Central Line-associated Bloodstream Infections Research Articles

Taurolidine lock in pediatric patients with intestinal failure. A practical guideline from the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition (SEGHNP)

Objectives: the prevention of central line-associated bloodstream infections is a critical aspect of care for patients with intestinal failure who are treated with parenteral nutrition. The use of taurolidine in this context is becoming increasingly popular, however there is a lack of standardization in its pediatric application. The objective of this work is to develop a guide to support its prescription. Methodology: the guide is based on a review of the literature and expert opinions from the Intestinal Failure Group of the SEGHNP. It was developed through a survey distributed to all its members, addressing aspects of usual practice with this lock solution. Results: this manuscript presents general recommendations concerning taurolidine indications, commercial presentations, appropriate forms of administration, use in special situations, adverse reactions, and contraindications in the pediatric population Conclusions: taurolidine is emerging as the primary lock solution used to prevent central line-associated bloodstream infections, proving to be safe and effective. This guide aims to optimize and standardize its use in pediatrics.

Daily Chlorhexidine Bath for Health Care Associated Infection Prevention (CLEAN-IT): protocol for a multicenter cluster randomized crossover open-label trial.

Critically ill patients are at increased risk of health care-associated infections due to various devices (central line-associated bloodstream infection, catheter-associated urinary tract infection, and ventilator-associated pneumonia), which pose a significant threat to this population. Among several strategies, daily bathing with chlorhexidine digluconate, a water-soluble antiseptic, has been studied as an intervention to decrease the incidence of health care-associated infections in the intensive care unit; however, its ability to reduce all health care-associated infections due to various devices is unclear. We designed the Daily Chlorhexidine Bath for Health Care Associated Infection Prevention (CLEAN-IT) trial to assess whether daily chlorhexidine digluconate bathing reduces the incidence of health care-associated infections in critically ill patients compared with soap and water bathing. The CLEAN-IT trial is a multicenter, open-label, cluster randomized crossover clinical trial. All adult patients admitted to the participating intensive care units will be included in the trial. Each cluster (intensive care unit) will be randomized to perform either initial chlorhexidine digluconate bathing or soap and water bathing with crossover for a period of 3 to 6 months, depending on the time of each center's entrance to the study, with a 1-month washout period between chlorhexidine digluconate bathing and soap and water bathing transitions. The primary outcome is the incidence of health care-associated infections due to devices. The secondary outcomes are the incidence of each specific health care-associated infection, rates of microbiological cultures positive for multidrug-resistant pathogens, antibiotic use, intensive care unit and hospital length of stay, and intensive care unit and hospital mortality. The CLEAN-IT trial will be used to study feasible and affordable interventions that might reduce the health care-associated infection burden in critically ill patients.

Impact of a midline catheter prioritization initiative on device utilization and central line-associated bloodstream infections at an urban safety-net community hospital.

Overuse of peripherally inserted central catheters (PICCs) can lead to idle central line (CL) days and increased risk for CL-associated bloodstream infections (CLABSIs). We established a midline prioritization initiative at a safety-net community hospital. This initiative led to possible CLABSI avoidance and a decline in PICC use.

Comparing the effects of two initial specimen diversion techniques on blood culture contamination rates and clinical outcomes—a multicenter study

Abstract Although the initial specimen diversion device (ISDD) has been shown to reduce blood culture contamination (BCC) rates, its impact on clinical outcomes remains unclear. This multicenter study showed that ISDD significantly decreased BCC. However, there was no reduction in length of stay, days of therapy, or central line-associated bloodstream infections.

