Catheter-associated Bloodstream Research Articles

Microbial profile and risk factors of central venous catheter associated blood stream infections in Tertiary Care Hospital, Amritsar

Introduction: Central venous catheter (CVC) related blood stream infections are associated with serious infectious complications resulting in significant morbidity, increased duration of hospitalization and added medical cost. Aim: The study was done to determine the incidence of central venous catheter related infections, their antimicrobial sensitivity pattern, biofilm production and associated risk factors in hospitalized patients. Material and Method: Catheter tip culture & blood cultures of 143 patients with indwelling central venous catheters were processed. Result: Out of 143 specimens, catheter tip colonization was observed in 45 samples, while 14 were both catheter tip as well as blood culture positive hence included ascatheter related blood stream infections (CRBSI). CRBSI was found significantly associated with increased duration of catheterization, increased number of attempts and placement of CVC in internal jugular vein. Most common isolated organisms were Klebsiella pneumoniae followed by Coagulase negative Staphylococcus, Staphylococcus aureus and Pseudomonas aerguinosa in CRBSI as well as in CVC colonization. Majority of them were resistant to Gentamicin, Ciprofloxacin, Ceftiazidime and Ceftrixone. Biofilm production was determined by tissue culture plate method and was found to be maximum seen in Klebsiella spp. Conclusion: Incidence of CRBSI was 9.79% and of CVC colonization was 34.26%. Rate of CRBSI was 8.53 per 1000 CVC days. Klebsiella pneumoniae was most common isolate and predominant biofilm producer and was found to be multidrug resistant to Gentamicin, Ciprofloxacin, Ceftiazidime.

Central line associated Bloodstream Infections

Catheter associated blood stream infections are common entity in ICU setting. Indeed it is having 1-13 % prevalence rate in various studies.

Central venous catheter associated blood stream infection in neonatal intensive care unit – Prediction and prevention

Central venous catheter associated blood stream infection in neonatal intensive care unit – Prediction and prevention

Preventing Hospital Infections: Real-World Problems, Realistic Solutions

PREVENTING HOSPITAL INFECTIONS: REAL-WO RLD PROBLEMS, REALISTIC SOLUTIONS Sanjay Saint, Sarah L. Krein, and Robert W. Stock Oxford University Press, 2015, 155 pp., $41.95 (softcover)Healthcare-associated infections (HAI) have become an important focus for health care personnel at all levels from the bedside to the executive suite. The approximately 100,000 Americans estimated to die each year as a result of a HAI experienced the most severe consequence, but the impact of HAI does not end there. Patients who contract HAI stay in the hospital longer, are exposed to more and stronger antibiotics, and generate a greater amount of health care costs than they would if the HAI was prevented. In addition, HAI may affect reimbursement rates and are thus a driver for health care quality improvement projects within many institutions.Implementation of technological advances such as antimicrobial surfaces and new devices less susceptible to contamination play an important role in HAI prevention. In this book, Preventing Hospital Infections, the authors turn the attention to the human factor in HAI prevention and transmission. The best device in the world may fail if used incorrectly, and the hospital protocol that lingers unused in a binder, known only to its creator, cannot change incidence of HAI in a health care facility.The book is written in a readable, conversational style, and arranged into 10 chapters. It begins with a discussion of the burden and impact of HAI and the most common device-related HAI: catheter-associated urinary tract infection (CAUTI), ventilator-associated pneumonia (VAP), and central line-associated bloodstream infection (CLABSI). Research has demonstrated shockingly low adherence to infection prevention practices related to these infections. The authors cite a recent study in which adherence to evidencebased CAUTI prevention practices ranged from 6% to 27% (p. 3).The majority of the book examines organizational and leadership strategies to change behaviors and prevent HAI using CAUTI as the example outcome. Urinary catheters are in wide use in many units of the hospital and long-term care facilities for many indications, not just the intensive care unit, and the strategies discussed are not unique to CAUTI.The following chapters describe how organizations can commit to infection prevention initiatives, types of interventions which may be considered, building teams, team roles of leaders and followers, realistic solutions, sustainability, collaborative approaches to infection prevention, and the future of infection prevention. …

