Central Line-associated Bloodstream Infections Prevention Research Articles

Use of Staff Feedback to Reduce Central Line-associated Bloodstream Infections

Central line-associated bloodstream infections (CLABSI) pose a major risk to hospitalized children. While current literature clearly identifies interventions demonstrated to reduce the risk of CLABSI, a lack of consistent and effective implementation of published guidelines continues. To test the effect of a staff-driven CLABSI prevention initiative, nursing staff feedback was collected and interventions were implemented that targeted the identified barriers to consistent use of central line bundle elements.

Survey of Central Line–Associated Bloodstream Infection Prevention Practices across American Burn Association–Certified Adult Burn Units

Central line–associated bloodstream infections (CLABSIs) have a considerable impact on morbidity, length of stay, and potential mortality. The estimated per-case cost of CLABSIs is $11,000–$56,167, and there is consensus that most are preventable. Publicly reported CLABSI data are also now used as a metric to compare hospitals.There are published guidelines for the prevention of central line–associated infections, but these practices have not been studied in burn patients. Patients with severe burns pose unique and specific challenges and differ substantially from the typical medical or surgical intensive care unit (ICU) patient. Our objective was to assess CLABSI prevention practices in burn units.We identified all American Burn Association (ABA)–certified adult burn centers through the ABA website (http://www.ameriburn.org) and contacted nursing leadership of each burn intensive care unit to conduct a telephone survey of CLABSI prevention practices in March 2012. The survey project was approved by the Johns Hopkins institutional review board.We had 100% survey participation. There was substantial variation among burn units in the number of beds, the mix of patients, and the acuity of patients' illness. Bed size varied from 4 to 38. Eight units stated that their burn unit incorporated a step-down unit or floor-status beds in their bed count. Thirty (58.8%) of the 51 units defined themselves as mixed burn/surgical or trauma units. The percentage of burned patients seen in the burn units varied from 10% to 100%, with 8 (15.4%) of 51 units stating that their census consisted of fewer than 30% burned patients in their burn ICU.

Decreasing Central-Line–Associated Bloodstream Infections in Connecticut Intensive Care Units

Central-line-associated bloodstream infections (CLABSIs) are a significant cause of preventable harm. A collaborative project involving a multifaceted intervention was used in the Michigan Keystone Project and associated with significant reductions in these infections. This intervention included the Comprehensive Unit-based Safety Program, a multifaceted approach to CLABSI prevention, and the monitoring and reporting of infections. The purpose of this study was to determine whether the multifaceted intervention from the Michigan Keystone program could be implemented in Connecticut and to evaluate the impact on CLABSI rates in intensive care units (ICUs). The primary outcome was the NHSN-defined rate of CLABSI. Seventeen ICUs, representing 14 hospitals and 104,695 catheter days were analyzed. The study period included up to four quarters (12 months) of baseline data and seven quarters (21 months) of postintervention data. The overall mean (median) CLABSI rate decreased from 1.8 (1.8) infections per 1,000 catheter days at baseline to 1.1 (0) at seven quarters postimplementation of the intervention. This study demonstrated that the multifaceted intervention used in the Keystone program could be successfully implemented in another state and was associated with a reduction in CLABSI rates in Connecticut. Moreover, even though the statewide baseline CLABSI rate in Connecticut was low, rates were reduced even further and well below national benchmarks.

