%
Posttest No 7 70 87,5 3 30 75 10 83,3% 15 55,6 No 0,592
Yes 1 50 12,5 1 50 25 2 16,7%
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
Pagina 42 van 49
Seq Variable description Test type Variable value CLABSI Total n missing
values
% missing
values
Mode Total P
No Yes
N Row % Column % N Row % Column % N %
PREPARATION PERFUSION LINES
82 Preparation perfusion lines: hand
Pretest hygiene
Yes 34 91,9 97,1 3 8,1 100 37 97,4% 5 11,6 0,683
Unknown 1 100 2,9 0 0 0 1 2,6%
Posttest Yes 19 76 100 6 24 100 25 100,0% 2 7,4
83 Hand hygiene preparation Pretest
perfusion lines: type
Water and soap 1 100 3 0 0 0 1 2,8% 7 16,3 Hand alcohol 0,358
Hand alcohol 23 88,5 69,7 3 11,5 100 26 72,2%
Water + soap + hand
alcohol
9 100 27,3 0 0 0 9 25,0%
Posttest Hand alcohol 15 78,9 78,9 4 21,1 66,7 19 76,0% 2 7,4 Hand alcohol 0,549
Water + soap + hand
alcohol
4 66,7 21,1 2 33,3 33,3 6 24,0%
84 Preparation perfusion lines: Pretest
disinfection medical table proceeding
preparation of perfusion lines
No 4 100 11,1 0 0 0 4 10,3% 4 9,3 Yes 0,651
Yes 31 91,2 86,1 3 8,8 100 34 87,2%
Unknown 1 100 2,8 0 0 0 1 2,6%
Posttest No 1 100 5,3 0 0 0 1 4,0% 2 7,4 Yes 0,453
Yes 18 75 94,7 6 25 100 24 96,0%
85 Preparation perfusion lines: Pretest
disinfection medical table type
Incidin foam 29 90,6 93,5 3 9,4 100 32 94,1% 9 20,9 Incidin foam 0,537
Incidin wipes 2 100 6,5 0 0 0 2 5,9%
Posttest Incidin foam 17 77,3 94,4 5 22,7 83,3 22 91,7% 3 11,1 Incidin foam 0,425
Incidin wipes 1 50 5,6 1 50 16,7 2 8,3%
86 Preparation perfusion lines: mouth
Pretest mask nurse
No 1 100 2,8 0 0 0 1 2,6% 4 9,3 Yes 0,848
Yes 34 91,9 94,4 3 8,1 100 37 94,9%
Unknown 1 100 2,8 0 0 0 1 2,6%
Posttest No 1 100 5,3 0 0 0 1 4,0% 2 7,4 Yes 0,453
Yes 18 75 94,7 6 25 100 24 96,0%
87 Preparation perfusion lines: use of
Pretest sterile field
Yes 36 92,3 100 3 7,7 100 39 100,0% 4 9,3 Yes
Posttest Yes 18 75 100 6 25 100 24 100,0% 3 11,1 Yes
88 Prepartion perfusion lines: use of
Pretest sterile material
No 1 100 2,8 0 0 0 1 2,6% 4 9,3 Yes 0,713
Yes 32 91,4 88,9 3 8,6 100 35 89,7%
Unknown 3 100 8,3 0 0 0 3 7,7%
Posttest Yes 17 73,9 100 6 26,1 100 23 100,0% 4 14,8 Yes
89 Preparation perfusion lines: purging
Pretest according to regulations
No 1 100 2,8 0 0 0 1 2,6% 5 11,6 Yes 0,795
Yes 32 94,1 88,9 2 5,9 100 34 89,5%
Unknown 3 100 8,3 0 0 0 3 7,9%
Posttest No 1 100 5,9 0 0 0 1 4,3% 4 14,8 Yes 0,431
Yes 16 72,7 94,1 6 27,3 100 22 95,7%