THE IMPACT OF HOSPITAL-ACQUIRED INFECTIONS ON PATIENT OUTCOMES

Hospital-acquired infections (HAIs), also known as healthcare-associated infections, are infections that patients acquire while they are in the hospital. They are typically not present or might be incubating at the time of admission. HAIs usually manifest 48 hours after admission to the hospital. The National Healthcare Safety Network (NHSN) of the Center for Disease Control and Prevention (CDC) closely monitors HAIs to prevent them and improve patient safety. HAIs include central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), surgical site infections (SSI), and Hospital-acquired Pneumonia (HAP), Ventilator-associated Pneumonia (VAP), and Clostridium difficile infections (CDI). For the last few decades, hospitals have taken HAIs seriously. Several hospitals have established infection tracking and surveillance systems in place, along with robust prevention strategies to reduce the rate of HAIs. HAIs can have a significant impact on patients, both at an individual level and at the community level. They can lead to longer hospital stays, increased costs of care, and even death. HAIs can also be linked to the spread of multidrug-resistant infections. In recent years, the definitions of pneumonia have been changed to better identify patients at risk for multidrug-resistant (MDR) pathogens. This change was made to avoid the overuse of antibiotics. The term Healthcare-acquired Pneumonia (HCAP) has been made obsolete, and the term Hospital-acquired Pneumonia (HAP) has replaced it. HAP is defined as pneumonia that occurs 48 hours or more after admission to the hospital and did not appear to be incubating at the time of admission. Ventilator-associated pneumonia (VAP) is defined as pneumonia that develops more than 48 to 72 hours after endo-tracheal intubation. Both HAP and VAP are associated with poorer outcomes and significant morbidity and mortality worldwide.

Central line-associated bloodstream infection related with umbilical vein catheterization and peripherally inserted central catheter in preterm infants: a meta-analysis and systematic review

BACKGROUND Central line-associated bloodstream infection (CLABSI) is a serious complication in preterm infants undergoing catheterization, including umbilical vein catheterization (UVC) and peripherally inserted central catheter (PICC) placement. This study aimed to compare the occurrence rate of CLABSI in preterm infants associated with UVC and PICC.
 METHODS We conducted a systematic review and meta-analysis of studies published from 2000 to 2023 using a random effects model from 3 databases (PubMed, ScienceDirect, and Google Scholar). This study was registered with PROSPERO (CRD42023416471).
 RESULTS Of 10 articles included in the systematic review, 2 were randomized controlled trials, 3 were prospective studies, and the rest were retrospective. A total of 3,962 UVCs and 2,922 PICCs were incorporated in the meta-analysis. The incidence rate of CLABSI in the UVC group was lower than that in the PICC group (1.23 versus 3.03 per 1,000 catheter days). However, the odds of developing CLABSI for infants with a UVC compared to those with a PICC were not statistically significant (odds ratio: 0.88, 95% confidence interval: 0.54–1.42).
 CONCLUSIONS UVCs had a lower incidence rate of CLABSI than PICCs. Therefore, additional prospective studies are required to confirm these results.

Haemostatic discs demonstrate physical efficacy against microbes commonly associated with central-line-associated bloodstream infections

Vascular access devices form an essential component in the management of acute and chronic medical conditions. Introduction and ongoing management of these devices are linked with bundles of care aimed at reducing associated risks including bleeding and infection. To evaluate the antimicrobial potential of the potassium ferrate haemostatic disc on Gram-positive (Staphylococcus aureus) and Gram-negative (Klebsiella pneumoniae, Pseudomonas aeruginosa) bacteria and on Candida albicans. The impact of the potassium ferrate disc was compared with the often-used chlorhexidine gluconate (CHG) impregnated disc to evaluate the potential efficacy of the potassium ferrate disc as an alternative to CHG in cases with an increased risk of active bleeding. In the presence of anticoagulated blood, we observed an inhibitory effect of the haemostatic disc on microbial growth for microbial strains commonly associated with vascular access device related infections. Our results indicate that the potassium ferrate disc may provide dual clinical benefits with both haemostatic and antimicrobial action observed during in-vitro testing.

