Rate Of Catheter-associated Bloodstream Infections Research Articles

PO-0348 The Relationship Between Broviac Lines And Catheter Associated Blood Stream Infection

Background Broviac lines are a common source of catheter-associated bloodstream infection (CABSI) in our 22-bed tertiary paediatric intensive care unit (PICU). Aims To assess data in Broviac lines CABSI cases Methods Prospective clinical and laboratory data on all PICU admissions for 24 months (3/2010–3/2012), missing data was supplemented retrospectively using electronic patient records. The UK National Patient Safety Association ‘Matching Michigan’ case definitions were utilised to identify bloodstream infections and CABSI. The study was approved by the Clinical Audit Department- a division of the Directorate of Research and Clinical Development at Alder Hey Children’s Hospital. Results PICU-acquired CABSI rate was 7.35 per 1000 central line days. Device utilisation ratio (CVC days per patient days) was 0.77. Central line associated with CABSI: Broviac line 23 (39%); Triple lumen CVC femoral 14 and jugular 13; ECMO circuit 4; Renal/Vascatheter 3; Portacath 2. Conclusions In our patient population Broviac lines are commonly associated with CABSI and especially in less than one year age group.

Urinary metabolome of children with autism and pervasive developmental disorder not otherwise specified

Urinary metabolome of children with autism and pervasive developmental disorder not otherwise specified

Assessing phenotype and disease course in children with earlier onset of IBD (<11 years). Data from two tertiary centres in the United Kingdom and Italy

Assessing phenotype and disease course in children with earlier onset of IBD (<11 years). Data from two tertiary centres in the United Kingdom and Italy

PC.101 Reducing catheter associated blood stream infections in neonatal intensive care

BackgroundCentral vessel catheterisation (CVC) is commonly used during neonatal intensive care. Catheter associated blood stream infection (CABSI) is a serious complication of CVC. We introduced a care bundle to reduce...

ABSTRACT 644

Background and aims: Triple lumen central venous catheters (CVC) are a common source of catheter-associated bloodstream infection (CABSI) in our 22-bed tertiary PICU. Aims: To assess the relationship between triple lumen CVC dwelling time and CABSI causative microorganism. Methods: Prospective clinical and laboratory data on all PICU admissions for 24 months (3/2010–3/2012), missing data was supplemented retrospectively using electronic patient records. The UK National Patient Safety Association ‘Matching Michigan’ case definitions were utilized to identify bloodstream infections and CABSI. The study was approved by the Clinical Audit Department- a division of the Directorate of Research and Clinical Development at Alder Hey Children’s Hospital. Results: PICU-acquired CABSI rate was 7.35 per 1000 central line days. Device utilization ratio (CVC days per patient days) was 0.77. Triple lumen CVC was the source of the CABSI in 27 cases (44%).Table 1: PICU blood cultures dataTable 2: Clinical characteristics of triple lumen CVC culturesConclusions: Enteral bacteria - Enterococcus and Enterobacter species may cause earlier CABSI onset than CONS and Candida (p=0.02).

Are infusion phlebitis assessment scales reliable and valid?

British Journal of Nursing, 2014 (IV Therapy Supplement), Vol 23, No 8 S15 © 2 01 4 M A H ea lth ca re L td Ramritu P, Halton K, Cook D, Whitby M, Graves N (2008) Catheter-related bloodstream infections in intensive care units: a systematic review with meta-analysis. J Adv Nurs 62(1): 3–21 Sacks GD, Diggs BS, Hadjizacharia P, Green D, Salim A, Malinoski DJ (2014) Reducing the rate of catheterassociated bloodstream infections in a surgical intensive care unit using the Institute for Healthcare Improvement central line bundle. Am J Surg pii: S00029610(13)00743-5. doi: 10.1016/j.amjsurg.2013.08.041 Ullman AJ, Long DA, Rickard CM (2014) Prevention of central venous catheter infections: a survey of paediatric ICU nurse’ knowledge and practice 34(2): 202–7. doi: 10.1016/j.nedt.2013.09.002 202–7

Reducing the rate of catheter-associated bloodstream infections in a surgical intensive care unit using the Institute for Healthcare Improvement central line bundle

BackgroundCentral line–associated bloodstream infections (CLABSIs) are a significant source of morbidity and mortality. This study sought to determine whether implementation of the Institute for Healthcare Improvement (IHI) Central Line Bundle would reduce the incidence of CLABSIs. MethodsThe IHI Central Line Bundle was implemented in a surgical intensive care unit. Patient demographics and the rate of CLABSIs per 1,000 catheter days were compared between the pre- and postintervention groups. Contemporaneous infection rates in an adjacent ICU were measured. ResultsBaseline demographics were similar between the pre- and postintervention groups. The rate of CLABSIs per catheter days decreased from 19/3,784 to 3/1,870 after implementation of the IHI Bundle (1.60 vs 5.02 CLABSIs per 1,000 catheter days; rate ratio .32 [.08 to .99, P < .05]). There was no significant change in CLABSIs in the control ICU. ConclusionsImplementation of the IHI Central Line Bundle reduced the incidence of CLABSIs in our SICU by 68%, preventing 12 CLABSIs, 2.5 deaths, and saving $198,600 annually.