Clabsi Reduction: No Longer Just an Inpatient Initiative

Significance and Background: BMT patients are frequently discharged to outpatient care with a central line catheter in place. These patients are at increased risk for developing a central lineassociated bloodstream infection (CLABSI). A review of literature and comparison CLABSI rates showed a paucity of studies in the outpatient population. An outpatient who develops a CLABSI usually requires admission to the hospital, where treatment costs may range from $35,000-53,000. CLABSI surveillance began in January 2009 for our outpatient BMT population utilizing the same NHSN definition used for inpatients. An analysis of data collected over 18 months prompted nursing staff to implement a plan to target reduction of CLABSIs. Interventions: BMT Treatment Center nurses were educated on CLABSI, current rates, and implications for patients as well as the department. The nurses researched ways to reduce CLABSIs and developed a post-insertion bundle for central line care utilizing CDC CLABSI prevention strategies and other evidence-based practices. Patient education materials were developed and a post-line insertion patient education plan was initiated. Nursing compliance with the bundle is continuallymonitoredby retrospective reviewsof central line charting,monthly central line audits, and reviewof electronic patient education tools. CLABSI surveillance is ongoing with an in-depth review of all CLABSIs for defects in nursing care. Results: The 18 month pre-bundle CLABSI rate was 1.66 per 1000 patient visits. The 18 month post-bundle rate fell to 0.88 per 1000 patient visits. The actual number of CLABSIs fell by 30. This resulted in 30 fewer hospital admissions and a minimal savings of over $1,000,000 dollars to the facility. Specifically, the number of coagulase-negative staph infections, frequently associated with indwelling devices, dropped from 32 pre bundle to 7 post bundle implementation. Nursing compliance with CLABSI prevention strategies continues to be well over 90%. Transplant (B) -0.2279 0.5967 <.001

A multicenter quasi-experimental study: impact of a central line infection control program using auditing and performance feedback in five Belgian intensive care units

BackgroundWe analyzed the impact associated with an intervention based on process control and performance feedback to decrease central line-associated bloodstream infection (CLABSI) rates.This study was conducted from March 2011 to September 2012 in five adult intensive care units (ICU) located in two Belgian tertiary hospitals A and B, with a total of 53 beds.MethodsThis study was divided in three phases: P1 (baseline), P2 (intervention) and P3 (post intervention).During P2, external monitoring of five central venous catheters (CVC) care critical processes and monthly reporting (meetings and feedbacks reports posted) of performance indicators (CLABSI rate, CVC utilization ratio, compliance rate with each care process, and insertion site) to ICU workers were performed. The external monitoring of process measures was assessed by the same trained research nurse.A Poisson regression analysis was used to compare CLABSI incidence density rate per phase. Statistical significance was achieved with 2-sided p-value of <0.05. For the analysis, we separated the five ICU in hospital A and B when appropriate.ResultsSignificantly improved total mean compliance was achieved for hand hygiene, CVC handling and CVC dressing. CLABSI rate declined from 4.00 (95% confidence interval (CI): 1.94-6.06) to 1.81 (0.46-3.17) per 1,000 CVC-days in P2 with an incidence rate ratio (IRR) of 0.49 (0.24-0.98, p = 0.043). A better response was observed in hospital A where the nurse participation at the monthly meeting was significantly higher than in hospital B (p < 0.001) as the percentage of feedbacks reports posted in ICU (p < 0.001). The decline in the CLABSI rate observed during P2 in comparison with P1 was independent of the insertion site (femoral or non-femoral; p = 0.054). The overall CLABSI rate increased to 2.73 (1.17-4.29) per 1,000 CVC-days with IRR of 0.67 (0.36-1.26, p = 0.212) in P3 compared to P1, but a high nursing turnover was observed in both hospitals.ConclusionsOur intervention focused on external auditing and performance feedback resulted in significant reduction in rates of CLABSI. Investigation continues regarding the most effective way to sustain CLABSI prevention practices and to improve the culture of safety in healthcare.

Impact of Nursing Staffing on Patient Outcomes in Intensive Care Unit

Background: The impact of nursing care on patient outcomes is not well understood. The objective of this study is to assess the effects of nursing care hours per patient day, nursing skill mix, and nurse turnover on central line-associated bloodstream infection (CLABSI) rates, length of stay (LOS), and mortality in the context of intensive care units (ICUs) using interventions to reduce bloodstream infections and improve patient safety, teamwork and interdisciplinary communication. Methods: This study uses longitudinal data from 45 ICUs from 35 hospitals in two faith-based health systems across12 states. The 45 ICUs were divided into two groups. We analyzed 19 months of experience for the first group and a year of experience for the second group. We collected hours worked by all bedside nurses to calculate National Quality Forum (NQF) nursing measures. We used a two-level random-intercept model to account for the correlations among repeated measures for the same ICU. Regressions accounted for the influences of number of Intensivists, type of ICUs, ICU bed size, which health system the unit belonged to, nursing practice environment (PES-NWI) and project phase. Models also adjusted for average patient charges, to partially account for ICU casemix. Results: Nursing care hours per patient day greater than 20 hours was associated with lower CLABSI rates. Increasing nursing hours per patient day was also associated with shorter LOS, with the strongest relationship where nursing hours per patient day was lower (< 20 hours compared to ≥ 20 hours). A Higher skill mix was associated with shorter LOS but higher CLABSI rates. We found no significant relationships of nursing turnover with any outcome, or between any nursing variables and mortality. Conclusions: Our findings suggest that nursing care hours per patient day and nursing skill mix significantly contribute to CLABSI prevention and LOS in the ICU setting.