Decreasing central line-associated bloodstream infections rates in intensive care units in 30 low- and middle-income countries: An INICC approach

Central line (CL)-associated bloodstream infections (CLABSIs) occurring in the intensive care unit (ICU) are common and associated with a high burden. We implemented a multidimensional approach, incorporating an 11-element bundle, education, surveillance of CLABSI rates and clinical outcomes, monitoring compliance with bundle components, feedback of CLABSI rates and clinical outcomes, and performance feedback in 316 ICUs across 30 low- and middle-income countries. Our dependent variables were CLABSI per 1,000-CL-days and in-ICU all-cause mortality rates. These variables were measured at baseline and during the intervention, specifically during the second month, third month, 4 to 16 months, and 17 to 29 months. Comparisons were conducted using a two-sample t test. To explore the exposure-outcome relationship, we used a generalized linear mixed model with a Poisson distribution to model the number of CLABSIs. During 1,837,750 patient-days, 283,087 patients, used 1,218,882 CL-days. CLABSI per 1,000 CL-days rates decreased from 15.34 at the baseline period to 7.97 in the 2nd month (relative risk (RR)=0.52; 95% confidence interval [CI]=0.48-0.56; P<.001), 5.34 in the 3rd month (RR=0.35; 95% CI=0.32-0.38; P<.001), and 2.23 in the 17 to 29 months (RR=0.15; 95% CI=0.13-0.17; P<.001). In-ICU all-cause mortality rate decreased from 16.17% at baseline to 13.68% (RR=0.84; P=.0013) at 17 to 29 months. The implemented approach was effective, and a similar intervention could be applied in other ICUs of low- and middle-income countries to reduce CLABSI and in-ICU all-cause mortality rates.

Inter-Hospital Transfer Is an Independent Risk Factor for Hospital-Associated Infection.

Background: Regionalization of surgical care shifts higher acuity patients to larger centers. Hospital-associated infections (HAIs) are important quality measures with financial implications. In our ongoing efforts to eliminate HAIs, we examined the potential role for inter-hospital transfer in our cases of HAI across a multihospital system. Hypothesis: Surgical patients transferred to a regional multihospital system have a higher risk of National Healthcare Safety Network (NHSN)-labeled HAIs. Patients and Methods: The analysis cohort of adult surgical inpatients was filtered from a five-hospital health system administration registry containing encounters from 2014 to 2021. The dataset contained demographics, health characteristics, and acuity variables, along with the NHSN defined HAIs of central line-associated blood stream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and Clostridioides difficile infection (CDI). Univariable and multivariable statistics were performed. Results: The surgical cohort identified 92,832 patients of whom 3,232 (3.5%) were transfers. The overall HAI rate was 0.6% (528): 86 (0.09%) CLABSI, 133 (0.14%) CAUTI, and 325 (0.35%) CDI. Across the three HAIs, the rate was higher in transfer patients compared with non-transfer patients (CLABSI: n = 18 (1.3%); odds ratio [OR], 4.79; CAUTI: n = 25 (1.8%); OR, 4.20; CDI: n = 37 (1.1%); OR, 3.59); p < 0.001 for all. Multivariable analysis found transfer patients had an increased rate of HAIs (OR, 1.56; p < 0.001). Conclusions: There is an increased risk-adjusted rate of HAIs in transferred surgical patients as reflected in the NHSN metrics. This phenomenon places a burden on regional centers that accept high-risk surgical transfers, in part because of the downstream effects of healthcare reimbursement programs.

Trainee educational curriculum to standardize central venous catheter repair

IntroductionChildren may require durable central venous catheters (CVCs) for various reasons. CVC-related integrity complications are common and can often be repaired at the bedside to increase lifetime. Variability in repair techniques can lead to complications, including the need for repeat repair and Central Line Associated Blood Stream Infection (CLABSI).MethodsThe impact of an educational curriculum to standardize tunneled CVC repairs for trainees on a pediatric surgery service was studied, focusing on comfort level with tunneled CVC repair and to determine the impact on complication rates. Rotating trainees studied a dedicated audiovisual educational curriculum comprised of a video, educational slides, and a practical component from November 2020 through January 2022. Experience and comfort level with tunneled CVC repairs were assessed before and after the rotation. CVCs repaired during the duration of the study were evaluated and compared to the period prior.ResultsForty-nine individuals completed the pre- and post-training survey. Respondents (34.7%, n = 17) most commonly reported one year of surgical experience, and (79.6%, n = 39) had never observed or assisted in a repair previously. Following training, respondents felt more comfortable with all aspects of the CVC repair process (p < 0.001). There were no statistically significant differences in re-repair rates or CLABSI rates following the implementation of the curriculum.ConclusionsTunneled CVC procedural repair variability can be standardized with a dedicated educational curriculum for rotating trainees, which improves knowledge and comfort with such procedures.