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
Pagina 43 van 49
Seq Variable description Test type Variable value CLABSI Total n missing
values
% missing
values
Mode Total P
No Yes
N Row % Column % N Row % Column % N %
90 Preparation perfusion lines: purging Pretest
product
Physiological serum 12 100 33,3 0 0 0 12 30,8% 4 9,3 TPN + physiological serum 0,445
TPN + physiological
serum
13 86,7 36,1 2 13,3 66,7 15 38,5%
Glucose 10% and
physiological serum
10 90,9 27,8 1 9,1 33,3 11 28,2%
Glucose 10% 1 100 2,8 0 0 0 1 2,6%
Posttest Physiological serum 3 60 18,8 2 40 33,3 5 22,7% 5 18,5 TPN + physiological serum 0,260
TPN 0 0 0 1 100 16,7 1 4,5%
TPN + physiological
serum
9 90 56,3 1 10 16,7 10 45,5%
Glucose 10% and
physiological serum
3 75 18,8 1 25 16,7 4 18,2%
Glucose 10% 1 50 6,3 1 50 16,7 2 9,1%
91 Preparation perfusion lines: nurse
Pretest absent
No 28 93,3 80 2 6,7 100 30 81,1% 6 14,0 No 0,649
Yes 6 100 17,1 0 0 0 6 16,2%
Unknown 1 100 2,9 0 0 0 1 2,7%
Posttest No 15 75 88,2 5 25 83,3 20 87,0% 4 14,8 No 0,764
Yes 2 66,7 11,8 1 33,3 16,7 3 13,0%
92 Preparation perfusion lines: Pretest number of
times nurse absent
1 1 100 33,3 1 33,3% 40 93,0 1=2=3
2 1 100 33,3 1 33,3%
3 1 100 33,3 1 33,3%
Posttest 1 1 100 50 0 0 0 1 33,3% 24 88,9 1=2=3 0,148
2 1 100 50 0 0 0 1 33,3%
3 0 0 0 1 100 100 1 33,3%
93 Preparation perfusion lines: hand
Pretest hygiene after
interruption
No 1 100 25 1 25,0% 39 90,7 Yes
Yes 3 100 75 3 75,0%
Posttest Yes 1 50 100 1 50 100 2 100,0% 25 92,6 Yes
94 Preparation perfusion lines: hand
Pretest hygiene after
interruption: type
Hand alcohol 3 100 100 3 100,0% 40 93,0 Hand alcohol
Posttest Hand alcohol 1 100 100 0 0 0 1 50,0% 25 92,6 Hand alcohol=Water + soap +
hand alcohol
0,096
Water + soap + hand
alcohol
0 0 0 1 100 100 1 50,0%
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
Pagina 44 van 49
Seq Variable description Test type Variable value CLABSI Total n missing
values
% missing
values
Mode Total P
No Yes
N Row % Column % N Row % Column % N %
BANDAGE
95 Umbilical cord stomp clean Pretest No 7 87,5 21,9 1 12,5 33,3 8 22,9% 8 18,6 Yes 0,664
Yes 25 92,6 78,1 2 7,4 66,7 27 77,1%
Posttest No 2 100 13,3 0 0 0 2 10,0% 7 25,9 Yes 0,269
Yes 13 72,2 86,7 5 27,8 100 18 90,0%
96 Bandage type Pretest Bridging to secure UVC 8 100 42,1 0 0 0 8 38,1% 22 51,2 Bridging to secure UVC +
steristrip
0,302
Bridging to secure UVC +
steristrip