Standardizing the Reporting of Central Line Tip Location

Research has demonstrated that additional reduction in paediatric catheter associated blood stream infection (CA-BSI) rates can be achieved through improving compliance with maintenance bundle care for central venous lines. Our objective was to improve maintenance bundle compliance rates and nursing competency surrounding central venous line (CVL) care in our paediatric intensive care unit (PICU).A multidisciplinary team developed a bedside simulation-based training programme to improve compliance with standard PICU CVL maintenance bundle. We then performed a randomised comparison study comparing a standard CVL bundle training process for bedside PICU nurses in a control group (CG) to an intervention group (IG) receiving bedside training to simulate a CVL dressing change and maintenance bundle followed by intermittent training refreshers. Groups were assessed for compliance with prescribed components of the CVL bundle maintenance (CVL score).At baseline the CG and IG had similar mean CVL scores (p = 0.725). At twelve months mean CVL bundle compliance score in the IG was significantly higher than in the CG (p < 0.0001). The largest CVL score increase for IG occurred between zero and three months. Coincidentally, CA-BSI rates in the Egleston PICU significantly decreased from 1.9 ± 2.2 BSIs per 1000/CVL days, prior to the study, to 0.6 ± 1.6 BSIs per 1000/CVL days following implementation of the intervention (p = 0.034).Bedside simulation based training in CVL dressing change is associated with improved compliance with CVL maintenance bundle practice. Enhanced CVL maintenance bundle practice could contribute to reduction in CA-BSI rates.

Hyperglycemia at the Time of Acquiring Central Catheter-Associated Bloodstream Infections Is Associated With Mortality in Critically Ill Children.

Hyperglycemia is common and may be a risk factor for nosocomial infections, including central catheter-associated bloodstream infections in critically ill children. It is unknown whether hyperglycemia at the time of acquiring central catheter-associated bloodstream infections in pediatric critical illness is associated with worse outcomes. We hypothesized that hyperglycemia (blood glucose concentration > 126 mg/dL [> 7 mmol/L]) at the time of acquiring central catheter-associated bloodstream infections (from 4 d prior to the day of first positive blood culture, i.e., central catheter-associated bloodstream infections) in critically ill children is common and associated with ICU mortality. Retrospective observational cohort study. Fifty-five-bed PICU and 26-bed cardiac ICU at an academic freestanding children's hospital. One hundred sixteen consecutively admitted critically ill children from January 1, 2008, to June 30, 2012, who were 0-21 years with central catheter-associated bloodstream infections were included. We excluded children with diabetes mellitus, metabolic disorders, and those with a "do not attempt resuscitation" order. None. The study cohort had an overall ICU mortality of 23%, with 48% of subjects developing hyperglycemia at the time of acquiring central catheter-associated bloodstream infections. Compared with survivors, nonsurvivors experienced more hyperglycemia both at the time of acquiring central catheter-associated bloodstream infections and subsequently. Median blood glucose at the time of acquiring central catheter-associated bloodstream infections was higher in nonsurvivors compared with survivors (139.5 mg/dL [7.7 mmol/L] vs 111 mg/dL [6.2 mmol/L]; p < 0.001) with 70% of nonsurvivors experiencing blood glucose greater than 126 mg/dL (> 7 mmol/L) during the 7 days following central catheter-associated bloodstream infections (in comparison to 45% of survivors; p = 0.03). After controlling for severity of illness and interventions, hyperglycemia at the time of acquiring central catheter-associated bloodstream infections was independently associated with ICU mortality (adjusted odds ratio, 1.9; 95% CI, 1.1-6.4; p = 0.03), in addition to other risk factors for ICU mortality (vasopressor use and severity of organ dysfunction). Hyperglycemia at the time of acquiring central catheter-associated bloodstream infections is common and associated with ICU mortality in critically ill children. Strategies to monitor and control blood glucose to avoid hyperglycemia may improve outcomes in critically ill children experiencing central catheter-associated bloodstream infections.

Central catheter-associated bloodstream infection reduction with ethanol lock prophylaxis in pediatric intestinal failure: broadening quality improvement initiatives from hospital to home.