Catheter-associated bloodstream infection after bowel surgery in patients with inflammatory bowel disease

Catheter-associated bloodstream infections (CABSIs) are a leading cause of nosocomial infections. The objectives of this study were to establish the incidence of CABSIs after bowel surgery and to identify the risk factors. We reviewed the prospectively collected data of patients who underwent abdominal surgery with central venous catheter (CVC) insertion between March, 2006 and September, 2009. We analyzed all possible variables, including age, sex, disease, CVC duration, insertion frequency, CVC site, infliximab, corticosteroid, and immunosuppressant administration, preoperative serum albumin level, surgical wound class, and emergency surgery. A total of 1261 patients were prospectively surveyed. The underlying diseases comprised ulcerative colitis (UC; n=428), Crohn's disease (CD; n=334), colorectal cancer (CA; n=344), esophageal cancer (ESO; n=28), gastric cancer (GAST; n=44), and others (n=83). The incidences of CABSI were 6.9/1000 catheter days for UC, 7.4 for CD, 4.3 for CA, 3.7 for ESO, 3.7 for GAST, and 5.1 for others. CD patients had the highest rate of CABSI. The risk factors for CABSI were CD with an odds ratio (OR) of 1.63, dirty/infected wound class (OR 3.34), and CVC insertion via the internal jugular vein (OR 9.89). A high CABSI incidence was found in association with CD, especially in dirty/infected surgery. Thus, the use of CVCs should be restricted in the presence of these risk factors.

Incidence and risk factors for catheter‐associated bloodstream infections in neonatal intensive care

To determine the incidence and potential novel risk factors for catheter-associated bloodstream infections (CABSI) in neonates. A retrospective study was conducted for infants admitted to the VU University Medical Center neonatal intensive care unit in 2007. One hundred and ninety six infants with a total of 369 central catheters were included. The CABSI rate was 18.1 infections/1000 catheter-days (95% CI 13.7-23.8) according to adjusted criteria used by the Centers for Disease Control and Prevention prior to 2008. Umbilical catheters had a higher infection rate than nonumbilical central catheters: rate ratio (rate ratio 2.4, 95% CI 1.2-4.9). Longer umbilical catheter dwell-time also increased infection rate (p < 0.05). Gestational age, birth weight, duration of parenteral nutrition and the administration of all-in-one feeding mixture versus parenteral nutrition administered in separate components were not related to infection rate in multivariate analysis. Of all catheter types, umbilical catheters carried the highest infection rate. Longer umbilical catheter dwell-time also increased infection rate. The present data suggest that the impact of gestational age and birth weight on infection rate is mainly due to a prolonged hospital stay. The composition, way of preparation and duration of parenteral nutrition did not seem to influence infection rate.

Modification of anesthesia practice reduces catheter‐associated bloodstream infections: a quality improvement initiative

A major strategic hospital goal is the prevention of catheter associated bloodstream infections (CABSI). In 2009, at our institution, the CABSI rate for patients who traveled out of the ICU to the operating room and other procedural areas under the care of an anesthesiologist was increased compared to patients who remained on the unit. Our objective was to develop countermeasures to improve intraoperative cleanliness by anesthesia providers, minimize contamination of intravenous access points, and ultimately reduce CABSIs. A multidisciplinary team identified barriers to following best practices for reducing contamination of intravenous line entry-ports. Using Continuous Performance Improvement (CPI) or Lean techniques, staff directly impacted by the changes developed countermeasures to improve anesthesia practice. Compliance with the new "best practices" improved with coaching and feedback. Postimplementation, CABSI rates for patients traveling off the ICU with anesthesiology providers decreased from 14.1 per thousand trips off the ICU preintervention in 2009 to 9.7 per 1000 trips in 2010 and to 0 per 1000 trips in 2011 postintervention. Hospital-wide CABSI rates decreased from 3.5 per 1000 central line days preintervention to 2.2 per 1000 central line days after. Practice modification by anesthesiology providers in the operating room can decrease workspace contamination and is associated with decreased CABSI rates.

