Risk Of Central Line-associated Bloodstream Infections Research Articles

Reduction in Central Line-Associated Bloodstream Infections Correlated With the Introduction of a Novel Silver-Plated Dressing for Central Venous Catheters and Maintained for 6 Years.

To assess a novel silver-plated dressing (SD) for central venous catheters in comparison to chlorhexidine gluconate-impregnated sponge (CHGIS) dressings in preventing central line-associated bloodstream infections (CLABSIs) in adult intensive care unit (ICU) patients. Retrospective cohort study. Tampa General Hospital, an academic medical tertiary care center. All adult ICU patients of an academic medical tertiary care center from January 2009 to December 2010. A total of 3189 patient records were studied from 7 different ICUs during the 2-year period. Patients received either CHGIS dressings (January 2009-December 2009) or SDs (January 2010-December 2010). Primary outcomes measured were CLABSI rates per 1000 catheter days and ICU length of stay. There were 30 696 catheter days with CHGIS dressings and 31 319 catheter days with SDs. There was a statistically significant decrease in the rate of CLABSI per 1000 catheter days in the SD group, from 2.38 to 1.28 ( P = .001), with an absolute risk reduction of 1.1. There was a significantly lower incidence in the rate of CLABSI per 1000 catheter days in the SD group (incidence rate ratio [IRR] = 0.54, 95% confidence interval [CI]: 0.36-0.80). The relative risk of CLABSI in the SD group was 0.502 (95% CI: 0.340-0.730; P < .001). If SDs are used on all catheters, the decreased rate of CLABSIs observed would calculate to a cost savings of US$4070 to US$39 600 per 1000 catheter days. After successful implementation of the SD, we observed significant reductions in CLABSI rates and a sustained reduction in the subsequent 6 years. Use of SDs is associated with a significant decrease in CLABSI rates in adult ICU patients compared to CHGIS dressings, with an estimated cost savings of US$4070 to US$39 600 per 1000 catheter days.

The idle central venous catheter in the NICU: When should it be removed?

PurposeThere is debate regarding the optimal timing of central line removal in the neonatal intensive care unit (NICU). The purpose was to evaluate outcomes of idle peripherally inserted central catheters (PICCs) and tunneled central venous catheters (TCVCs) and determine the incidence of line-related infections and replacements. MethodsPatients in the NICU with T-CVCs placed between 11/2008 and 8/2015 (n=134) or PICCs placed between 7/2013 and 10/2015 (n=467) were included. Demographics and outcomes were compared. ResultsThe most common indications for line placement were parenteral nutrition for PICCs (74%) and lack of access for T-CVCs (53%). T-CVCs had a greater proportion of idle days (T-CVC- 25.2% vs PICC- 5.1%, p<0.001) and removal within 24h of discharge (T-CVC-53% vs PICC-5.8%, p<0.001). Conversely, 81% of PICCs were removed within 24h of nonuse. Line replacement after removal for nonuse was required in 6% of PICCs and zero T-CVCs. In both groups, the central line-associated bloodstream infection (CLABSI) rate was lower in idle lines compared to ones in use. ConclusionPatients treated with PICCs and T-CVCs are different populations and should have different guidelines for removal. In neonates with difficult access, the low risk of CLABSIs in idle surgically placed catheters may justify maintaining access until discharge. Type of studyTreatment study. Level of evidenceIII.

Chlorhexidine Bed-Bath Improves CLABSI: A Meta-Analysis

Central catheters are used primarily in ICU settings. Bloodstream infections in the central line of central catheters have been shown to cause longer hospital stays for patients and result in higher medical costs. The present study applies a systematic review and meta-analysis to assess the effect of a 2% chlorhexidine (CHG) bed-bath on the risk of central line-associated bloodstream infections (CLABSI). The Public Health Resource Unit of England issued the Critical Appraisal Skills Programme and evaluated the standardized crucial appraisal tools from the Joanna Briggs Institute that are used to assess methodological quality. The present study identified 6 studies that met the criteria from a keyword search that included: CHG and soap-water for bed-bath experiment. The experiment used RevMan 5 software to conduct the meta- analysis. The results support the homogeneity (p = .002, I2 = 64%) of the sample. Comprehensive effectiveness was 0.45 (95% CI [0.35, 0.58], p < .001). The CHG bed-bath intervention was shown to effectively reduce CLABSI. The meta-analysis indicated that bed-bath with CHG reduces the incidence of CLABSI. We recommend that center catheter bundle care be applied in ICUs in combination with CHG bed-bath in order to reduce the risk of CLABSI.

