Incidence Of Catheter-related Bloodstream Infection Research Articles

PICC在SICU控制血管导管相关性感染发病率中的应用研究

目的：探讨中心静脉导管(Central Venous Catheters, CVC)和经外周静脉植入中心静脉导管(Peripherally Inserted Central Catheter, PICC)在长期入住外科重症监护病房(Surgical Intensive Care Units, SICU)的患者中导管相关血流感染(Catheter-Related Blood Stream Infections, CR-BSI)发生率。方法：随机观察并分析长期入住SICU的90例患者更换抗感染中心静脉导管或PICC置管治疗后的导管相关性感染发生情况。按照感染诊断标准，Logistic回归分析CR-BSI确定推测。结果：CVC置管感染8例(感染率8.6/千导管日)，PICC置管感染1例(感染率1.2/千导管日)。CVC置管时间为(19.74 ± 2.14) d，其中发生感染的CVC为置管(13.87 ± 1.56) d；PICC置管时间为(30.41 ± 3.58) d，发生感染的时间为置管第28d。Logistic回归分析表明，置管天数是唯-CVC感染的预测因子(P=0.013)。结论：缩短CVC留置时间，长期入住ICU患者用PICC代替CVC可能降低CR-BSI的发生。 Objective: To study the incidence of CR-BSI (Catheter-Related Blood Stream Infections) of CVC (Central Venous Catheters) and PICC (Peripherally Inserted Central Catheter) in SICU. Methods: Random observation and analysis on the catheter-related infections of the 90 patients’ replacement of CVC or PICC in SICU. According to the diagnostic criteria of infection, CR-BSI Logistic regression analysis is used to determine speculation. Results: 8 cases of infection in CVC (8.6 per thousand) and 1 case of infection in PICC (1.2 per thousand). For CVC the indwelling time was (19.74 ± 2.14) d, in which the infected CVC’s indwelling time was (13.87 ± 1.56) d; For PICC the indwelling time was (30.41 ± 3.58) d and the infection indwelling time was on the 28th. Logistic regression analysis showed that the catheter indwelling time was the only predictor of CVC infection (P = 0.013). Conclusion: Shortening the indwelling time of CVC, using PICC instead of CVC may reduce CRBSI for long-term-stay patients in ICU.

Incidence, risk factors and microbiology of central vascular catheter-related bloodstream infection in an intensive care unit

Although there are many studies about catheter related infection in industrialized countries, very few have analyzed it in emerging countries. The aim of our study was to determine the incidence, microbiological profile and risk factors for catheter-related bloodstream infection (CRBSI) in a Tunisian medical intensive care unit. Over eight months (1 January 2012-30 August 2012) a prospective, observational study was performed in an 18-bed medical surgical intensive care unit at Tunis military hospital. Patients who required central venous catheter (CVC) placement for a duration greater than 48 h were included in the study. Two hundred sixty patients, with a total of 482 CVCs were enrolled. The mean duration of catheterization was 9.6 ± 6.2 days. The incidence for CRBSI and catheter colonization (CC) was 2.4 and 9.3 per 1000 catheter days, respectively. Risk factors independently associated with CRBSI were diabetes mellitus, long duration of catheterization, sepsis at insertion and administration of one or more antibiotics before insertion. The mortality rate among the CRBSI group was 21.8%. The predominant microorganisms isolated from CRBSI and CC episodes were Gram negative bacilli. All Gram negative organisms isolated among dead patients in CRBSI group were Extensive Drug Resistant (XDR). In our study the mortality rate among patients with CRBSI was high despite a low incidence of CRBSI. This high rate can be explained by the high-virulent status of Gram negative bacteria involved in CRBSI.