Catheter-associated Bloodstream Infections in Pediatric Hematology-Oncology Patients

Catheter-associated bloodstream infections (CABSIs) are common complications encountered with cancer treatment. The aims of this study were to analyze the factors associated with recurrent infection and catheter removal in pediatric hematology-oncology patients. All cases of CABSIs in patients attending the Department of Pediatric Hematology-Oncology between January 2008 and December 2010 were reviewed. A total of 44 episodes of CABSIs, including multiple episodes involving the same catheter, were identified in 31 children with cancer. The overall CABSIs rate was 7.4 infections per 1000 central venous catheter (CVC) days. The most frequent organism isolated was coagulase-negative Staphylococcus (CONS). The CVC was removed in nine (20.4%) episodes. We found that hypotension, persistent bacteremia, Candida infection, exit-side infection, neutropenia, and prolonged duration of neutropenia were the factors for catheter removal. There were 23 (52.2%) episodes of recurrence or reinfection. Mortality rate was found to be 9.6% in children with CABSIs. In this study, we found that CABSIs rate was 7.4 infections per 1000 catheter-days. CABSIs rates in our hematology-oncology patients are comparable to prior reports. Because CONS is the most common isolated microorganism in CABSIs, vancomycin can be considered part of the initial empirical regimen.

Minimizing Complications Associated With Percutaneous Central Venous Catheter Placement in Children

To summarize existing knowledge regarding the prevalence of complications associated with temporary percutaneous central venous catheters placed in critically ill children, and to review evolving strategies to minimize the prevalence of these complications. Literature review was performed: PubMed and EBSCOhost were searched using the terms central venous catheter, children, ultrasound, infection, thrombosis, and thromboembolism in various combinations. Citations of interest from identified articles were also reviewed. The review focused primarily on pediatric literature relevant to the topic of interest. Randomized clinical trials and other prospective studies were discussed in greater detail than retrospective, single-center investigations. Complications during percutaneous central venous catheter placement in children are not rare and may be in part attributable to abnormalities in vascular anatomy. Thromboses in children with central venous catheters are increasingly recognized as an important problem for which evidence-based preventive measures are lacking. Catheter-associated bloodstream infection rates in critically ill children have markedly decreased over the last decade, associated with an increased emphasis on staff education and the use of insertion and maintenance bundles. Available evidence tends to support the use of two-dimensional ultrasound to augment the landmark technique for catheter placement, but more studies are needed.

Intensity of Vascular Catheter Use in Critical Care: Impact on Catheter-Associated Bloodstream Infection Rates and Association with Severity of Illness

Intensity of Vascular Catheter Use in Critical Care: Impact on Catheter-Associated Bloodstream Infection Rates and Association with Severity of Illness

Association between antimicrobial locks for hemodialysis central venous catheters and antibiotic resistance

Antimicrobial locks (AMLs) are effective in preventing catheter-associated bloodstream infections (CABSI) in hemodialysis (HD) patients, but may increase antibiotic resistance. In our center, gentamicin-heparin locks have been used for all HD central venous catheters since July 1, 2004. We previously reported a significant reduction in CABSI rates, but a short-term trend to increased gentamicin resistance among coagulase-negative staphylococci (CNS). We present a further 3-year follow-up study of bacterial resistance in our dialysis center. We examined the susceptibility of bacterial isolates from CABSI from July 1, 2006 to July 31, 2009, restricting analyses to CNS, gram-negative bacilli, and Staphylococcus aureus. We compared the frequency of gentamicin resistance in these isolates between four groups: CABSI in HD patients, non-CABSI in HD patients, peritonitis in peritoneal dialysis (PD) patients, and bloodstream infection in the non-end-stage kidney failure general population. For CNS isolates, the frequency of gentamicin resistance was similar between the CABSI and PD peritonitis groups, but higher in both groups than the general population. The pattern was similar for S. aureus although the differences were of borderline statistical significance. The frequency of gentamicin resistance among gram-negative bacilli isolates did not differ between groups. Gentamicin resistance was more common than expected in CNS and possibly S. aureus isolates from CABSI, although this resistance may be part of a generally higher frequency of antibiotic resistance in the dialysis population, rather than a direct result of AML use. AMLs remain a valuable clinical tool although surveillance is needed to ensure that benefits continue to outweigh risks.

A Randomized, Controlled Trial of Catheter-Related Infectious Event Rates Using Antibiotic-Impregnated Catheters Versus Conventional Catheters in Pediatric Cardiovascular Surgery Patients.