Children with intestinal failure are at high risk for developing central catheter-associated bloodstream infections (CCABSIs) owing to children's chronic dependence on central venous catheters for parenteral nutrition. To evaluate the effectiveness and safety of the addition of ethanol lock prophylaxis to a best-practice CCABSI prevention bundle on hospital and ambulatory CCABSI rates in children with intestinal failure. Quality improvement and statistical process control analysis that took place at a tertiary care pediatric hospital and patient homes. Participants included children who were 18 years or younger with intestinal failure requiring a central venous catheter. Central catheter-associated bloodstream infection prevention bundle that included daily ethanol lock prophylaxis. Central catheter-associated bloodstream infection rates and safety outcomes (central catheter insertions, repairs, and hospitalizations) before (January 1, 2011-January 31, 2012) and after (February 1, 2012-December 31, 2013) ethanol lock prophylaxis bundle implementation. Twenty-four children with intestinal failure received the ethanol lock prophylaxis CCABSI prevention bundle for a median of 266 days (range, 12-635 days). Rates of CCABSI decreased from 6.99 CCABSIs per 1000 catheter days at baseline to 0.42 CCABSI per 1000 catheter days after ethanol lock prophylaxis bundle implementation, despite an increase in the total number of catheter days. A subset of 14 children who received prolonged ethanol lock prophylaxis (≥3 months) had fewer median (range) central catheter insertions 0 (0-2) vs 3 (0-6); P = .001. The pre-ELP intervention CCABSI rates in this subset was 7.01 per 1000 catheter days vs 0.64 per 1000 catheter days for post-ELP intervention (P = .004). There were no significant differences in the total number of hospital admissions; however, there were fewer hospitalizations for fever and CCABSI (P = .003). A best-practice CCABSI prevention bundle that included ethanol lock prophylaxis in both the hospital and home was successfully implemented, well tolerated, and demonstrated a significant and sustained reduction in preventable harm in the form of CCABSIs in children with intestinal failure.

Simulation-based paediatric intensive care unit central venous line maintenance bundle training

Research has demonstrated that additional reduction in paediatric catheter associated blood stream infection (CA-BSI) rates can be achieved through improving compliance with maintenance bundle care for central venous lines. Our objective was to improve maintenance bundle compliance rates and nursing competency surrounding central venous line (CVL) care in our paediatric intensive care unit (PICU). A multidisciplinary team developed a bedside simulation-based training programme to improve compliance with standard PICU CVL maintenance bundle. We then performed a randomised comparison study comparing a standard CVL bundle training process for bedside PICU nurses in a control group (CG) to an intervention group (IG) receiving bedside training to simulate a CVL dressing change and maintenance bundle followed by intermittent training refreshers. Groups were assessed for compliance with prescribed components of the CVL bundle maintenance (CVL score). At baseline the CG and IG had similar mean CVL scores (p=0.725). At twelve months mean CVL bundle compliance score in the IG was significantly higher than in the CG (p<0.0001). The largest CVL score increase for IG occurred between zero and three months. Coincidentally, CA-BSI rates in the Egleston PICU significantly decreased from 1.9±2.2 BSIsper 1000/CVL days, prior to the study, to 0.6±1.6 BSIsper 1000/CVL days following implementation of the intervention (p=0.034). Bedside simulation based training in CVL dressing change is associated with improved compliance with CVL maintenance bundle practice. Enhanced CVL maintenance bundle practice could contribute to reduction in CA-BSI rates.

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...

G119(P) Reducing Catheter Associated Blood Stream Infections and Peripheral Line Insertions on a Regional Neonatal Unit

AimsCatheter associated blood stream infection (CABSI) is a serious complication of central vessel catheterisation (CVC). During 2010 a series of policy changes were introduced including the use of multi-lumen umbilical...

Management of short bowel syndrome

Most intestinal failure in children is due to short bowel syndrome (SBS) where congenital or acquired lesions have led to an extensive loss of intestinal mass. The vast majority of morbidity and mortality of patients with SBS is due to complications secondary to their long term dependence on parenteral nutrition. In response to SBS, the intestine undergoes a process of remodeling termed adaptation. Principles guiding the medical management of SBS include providing adequate parenteral nutrition, fluids and electrolytes for growth and normal development, promoting small bowel adaptation, and preventing and treating complications related to the patient's underlying disease and their parenteral nutrition. Catheter associated blood stream infection (CABSI) is major source of morbidity and mortality in patients with intestinal failure from SBS. Intestinal failure associated liver disease (IFALD)is another major source of morbidity and mortality in patients with SBS. IFALD is the most consistent negative predictor of outcome including death and continued parenteral nutrition dependence. Enteral nutrition is critical for intestinal adaptation and preventing IFALD. Patients with SBS who develop dilated dysmotile segments may benefit from autologous intestinal reconstruction surgery (AIRS) with the goal of decreasing stasis and disordered motility through intestinal narrowing and lengthening. Patients with SBS should be referred for transplantation if they have failed intestinal rehabilitation including AIRS, have no reasonable chance for enteral feeding tolerance, develop irreversible IFALD, have recurrent sepsis, or have exhausted their central venous access sites. With improvements in medical and surgical care, overall survival of patients with SBS now exceeds 90%.