Hospital‐wide survey of the adequacy in the number of vascular catheters and catheter lumens

Removal of unnecessary catheters has been proposed as an important measure to reduce catheter-related morbidity. Nevertheless, there is scarce information about the potential magnitude of such intervention. The present study was aimed at analyzing the appropriateness of use of vascular catheters and catheter lumens in the inpatient setting. Cross-sectional survey. The entire population of adult inpatients admitted to a 1368-bed tertiary-care hospital in a single day. We used a set of preestablished criteria to evaluate the appropriateness of use of vascular catheters and catheter lumens according to the number and administration regimen of intravenous drugs. Out of 834 patients, 575 (68.9%) had ≥1 vascular catheters in place on the day of the survey. The type and distribution of the 703 surveyed catheters were peripheral venous catheter, 80.6%; central venous catheter, 15.8%; and arterial catheter, 3.6%. We found an overall mean of 2.06 ± 0.82 lumens per catheter, with significant differences between intensive care units and conventional wards (P < 0.0001). Based on our criteria, 126 out of 575 patients (21.9%) had an inappropriate number of catheters (medical wards, 20.0%; surgical wards, 23.9%; intensive care units, 26.3%), and 631 out of 14248 nonarterial catheter lumens (43.6%) were considered unnecessary. Significant room exists for improving the adequacy of the number of vascular catheters and catheter lumens as a potentially useful tool for decreasing the incidence of catheter-related bloodstream infection.

Peripherally Inserted Central Catheters Are a Good Option For Venous Access In The Patients With Hematologic Diseases

BackgroundCentral venous catheters are widely used for treatments of hematologic diseases. Conventional central venous catheters (CVC), however, often cause complications such as pneumothorax, hematoma, catheter-related blood stream infection (CR-BSI), and so on. Peripherally inserted central venous Catheters (PICC) are recently expected to reduce these complications. The aim of this study was to compare the frequencies of and risk factors for complications with PICC and CVC in patients with hematologic diseases. Patients and MethodsWe retrospectively reviewed all 363 patients who had inserted PICC or CVC for treatment of hematologic diseases in January 2011 through July 2013 at the University of Tsukuba Hospital. Overall and device-specific frequencies of infectious and non-infectious complications were evaluated and potential risk factors were captured. ResultsThe PICC group (N = 215) and CVC group (N = 148) were similar in terms of clinical backgrounds, types of complications during catheter insertion, and total time of catheter-inserted periods. The CVC group had significantly higher proportions of patients who received hematopoietic cell transplantation (PICC 17.7% vs. CVC 49.3%, P<0.001). The significant intergroup differences were found in frequencies of CR-BSI (PICC, 1.4/1000 catheter days and CVC, 5.9/1000 catheter days; P<0.001) and local infection at the insertion site (PICC, 0.3/1000 catheter days and CVC, 2.3/1000 catheter days; P=0.002). The cumulative incidence of catheter removal for infective infectious complications was higher in the CVC group than the PICC group (PICC 8.7% vs. CVC 37.3%, P<0.001). Multivariate analysis showed that PICC significantly reduced the incidence of CR-BSI (odds ratio (OR), 0.15; 95% confidence interval (CI), 0.06-0.33; P<0.001). The incidence of CR-BSI was also significant higher in patients who received hematopoietic cell transplantation (OR, 2.4; 95%CI, 1.22-4.69; P=0.01). Phlebitis and deep vein thrombosis was noted in no patient in PICC group and 1 patient in CVC group. ConclusionOur date suggest that PICC is superior to CVC in terms of infectious complications. Low incidence of thrombophlebitis, observed in this study, is a key to a major change of practice from CVC to PICC.▪ Disclosures:No relevant conflicts of interest to declare.