: We conducted a randomized, controlled clinical trial to determine whether a difference in catheter-associated blood stream infection (CABSI) incidence existed between children who underwent cardiac surgery and had a central venous catheter impregnated with minocycline and rifampin versus those who had a conventional, nonimpregnated catheter after cardiac surgery. Due to a lower number of infections than expected, the study was terminated early. Among 288 evaluable patients, the rates of CABSI and line-related complications were similar between the 2 groups.

Taxonomical Risk Assessment

Issue: The Special Care Nursery (SCN) at a community Magnet hospital had a total of nine Catheter Associated Blood Stream Infections (CABSIs) from January 2008 to August 2009. Project: The Special Care Nursery (SCN) is a 12-bed Level III Nursery within a 258-bed, not-for-profit, Magnet hospital located in North Carolina that offers a full range of medical services and specialties to a 5-county region. From September 2009-June 2010, the SCN participated with the Perinatal Quality Collaborative of North Carolina (PQCNC) in a project to decrease CABSIs in neonates. A total of 13 intensive care nurseries participated. While the SCN CABSI rate was considered low for a unit of its size, even one CABSI was too many. The PDSA (Plan, Do, Study, Act) cycle for process improvement for the SCN included implementing new evidence-based practices to decrease the chance of infections. These practices included: Discontinuing the central lines as soon as possible (to decrease the possibility of an infection occurring), Using sterile gloves during tubing changes (to maintain line sterility), Applying 3.15% Chlorhexidine on hubs, 2% Chlorhexidine on infants that qualify (a more effective skin disinfectant), Utilizing a closed system for umbilical arterial catheters (less likely to cause an infection), and Obtaining a dedicated X-ray machine that stays in the SCN (to prevent contamination throughout the hospital). During the duration of this project, nurses completed forms every shift documenting insertion and maintenance techniques. Chart audits, observations and data entry ensured compliance from nurses, mid-level practitioners and physicians. Results: The goal for this project from September 2009-June 2010 was to decrease the CABSI infections by 50%. This goal was met, and exceeded in the months to follow. In 2010, the SCN had 2 CABSIs, with a rate of 3.19. In 2011, the SCN had zero CABSIs. Overall, the PQCNC experienced a 62% decrease in CABSIs across the state, which is equivalent to approximately 8 lives and 2 Â1⁄2 million dollars saved. While the collaborative initiative ended in June 2010, the SCN continued the practice changes that were made and celebrated one year with zero CABSIs on November 2, 2011. We have now started the second project with PQCNC, and expect continued success. Lesson Learned: While the SCN had a very low rate of CABSIs in previous years, it is now known that having zero CABSIs is achievable. The evidence based practices that were put into practice will continue and new ideas will be implemented to prevent CABSIs in neonates.

Central venous catheter-associated bloodstream infections in a pediatric intensive care unit

To compare the rate of central venous catheter-associated bloodstream infections between pediatric intensive care unit admissions where central venous catheters were inserted within the same hospital (internal central venous catheters) and those where central venous catheters were inserted before transfer from other hospitals (external central venous catheters). Retrospective analysis of prospectively collected data. A tertiary care pediatric intensive care unit in London, UK. Consecutive pediatric intensive care unit admissions between May 2007 and March 2009. None. Catheter-associated bloodstream infections were identified using a widely accepted surveillance definition. The rate and time to occurrence of catheter-associated bloodstream infection were compared between internal and external nontunneled central venous catheters. A multilevel Cox-regression model was used to study the association between location of central venous catheter insertion and time to catheter-associated bloodstream infection. In total, 382 central venous catheters were studied (245 internal; 137 external) accounting for a total of 1,737 central venous catheter days. There was a higher catheter-associated bloodstream infection incidence density among external central venous catheters (23.1 [95% confidence interval 11.0-35.2] vs. 9.7 [95% confidence interval 3.9-15.5] per 1,000 catheter-days). Multivariable analyses demonstrated higher infection risk with external central venous catheters (hazard ratio 2.65 [95% confidence interval 1.18-5.96]) despite adjustment for confounding variables. The rate of catheter-associated bloodstream infections in the pediatric intensive care unit is significantly affected by external insertion of the central venous catheter. Future interventions to reduce nosocomial infections on pediatric intensive care units will need to be specifically targeted at this high-risk patient group.