10 83,3 52,6 2 16,7 100 12 57,1%
Bridging to secure UVC +
steristrip + attached to
skin
1 100 5,3 0 0 0 1 4,8%
Posttest Bridging to secure UVC 3 100 37,5 0 0 0 3 30,0% 17 63,0 Bridging to secure UVC +
steristrip
0,201
Bridging to secure UVC +
steristrip
5 71,4 62,5 2 28,6 100 7 70,0%
97 Tegaderm 5 x 5 cm Pretest No 4 100 25 0 0 0 4 23,5% 26 60,5 Yes 0,456
Yes 12 92,3 75 1 7,7 100 13 76,5%
Posttest Yes 8 66,7 100 4 33,3 100 12 100,0% 15 55,5 Yes
98 Tegarderm oval Pretest No 1 100 6,3 0 0 0 1 5,9% 26 60,5 Yes 0,724
Yes 15 93,8 93,8 1 6,3 100 16 94,1%
Posttest Yes 8 66,7 100 4 33,3 100 12 100,0% 15 55,6 Yes
99 Tegafilm Pretest No 15 93,8 93,8 1 6,3 100 16 94,1% 26 60,5 No 0,724
Yes 1 100 6,3 0 0 0 1 5,9%
Posttest No 7 63,6 100 4 36,4 100 11 100,0% 16 59,3 No
100 Cut tegaderm Pretest No 14 93,3 87,5 1 6,7 100 15 88,2% 26 60,5 No 0,611
Yes 2 100 12,5 0 0 0 2 11,8%
Posttest No 7 63,6 100 4 36,4 100 11 100,0% 16 59,3 No
101 Bandage: protective dressing under Pretest
PICC connection
Yes 16 100 100 16 100,0% 27 62,8 Yes
Posttest No 1 100 12,5 0 0 0 1 8,3% 15 55,6 Yes 0,355
Yes 7 63,6 87,5 4 36,4 100 11 91,7%
102 PICC connection piece sterile Pretest No 0 0 0 1 100 50 1 2,6% 5 11,6 Yes 0,011
Yes 36 97,3 100 1 2,7 50 37 97,4%
Posttest Yes 17 73,9 100 6 26,1 100 23 100,0% 4 14,8 Yes
103 Perfusion instantly ready for Pretest
connection
Yes 35 94,6 100 2 5,4 100 37 100,0% 6 14,0 Yes
Posttest Yes 16 72,7 100 6 27,3 100 22 100,0% 5 18,5 Yes
104 Perfusion: method of connection Pretest Doctor holds catheter
end, nurse makes
connection
30 93,8 93,8 2 6,3 100 32 94,1% 9 20,9 Doctor holds catheter end,
nurse makes connection
0,617
Doctor holds catheter
end, than takes clean
perfusion line and makes
connection
2 100 6,3 0 0 0 2 5,9%
Posttest Doctor holds catheter
end, nurse makes
connection
13 68,4 100 6 31,6 100 19 100,0% 8 29,6 Doctor holds catheter end,
nurse makes connection
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
Pagina 45 van 49
Seq Variable description Test type Variable value CLABSI Total n missing
values
% missing
values
Mode Total P
No Yes
N Row % Column % N Row % Column % N %
CHECK
105 RX control Pretest Yes 38 92,7 100 3 7,3 100 41 100,0% 2 4,7 Yes
Posttest Yes 19 76 100 6 24 100 25 100,0% 2 7,4 Yes
106 Catheter repositioning Pretest No 16 88,9 41 2 11,1 66,7 18 42,9% 1 2,3 Yes 0,389
Yes 23 95,8 59 1 4,2 33,3 24 57,1%
Posttest No 9 64,3 47,4 5 35,7 83,3 14 56,0% 2 7,4 No 0,107
