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Catheter sepsis and antisepsis: matters of life, death, obscurity and resistance
  1. Paul Clarke1,2,
  2. Mark A Webber2,3
  1. 1Neonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
  2. 2Norwich Medical School, University of East Anglia, Norwich, UK
  3. 3Quadram Institute Bioscience, Norwich Research Park, Norwich, UK
  1. Correspondence to Dr Paul Clarke, Neonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, NR4 7UY, UK; paul.clarke{at}nnuh.nhs.uk

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The very lines inserted daily to provide nutrition to neonates during intensive care remain associated with real risks of both mortality and life-impacting brain injury from associated sepsis. However, most cases of central line-associated bloodstream infection (CLABSI) are preventable. There is now compelling observational evidence that adoption of catheter-care ‘bundles’ markedly reduces rates of CLABSI in the neonatal intensive care unit (NICU).1 2 Catheter-care bundles represent grouped evidence-based interventions for good catheter insertion and maintenance practices that, collectively implemented, reduce infection rates compared with individual component interventions. North American centres have shown that, by using bundles in conjunction with dedicated personnel, enhanced education, documentation and a continuous focus on the gravity of the whole catheterisation process, it is possible to achieve zero CLABSI rates for protracted periods—even as long as 1–2 years.3 In the most recent published UK survey, however, only 70% of tertiary-level UK NICUs had catheter-care bundles in place.4 Current evidence implies that infants cared for on units that have not yet implemented best practice guidelines may be at an increased risk of CLABSI2; such hospitals may be vulnerable to possible litigation in cases of damaging late-onset sepsis.

Furthermore, there is still debate as to preferred choice and accuracy of CLABSI working definition, inconsistency in definitions used to report CLABSI rates, and concern about data reliability.2 5 The National Neonatal Audit Programme’s latest report (2016) shows that data entry was considered complete and reliable enough to allow inter-unit comparisons of CLABSI rates for only 22 (14%) of the 182 individual NICUs audited.5 So while many US centres have raced to slash their CLABSI rates, sometimes spurred on by the Medicare health insurance programme’s withholding of funding for hospital-acquired CLABSI cases,6 it appears that most UK units do not even know their …

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