Central line associated bloodstream infections in cohort of abdominal surgical patients

INTRODUCTION: Central venous catheter (CVC) placement is an unavoidable part of the everyday medical practice. At the same time CVC application is associated with high risk of development of central line-associated bloodstream infections (CLABSIs). These infections are cause of icreased morbidity and mortality rates as well as higer costs of the inpatient treatment2. Risk factors for onset of CLABSIs include duration of catheterization, length of hospital stay before catheterization, anatomic site of placement, CVC placement at the intensive care units (ICU), parenteral nutrition (PN) and ommisions diring CVC placement, use and care. CLABSI incidence rates vary depending on distribution of different risk factors associated with CVC and patient him/herself. The most significant causative organisms of CLABSIs are coagulase-negative Staphylococcocae, Staphylococcus aureus (S.aures), Enterococcus spp. i Candida spp. CLABSIs prevention measures include compliance with the rules of the aseptic technique upon placement, use and care of CVCs, which, based on the study results, may enable prevention of 65% to 70% of cases of CLABSIs. METHODS: A prospective cohort study included 200 patients hospitalized at the intensive care and therapy units of the CCS Clinic of Digestive Surgery in the period November 30th, 2006-November 31st, 2007 in whom CVC was placed for more than 48 hours. All the data necessary for the study were obtained based on the review of the case histories and they were recorded into the individual questionnaires for each patient. The questionnarire included patient information (age, gender, underlying disease, presence of other infections), information related to diagnostic and therapeutic procedures to which the patient was exposed. The incidence of CRBSIs in ICU patients, Institute of Digestive Diseases, CCS over the study period was 10.08 per 1,000 catheter-days. During the study CLABSI more often present in the females. Additionally, application of albumin and amino acids, ICU stay longer that 7 days and CVC application longer than 15 days, significantly more often present in patients with CRBSIs than in the group of patients without CRBSIs. Independent factors for development of CRBSI are gender, administration of albumin and amino acids. The most common microorganisms isolated from hemocultures and CVC were S. aureus and Klebsiella spp., with 31,8% of isolates each. Statistically significant difference was evidenced in frequency of resistance of S. aureus isolates to methicillin in the group of patients with CRBSI in comparison to the group of patients without CLABSIs. CLABSIs prevention measurs include compliance with the rules of the aseptic technique upon placement, use and care of CVCs.

The reduction of risk in central line-associated bloodstream infections: Knowledge, attitudes, and evidence-based practices in health care workers

We set out to acquire information about the knowledge, attitudes, and evidence-based practices associated with the insertion and maintenance of central vascular catheters (CVC) for the prevention of central line-associated bloodstream infections (CLABSI). We selected all health care workers (HCW) in all units using CVCs in the Calabria region of Italy. Correct answers about the knowledge of physicians and nurses ranged from 43% to 72.9% and were significantly higher in respondents who worked in intensive care unit (ICU) wards in hospitals that had a written policy about CVC maintenance and had active formal training. Respondents' attitudes toward general aspects of CLABSI prevention were very positive and were significantly higher for HCWs working in regional general hospitals, practicing in ICU wards, and having appropriate knowledge. Concerning HCWs, 83.9% reported that, if patients had any manifestations suggesting local or bloodstream infection, the dressing was removed for assessment purposes; this practice was significantly more likely to occur in HCWs having appropriate knowledge and positive attitudes and who worked in hospitals with a written policy about CVC maintenance. The study demonstrated that written policies, formal training, and years of experience contributed to an increase in knowledge, practice, and positive attitudes toward CLABSI prevention. In addition the paper demonstrates how great this need is, having reported many non-evidence-based practices still continuing despite new evidence.