Yes 10 90,9 52,6 1 9,1 16,7 11 44,0%
107 Catheter repositioning: mechanism Pretest Doctor still sterile 11 100 57,9 0 0 0 11 55,0% 23 53,5 Doctor still sterile 0,333
Hand hygiene and sterile
gloves by doctor
6 85,7 31,6 1 14,3 100 7 35,0%
Use of sterile gloves by
doctor, no hand hygiene
performed
2 100 10,5 0 0 0 2 10,0%
Posttest Doctor still sterile 3 100 33,5 0 0 0 3 30,0% 17 63,0 Hand hygiene and sterile
gloves by doctor
0,090
Doctor again sterile 1 100 11,1 0 0 0 1 10,0%
Hand hygiene and sterile
gloves by doctor
5 100 55,6 0 0 0 5 50,0%
Use of sterile gloves by
doctor, no hand hygiene
performed
0 0 0 1 100 100 1 10,0%
108 Catheter repositioning: disinfection Pretest
insertion place before catheter repositioning
No 9 90 47,4 1 10 100 10 50,0% 23 53,5 No=Yes 0,230
Yes 10 100 52,6 0 0 0 10 50,0%
Posttest No 1 100 16,7 0 0 0 1 14,3% 20 74,1 Yes 0,563
Yes 5 83,3 83,3 1 16,7 100 6 85,7%
109 Catheter repositioning: new Pretest
bandage
No 8 100 44,4 0 0 0 8 42,1% 24 55,8 Yes 0,287
Yes 10 90,9 55,6 1 9,1 100 11 57,9%
Posttest Yes 5 83,3 100 1 16,7 100 6 100,0% 21 77,8 Yes
MANIPULATIONS
110 Month Manipulations catheter Pretest January 10 100 25,6 0 0 0 10 23,8% 1 2,3 December 0,459
February 4 100 10,3 0 0 0 4 9,5%
March 5 100 12,8 0 0 0 5 11,9%
May 3 75 7,7 1 25 33,3 4 9,5%
June 5 83,3 12,8 1 16,7 33,3 6 14,3%
December 12 92,3 30,8 1 7,7 33,3 13 31,0%
Posttest January 8 100 38,1 0 0 0 8 30,8% 1 3,7 November 0,085
February 4 100 19 0 0 0 4 15,4%
October 2 66,7 9,5 1 33,3 20 3 11,5%
November 6 60 28,6 4 40 80 10 38,5%
December 1 100 4,8 0 0 0 1 3,8%
111 N Reattaching bandage Pretest 0 30 100 90,9 0 0 0 30 85,7% 8 18,6 0 0,013
1 1 50 3 1 50 50 2 5,7%
2 2 66,7 6,1 1 33,3 50 3 8,6%
Posttest 0 27 100,0
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
Pagina 46 van 49
Seq Variable description Test type Variable value CLABSI Total n missing
values
% missing
values
Mode Total P
No Yes
N Row % Column % N Row % Column % N %
INFECTION
112 Catheter infection: type Pretest S. Capitis 2 100 66,7 2 66,7% 40 93,0 S. Capitis
Clinical 1 100 33,3 1 33,3%
Posttest S. Capitis 2 100 33,3 2 33,3% 21 77,8 S. Epidermis
S. Epidermis 3 100 50 3 50,0%
S. Capitis + S. Epidermis 1 100 16,7 1 16,7%
EXTRA
113 Catheter type Pretest PICC 17 94,4 42,5 1 5,6 33,3 18 41,9% 43 0,0 UVC 0,754
UVC 23 92 57,5 2 8 66,7 25 58,1%
Posttest PICC 10 71,4 47,6 4 28,6 66,7 14 51,9% 27 0,0 UVC 0,406