Epidemiology and impact of a multifaceted approach in controlling central venous catheter associated blood stream infections outside the intensive care unit.

BackgroundOutside ICUs, CVC-ABSIs epidemiology and the results of strategies for their prevention are not well known. The aim of this study was to investigate the epidemiology and the impact of a multifaceted “bundle” approach in controlling CVC-ABSIs outside ICU.MethodsFrom 1991 we performed prevalence studies of device and parenteral nutrition use, and prospective surveillance of all episodes of CVC-ABSIs in a 350-bed teaching hospital. CVC-ABSIs incidence/1,000 inpatient-days was calculated. An estimated CVC-ABSIs incidence/1,000 catheter-days was calculated based on the prevalence rates of catheter use and the total number of inpatient-days in each year. On november 2008, an education programme was instituted for care of catheter lines: reinforcing instructions in aseptic insertion technique, after care and hand-washing; in order to assess the adherence to these measures the quantity of alcohol-based hand-rub consumption/1,000 patient-days was quoted in litres. From January 2009, a checklist intervention for CVC insertion in ICU was started: hand hygiene, using full barrier precautions, cleaning the skin with alcoholic chlorhexidine, avoiding femoral access and removing unnecessary catheters. Compliance with the central line insertion checklist was measured by real-time audits and was achieved in 80% of cases.ResultsPrevalence of use of CVC and parenteral nutrition was similar throughout the study. We followed-up 309 CVC-ABSIs cases. Estimated CVC-ABSIs rate progressively increased to 15.1/1,000 catheter-days in 2008 (0.36/1,000 inpatient-days). After the intervention, the alcohol-based hand-rub consumption increased slightly and estimated CVC-ABSIs rate fell to 10.1 /1,000 catheter-days in last three years (0.19/1,000 inpatient-days), showing a 32.9% decrease. The infection rates achieved were lower in Internal Medicine wards: decreased from 14.1/1,000 catheter-days (0.17/patient-days) in 2008 to 5.2/1,000 catheter-days (0.05/1,000 inpatient-days) in last three years, showing a 63.1% decrease. In 2009, the estimated CVC-ABSIs incidence rate was significantly lower in the Internal Medicine ward compared to the Surgery ward: rate ratio (RR) = 0.14, 95%CI: 0.03-0.60), and within the Internal Medicine ward, the estimated CVC-ABSIs incidence rate was significantly lower in 2009 compared to 2008 (RR = 0.20, 95%CI: 0.04-0.91).ConclusionThe rate of CVC-ABSIs increased outside-ICU, and the implementation of multifaceted infection control programme decreased their clinical impact.

Video observation of anesthesia practice: a useful and reliable tool for quality improvement initiatives

Patients with central venous catheters who are transferred out of the Intensive Care Unit to the care of an anesthesiology team for an operation or interventional radiology procedure had excessive rates of catheter associated blood stream infection (CABSI). We convened a multi-disciplinary team to audit anesthesia practice and to develop countermeasures for those aspects of practice that were thought to be contributing to CABSI's. It was noted that provider behavior changed in the presence of an auditor (Hawthorne effect) and so videorecordings were used, in the hope that this Hawthorne effect would be reduced. Clips were chosen from the hours of video (without audio) recordings that showed medication administration, airway management and touching the anesthesia cart of equipment/supplies. These clips were viewed by three observers and measurements were made to assess intra-rater and inter-rater reliability. The clips were then viewed to quantify differences in practice before and after our bundle of "best practices" was introduced. Although video recording has been used to evaluate adherence to resuscitation protocols in both trauma and in neonatal resuscitation, (Pediatric Emergency Care, 26, 2010, 803; Pediatrics, 117, 2006, 658; Pediatrics, 106, 2000, 654) we believe this is the first time that video has been used to record before and after behaviors for an anesthesia quality improvement initiative.

Sustaining the Gain: A Units Quest to Maintain Significant Catheter Associated Blood Stream Infection (CA-BSI) Rate Reductions

Sustaining the Gain: A Units Quest to Maintain Significant Catheter Associated Blood Stream Infection (CA-BSI) Rate Reductions

Catheter associated blood stream infections in patients receiving parenteral nutrition: a prospective study of 850 patients.