Standardizing Central Venous Catheter Lab Collection Process to Reduce Risk of Central Line Associated Blood Stream Infection

According to the Centers for Disease Control CDC, an estimated 30,100 central line associated bloodstream infections (CLABSI) occur in acute care facilities each year. The Joint Commission National Patient Safety Goals recommends implementing proven guidelines to prevent CLABSI. In a major cancer center, with an average of 60 to 80 surgical procedures performed daily, the risk of CLABSI is significant considering the immunocompromised patient population. Post Anesthesia Care Unit (PACU) nurses committed to infection control developed a standardized process for collecting lab samples from the Central Venous Catheter (CVC).

2. Central line associated blood stream infection in a pediatric cardiac intensive care unit: Incidence, risk factors, and outcome

Clinical research. Oral presentation. Central Line Associated Blood Stream Infection (CLABSI) is a serious infection associated with 28,000 deaths and expenses from $296 million to $2.3 billion yearly. There is scarcity of data on CLABSI in pediatric cardiac intensive care units (PCICU). The aim of the study is to describe the risk factors, causative organisms and outcome of CLABSI in a PCICU. The study was retrospective cohort in which all charts of patients admitted to the PCICU from January 2012 to September 2012 were reviewed. Patients who had central line were followed to see if they develop CLABSI from the central line insertion date until discharge. Two hundred and sixty-one patients were included in the study. There were 2275 central line days and 19 CLABSI episodes (8.35 CLABSIs per 1000 central line days). Most common causative pathogens isolated were gram negative bacteria (N = 10, 50%) with Klebsiella pneumoniae and coagulase negative Staphylococcus were the leading causative organisms (N = 4, 20% each). Patients who developed the infection had a longer stay at the PCICU with a mean of 27.1 days compared to 8.20 days for non CLABSI Patients (P < 0.0001). The death rate associated with CLABSI was 10.5% compared with 1.2% in non CLABSI patients (P = 0.004). Multiple logistic regression analysis showed TPN, systemic corticosteroids and Mechanical ventilator utilization >7 days were independent risk factors. CLABSI increased the length of PCICU stay and mortality, yet it has recognizable associated risk factors. Infection control measures should be carefully implemented with special attention given to patients with CLABSI risk factors.

Central line-associated bloodstream infection in childhood malignancy: Single-center experience.

Central line-associated bloodstream infection (CLABSI) is a common complication in children with malignancy, often leading to prolonged hospitalization, delay in chemotherapy or catheter removal. This retrospective epidemiological study reviewed 91 children with malignancy over a 5year period between 2011 and 2015 and analyzed potential risk factors for CLABSI. Symptoms, laboratory and microbiology characteristics, subsequent treatment and outcome were recorded and analyzed. All the collected data were processed through SPSS for statistical analysis. Among 40 episodes of CLABSI recorded in 30 patients, the rate of CLABSI was estimated as 2.62 episodes per 1,000days of central venous catheter (CVC) carriage. Most of the bacterial pathogens isolated in CLABSI episodes were Gram positive, including different strains of staphylococci, while Gram-negative bacteria were involved in 30% of episodes. Invasive mycosis was isolated in 7.5% of episodes, accounting for the highest catheter removal rate. Intensive chemotherapy and prolonged hospitalization proved to be independent risk factors for CVC infection. In children with neutropenia, the risk for CLABSI was also fourfold greater (P=0.001). Children with leukemia had a fivefold greater risk for CLABSI (P=0.005). Finally, although 36% of patients received antibiotic lock therapy, in 15% of these patients catheter replacement could not be avoided due to persistent serious infection. Younger age, neutropenia, hematologic malignancy and longer catheterization are important risk factors for CLABSI, but further research is required for the prevention of catheter-related infection in children with malignancy.