UVC 11 84,6 52,4 2 15,4 33,3 13 48,1%
114 Reason Admission Pretest PROM 5 100 12,5 0 0 0 5 11,6% 43 0,0 Prematurity 0,650
Prematurity 23 92 57,5 2 8 66,7 25 58,1%
Respiratory 3 75 7,5 1 25 33,3 4 9,3%
Infection 5 100 12,5 0 0 0 5 11,6%
Other 2 100 5 0 0 0 2 4,7%
Asphyxia 2 100 5 0 0 0 2 4,7%
Posttest PROM 4 66,7 19 2 33,3 7,4 6 22,2% 27 0,0 Prematurity 0,378
Prematurity 10 71,4 47,6 4 28,6 66,7 14 51,9%
Respiratory 2 100 9,5 0 0 0 2 7,4%
Other 3 100 14,3 0 0 0 3 11,1%
Asphyxia 2 100 9,5 0 0 0 2 7,4%
115 Moment of the day Pretest Morning 11 91,7 27,5 1 8,3 33,3 12 27,9% 0 0,0 Afternoon 0,794
Afternoon 21 95,5 52,5 1 4,5 33,3 22 51,2%
Evening 8 88,9 20 1 11,1 33,3 9 20,9%
Posttest Morning 9 81,8 45 2 18,2 33,3 11 42,3% 1 3,7 Afternoon 0,447
Afternoon 9 69,2 45 4 30,8 66,7 13 50,0%
Evening 2 100 10 0 0 0 2 7,7%
116 N Disinfection clave Pretest <3 5 100 13,5 0 0 0 5 12,5% 3 7,0 3-46 0,311
3-46 30 93,8 81,1 2 6,3 66,7 32 80,0%
47-90 1 50 2,7 1 50 33,3 2 5,0%
>91 1 100 2,7 0 0 0 1 2,5%
Posttest 3-46 17 94,4 94,4 1 5,6 25 18 81,8% 5 18,5 3-46 0,003
47-90 1 25 5,6 3 75 13,6 4 18,2%
117 N administration medication Pretest <2 17 100 45,9 0 0 0 17 42,5% 3 7,0 2-13 0,195
2-13 17 89,5 45,9 2 10,5 66,7 19 47,5%
14-25 2 66,7 5,4 1 33,3 33,3 3 7,5%
26-37 1 100 2,7 0 0 0 1 2,5%
Posttest <2 7 100 33,3 0 0 0 7 26,9% 1 3,7 2-13 0,200
2-13 8 88,9 38,1 1 11,1 20 9 34,6%
14-25 4 66,7 19 2 33,3 40 6 23,1%
26-37 1 50 4,8 1 50 20 2 7,7
38-63 1 50 4,8 1 50 20 2 7,7
118 Birth weight (gram) Pretest 0-1499 17 94,4 42,5 1 5,6 33,3 18 41,9% 0 0,0 >1500 0,754
>1500 23 92 57,5 2 8 66,7 25 58,1%
Posttest 0-1499 8 57,1 38,1 6 42,9 100 14 51,9% 0 0,0 0-1499 0,002
>1500 13 100 61,9 0 0 0 13 41,8%
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
Pagina 47 van 49
Seq Variable description Test type Variable value CLABSI Total n missing
values
% missing
values
Mode Total P
No Yes
N Row % Column % N Row % Column % N %
119 Duration catheter period Pretest 0-3 7 100 17,5 0 0 0 7 16,3% 0 0,0 4-9 0,382
4-9 29 93,5 72,5 2 6,5 66,7 31 72,1%
>9 4 80 10 1 20 33,3 5 11,6%
Posttest 0-3 5 100 23,8 0 0 0 5 18,5% 0 0,0 4-9 0,001
4-9 11 100 52,4 0 0 0 11 40,7% >9
>9 5 45,5 23,8 6 54,5 100 11 40,7%
120 Gestational Age (weeks) Pretest 0-24,6 1 100 2,5 0 0 0 1 2,3% 0 0,0 33-36,6 0,664
25-28,6 11 91,7 27,5 1 8,3 33,3 12 27,9%
29-32,6 9 100 22,5 0 0 0 9 20,9%
33-36,6 15 93,8 37,5 1 6,3 33,3 16 37,2%