Central Line–Associated Bloodstream Infection Surveillance outside the Intensive Care Unit: A Multicenter Survey

The success of central line-associated bloodstream infection (CLABSI) prevention programs in intensive care units (ICUs) has led to the expansion of surveillance at many hospitals. We sought to compare non-ICU CLABSI (nCLABSI) rates with national reports and describe methods of surveillance at several participating US institutions. An electronic survey of several medical centers about infection surveillance practices and rate data for non-ICU patients. Ten tertiary care hospitals. In March 2011, a survey was sent to 10 medical centers. The survey consisted of 12 questions regarding demographics and CLABSI surveillance methodology for non-ICU patients at each center. Participants were also asked to provide available rate and device utilization data. Hospitals ranged in size from 238 to 1,400 total beds (median, 815). All hospitals reported using Centers for Disease Control and Prevention (CDC) definitions. Denominators were collected by different means: counting patients with central lines every day (5 hospitals), indirectly estimating on the basis of electronic orders ([Formula: see text]), or another automated method ([Formula: see text]). Rates of nCLABSI ranged from 0.2 to 4.2 infections per 1,000 catheter-days (median, 2.5). The national rate reported by the CDC using 2009 data from the National Healthcare Surveillance Network was 1.14 infections per 1,000 catheter-days. Only 2 hospitals were below the pooled CLABSI rate for inpatient wards; all others exceeded this rate. Possible explanations include differences in average central line utilization or hospital size in the impact of certain clinical risk factors notably absent from the definition and in interpretation and reporting practices. Further investigation is necessary to determine whether the national benchmarks are low or whether the hospitals surveyed here represent a selection of outliers.

Prevention of Central Line–Associated Bloodstream Infections in Hemodialysis Patients

An increasing proportion of central line-associated bloodstream infections (CLABSIs) are seen in outpatient settings. Many of such infections are due to hemodialysis catheters (HD-CLABSIs). Such infections are associated with substantial morbidity, mortality, and excess healthcare costs. Patients who receive dialysis through a catheter are 2-3 times more likely to be hospitalized for infection and to die of septic complications than dialysis patients with grafts or fistulas. Prevention measures include minimizing the use of hemodialysis catheters, use of CLABSI prevention bundles for line insertion and maintenance, and application of antimicrobial ointment to the catheter exit site. Instillation into dialysis catheters of antimicrobial solutions that remain in the catheter lumen between dialyses (antimicrobial lock solutions) has been studied, but it is not yet standard practice in some dialysis units. At least 34 studies have evaluated the impact of antimicrobial lock solutions on HD-CLABSI rates. Thirty-two (94%) of the 34 studies demonstrated reductions in HD-CLABSI rates among patients treated with antimicrobial lock solutions. Recent multicenter randomized controlled trials demonstrated that the use of such solutions resulted in significantly lower HD-CLABSI rates, even though such rates were low in control groups. The available evidence supports more routine use of antimicrobial lock solutions as an HD-CLABSI prevention measure in hemodialysis units.

Central line-associated bloodstream infection prevention

This review summarizes recent literature regarding the prevention of central line-associated bloodstream infection (CLABSI). CLABSI rates in United States ICUs reported to the National Healthcare Safety Network (NHSN) have decreased dramatically in recent years. This has been achieved largely through a multifaceted approach and a focus on evidence-based best practices for central line insertion. More recent studies suggest an added benefit from implementation of evidence-based best practices for central line maintenance. Recent investigations also focus on CLABSI prevention among pediatric patients and in the non-ICU setting, in which a significant proportion of central line-days and CLABSI occur. A recent meta-analysis supports the practice of daily chlorhexidine gluconate (CHG) bathing in the ICU population for CLABSI prevention. Investigation continues regarding the most effective way to implement and sustain CLABSI prevention practices, including ways to best address and improve the culture of safety in healthcare. Recent literature on CLABSI prevention shows that a multifaceted approach to improving central line insertion and maintenance practices results in decreased CLABSI rates in both the ICU and non-ICU settings. More data are needed to develop appropriate benchmarks and prevention strategies specific to the non-ICU setting, in which a significant proportion of central line-days and CLABSI occur.