Citrate Versus Heparin Lock for Hemodialysis Catheters: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Citrate solution has been suggested as an effective and safe catheter lock in hemodialysis. However, whether a citrate lock is superior to a heparin lock in preventing catheter-related infections and maintaining catheter patency is inconclusive. A systematic review and meta-analysis was performed by searching in PubMed, EMBASE, Ovid, the Cochrane Library, and Web of Science databases and major nephrology journals. Patients receiving hemodialysis with central venous catheters. Randomized controlled trials comparing citrate locks with heparin locks in hemodialysis patients with central venous catheters. Locking central venous catheters with citrate locks. Primary outcomes include catheter-related bloodstream infection (CRBSI), exit-site infection, catheter removal for poor flow, and thrombolytic treatment. 13 randomized controlled trials (1,770 patients, 221,064 catheter-days) met the inclusion criteria. Pooled analyses found that citrate locks could significantly reduce the incidence of CRBSI (risk ratio [RR], 0.39; 95% CI, 0.27-0.56; P < 0.001). Subgroup analysis showed that antimicrobial-containing citrate locks (citrate + gentamicin, citrate + taurolidine, and citrate + methylene blue + methylparaben + propylparaben) were superior to heparin locks in the prevention of CRBSI (P < 0.001, P = 0.003, and P = 0.008, respectively), whereas citrate alone failed to show a similar advantage (P = 0.2). Low- (1.04%-4%) to moderate-concentration (4.6%-7%) citrate locks were associated with decreased CRBSI incidence (P < 0.001 and P = 0.003, respectively), but patients receiving high-concentration (30%-46.7%) citrate and heparin locks had similar incidences (P = 0.3). The incidence of bleeding episodes (RR, 0.48; 95% CI, 0.30-0.76; P = 0.002) was significantly lower in patients receiving citrate locks, whereas both groups were similar in terms of exit-site infection (P = 0.2), catheter removal for poor flow (P = 0.9), thrombolytic treatment (P = 0.8), all-cause death (P = 0.3), catheter thrombosis (P = 0.9), mean catheter duration (P = 0.2), CRBSI-free catheter survival (P = 0.2), and catheter-related readmission (P = 0.5). All studies used in the meta-analysis were performed in Western countries. The applicability of our findings to other regions remains to be clarified. An antimicrobial-containing citrate lock is better than a heparin lock in the prevention of catheter-related infection, while citrate alone fails to show a similar advantage. Citrate locks of low to moderate concentrations, rather than high concentration, were superior to heparin locks in preventing CRBSI. Citrate locks also might decrease bleeding episodes. No difference has been identified in the efficacy to prevent exit-site infection or preserve catheter patency between citrate and heparin locks.

Evolution and aetiological shift of catheter-related bloodstream infection in a whole institution: the microbiology department may act as a watchtower

The incidence of central-line-associated bloodstream infection (CLA-BSI) is reported per 1000 days of catheter exposure, mainly in the intensive care unit (ICU), because recording exposure throughout an institution is not always feasible. Confirmation of catheter-related bloodstream infection (CR-BSI) requires specific laboratory testing that identifies the catheter as the source of infection. This information is available in microbiology laboratories and can be assessed using a denominator of 1000 admissions. We evaluated recent trends in the incidence and aetiology of CR-BSI and compared adult ICUs with the remaining areas of the hospital in a retrospective cohort analysis of all confirmed CR-BSIs. During the 8-year study period, we recorded 1208 episodes (8.2% of BSIs) of CR-BSI. After adjusting for the blood cultures drawn, a significant reduction in incidence was observed in adult ICUs (47%), where care bundles had been applied. The reduction was similar irrespective of whether CLA-BSI or CR-BSI was assessed. We recorded a significant reduction in the incidence of Staphylococcus aureus CR-BSI, and a significant increase in the incidence of CR-BSI caused by Enterococcus sp., Gram-negative microorganisms and fungi. The microbiology department may complement CLA-BSI/1000 catheter-days by providing CR-BSI when days of exposure are not available, because both figures are parallel. We demonstrated a significant reduction in the incidence of CR-BSI in recent years in the population admitted to adult ICUs but not in the remaining areas of the hospital. A shift in the aetiological spectrum of CR-BSI may be occurring.