Dwell time and risk of central-line-associated bloodstream infection in neonates

Umbilical venous catheters (UVCs) or peripherally inserted central catheters (PICCs), widely used in high-risk neonates, may have a threshold dwell time for subsequent increased risk of central-line-associated bloodstream infection (CLABSI). To evaluate the CLABSI risks in neonates having either UVC, PICC, or those having both sequentially. The study included 3985 infants who had UVC or PICC inserted between 2007 and 2009 cared for in 10 regional neonatal intensive care units: 1392 having UVC only (group 1), 1317 PICC only (group 2), and 1276 both UVC and PICC (group 3). There were 403 CLABSIs among 6000 venous catheters inserted, totalling 43,302 catheter-days. CLABSI rates were higher in group 3 infants who were of lowest gestation (16.9 per 1000 UVC-days and 12.5 per 1000 PICC-days; median: 28 weeks) when compared with group 1 (3.3 per 1000 UVC-days; 37 weeks) and group 2 (4.8 per 1000 PICC-days; 30 weeks). Life table and Kaplan-Meier hazard analysis showed that UVC CLABSI rate increased stepwise to 42 per 1000 UVC-days by day 10, with the highest rate in group 3 (85 per 1000 UVC-days). PICC CLABSI rates remained relatively stable at 12-20 per 1000 PICC-days. Compared to PICC, UVC had a higher adjusted CLABSI risk controlled for dwell time. Among group 3, replacing UVC electively before day 4 may have a trend of lower CLABSI risk than late replacement. There was no cut-off duration beyond which PICC should be removed electively. Early UVC removal and replacement by PICC before day 4 might be considered.

Bloodstream Infection Incidence of Different Central Venous Catheters in Neonates: A Descriptive Cohort Study.

Central venous catheters (CVCs) in neonates are associated with a risk of central line-associated bloodstream infections (CLABSI). Most reports on the incidence of CLABSI in neonates focus on umbilical venous catheters (UVCs) and peripherally inserted central catheters (PICCs). We evaluated the incidence and risk factors for CLABSI in a cohort of neonates with femoral venous catheters (FVCs), UVCs, and PICCs, with a gestational age ≥34 weeks born between January 1, 2006 and June 30, 2013. We included 2,986 neonates with a total of 656 catheters. The CLABSI incidence rate varied from 12.3 per 1,000 catheter-days in FVCs to 10.6 per 1,000 catheter-days in UVCs and 5.3 per 1,000 catheter-days in PICCs. In a Kaplan–Meier survival analysis, we did not find a difference in CLABSI risk between the catheter types (p = 0.29). The following factors were independently associated with an increased risk of CLABSI: parenteral nutrition [hazard ratio (HR) 2.60, 95% confidence interval (CI) 1.25–5.41], male gender (HR 2.63, 95% CI 1.17–5.90), and higher birth weight (HR 1.04, 95% CI 1.002–1.09), whereas antibiotic treatment at birth (HR 0.25, 95% CI 0.12–0.52) was associated with a decreased risk. Conclusion: In our cohort, we did not find a difference between the CLABSI incidence in FVCs, PICCs, and UVCs. Occurrence of CLABSI is associated with parenteral nutrition, male gender, and higher birth weight. Antibiotic treatment at birth was associated with a decreased risk of CLABSI.

0.2% chlorhexidine acetate as skin disinfectant prevents skin lesions in extremely preterm infants: a preliminary report

ObjectiveThe skin disinfectant ‘0.5% chlorhexidine gluconate in 70% alcohol’ (0.5% CHG-70% alc) may cause skin lesions in extremely preterm infants (gestational age <26 weeks). In April 2013, 0.2% chlorhexidine gluconate...