BackgroundData was prospectively collected on 850 consecutive patients undergoing central venous catheterisation (CVC) to receive total parenteral nutrition (TPN) in a major university teaching hospital over a 46 months period.MethodsData included information about CVC insertion and clinical outcomes, most notably, suspected catheter-related blood stream infections (CRBSI).ResultsThe internal jugular vein was the most common site (n = 882, 68%), followed by the subclavian vein (n = 344, 24.6%) and femoral vein (n = 95, 6.5%). The CRBSI rate per 100 line feeding days was 0.93% in patients cared for in a non ICU setting versus 1.98% for ICU managed patients. The mean number of line days preceding a pyrexial spike was 13.1. CRBSI was commonest in patients with femoral lines (n = 21/95, 22.1%), especially those cared for in a non-ICU setting (29.6% versus 14.5% for those in the ICU group). Preference should be given to internal jugular or subclavian-sited CVCs in ICU and non-ICU patients to reduce the risk of CRBSI. If femoral catheterisation is unavoidable, strict attention to aseptic technique is mandatory.ConclusionThe aim of this study was to investigate the rate and pattern of CRBSI and to recommend changes in protocol, technique and equipment as deemed necessary from these findings.

584 Catheter Associated Blood Stream Infection in Pediatric Intensive Care

Background and AimThe aim of this study, the frequency of catheter associated blood stream infection (CA-BSI) and its effect to mortality and length stay (LOS) of hospital.MethodsThis study was conducted...

Acinetobacter baumannii isolates in a tertiary care hospital: Antimicrobial resistance and clinical significance

Objectives: To carry out a retrospective study on Acinetobacter baumannii isolates from various clinical samples in a tertiary care hospital in India and analyze its epidemiology, antibiotic susceptibility patterns, pathogenic potential and nosocomial status. Materials and methods: The clinical specimens over a period of 14 months from December 2008 to January 2010 were analyzed and the A.baumannii isolates obtained by an automated identification system (Vitek 2 Compact) were segregated for further study. Their antibiograms were studied and a clinical correlation was made to assess their pathogenic status and mode of acquisition. Further, the nosocomial infections acquired during this period were studied and the contribution made by A.baumannii was calculated to assess its nosocomial status. Results: A.baumannii was isolated in 155 samples out of 1632 gram negative isolates (9.4% prevalence) from the entire hospital. Maximum isolates were from respiratory secretions (57.4%) followed by blood (23.8%). Prevalence of A.baumannii rose to 22.7% (119 out of 525) in intensive care unit (ICU) and 65 isolates (54.6%) proved to be pathogenic. A.baumannii contributed to 30.4% ventilator associated pneumonia, 35.2% Catheter Associated Blood Stream Infections, 12.5% Surgical Site Infections and 2.94% Catheter Associated Urinary Tract Infections. Overall resistance of A.baumannii towards carbapenems was 90% from all hospital isolates. ICU isolates showed higher resistance (93.2%) as compared to Inpatient Department (82.7%) and Out-patient Department (57.1%). Conclusion: In this study, A.baumannii isolates showed a pathogenic potential of around 54.6% and a majority were found to be carbapenem resistant. We must be cognizant of the fact that all A.baumannii isolations doesn\'t necessarily mean infection and antibiotics should only be given in clinically proven infections.

Innovative Instructional Design to Alleviate the Shortage of Clinical Practice Sites for Education Through the Use of a Simulated OB Experience

Leadership: Self-scheduling, peer interview team. Practice: Developed policies for unit practice changes: kangaroo care, cue-based feeding, and care of micropreemie. Professional development: Unit skills fair, “Policy of the Month” as continuing education. Service and Satisfaction: Neonatal intensive care unit parent support group, developed floating expectations for staff. Research: Cue-based feeding research project. Quality and safety: Because of a catheter associated blood stream infection initiative and a methicillin-resistant Staphylococcus aureus action plan, we have more than 1,000 days with no reported cases of catheter associated blood stream infection, and we have been methicillin-resistant Staphylococcus aureusfree for almost 1 year.

Reducing Catheter Associated Bloodstream Infections in the Neonatal Intensive Care Unit: Challenging Nurses to Be Champions

Implementation, Outcomes, and Evaluation Focused staff and patient education were implemented in April 2010. In 2009, there were 5.83 falls per 10,000 live births, and in 2010 there were 2.5 falls per 10,000 live births (8,568 live births in 2010). Three falls occurred in 2010 prior to the implementation of staff and patient education. From the implementation of education, there were no falls for nearly a year. At the time of this abstract submission, there were 0.43 falls per 10,000 live births (4,341 live births as of June, 2011).

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.