National Survey of Practices to Prevent Healthcare-Associated Infections in Thailand: The Role of Safely Culture and Collaboratives

To evaluate hospital characteristics and practices used by Thai hospitals to prevent catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP), the 3 most common types of healthcare-associated infection (HAI) in Thailand. Survey. Thai hospitals with an intensive care unit and 250 or more hospital beds. Between January 1, 2010, and October 31, 2010, research nurses collected data from all eligible hospitals. The survey assessed hospital characteristics and practices to prevent CAUTI, CLABSI, and VAP. Ordinal logistic regression was used to assess relationships between hospital characteristics and use of prevention practices. A total of 204 (80%) of 256 hospitals responded. Most hospitals (93%) reported regularly using alcohol-based hand rub. The most frequently reported prevention practice by infection was as follows: for CAUTI, condom catheters in men (47%); for CLABSI, avoiding routine central venous catheter changes (85%); and for VAP, semirecumbent positioning (84%). Hospitals with peripherally inserted central catheter insertion teams were more likely to regularly use elements of the CLABSI prevention bundle. Greater safety scores were associated with regular use of several VAP prevention practices. The only hospital characteristic associated with increased use of at least 1 prevention practice for each infection was membership in an HAI collaborative. While reported adherence to hand hygiene was high, many of the prevention practices for CAUTI, CLABSI, and VAP were used infrequently in Thailand. Policies and interventions emphasizing specific infection prevention practices, establishing a strong institutional safety culture, and participating in collaboratives to prevent HAI may be beneficial.

Lessons Learned from 5-yrs of Central Line-Associated Bloodstream Infection Real-Time Event Reviews

Central line-associated bloodstream infection (CLABSI) prevention for all patients has been a quality improvement inititative at this facility since 2002. Subsequently, the practice of conducting real-time event reviews following recognition of a CLABSI was initiated with the aim of identifying additional interventions to prevent these infections.

Using a checklist to identify barriers to compliance with evidence-based guidelines for central line management: a mixed methods study in Mongolia

This study aimed to determine the extent to which a checklist has potential for identifying barriers to compliance with central line management guidelines, to evaluate the potential utility of checklists to improve the management of central lines in Mongolia, and to define the gap between current and best practices. A 22-item checklist was developed based on the Centers for Disease Control and Prevention (CDC, USA) guidelines and existing central line-associated bloodstream infection (CLABSI) checklists. The checklist was used to observe 375 central line procedures performed in the intensive care units of four tertiary hospitals of Mongolia between July and December 2010. In parallel, 36 face-to-face interviews were conducted in six other tertiary hospitals to explain practice variations and identify barriers. The baseline compliance level across all components of the checklist was 68.5%. The main factors explaining low levels of compliance were outdated local standards, a lack of updated guidelines, poor control over compliance with existing clinical guidelines, poor supply of medical consumables, and insufficient knowledge of contemporary infection control measures among health care providers. The health authorities of Mongolia need to adequately address the prevention and control of CLABSIs in their hospitals. Updating local standards and guidelines and implementing adequate multifaceted interventions with behavioral, educational, and logistical components are required. Use of a checklist as a baseline evaluation tool was feasible. It described current practice, showed areas that need urgent attention, and provided important information needed for future planning of CLABSI interventions.

Assessment of the Reported Effectiveness of Five Different Quality- Improvement Initiatives for the Prevention of Central Line-Associated Bloodstream Infections in Intensive Care Units