AN INTERVENTIONAL STUDY TO DECREASE CENTRAL VENOUS CATHETER RELATED BLOOD STREAM INFECTION IN INTENSIVE CARE UNITS AT ZAGAZIG UNIVERSITY HOSPITAL

Background: Catheter related blood stream infection (CRBSI) is a complication of central venous catheter (CVC) use. This Infection particularly in the ICU population results in higher levels of morbidity and mortality coupled with greater costs in terms of care and increased duration of hospital stay. Aim & Objectives: The aim of this study is to improve the safety of patients with CVC via decreasing the incidence of CRBSI in ICUs patients at Zagazig University Hospital through the following objectives: 1- Calculation the incidences of CRBSI in ICUs patients over six months before and after intervention through active surveillance. 2- Assessment the level of the knowledge and adherence of health care providers in ICUs to evidence based guidelines recommended by CDC to decrease the incidences of CRBSI in ICUs patients before and after intervention. 3- Implementation of health education program on ICUs health care providers i.e. providing them by information about evidence based guidelines recommended by CDC to decrease the incidence of CRBSI in ICUs patients. Subjects & Methods: An interventional study was conducted in surgical and emergency ICUs at Zagazig University Hospital during the academic year between 2011 and 2012. All patients with CVC in the studied ICUs were consecutively enrolled in the study and all health care providers working in the studied units and involved in insertion, maintenance and care of CVC during the period of study were included in the study. The study was carried out through 3 phases. Results: Statistically, there is a significant improvement in physician practice in both ICUs after intervention. The incidence of CRBSI decreased after intervention in surgical ICU but in comparison with that before intervention it was found no significant difference. In emergency ICU, the incidence of CRBSI after intervention is 0% and in comparison with that before intervention it was found a significant difference. Incidence of CRBSI decreased from 6.01/1000 catheter-days to 3.9/1000 catheter-days after intervention in surgical ICU. In emergency ICU, the incidence of CRBSI was 0% after intervention. Conclusion: This study revealed that, implementation of simple education program increased adequacy of knowledge, improved the practice of healthcare providers and reduced CVC blood stream infection rates in ICUs by almost 50%, during the intervention period. Keywords: Central venous catheter, Blood stream infection, Intensive care unit

Impact of a multimodal intervention to reduce bloodstream infections related to vascular catheters in non-ICU wards: a multicentre study

To determine the impact of a multimodal intervention designed to reduce the incidence of catheter-related bloodstream infections (CRBSIs) outside the ICU, we conducted a prospective, quasi-experimental, before-after intervention study in 11 hospitals participating in the VINCat programme in Catalonia, Spain. The intervention consists of: (i) an evidence-based bundle of practices relating to catheter insertion and maintenance; (ii) a training programme for healthcare workers; (iii) four point–prevalence surveys to track the status of the catheters; and (iv) feedback reports to the staff involved. The study included both central (CVC) and peripheral venous catheters (PVCs). Rates of CRBSI per 1000 patient-days were prospectively measured in 2009 (pre-intervention period) and 2010 (post-intervention period). The analysis included 1 191 843 patient-days in 2009 and 1 173 672 patient-days in 2010. The overall incidence of CRBSI decreased from 0.19 to 0.15 (p 0.04) and the incidence of CRBSI associated with a CVC decreased from 0.14 to 0.10 (p 0.004) after the intervention. The incidence in PVCs remained unchanged. There was a statistically significant improvement in the adequate maintenance of both CVCs and PVCs. Among the CRBSIs originating in PVCs, 61.8% appeared more than 72 h insertion. There was a lower infection rate in the hospitals with a higher adherence to the recommendation to replace PVCs every 72 h. Our findings suggest that the implementation of intervention programmes similar to ours could have a major impact on patient safety by reducing the incidence of CRBSIs, and that routine replacement of PVCs might additionally prevent a significant number of bloodstream infections.