Bloodstream infections in cardiac intensive care units from a tertiary care center

Blood stream infections (BSIs) occur more frequently in patients hospitalized in Intensive care units (ICUs). Intravascular devices are the most frequent predisposing factor causing BSI. To compare the proportion, risk factors, microbiological profile of Blood stream Infections and Central line associated bloodstream infection in Cardiology Intensive care units (CICU) and Cardiothoracic Intensive care units (CTICU).This is a prospective study conducted by the Dept. of Microbiology along with Cardiology Intensive care unit(CICU), and Cardiothoracic Intensive care unit (CTICU) of a tertiary care centre, from June 1st 2017-Oct 312018.Laboratory confirmed BSIs (LCBSI’s), occurring more than 48hrs after ICU admission were included in the study. Identification of pathogens were done by standard methods.A total of 1640 blood cultures were analyzed (CICU=890,CTICU=750).73 Primary BSIs were observed with male preponderance.68/73 diagnosed to have non CLABSI (CTICU=35/68 51.4%, CICU=33/68, 48.5%) and 5/73 cases diagnosed to have CLABSI (CTICU=5/73, 6.84% CICU=0%) 47.94% of our isolates were Gram negative pathogens with as the predominant followed by 35.6% of Gram positive with as the major pathogen &amp; 16.4% were Candida spp. 20.5% were multi drug resistant and 10% were ESBL producers. Prevalence and incidence rates were high in CTICU (5.3% &amp; 1.5%) compared to CICU (3.7% &amp; 0%) of BSI &amp; CLABSI respectively.BSI is preventable costly complication that occur with greater frequency in the ICU settings. Strict adherence to Infection control measures such as hand hygiene, aseptic precautions during blood culture collection and bundle care measures can decrease the BSI and CLABSI incidence rates.

Central-line-associated bloodstream infection burden among Dutch neonatal intensive care units

The establishment of an epidemiological overview provides valuable insights needed for the (future) dissemination of infection-prevention initiatives. To describe the nationwide epidemiology of central-line-associated bloodstream infections (CLABSI) among Dutch Neonatal Intensive Care Units (NICUs). Data from 2935 neonates born at <32 weeks' gestation and/or with a birth weight <1500g admitted to all nine Dutch NICUs over a two-year surveillance period (2019-2020) were analysed. Variations in baseline characteristics, CLABSI incidence per 1000 central-line days, pathogen distribution and CLABSI care bundles were evaluated. Multi-variable logistic mixed-modelling was used to identify significant predictors for CLABSI. A total of 1699 (58%) neonates received a central line, in which 160 CLABSI episodes were recorded. Coagulase-negative staphylococci were the most common infecting organisms of all CLABSI episodes (N=100, 63%). An almost six-fold difference in the CLABSI incidence between participating units was found (2.91-16.14 per 1000 line-days). Logistic mixed-modelling revealed longer central line dwell-time (adjusted odds ratio (aOR):1.08, P<0.001), umbilical lines (aOR:1.85, P=0.03) and single rooms (aOR:3.63, P=0.02) to be significant predictors of CLABSI. Variations in bundle elements included intravenous tubing care and antibiotic prophylaxis. CLABSI remains a common problem in preterm infants in The Netherlands, with substantial variation in incidence between centres. Being the largest collection of data on the burden of neonatal CLABSI in The Netherlands, this epidemiological overview provides a solid foundation for the development of a collaborative platform for continuous surveillance, ideally leading to refinement of national evidence-based guidelines. Future efforts should focus on ensuring availability and extraction of routine patient data in aggregated formats.

Effects of the care given to intensive care patients using an evidence model on the prevention of central line-associated bloodstream infections.