Five studies that evaluated five different quality-improvement initiatives for the prevention of central line-associated bloodstream infections (CLABSIs) in adult, pediatric and/or neonatal intensive care units (ICUs) and that were published within the past two years in an infection-control and epidemiology journal were reviewed, assessed and compared. Each is a prospective cohort study that similarly concludes that the evaluated initiative was responsible for a significant and calculated reduction in the CLABSI rate, ranging from 30.3% to 85%. The soundness of these conclusions and calculations, however, like the legitimacy of several other common uses of CLABSI data, requires, in addition to satisfying a number of other criteria, that each study's CLABSI rates be accurate and complete. The primary goal of this analysis, therefore, was to confirm the hypothesis that each of these five studies had validated its CLABSI rates. The analysis found, however, that these five studies did not validate the accuracy and completeness of their CLABSI rates, which raises reasonable questions about each study’s assessment of and conclusions about the initiative's effectiveness for the prevention of CLABSIs. In addition to their aims, calculations, and conclusions, these five studies share in common a number of features, as well as circumscribing qualities, which are discussed. The distinction between a qualitative assessment and a quantitative determination of an initiative's performance is also discussed. Both the circumspective use of CLABSI data that have not been validated and the cautious interpretation of conclusions about central-line care that are based on these CLABSI data are recommended.

Effect of a multidisciplinary intervention on central line utilization in an acute care hospital

Many institutions that have adopted evidence-based infection prevention practices have achieved reductions in the rate of central line-associated bloodstream infection (CLABSI) in their intensive care units (ICUs). Few studies have investigated the impact of CLABSI prevention strategies in non-ICU settings, however. This study was conducted to assess whether a multifaceted educational initiative significantly improved health care workers' adherence to clinical practices that have been demonstrated to reduce CLABSI rates. This prospective interventional study compared central line utilization and other variables in medical ICU (MICU) and non-ICU settings at an inner city community teaching hospital. The study included 3 phases: preintervention, intervention, and postintervention. A total of 128 central venous catheter (CVC) placements were reviewed. After the intervention, the proportion of patients transferred out of the MICU with a CVC in place decreased significantly (P=.05), and the percentage of patients transitioned from a CVC to a peripherally inserted venous catheter increased (P= .004). The mean duration of CVC use decreased from 8.2 days to 5.7 days (P=.004), which was confirmed by linear regression (P= .003). Our data indicate that multidisciplinary, evidenced-based educational interventions can significantly improve targeted measures of CVC use. Our program was successfully implemented with limited resources and should be reproducible at other hospitals.

Preventing hospital-acquired infections: a national survey of practices reported by U.S. hospitals in 2005 and 2009.

Hospital-acquired infection (HAI) is common, costly, and potentially lethal. Whether initiatives to reduce HAI--such as the Centers for Medicare and Medicaid Services (CMS) no payment rule--have increased the use of preventive practices is not known. To examine the use of infection prevention practices by U.S. hospitals and trends in use between 2005 and 2009. Surveys of infection preventionists at non-federal general medical/surgical hospitals and Department of Veterans Affairs (VA) hospitals, which are not subject to the CMS no payment rule, in 2005 and 2009. Percent of hospitals using practices to prevent central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI). Survey response was approximately 70%. More than 1/2 of non-federal hospitals reported a moderate or large increase in CLABSI, VAP and CAUTI prevention as a facility priority due to the non-payment rule; over 60% of VA hospitals reported no change in priority. However, both non-federal and VA hospitals reported significant increases in use of most practices to prevent CLABSI, VAP and CAUTI from 2005 to 2009, with 90% or more using certain practices to prevent CLABSI and VAP in 2009. In contrast, only one CAUTI prevention practice was used by at least 50% of hospitals. Since 2005, use of key practices to prevent CLABSI, VAP and CAUTI has increased in non-federal and VA hospitals, suggesting that despite its perceived importance, the non-payment rule may not be the primary driver. Moreover, while 65% of non-federal hospitals reported a moderate or large increase in preventing CAUTI as a facility priority, prevention practice use remains low.

Central LINE-Associated Blood STREAM INFECTIONS In PATIENTS with Hematological Malignancies AN EXPERIENCE FROM Qatar