Risk factors for catheter-related bloodstream infections in adult hospitalized patients — multicenter cohort study

Risk factors for catheter-related bloodstream infections (CRBSIs) may change over time with progress in infection control. This study was undertaken to explore the current risk factors for CRBSIs in hospitalized patients. Adult patients with non-tunneled central venous catheters (CVCs) in 12 Japanese referral hospitals were prospectively enrolled between December 2009 and January 2012. Patients were monitored for CRBSIs for up to 8 weeks from CVC insertion; data were collected regarding patient characteristics, the purpose of CVC insertion, insertion methods, mechanical complications during insertion, and post-insertion catheter care. A total of 892 patients were enrolled in this study. The overall incidence of CRBSIs was 0.40 infections per 1000 catheter-days. Univariate analysis using the Fisher's exact test identified one of the participating hospitals (hospital A; p < 0.001), internal jugular vein catheterization (IJVC) (p = 0.0013), not using maximal sterile barrier precautions (p = 0.030), and the Seldinger technique for catheter insertion (p = 0.025) as significant risk factors for CRBSI. After excluding data from hospital A, only IJVC remained a significant risk factor for CRBSI (p = 0.025). The cumulative probability of remaining without CRBSI was significantly lower in patients with IJVCs than in patients with other catheter routes (p < 0.001; log-rank test). Similarly, the cumulative probability of remaining without catheter removal due to a suspected infection was significantly lower in patients with IJVCs (p = 0.034; log-rank test). The current study suggests that IJVC might be a risk factor for CRBSI under current infection control conditions.

Catheter-related bloodstream infections: a prospective observational study of central venous and arterial catheters

Catheter-related bloodstream infections (CRBSIs) can lead to increased morbidity and length of stay (LOS) in the intensive care unit (ICU). The purpose of this study was to analyse the incidence of catheter-related bloodstream infection associated with central venous catheters (CVCs) and arterial catheters (ACs) and to identify risk factors for CRBSIs in our ICU. This was a prospective observational study in a 17-bed medical-surgical ICU of a 715-bed university hospital. Patients admitted to the ICU for ≥ 24 h between 1 September 2007 and 30 April 2008, who received a CVC or AC, were included in the study. A total of 219 patients with 258 CVCs and 336 ACs were included in the study and observed for a combined total of 3172 catheter-days. The CRBSI incidence density was 1.2 per 1000 catheter-days for CVCs and 2.1 per 1000 catheter-days for ACs. The mean LOS (p = 0.003), the number of days a catheter remained in situ (p = 0.001), and the length of pre-ICU in-hospital stay (p = 0.031) were significantly higher in the CRBSI group. Risk factor analysis was not reliable due to the low number of CRBSIs. The incidence of AC- and CVC-related CRBSIs was comparable to the incidence reported in the literature. However, the incidence for ACs was higher than for CVCs. In addition to CVCs, ACs should be considered a possible cause of catheter-related infections and both should be replaced when CRBSI is suspected.

Design and application of quality improvement checklist of catheter-related blood stream infection in the intensive care units

Objective To design quality improvement checklist of catheter-related blood stream infection (CRBSI),in order to improve the nursing quality of ICU and ensure nursing safety.Methods A new ICU quality improvement checklist of CRBSI was designed and applied for the quality control of the patients with central venous catheter from April to June 2012.The using rate of central venous catheter and incidence of CRBSI were observed.Results After application of the checklists,the using rate of central venous catheter was decreased and the incidence of CRBSI was decreased.Conclusions The checklist may help improve the prevention and control of CRBSI in ICU. Key words: Forms and records control; Intensive care unit; Quality control; Catheter-related blood stream infection

Peripherally Inserted Central Catheters for Long‐term Parenteral Nutrition in Infants With Intestinal Failure

Infants with intestinal failure often require long-term central access for delivery of parenteral nutrition (PN). Traditionally, surgically placed central venous catheters (CVCs) have been used; however, the complications associated with these catheters can lead to significant morbidity. Peripherally inserted central catheters (PICCs) are potentially superior to CVCs because they tend to be smaller, and can be placed without general anesthesia. The purpose of the study is to report the use of PICCs for long-term administration of PN in infants with intestinal failure and compare with previously published catheter infection and venous thrombosis rates. A 4-year review of infants younger than 12 months with intestinal failure and a PICC for PN delivery was performed to determine the incidence of catheter-related bloodstream infections (CRBSIs) and PICC-associated venous thrombosis. The complication rates were compared with those reported for CVCs and PICCs in the pediatric literature. A total of 45 infants with intestinal failure, receiving PN through a PICC were included in the study. Data from 95 PICCs accounting for 10,189 catheter days were collected. The overall incidence of CRBSI was 5.3/1000 catheter days and the incidence of venous thrombosis was 2.0/1000 catheter days. PICCs offer an advantage over CVCs in that they can often be inserted without a general anesthesia and do not require manipulation of the vein. Given the low rate of CRBSI and venous thrombosis, we recommend PICCs for infants with intestinal failure requiring PN.