Identifying Structural Factors Associated with Central Line-Associated Bloodstream Infections (CLABSI) Risk in a Single-Center Pediatric Academic Hospital

BackgroundEfforts to prevent CLABSIs have primarily focused on individual compliance with established care bundles, however little is known to what extent organizational structure and process influence CLABSI outcomes.MethodsTo expose associations within clinical units and identify CLABSI risk, aggregate monthly data from July 2014 to June 2016 was collected on admitted patients aged 0 months to 18 years. Nine clinically disparate units were categorized into four clinical paradigms to analyze factor effect: Intensive Care Nursery (ICN), Pediatric Intensive Care Unit (PICU), Hematology/Oncology (Heme/Onc) and Medical Surgical (Med/Surg). This retrospective analysis evaluates three structure-related factors: acuity-based nurse workload/rate of hours per patient day (HPPD), number of full and part-time staff (FTPT), and number of separations/nurse turnover. Four process-related factors include average length of stay and rates of central line entry stratified by type: laboratory collection, medications, and flush. Multivariable Poisson regression was used to produce incidence rate ratios (IRR) and account for central line days. Factors by unit type were standardized to represent one standard deviation change.ResultsA total of 104 CLABSIs were identified with rates ranging from 0 to 9.5 CLABSI per 1,000 central line days. Nurse turnover was a significant risk in ICN (IRR: 1.41; P = .018) and Med/Surg (IRR: 1.36; P = .046) yet non-significant for the PICU (IRR: 0.90; P = .341) and Heme/Onc (IRR: 1.01; P = .871) floors. FTPT was associated with increased CLABSI in PICU (IRR: 1.49; P = 0.005) yet protective for the ICN (IRR: 0.34; P < .001). Length of stay was a risk for Heme/Onc (IRR: 1.43; P = 0.088), yet protective for the ICN (IRR: 0.65; P = .002) and PICU (IRR: 0.62; P = .016). Central line access reasons were not statistically significant with the exception of lab entries on the Med/Surg floor (IRR:1.67; P = 0.030).ConclusionCLABSI mitigation requires more than individual competence with task-related practices. The unique work ecology of each clinical area may broadly influence CLABSI as an outcome. Extending analyses to consider organizational structure can inform resource allocation and recalibrate traditional prevention strategies.Disclosures All authors: No reported disclosures.

An All-Harm Index Quantifying Central Line Associated Infectious and Noninfectious Complications Among Pediatric Oncology Patients

BackgroundIn contrast to inpatient central line associated blood stream infections (CLABSIs), little attention has been devoted to preventing outpatient CLABSIs or central line associated noninfectious complications (CLANCs). Our aim was to develop and validate a novel index to comprehensively quantify the rates of both CLABSIs and CLANCs among pediatric oncology patients.MethodsCLABSIs were defined according to CDC/NHSN definitions. CLANCs were defined using a novel classification as noninfectious events resulting in premature removal of the line. 592 oncology patient records (< 24 years; 2006–16) were reviewed. Wilcoxon rank-sum tests were used for continuous and ordinal characteristics and Chi-square or Fisher’s exact tests for categorical characteristics.Results656 CVCs were inserted in 368 patients, for a total of 175,941catheter days (9.6% inpatient). Events included: 108 CLABSIs (42 inpatient and 66 outpatient) and 89 CLANCs (44 inpatient and 45 outpatient). The all-harm event rate was 1.1 per 1000 CVC days; the sum of CLABSI (0.61) and CLANC (0.50) rates. Inpatient rates were: all-harm (4.9), CLABSIs (2.4), and CLANCs (2.5). Outpatient event rates were: all-harm (0.72), CLABSIs (0.45), and CLANCs (0.27). For all lines treated independently, risk ratio of an adverse event was strongly correlated with CVC type (tunneled CVCs vs ports; 11.8; <0.001), age at placement per 1 year older (0.89; <0.001), gender (females vs males; 1.6; 0.021), and tumor type (AML vs Non-AML Leukemia/Lymphoma; 4.0; <0.001). Tunneled CVCs carried greater risk for both CLABSI (10.8; <0.001) and CLANC (13.2; <0.001) than ports.ConclusionWe have developed an all-harm index to quantify the total harm associated with central line use. Among pediatric oncology patients with CVCs, major noninfectious complications occur at rates similar to those reported for CLABSIs. Although event rates per 1000 CVC days were lower among outpatients, the total number of infectious and noninfectious harm events was similar in the inpatient and outpatient settings. Additional quality improvement efforts are required to reduce the total harm associated with CVC use, and modifiable factors such as catheter choice could significantly impact the rate of both CLABSIs and CLANCs.Disclosures All authors: No reported disclosures.