Effectiveness of stepwise interventions targeted to decrease central catheter-associated bloodstream infections*

Determine the impact of three stepwise interventions on the rate of central catheter-associated bloodstream infections. Quasi-experimental study. Three surgical intensive care units (general surgery, trauma, and neurosurgery) at a 1500-bed county teaching hospital in the Miami metro area. All consecutive central catheter-associated bloodstream infection cases as determined by the Infection Control Department. Three interventions aimed at catheter maintenance were implemented at different times in the units: chlorhexidine "scrub-the-hub," chlorhexidine daily baths, and daily nursing rounds aimed at assuring compliance with an intensive care unit goal-oriented checklist. The primary outcome was the monthly intensive care unit rate of central catheter-associated bloodstream infections (infections per 1000 central catheter days). Over 33 months of follow-up (July 2008 to March 2011), we found decreased rates in each of the three intensive care units evaluated during the interventions, especially after implementation of chlorhexidine daily baths. Rates in unit A decreased from a rate of 8.6 to 0.5, unit B from 6.9 to 1.6, and unit C from 7.8 to 0.6. Secondary bloodstream infection rates remained unchanged throughout the observation period in units A and B; however, unit C had a decrease in its rates over time. We report the progressive reduction of central catheter-associated bloodstream infection rates after the stepwise implementation of chlorhexidine "scrub-the-hub" and daily baths in surgical intensive care units, suggesting effectiveness of these interventions.

Inserción eco-guiada de catéteres centrales de inserción periférica (PICC) en pacientes oncológicos y hematológicos: éxito en la inserción, supervivencia y complicaciones

To evaluate the results of peripherally inserted central catheters (PICC) inserted by nurses using an ultrasound-guided technique at bed-side. An observational and prospective study was conducted on all the PICC inserted at bed-side by an ultrasound-guided technique at the Araba University Hospital. The technique was introduced in June 2010, and the data collection period ended in November 2011. The main study variables were successful insertion, duration of PICC, incidences related to the catheter, devices reaching end of treatment and reasons for withdrawal. Patient sociodemographic data and PICC technical features were also registered. A total of 165 PICC were inserted, 73 are still in use, with 95.2% inserted in patients from oncology or haematology departments. Insertion was successful in the 89.7% (95% CI: 85.1%-94.3%) of the cases. The study included 16,234 catheter days, with a median dwell time of 92 days by PICC. The most frequent incidence was accidental removal in 0.986 per 1000 catheter days (95% CI=0.970-1.001). The thrombosis rate was 0.308 per 1,000 days (95% CI= 0.299-0.317), and the catheter-associated bloodstream infection rate was 0.062 per 1,000 catheter days (95% CI=0.058-0.065). Ultrasound-guided PICC insertion can be performed at bedside by trained nurses with a high probability of success. PICC, because of its low complication rate and long indwelling catheter survival, is a suitable central venous device for long-term treatment in oncology and haematology patients.

Chlorhexidine Bathing to Reduce Central Venous Catheter-associated Bloodstream Infection: Impact and Sustainability

BackgroundChlorhexidine bathing has been associated with reductions in healthcare-associated bloodstream infection. To determine the impact and sustainability of the effect of chlorhexidine bathing on central venous catheter-associated bloodstream infection, we performed a prospective, 3-phase, multiple-hospital study. MethodsIn the medical intensive care unit and the respiratory care unit of a tertiary care hospital and the medical-surgical intensive care units of 4 community hospitals, rates of central venous catheter-associated bloodstream infection were collected prospectively for each period. Pre-intervention (phase 1) patients were bathed with soap and water or nonmedicated bathing cloths; active intervention (phase 2) patients were bathed with 2% chlorhexidine gluconate cloths with the number of baths administered and skin tolerability assessed; post-intervention (phase 3) chlorhexidine bathing was continued but without oversight by research personnel. Central venous catheter-associated bloodstream infection rates were compared over study periods using Poisson regression. ResultsCompared with pre-intervention, during active intervention there were significantly fewer central venous catheter-associated bloodstream infections (6.4/1000 central venous catheter days vs 2.6/1000 central venous catheter days, relative risk, 0.42; 95% confidence interval, 0.25-0.68; P<.001), and this reduction was sustained during post-intervention (2.9/1000 central venous catheter days; relative risk, 0.46; 95% confidence interval, 0.30-0.70; P<.001). During the active intervention period, compliance with chlorhexidine bathing was 82%. Few adverse events were observed. ConclusionIn this multiple-hospital study, chlorhexidine bathing was associated with significant reductions in central venous catheter-associated bloodstream infection, and these reductions were sustained post-intervention when chlorhexidine bathing was unmonitored. Chlorhexidine bathing was well tolerated and is a useful adjunct to reduce central venous catheter-associated bloodstream infection.