Catheter-related bloodstream infection caused by Enterococcus spp.

The role of Enterococcus spp. as a cause of catheter-related bloodstream infections (CR-BSI) is almost unexplored. We assessed the incidence and clinical characteristics of enterococcal CR-BSI (ECR-BSI) over an 8-year period in our hospital. We performed a retrospective study (January 2003 to December 2010) in a large teaching institution. We recorded the incidence, and the microbiological and clinical data from patients with ECR-BSI. The incidence per 10 000 admissions for enterococcal BSI and ECR-BSI was 25 and 1.7, respectively. ECR-BSI was the fourth leading cause of CR-BSI in our institution (6%). A total of 75 episodes of ECR-BSI were detected in 73 patients (6% of all enterococcal BSI). The incidence of ECR-BSI increased by 17% annually (95% CI 19.0–21.0%) during the study period. Nineteen percent of ECR-BSI episodes were polymicrobial. Overall mortality was 33%. ECR-BSI is an emerging and increasingly common entity with a high mortality. This finding should be taken into account when selecting empirical treatment for presumptive CR-BSI.

Risk factors for catheter-related bloodstream infection in non-critical patients with total parenteral nutrition

Catheter-related bloodstream infection (CRBSI) is one of the most important complications in patients with a central venous catheter (CVC), due to its association with increased mortality, morbidity and health care cost. The administration of total parenteral nutrition (TPN) is considered a CRBSI risk factor. The aim of our study was to determine the incidence rate and risk factors of CRBSI in patients with TPN that were hospitalized at the medical-surgical wards. This is a prospective observational study in non-critical patients who received TPN and were admitted at our hospital from January 2010 to November 2011. The clinical end point was the CRBSI. CRBSI incidence rate was calculated from episodes by every 1000 CVC-day. CRBSI independent risk factors were obtained from logistic regression analysis. A total of 331 patients were prescribed TPN during our study. The mean time of catheterization was 12.4 (DE 8.7) days and the mean TPN duration was 10.4 (DE 8.3) days. 47 cases of CRBSI were recorded, with an incidence rate of 11.4/1,000 CVC-day and of 13.7/1,000 NPT-day. Risk factors for CRBSI on univariante analysis included duration of catheterization more than 20 days (OR = 2.48; IC 95%: 1.16-5.26), TPN duration more than 2 weeks (OR= 4.63; IC 95%: 2.16-9.90) and the presence of fistulas (OR = 3.08; IC 95%: 1.24-7.63). At multivariate analysis, TPN duration (OR for a duration more than 14 days= 4.9; IC 95%: 2.2-10.9; p < 0.0001) was the only independent risk factor for CRBSI. In non-critical adult patients hospitalized at the medical-surgical wards, we have demonstrated that duration of TPN infusion increases the CRBSI risk. This risk increase is especially remarkable, being multiplied by 5, with a duration superior to 2 weeks.

Epidemiology of infections in a Burn Unit, Albania

BackgroundMany types of nosocomial infections (NIs) can be present in the burned patient. The purpose of this study is to calculate the rates for NI in the Intensive Care Unit of the Service of Burns and Plastic Surgery in University Hospital Centre (UHC) in Tirana, Albania. MethodThe study is prospective, clinical and analytical. The study is continued/longitudinal because monitors all patients with severe burns during a specified time period (1year). For data analysis was used SPSS 19.0. ResultsThe infection prevalence rate was 12 infected patients per 100 patients. The colonisation prevalence rate was 43 colonised patients for 100 patients. The most frequent infection microorganisms were Pseudomonas aeruginosa and Staphylococcus aureus (67% and 24%). Incidence of BSI was 3 BSI for 1000 hospitalization days. Incidence of catheter-related bloodstream infection (CRBSI) was 11.7 BSI for 1000 catheter days. Colonisation of the tip of the central catheter (CTC) was 15.6 for 1000 catheter days. ConclusionsThe epidemiology of burn wound infections as well as the definitions have changed due to important changes in burn wound treatment but further studies should be done documented the factors that can reduce the burn wound infection rates.