It is important to put evidence-based guidelines into practice in the prevention of central line-associated bloodstream infections in intensive care patients. In contrast to expensive and complex interventions, a care bundle that includes easy-to-implement and low-cost interventions improves clinical outcomes. The compliance of intensive care nurses with guidelines is of great importance in achieving these results. The Translating Evidence into Practice Model provides guidance in how to implement the necessary guidelines. This quasi-experimental study used a post-test control group design in nonequivalent groups and was conducted in the anesthesia intensive care unit of a tertiary-level training and research hospital. All patients who were hospitalized in the intensive care unit, who had a central line during the study, and who met the inclusion criteria were included in the sample. The care bundle comprised education, and protocols for hand hygiene and the aseptic technique, maximum sterile barrier precautions, central line insertion trolley, and management of nursing care. To analyze the data, the independent samples t-test, the Mann-Whitney U test, chi-square test, dependent samples t-test, rate ratio, and relative risk were used with 95% confidence intervals. The rate of central line-associated bloodstream infections was significantly lower in the intervention group (2.85/1000 central line days) than in the control group (3.35/1000 central line days) (P = 0.042). The number of accesses to the central line by the nurses decreased significantly in the intervention group compared to the control group (P < 0.001). The mean score for the nurses' evidence-based guideline post-education knowledge (70.80 ± 12.26) was significantly higher than that pre-education (48.20 ± 14.66) (P < 0.001). Compliance with the guideline recommendations in central line-related nursing interventions and in the central line insertion process was significantly better in the intervention group than in the control group in many interventions (P < 0.05). The mean score for the nurses' attitude towards evidence-based nursing increased significantly over time (59.87 ± 7.23 at the 0th month; 63.79 ± 7.24 at the 6th month) (P < 0.001). Nursing care given by implementing the central line care bundle with the Translating Evidence into Practice Model affected the measures. Thanks to the implementation of the care bundle, the rate of infections and the number of accesses to the central line decreased, while the critical care nurses' knowledge of evidence-based guidelines, compliance with the guideline recommendations in central line-related nursing interventions, and attitudes towards evidence-based nursing improved.

Promoting Patient Safety: Exploring Device-Associated Healthcare Infections and Antimicrobial Susceptibility Pattern in a Multidisciplinary Intensive Care Units.

Device-associated healthcare infections are among the prevailing threats to patient safety worldwide. They constitute the third most common adverse event during healthcare delivery, resulting in heightened morbidity, mortality, and healthcare costs. Patients in intensive care units (ICUs) are at increased risk for device-associated healthcare infections. Focused active surveillance is a crucial measure for assessing the prevalence of healthcare-associated infections and controlling the transmission of pathogens, ultimately contributing to the establishment of quality outcome indicators.This study aimed to investigate and establish the baseline rates of healthcare-associated infections associated with medical devices in adult multidisciplinary ICUs within a tertiary care institute. This hospital-based prospective observational study was conducted in two adult ICUs of atertiary care institute in Central India over nine months. Targeted active surveillance for three device-associated health care infections namely central line-associated bloodstream infection(CLABSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated event (VAE)was conducted as per the Center for Disease Control (CDC)/National Healthcare Safety Network (NHSN) 2016 surveillance definitions and criteria. Pathogens associated with device-associated healthcare infections were identified and their antimicrobial susceptibility profile was studied. During the study period, a total of 5,773 patientdays were investigated. Of1,270patients, 28 episodes of device-associated healthcare infectionswere detected in 26 patients, this suggests a collective occurrence of five device-associated healthcare infections for every 1,000 patient days in the ICUs. The device utilization ratios of the central line, mechanical ventilator, and urinary catheters were 0.33, 0.27, and 0.68, respectively. VAE, CLABSI, and CAUTI rates were 8.92, 5.68, and 0.76 per 1,000 device days, respectively. The most common pathogenisolated from device-associated healthcare infections wasKlebsiella pneumoniae (39%) followed by Acinetobacter baumanii (22%). The majority (82.3%) of pathogens were multidrug resistant. The death rate among device-associated healthcare infections was 69.2% with a crude excess mortality rate of 37.7%. The study sheds light on the proportion, types of device-associated healthcare infections, and underlying etiological agents associated with these infections in our institute's ICUs, thereby facilitating a better understanding of the healthcare-associated infection landscape within our facility. Moreover, the susceptibility patternof pathogens associated with these infections offers crucial information for guiding the selection of appropriate antimicrobial therapies and infection control measures.

