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Care bundles to reduce central line-associated bloodstream infections in the neonatal unit: a systematic review and meta-analysis
  1. Victoria Payne1,
  2. Mike Hall2,
  3. Jacqui Prieto1,
  4. Mark Johnson2,3
  1. 1 Faculty of Health Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
  2. 2 Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  3. 3 National Institute for Health Research, Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
  1. Correspondence to Victoria Payne, Faculty of Health Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, Princess Anne Hospital F- 120, Southampton, UK; vp1m14{at}


Background Central line-associated bloodstream infections (CLABSIs) are associated with increased mortality, prolonged hospitalisation and increased healthcare costs. Care bundles have reduced CLABSIs in adult intensive care units (ICUs) but replication in paediatric ICUs has had inconsistent outcomes. A systematic review was performed to assess the evidence for the efficacy of care bundles in reducing CLABSIs in the neonatal unit (NNU).

Methods MEDLINE, CINAHL and EMBASE were searched from January 2010 up to January 2017. The Cochrane Library, Web of Science, Zetoc and Ethos were searched for additional studies. Randomised controlled trials (RCTs), quasi-experimental and observational studies were eligible. The primary outcome measure was CLABSI rates per 1000 central line, or patient, days. A meta-analysis was performed using random effects modelling.

Results Twenty-four studies were eligible for inclusion: six were performed in Europe, 12 were in North America, two in Australia and four were in low/middle-income countries. Five were observational studies and 19 were before and after quality improvement studies. No RCTs were found. Meta-analysis revealed a statistically significant reduction in CLABSIs following the introduction of care bundles (rate ratio=0.40 (CI 0.31 to 0.51), p<0.00001), which equates to a 60% reduction in CLABSI rate.

Conclusion There is a substantial body of quasi-experimental evidence to suggest that care bundles may reduce CLABSI rates in the NNU, though it is not clear which bundle elements are effective in specific settings. Future research should focus on determining what processes promote the effective implementation of infection prevention recommendations, and which elements represent essential components of such care bundles.

  • care bundles
  • central line-associated bloodstream infections
  • late-onset sepsis
  • neonates
  • neonatal intensive care

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  • Contributors MH and VP contributed to the conception of the research. MJ and VP performed the search and selection process separately, and disagreements were resolved by discussion. VP performed data collection and analysis, and MJ assisted with data analysis. VP drafted the original manuscript. All authors were involved in critical revision of the article and approved the final version for publication.

  • Funding The Royal College of Nursing Foundation Trust provided VP with financial support towards tuition fees.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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