A prospective observational study on 249 subcutaneous central vein access ports in a Swedish county hospital

Background. Reliable central vein access is a fundamental issue in modern advanced oncological care. The aim of this study was to determine the incidence of complications and patient perception regarding central vein access ports. Methods. We prospectively studied 249 single lumen access ports implanted between 1 July 2008 and 15 March 2010 in a mixed patient population at a 500-bed secondary level hospital in Sweden. We determined the number of catheter days, infection rate and mechanical complications, as well as patient satisfaction regarding the access port, over a six-month follow-up period. Results. Two hundred and forty-four different patients received 249 ports yielding a total of 37 763 catheter days. Ultrasound and fluoroscopic guidance was used in 98% of procedures. Vein access was obtained percutanously by an anaesthesiologist in all cases. There was no case of pneumo- or haemothorax. The incidence of catheter-related bloodstream infection, was 0.05/1000 catheter days and the incidence of pocket/tunnel infection was 0.39/1000 catheter days. Clinically apparent deep vein thrombosis occurred in four patients (1.6%). Patient satisfaction was overall high. Conclusion. These results confirm that our team-based approach with written easily accessible evidence-based guidelines and a structured education programme leads to a very low complication rate and a high degree of patient satisfaction.

Catheter related blood stream infections in the paediatric intensive care unit: A descriptive study

Context:Catheter related blood stream infections (CRBSI) contributes significantly to morbidity, mortality and costs in intensive care unit (ICU). The patient profile, infrastructure and resources in ICU are different in the developing world as compared to western countries. Studies regarding CRBSI from pediatric intensive care unit (PICU) are scanty in the Indian literature.Aims:To determine the frequency and risk factors of CRBSI in children admitted to PICU.Settings and Design:Descriptive study done in the PICU of a tertiary care teaching hospital over a period of four months.Materials and Methods:Study children were followed up from the time of catheterization till discharge. Their clinical and treatment details were recorded and blood culture was done every 72 h, starting at 48 h after catheterization. The adherence of doctors to Centre for Disease Control (CDC) guidelines for catheter insertion was assessed using a checklist.Statistical Analysis:Clinical parameters were compared between colonized and non-colonized subjects and between patients with and without CRBSI. Unpaired t-test and Chi-square test were used to test the significance of observed differences.Results:Out of the 41 children, 21 developed colonization of their central venous catheter (66.24/1000 catheter days), and two developed CRBSI (6.3/1000 catheter days). Infants had a higher risk for developing colonization (P = 0.01). There was 85% adherence to CDC guidelines for catheter insertion.Conclusions:The incidence of CRBSI and catheter colonization is high in our in spite of good catheter insertion practices. Hence further studies to establish the role of adherence to catheter maintenance practices in reducing risk of CRBSI is required. The role of a composite package of interventions including insertion and maintenance bundles specifically targeting infants needs to be studied to bring down the catheter colonization as well as CRBSI rates.

Effect of Shorter Term of Intravenous Infusion for Reduction of Catheter-Related Bloodstream Infection After Gastrectomy

After gastrectomy, a longer period of intravenous alimentation is required than for other digestive surgeries, portending a higher risk of catheter-related bloodstream infection (CRBSI). From assessment of CRBSI occurring between 2004 and 2007 (preintervention group), the duration of intravenous infusion between 2008 and 2010 (postintervention group) was changed to shorter-term (6-day) infusion. To verify the effect of changes in injection schedule on the incidence of CRBSI, the occurrence of CRBSI was studied comparatively among preintervention and postintervention cases, excluding cases requiring intravenous infusion preoperatively, and cases requiring long-term intravenous infusion postoperatively due to postoperative complications. The rate of CRBSI in the postintervention group (0%; 0 of 298) was significantly lower than that in the preintervention group (1.7%; 8 of 477; P = 0.026). There was no significant difference between preintervention and postintervention groups in postoperative complications. Six-day infusion decreased the incidence of CRBSI after gastrectomy significantly, without increasing postoperative complications.