Central line-associated bloodstream infection in pediatric oncology patients in Qatar: A prospective study

Objective: To assess the central line-associated bloodstream infection (CLABSI) rate and risk factors in hospitalized pediatric oncology patients in Qatar. Materials and Methods: A prospective, observational study was conducted in pediatric oncology department at Hamad Medical Corporation, Qatar between January 1, 2013 and December 31, 2014. All children Results: Thirty-seven subcutaneous tunneled catheters were inserted. Majority of the patients were younger than 10 years of age (88%), and the male-to-female ratio was 1.3:1. Leukemia was the most frequently encountered diagnosis. The overall mean central venous catheter (CVC) infection rate was 4.12 CLABSI per 1000 CVC days (95% confidence interval 2.41, 7.05). Thirteen catheters were infected (35.1%), of which 11 catheters were Porta-a-Cath, and two catheters were Hickman double lumen line. Gram-negative bacteria were found in 69.2% of the CLABSI cases, and no fungal infection was detected. Gender, age, type of disease, and type of catheter were not associated with increased risk for CLABSI (P > 0.05). The mean number of days with neutropenia was more in the patients who had CLABSI 73.5 ± 44.5 compared to the patients who did not have CLABSI 48.9 ± 52.1, but the difference did not reach statistical significance (P = 0.140). Conclusion: The incidence rate of CLABSI continues to be a concern in hospitalized pediatric oncology patients in Qatar. This study showed that mean CVC infection rate was 4.12 CLABSI per 1000 CVC days. Gram-negative bacteria CLABSI were the dominant organism in this group of patients and catheters.

Risk factors for recurrent central line-associated bloodstream infections in a pediatric intensive care unit

Background/aim: It is recommended that a central venous catheter (CVC) be removed if central line-associated bloodstream infection (CLABSI) has been diagnosed. The objective of this retrospective study was to evaluate the risk factors for recurrent CLABSI in reinserted catheters in a pediatric intensive care unit. Materials and methods: Patients with recurrent and nonrecurrent CLABSI were compared in terms of the catheter exchange interval, the interval between negative blood culture and reinsertion of the CVC, and the pre-/reinsertion treatment duration. Results: Thirty-one patients with initial CLABSI had reinserted CVCs, and 12 (38.7%) of these patients were diagnosed with recurrent CLABSI. In the recurrent group, the catheter exchange interval, the interval between negative blood culture and reinsertion of the second CVC, and pre-/reinsertion treatment duration were found to be shorter. Logistic regression analysis revealed that if the interval between negative blood culture and reinsertion of the second CVC was shorter than 4 days, recurrent CLABSI risk increased by 1.7-fold (P = 0.021). Sterile gauze-dressed patients had shorter cumulative catheter surveys than the polyurethane-dressed patients (P = 0.005). Conclusion: Using transparent polyurethane dressings instead of sterile gauze for maintaining the CVC and delaying the reinsertion procedure for at least 4 days after the negative culture might be helpful in preventing recurrent CLABSI.

Central venous catheter infections in home parenteral nutrition patients: Outcomes from Sustain: American Society for Parenteral and Enteral Nutrition's National Patient Registry for Nutrition Care.