Device-Associated Nosocomial Infections in Intensive Care Units at Al-Ahsa Hospitals, Saudi Arabia.

Introduction Patients admitted to intensive care units (ICU), especially those with devices used to support their condition, are at a higher risk of getting healthcare-associated infections (HAIs). The aim of the present study was to analyze the surveillance data and assess the device-associated infection (DAI) rates such as central line-associated blood-stream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), ventilator-associated pneumonia (VAP) and ventilator-associated event (VAE) in ICUs of the Ministry of Health (MoH) hospitals in Al-Ahsa region. Methodology The study was conducted retrospectively using the surveillance data of governmental hospitals' intensive care units in the Al-Ahsa region. The surveillance data was collected from 10 ICUs at six MoH hospitals in the Al-Ahsa region during the year 2022. The data from the participating hospitals was entered into the Health Electronic Surveillance Network (HESN) plus program by trained infection prevention control practitioners of the respective hospitals. Results An overall CLABSI rate of 4.29 per 1000 central line days was reported during the study period. The CAUTI rate was 0.55 with a range from 0 to 1.29 cases per 1000 urinary catheter days. VAP rate ranged from 0.33 to 2.21 cases per 1000 ventilator days (average of 1.17). The study reported VAE only for the adult medical-surgical ICU (3.36 per 1000 ventilator days). Conclusion The present study revealed that the most common DAIs in the Al-Ahsa region are CLABSI and CAUTI. DAI rates generated from this study may be used as benchmarks for regional hospitals. An educational program regarding the prevention and control of DAIs targeting all healthcare workers, especially ICU staff, has to be done in the Al-Ahsa region.

Reducing central line-associated bloodstream infection with a dedicated CLABSI prevention registered nurse role

Following a 200% increase in the central line-associated bloodstream infection (CLABSI) standardized infection ratio in a private teaching hospital between 2019 and 2020, a program with the utilization of a CLABSI Prevention Registered Nurse was implemented to reduce CLABSIs through a variety of focused prevention efforts and education. The CLABSI P-RN project consisted of a dedicated team of RNs that performed interventions that included an audit of all central lines daily, real-time education and remediation, bi-weekly educational handouts, and assistance with 2-person dressing changes. Audit data were utilized to identify trends in gaps in compliance with the CLABSI bundle (ie, daily bathing, dressing integrity). The CLABSI rate/1,000 central line days were tracked in preintervention, intervention, and postintervention time periods. During the intervention, the CLABSI rate decreased from 1.4 during the preintervention time period, to 0.4 during the intervention time period (P-value .04). Additionally, daily bathing compliance improved from 84.3% during the preintervention time period, to 90.8% during the intervention time period (P-value .004). The implementation of the CLABSI P-RN was beneficial in reducing CLABSIs. An expert-trained role dedicated to central line management reduces CLABSI occurrences, reduces health care costs, and improves patient outcomes.

Predictors of central line-associated bloodstream infections in cancer patients undergoing chemotherapy through implanted venous access ports: a retrospective, observational study.