Ethanol Lock Therapy as additional treatment of catheter-related bloodstream infections in pediatric patients receiving home parenteral nutrition

Background: Catheter related bloodstream infections (CRIs) are a major cause of morbidity, mortality and prolonged hospitalization in pediatric patients with home parenteral nutrition (HPN). In recent years, new prophylactic and treatment options have been evaluated to reduce the incidence of CRIs and infection related catheter removals. In children, two retrospective studies have shown the efficacy of ethanol lock treatment (ELT) in reducing the incidence of CRIs in pediatric oncology patients. However, prospective data are missing. Our aim of the present study was to evaluate prospectively the effect of ELT on the cure and recurrence rate of CRIs, duration of hospitalization and antibiotic use in HPN pediatric patients. Methods: HPN children older than three months with a clinical suspicion of a CRI were included and randomised to ELT or standard flushing treatment (heparin or taurolidine). The primary outcomes were persistence and recurrence of the bacteraemia and Central Venous Access Device (CVAD) removal. Secondary outcomes included duration of antibiotic use, duration of hospitalization and side effects. Results: Data from eight HPN children experiencing 14 suspected CRI were analysed. Seven patients had proven CRIs by positive blood cultures. Four were treated with ELT and three with their standard flushing treatment. One CRI persisted in the control group. In one single patient, bacteraemia recurred three times within 24 weeks. This patient had been enrolled in both study arms. A CVAD removal was needed in one patient because of occlusion. Conclusions: This small study showed no additional efficacy of the use of ELT on cure rate or recurrences of CRIs compared to standard therapy in HPN treated children. There were also no differences in duration of hospitalization, the use of antibiotics or CVAD removal between both groups.

Prevention of central venous catheter-related bloodstream infections: is it time to add simulation training to the prevention bundle?

Study ObjectiveTo study the impact of adding simulation-based education to the pre-intervention mandatory hospital efforts aimed at decreasing central venous catheter-related blood stream infections (CRBSI) in intensive care units (ICU). DesignPre- and post-intervention retrospective observational investigation. Setting24-bed ICU and a 562-bed university-affiliated, urban teaching hospital. PatientsICU patients July 2004-June 2008 were studied for the development of central venous catheter related blood stream infections (CRBSI). MeasurementsICU patients from July 2004-June 2008 were studied for the development of central venous catheter-related blood stream infections (CRBSI). Pre-Interventionmandatory staff and physician education began in 2004 to reduce CRBSI. The CRBSI-prevention program included online and didactic courses, and a pre- and post-test. Elements in the pre-intervention efforts included hand hygiene, full barrier precautions, use of Chlorhexidine skin preparation, and mask, gown, gloves, and hat protection for operators. A catheter-insertion cart containing all supplies and checklist were was a mandatory element of this program; a nurse was empowered to stop the procedure for non-performance of checklist items. InterventionAs of July 1, 2006, a mandatory simulation-based program for all intern, resident, and fellow physicians was added to teach central venous catheter (CVC) insertion. MeasurementsData collected pre- and post-intervention were CRBSI incidence, number of ICU catheter days, mortality, laboratory pathogen results, and costs. Main ResultsThe pre-intervention CRBSI incidence of 6.47/1,000 catheter days was reduced significantly to 2.44/1,000 catheter days post-intervention (58%; P < 0.05), resulting in a $539,902 savings (USD; 47%), and was attributed to shorter ICU and hospital lengths of stay. ConclusionsFollowing simulation-based CVC program implementation, CRBSI incidence and costs were significantly reduced for two years post-intervention.