Home parenteral nutrition (HPN) is a high-cost, complex nutrition support therapy that requires the use of central venous catheters. Central line-associated bloodstream infections (CLABSIs) are among the most serious risks of this therapy. Sustain: American Society for Parenteral and Enteral Nutrition's National Patient Registry for Nutrition Care (Sustain registry) provides the most current and comprehensive data for studying CLABSI among a national cohort of HPN patients in the United States. This is the first Sustain registry report detailing longitudinal data on CLABSI among HPN patients. To describe CLABSI rates for HPN patients followed in the Sustain registry from 2011-2014. Descriptive, χ2, and t tests were used to analyze data from the Sustain registry. Of the 1,046 HPN patients from 29 sites across the United States, 112 (10.7%) experienced 194 CLABSI events during 223,493 days of HPN exposure, for an overall CLABSI rate of 0.87 episodes/1,000 parenteral nutrition-days. Although the majority of patients were female (59%), adult (87%), white (75%), and with private insurance or Medicare (69%), CLABSI episodes per 1,000 parenteral nutrition-days were higher for men (0.69 vs 0.38), children (1.17 vs 0.35), blacks (0.91 vs 0.41), and Medicaid recipients (1.0 vs 0.38 or 0.39). Patients with implanted ports or double-lumen catheters also had more CLABSIs than those with peripherally inserted or central catheters or single-lumen catheters. Staphylococci were the most commonly reported pathogens. These data support findings of smaller studies about CLABSI risk for children and by catheter type and identify new potential risk factors, including gender, race, and insurance type. Additional studies are needed to determine effective interventions that will reduce HPN-associated CLABSI.

Chlorhexidine bathing and health care-associated infections among adult intensive care patients: a systematic review and meta-analysis.

BackgroundHealth care-associated infections (HAI) have been shown to increase length of stay, the cost of care, and rates of hospital deaths (Kaye and Marchaim, J Am Geriatr Soc 62(2):306–11, 2014; Roberts and Scott, Med Care 48(11):1026–35, 2010; Warren and Quadir, Crit Care Med 34(8):2084–9, 2006; Zimlichman and Henderson, JAMA Intern Med 173(22):2039–46, 2013). Importantly, infections acquired during a hospital stay have been shown to be preventable (Loveday and Wilson, J Hosp Infect 86:S1–70, 2014). In particular, due to more invasive procedures, mechanical ventilation, and critical illness, patients cared for in the intensive care unit (ICU) are at greater risk of HAI and associated poor outcomes. This meta-analysis aims to summarise the effectiveness of chlorhexidine (CHG) bathing, in adult intensive care patients, to reduce infection.MethodsA systematic literature search was undertaken to identify trials assessing the effectiveness of CHG bathing to reduce risk of infection, among adult intensive care patients. Infections included were: bloodstream infections; central line-associated bloodstream infections (CLABSI); catheter-associated urinary tract infections; ventilator-associated pneumonia; methicillin-resistant Staphylococcus aureus (MRSA); vancomycin-resistant Enterococcus; and Clostridium difficile. Summary estimates were calculated as incidence rate ratios (IRRs) and 95% confidence/credible intervals. Variation in study designs was addressed using hierarchical Bayesian random-effects models.ResultsSeventeen trials were included in our final analysis: seven of the studies were cluster-randomised crossover trials, and the remaining studies were before-and-after trials. CHG bathing was estimated to reduce the risk of CLABSI by 56% (Bayesian random effects IRR = 0.44 (95% credible interval (CrI), 0.26, 0.75)), and MRSA colonisation and bacteraemia in the ICU by 41% and 36%, respectively (IRR = 0.59 (95% CrI, 0.36, 0.94); and IRR = 0.64 (95% CrI, 0.43, 0.91)). The numbers needed to treat for these specific ICU infections ranged from 360 (CLABSI) to 2780 (MRSA bacteraemia).ConclusionThis meta-analysis of the effectiveness of CHG bathing to reduce infections among adults in the ICU has found evidence for the benefit of daily bathing with CHG to reduce CLABSI and MRSA infections. However, the effectiveness may be dependent on the underlying baseline risk of these events among the given ICU population. Therefore, CHG bathing appears to be of the most clinical benefit when infection rates are high for a given ICU population.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1553-5) contains supplementary material, which is available to authorized users.

Are antimicrobial peripherally inserted central catheters associated with reduction in central line-associated bloodstream infection? A systematic review and meta-analysis.