37-42,6 4 80 10 1 20 33,3 5 11,6%
Posttest 0-24,6 3 75 14,3 1 25 16,7 4 14,8% 0 0,0 25-28,6 0,122
25-28,6 4 50 19 4 50 66,7 8 29,6%
29-32,6 6 85,7 28,6 1 14,3 16,7 7 25,9%
33-36,6 3 100 14,3 0 0 0 3 11,1%
37-42,6 5 100 23,8 0 0 0 5 18,5%
121 N connecting line Pretest <37 36 94,7 97,3 2 5,3 66,7 38 95,0% 3 7,0 <37 0,090
37-73 1 50 50 1 50 33,5 2 5,0%
Posttest <37 17 85 81 3 15 60 20 76,9% 1 3,7 <37 0,634
37-73 2 66,7 9,5 1 33,3 20 3 11,5%
>73 2 66,7 9,5 1 33,3 20 3 11,5%
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
Pagina 48 van 49
APPENDIX 5: STATISTICAL DATA ANALYSIS QUANTITATIVE
VARIABLES
No: No CLABSI Yes: CLABSI P Mann Withney U test
N
Median Minimum Maximum
Percentiles
N
Median Minimum Maximum
Valid Missing 25 75 Valid Missing
Duration procedure (min) Prestest
Posttest
35 5
18 3
45,0
32,5
15,0 78,0
15,0 120,0
30,0 50,0
26,5 48,8
2,0
6,0
1,0
0,0
27,5 15,0
35,0 30,0
40,0
65,0 0,192
0,673
Gestational age (weeks, days) Pretest
Posttest
40 0
21 0
32,5
32,3
24,0 40,2
24,0 39,4
28,5 35,1
26,6 37,1
3
6 0
0 33,1 28,5
26,6 24,1
38,0
29,6 0,668
0,057
Birth weight (grams) Prestest
Posttest
40 0
21 0
1753
2035
695 3035
595 4370
1005 2386 845
2725 3
6
0
0
2415 900 838
725 4663
1330 0,396
0,049
Age at moment of cateher insertion (days) Pretest
Posttest 40 0
20 1
0
1
0 12
0 98
0 3
0 7
3
6
0
0
0 0
5 0
6
17 0,875
0,533
Weight at moment of catheter insertion (grams) Prestest
Posttest 39 1
20 1
1770
1942
695 3035
667 4370
872 2328
1006 2513
3
6 0
0
2415 855 924
800 4663
1150 0,371
0,046
Birthweight - weight catheter insertion Pretest
Posttest 39 1
20 1
0
0
-350 107 0
1675 -60 0 0
174 3
6 0
0 0 0
64 0
45
345 0,255
0,533
Temperature NICU (°C) Prestest
Posttest
37 3
14 7
27,0
27,3
25,1 29,7
26,6 28,1
26,6 27,6
26,9 27,8
3
6
0
0
29,2 27,6
26,7 26,2
29,6
28,3 0,025
0,076
Humidity NICU (%) Pretest
Posttest
36 4
12 9
29,8
31,0
22,8 41,6
21,7 42,0
27,5 32,8
27,3 35,7
3
6
0
0
31,0 29,8
33,7 29,3
33,0
35,5 0,464
0,750
Humidity incubator (%) Pretest
Posttest
38 2
19 2
54,5
50,0
0,0 85,0
0,0 75,0
41,8 65,0 0,0
63,0 3
6
0
0
46,0 0,0
60,0 0,0
46,0
70,0 0,120
0,221
Labo CRP (mg/dl) Prestest
Posttest
34 6
18 3
0,5
0,5
0,5 44,0
0,5 23,0
0,5 1,0
0,5 1,4
3
6
0
0
8,1 0,5
1,0 0,5
10,4
193,0 0,165
0,454
Labo WBC (x10³/mm³) Pretest
Posttest
36 4
17 4
9,6
14,0
3,1 64,7
2,6 48,8
5,9 13,6
8,4 26,1
3
5
0
1
11,9 4,9
15,1 4,6
18,2
22,2 0,823
0,820
Hemoglobin (g/dl) Prestest
Posttest
36 4
17 4
16,1
