Cluster of coagulase-negative Staphylococcus associated with central line care in the intensive care unit

Abstract

BACKGROUND: The hospital, a 451-bed acute care facility in Portland, Oregon, was alerted to a significant increase in hospital-associated coagulase-negative <i>Staphylococcus</i> isolates from blood sources during August-September 2003. OBJECTIVES: Identify processes putting patients at risk, correct process breakdowns, and share information for future prevention with other clinical staff. METHODS: Data-mining services are provided to the hospital. Monthly reports are generated to detect unsuspected patterns of infection within the hospital and community. In September 2003, infection control (IC) received an alert describing a 170% increase (p=0.041) in patients with non-duplicate hospital-associated coagulase-negative <i>Staphylococcus</i> isolates from the blood of patients with central lines in the intensive care unit (ICU). When IC sent the pattern to the manager of critical care, the issue was presented at a staff meeting. It was discovered that a new product had been introduced (CLC2000™ from ICU Medical, Inc., San Clemente, California), and the staff was not familiar with some aspects of utilization. Addition of the CLC2000 was done to decrease heparin flushes as this product requires only saline. Equipment replacement frequency was not established, and the valve on the needleless connection did not retract when positive pressure was created. Reviewing the issues with the vendor found the instruction care card provided had missed a key step when creating the positive pressure in the access device. Interventions included updating the printed instruction cards for all nursing, re-education of the full ICU staff in the use of the CL2000, use of alcohol when swabbing all ports prior to entry, and use of ChloraPrep™ for insertion and maintenance of all central lines. RESULTS: Continuing electronic surveillance for hospital-associated coagulase-negative <i>Staphylococcus</i> blood isolates revealed an 80% decrease by the end of January 2004. CONCLUSION: Investigation of a cluster of coagulase-negative blood isolates reduced the contaminated blood cultures and potentially the decrease of antibiotics started in response to a positive blood culture.