Antimicrobial peripherally inserted central catheters (PICCs) may reduce the risk of central line-associated bloodstream infection (CLABSI). However, data regarding efficacy are limited. We aimed to evaluate whether antimicrobial PICCs are associated with CLABSI reduction. MEDLINE, EMBASE, CINHAL, and Web of Science were searched from inception to July 2016; conference proceedings were searched to identify additional studies. Study selection and data extraction were performed independently by 2 authors. Of 597 citations identified, 8 studies involving 12,879 patients met eligibility criteria. Studies included adult and pediatric patients from intensive care, long-term care, and general ward settings. The incidence of CLABSI in patients with antimicrobial PICCs was 0.2% (95% confidence interval [CI], 0.0%-0.5%), and the incidence among nonantimicrobial catheters was 5.3% (95% CI, 2.6%-8.8%). Compared with noncoated PICCs, antimicrobial PICCs were associated with a significant reduction in CLABSI (relative risk [RR], 0.29; 95% CI, 0.10-0.78). Statistical heterogeneity (I2, 71.6%; T2 = 1.07) was resolved by publication type, with peer-reviewed articles showing greater reduction in CLABSI (RR, 0.21; 95% CI, 0.06-0.74). Twenty-six patients (95% CI, 21-75) need to be treated with antimicrobial PICCs to prevent 1 CLABSI. Studies of adults at greater baseline risk of CLABSI experienced greater reduction in CLABSI (RR, 0.20; P = .003). Available evidence suggests that antimicrobial PICCs may reduce CLABSI, especially in high-risk subgroups. Randomized trials are needed to assess efficacy across patient populations.

Risk factors for central line-associated bloodstream infection in pediatric oncology patients with a totally implantable venous access port: A cohort study.

Totally implantable venous access ports (TIVAPs) are used for prolonged central venous access, allowing the infusion of chemotherapy and other fluids and improving the quality of life of children with cancer. TIVAPs were developed to reduce the infection rates associated with central venous catheters; however, infectious events remain common and have not been fully investigated in pediatric oncology patients. A retrospective cohort was formed to investigate risk factors for central line-associated bloodstream infection (CLABSI) in pediatric cancer patients. Sociodemographic, clinical, and TIVAP insertion-related variables were evaluated, with the endpoint being the first CLABSI. A Kaplan-Meier analysiswas performed to determine CLABSI-freecathetersurvival. Overall, 188 children were evaluated over 77,541 catheter days, with 94 being diagnosed with CLABSI (50%). Although coagulase-negative staphylococci were the pathogens most commonly isolated,Gram-negativemicroorganisms (46.8%) were also prevalent. In the multivariate analysis, factors that increased the risk for CLABSI were TIVAP insertion prior to chemotherapy (risk ratio [RR] = 1.56; P < 0.01), white blood cell count less than 1,000 mm-3 on the day of implantation (RR = 1.64; P < 0.01), and chronic malnutrition (RR = 1.41; P < 0.05). Median time without CLABSI following TIVAP insertion was 74.5 days. Risk factors for CLABSI in pediatric cancer patients with a TIVAP may be related to the severity of the child's condition at catheter insertion. Insertion of the catheter before chemotherapy and unfavorable conditions such as malnutrition and bone marrow aplasia can increase the risk of CLABSI. Protocols must be revised and surveillance increased over the first 10 weeks of treatment.

CLABSI Risk Factors in the NICU: Potential for Prevention: A PICNIC Study.