14,9
1,5 22,0
8,8 19,0
13,0 17,6
11,6 15,7
3
5
0
1
14,8 12,2
11,6 8,3
16,2
16,9 0,433
0,704
Depth catheter (cm) Pretest
Posttest
38 2
18 3
10,3
12,3
5,0 23,5
5,5 23,0
8,0 18,5
7,8 15,0
3
6
0
0
12,0 10,0
10,8 7,0
13,0
18,0 0,906
1,000
Start procedure - start table preparation (min) Pretest
Posttest 29 11
15 6
5,0
5,0 0,0 85,0
0,0 30,0
0,5 16,5
0,0 15,0
2
4 1
2 7,5 5,0
7,5 5,0
10,0
20,0 1,000
0,530
Duration medical table setup (min) Prestest
Posttest 34 6
17 4
3,0
2,0 2,0 75,0
2,0 10,0
2,0 5,0
2,0 5,0
3
5 0
1 5,0 5,0
3,0 2,0
7,0
4,0 0,183
0,880
Disinfection umbilical region: diameter (cm) Pretest
Posttest 35 5
12 9
5,0
5,0
1,0 11,0
3,0 15,0
4,0 6,0
4,3 9,0
3
5
0
1 5,0 4,0
5,0 5,0
10,0
10,0 0,959
0,646
Perfusion: Time of preservation before connection (min) Prestest
Posttest 32 8
15 6
20,0
20,0
1,0 180,0 0,0
60,0 10,0 45,0 5,0
30,0 2
6 1
0
21,5 3,0 32,5
10,0 40,0
75,0 0,602
0,267
Time difference catheter placement - RX control (min) Pretest
Posttest 25 15
12 9
10,0
6,0 0,0 70,0
0,0 30,0
9,5 20,0
5,0 13,8
3
6
0
0
15,0 10,0 7,5
5,0 40,0
20,0 0,622
0,750
Catheter repositioning: distance (cm) Prestest
Posttest 36 4
11 10
1,0
0,0 0,0 4,0
0,0 3,0
0,0 1,5
0,0 2,0
3
5
0
1 0,0 0,0
0,0 0,0
0,5
0,0 0,249
0,441
Time difference catheter repositioning - catheter placement
(min) Pretest
Posttest 18 22
7 14 12,5
35,0
0,0 185,0
0,0 240,0
8,8 41,3 5,0 120,0 1
1
2
5 16,0 16,0 1,0
1,0 16,0
1,0 0,737
0,500
Appendix 5 -Page 1 of 2
EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)
Pagina 49 van 49
No: No CLABSI Yes: CLABSI P Mann Withney U test
N
Median Minimum Maximum
Percentiles
N
Median Minimum Maximum
Valid Missing 25 75 Valid Missing
N Rinsing clave Prestest 37 3 6 0 123 2 14 3 0 10 3 60 0,461
Posttest 21 0 8 0 195 4 30 5 1 53 23 254
0,015 N Administration of medication Pretest 37 3 4 0 31 0 7 3 0 4 2 17
0,401
Posttest 21 0 2 0 58 1 16 5 1 22 3 63
0,028 N Disinfection clave Prestest 37 3 7 0 93 3 14 3 0 6 3 66
0,847
Posttest 21 0 13 3 165 10 32 5 1 54 35 272
0,015 N Connecting line Pretest 37 3 4 0 61 3 10 3 0 2 2 46
0,809
Posttest 21 0 10 4 160 8 19 5 1 35 29 228
0,012 N deconnecting line Prestest 37 3 1 0 57 0 4 2 1 22 2 42
0,243
Posttest 21 0 9 1 161 7 25 4 2 28 18 223
0,057 Duration catheter period (days) Pretest 40 0 6 1 42 4 8 3 0 8 8 31
0,028
Posttest 21 0 7 2 29 4 10 6 0 18 10 65
0,003
Appendix 5 -Page 2 of 2
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