Abstract 4937 Background:Central-line access is an important part of healthcare practice especially for patients with hematological malignancies; however,central line-associated blood stream infection (CLABSIs) are important and deadly Health- care–associated infections (HAIs) and they are considered as a major problem that causes significant morbidity and mortality, and excess length of stay and cost. The risk of infection depends on, the site of insertion, the type of device, the underlying co morbidity and the appropriate prevention measures taken during insertion. Management of central line-associated bloodstream infections involves deciding on the type and duration of systemic antimicrobial therapy and catheter removal, antibiotic lock therapy. Systemic antimicrobial use is essential but, although generally effective in controlling sepsis, it often fails to sterilize the line, increasing the incidence of complications or recurrence. The decision regarding whether the catheter should be removed or retained is therefore crucial. One of the major factors to be considered is the type of organism involved in the line-related infection. Aim:to evaluate the central Line-associated blood stream infections in patients with hematological malignancies in Al-Amal Hospital, (inpatient wards, outpatient day care unit) and among patients transferred to intensive-care units. Patients and Methods:we evaluated central Line-associated blood stream infections in patients with hematological malignancies admitted to Al-Amal Hospital in Qatar between February 2007-December 2010. Strict protocol for febrile neutropenia is followed with proper timely intervention. Systematic review for all blood stream infections were done by nursing infection control practitioners, hematologists, microbiologists following the definitions of CDC-NHSN. Results:39 events were evaluated, 25 (64%) events in patients with AML, 10 (26%) events with ALL, 2 (5%) events with CLL, 1 (2.5%) event with CML and 1 (2.5%) event with NHL. Males were 25 and females were 14, with male to female ratio 1.8:1. The age range from 19 to 69 year with mean age group of 42 year. The most common infections were Gram negative organisms (27events), and among the gram negative organisms pseudomonas was the commonest infection (7 events), with 4 of them died, MDR reported in 6 events among the gram negative infections.Fungal infections were 9 events (6 Candida and 3 Aspergillus) with one death due to Candida tropicalis, the least common infections were Gram positive organisms, 3 events were recorded with one mortality due to staph. hemoliticus. Overall mortality was 9 out of 39 (23%). Conclusion:most of the infections occurred in non-tunneled catheters, and then tunneled catheters, rarely with port-A-Catheter. Based on the isolates the mortality was higher among patients with gram negative which is expected in such category of patients, and despite high number of fungal infections the mortality rate was low in affected patients (due to timely intervention with removal of line and proper use of anti-fungal ). Continued success in CLABSI prevention will require increased adherence to current CLABSI prevention recommendations, development and implementation of additional prevention strategies, and the ongoing collection and analysis of data, including specific microbiological informations. Disclosures:No relevant conflicts of interest to declare.

Eradicating Central Line–Associated Bloodstream Infections Statewide

The authors' goal was to determine if a national intensive care unit (ICU) collaborative to reduce central line-associated bloodstream infections (CLABSIs) would succeed in Hawaii. The intervention period (July 2009 to December 2010) included a comprehensive unit-based safety program; a multifaceted approach to CLABSI prevention; and monitoring of infections. The primary outcome was CLABSI rate. A total of 20 ICUs, representing 16 hospitals and 61 665 catheter days, were analyzed. Median hospital bed size was 159 (interquartile range [IQR] = 71-212) and median ICU bed size was 10 (IQR = 8-12). Median unit catheter days per month were 112 (IQR = 52-197). The overall mean CLABSI rate decreased from 1.5 infections per 1000 catheter days at baseline (January to June 2009) to 0.6 at 16 to 18 months postintervention (October to December 2010). The median rate was zero CLABSIs per 1000 catheter days at baseline and remained zero throughout the study period. Hawaii demonstrated that the national program can be successfully spread, providing further evidence that most CLABSIs are preventable.

A Quality Improvement Program Combining Maximal Barrier Precaution Compliance Monitoring and Daily Chlorhexidine Gluconate Baths Resulting in Decreased Central Line Bloodstream Infections

A quality improvement intervention on central line-associated bloodstream infection prevention has been ongoing at a regional medical center since February 2004, and although improvements were noted between 2004 and 2007, the incidence rate of central line-associated bloodstream infections was still of concern. A comprehensive review of all infections from October 2005 through January 2007 indicated that these rates decreased when maximal barrier precaution compliance was tracked and increased when compliance tracking stopped; therefore, an ongoing compliance-tracking program for maximal barrier precautions was instituted, and caregivers were reeducated on the importance of central-line-bundle prevention efforts. A quality improvement intervention of daily CHG baths for all ICU patients was added in April 2008. The goal of this QI intervention was to decrease the incidence rate to 0 for a sustained period, and it was successful.