OBJECTIVE Central-line-associated bloodstream infections (CLABSI) are an important cause of morbidity and mortality in neonates. We aimed to determine whether intra-abdominal pathologies are an independent risk factor for CLABSI. METHODS We performed a retrospective matched case-control study of infants admitted to the neonatal intensive care units (NICUs) of the Montreal Children's Hospital (Montreal) and the Royal Alexandra Hospital, Edmonton, Canada. CLABSI cases that occurred between April 2009 and March 2014 were identified through local infection control databases. For each case, up to 3 controls were matched (National Healthcare Safety Network [NHSN] birth weight category, chronological age, and central venous catheter (CVC) dwell time at the time of CLABSI onset). Data were analyzed using conditional logistic regression. RESULTS We identified 120 cases and 293 controls. According to a matched univariate analysis, the following variables were significant risk factors for CLABSI: active intra-abdominal pathology (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.8-6.4), abdominal surgery in the prior 7 days (OR, 3.5; 95% CI, 1.0-10.9); male sex (OR, 1.7; 95% CI, 1.1-2.6) and ≥3 heel punctures (OR, 4.0; 95% CI, 1.9-8.3). According to a multivariate matched analysis, intra-abdominal pathology (OR, 5.9; 95% CI, 2.5-14.1), and ≥3 heel punctures (OR, 5.4; 95% CI, 2.4-12.2) remained independent risk factors for CLABSI. CONCLUSION The presence of an active intra-abdominal pathology increased the risk of CLABSI by almost 6-fold. Similar to CLABSI in oncology patients, a subgroup of CLABSI with mucosal barrier injury should be considered for infants in the NICU with active intra-abdominal pathology. Infect Control Hosp Epidemiol 2016;1446-1452.

Central Line-Associated Bloodstream Infection Rates by Chronic Condition Groups in Children.

The Deficit Reduction Act of 2005 and the Affordable Care Act of 2010 mandated that Medicaid and Medicare adopt payment-reduction policies that document hospital-acquired conditions.1,2 Central line–associated blood stream infection (CLABSI) is one of the most prevalent, potentially preventable acquired conditions in hospitalized children.3–5 The epidemiology of CLABSIs in PICUs and successes in reducing CLABSIs have been well described.6–9 Although line days are a recognized way of measuring risk of CLABSIs, there is no method to identify line days in the hospital discharge administrative billing data used for public reporting. Insertions of central lines and the risk of CLABSI are likely to increase according to the complexity of underlying conditions. In the absence of documentation of line days in administrative data, stratification of patient populations by medical complexity could be a useful way to determine CLABSI risk. Currently there is no method in administrative data reports to measure the risk of CLABSI according to underlying conditions. Diagnostic-related groups methods may provide a severity index for an admission, but they may not identify the patient’s underlying conditions. Children’s hospitals care for children with many complex chronic conditions, a group that seems to be increasing more than any other category.10 We proposed to determine the rates of CLABSI in 3 similar children’s hospitals according to patient complexity groups by using the 3M Health Information Systems’ clinical risk groups (CRGs).11 CRGs have already been used and validated as a method to stratify patients into complex chronic condition groups in children’s hospitals and health plan administrative data.10,12 We explore whether such stratification can provide reportable rates of CLABSI that reflect populations at risk. We have divided our population into 2 age groups, <1 year and ≥1 year, because of a …

A comparative evaluation of antimicrobial coated versus nonantimicrobial coated peripherally inserted central catheters on associated outcomes: A randomized controlled trial

Central line-associated bloodstream infections (CLABSIs) are a common life-threatening risk factor associated with central venous catheters (CVCs). Research has demonstrated benefit in reducing CLABSIs when CVCs coated with antimicrobials are inserted. The impact of chlorhexidine (CHG)-impregnated versus non-CHG peripherally inserted central catheters (PICCs) on risk of CLABSI is unknown. Venous thromboembolism (VTE) is also a complication associated with CVCs. This study compares the impact of both PICC lines on these outcomes. Patients in 3 high-risk units were randomly assigned to receive either a CHG-impregnated or non-CHG PICC line. Laboratory data were collected and reviewed daily on all study patients. The PICC dressing site was assessed daily. Medical record documentation was reviewed to determine presence of CLABSI or VTE. There were 167 patients who completed the study. Three patients developed CLABSI (2 in the CHG group, and 1 in the non-CHG group), and 3 patients developed VTE (2 in the non-CHG group, and 1 in the CHG group). No significant relationship was noted between the type of PICC line on development of a CLABSI (P = .61) or VTE (P > .99). A significant difference was noted in moderate bleeding (P ≤ .001) requiring thrombogenic dressing in the patients who had the CHG PICC line. No differences were noted in the development of CLABSI and VTE between the CHG and non-CHG groups.