Central venous catheters (CVCs) are sometimes superior to peripheral vascular access for chemotherapy. Central line-associated bloodstream infections (CLABSIs) are an important complication of CVCs in chemotherapy. A retrospective, observational study was conducted to investigate patients with implanted venous access ports (PORTs) from July 2010 to June 2021 in a teaching hospital. General conditions of the PORTs, backgrounds, and characteristics of patients were compared between CLABSI cases and uninfected cases to identify predictors of CLABSI. A total of 566 patients with PORTs who underwent chemotherapy were enrolled in this study, with CLABSI identified in 41 patients, for a total of 436,597 catheter-days. The median duration of PORT use was 26 vs. 494 days (P<0.001) in the CLABSI and uninfected groups, respectively. There were no significant differences in tumor classification, staging, white blood cell (WBC) count, neutrophil proportion, lymphocyte proportion, albumin, C-reactive protein (CRP), and performance status between the CLABSI and uninfected groups. Multivariable analysis showed that antibiotic usage within the previous week, total protein (TP), and immediate PORT use were independently associated with CLABSI, and their odds ratios (ORs) were 4.89 [95% confidence interval (CI): 1.67, 14.35], 1.95 (95% CI: 1.14, 3.53), and 3.13 (95% CI: 1.18, 8.30), respectively. The area under the curve (AUC) of the receiver-operating characteristic curve for TP was 0.63, and the cutoff value was 5.9 g/dL. PORT implantation should be avoided in patients who had antibiotic treatment episodes within 1 week, especially for those with low serum TP levels.

PP101 Clinical And Economic Impact Of Flushing Vascular Access Devices With Pre-filled versus Manually-Prepared Saline Flush Syringes In Korea

IntroductionAround 90 percent of hospitalized patients require vascular access devices (VADs) during hospitalization to administer fluids, medications and facilitate blood transfusions. After insertion, it is essential to maintain VADs to achieve optimal dwell time and reduce complications. Flushing of VADs is an integral part of catheter maintenance practices. With increasing cost burden on healthcare systems and nursing shortages, it is crucial to use time-and cost-saving technologies such as pre-filled flush syringes for common procedures namely VAD maintenance. This study aims to compare the clinical and economic impact of using pre-filled saline syringes versus manually-prepared saline syringes for flushing VADs in Korea.MethodsA budget impact analysis was developed using Microsoft Excel to estimate the annual clinical and economic impact of pre-filled saline syringes and a base case scenario of flushing 100,000 VADs was modeled. Clinical impact was estimated for peripheral intravenous catheter (PIVC) failure, central line-associated bloodstream infections (CLABSIs), central line occlusion and nurse time. Economic impact was estimated for costs associated with flushing materials, additional length of stay (LOS) due to CLABSI, VAD replacement, and nurse-time. Global and local data sources were used for inputs. Assumptions include: (i) Distribution of 95 percent peripheral and 5 percent central VADs; (ii) 50 percent peripheral and 50 percent central VADs on intermittent therapy; and (iii) 3 flushes/catheter-day.ResultsOver a one-year timeframe, the model estimated 3,344 fewer PIVC failures, 15 fewer CLABSIs and 157 fewer occlusions with adoption of pre-filled saline syringes. Nurse time was reduced by 3,465 hours. Potential net annual savings from lower device cost, reduced complications, shortened LOS and increased nurse efficiency were estimated to be KRW23.7 million (USD178,957).ConclusionsUsing pre-filled saline syringes instead of manually-prepared syringes for flushing VADs may result in fewer complications, lower VAD utilization, nurse time saving and cost savings in Korea. This can potentially help improve patient outcomes, relieve nurses’ stress to some extent and help healthcare decision-makers to reallocate these cost savings to other life-saving technologies.

An Interprofessional Quality Improvement Project to Reduce Community-Acquired Central Line-Associated Bloodstream Infections in the Pediatric Intestinal Failure Population

Highlights Abstract Aim: Central line-associated bloodstream infections (CLABSIs) result in significant morbidity but are largely preventable. Methods to reduce hospital-acquired CLABSIs are well described, but few recommendations exist for how these practices might translate to patients with central lines in the ambulatory setting. This team sought to reduce the mean monthly community-acquired CLABSI rate by 25% from 11.7 to 8.8 per 1000 community line-days in children with intestinal failure who require home parenteral nutrition within 12 months. Methods: First, an interprofessional quality improvement team was formed. After baseline data collection, plan-do-study-act cycles began. Tests of change consisted of a central venous catheter (CVC) maintenance bundle. This bundle included a CVC care tote with additional supplies, improved educational materials, and ethanol lock prophylaxis. A control chart was used to display the monthly community-acquired CLABSI rate and observe for special cause variation. Results: At baseline, the average monthly community-acquired CLABSI rate was 11.7 per 1000 community catheter-days. The home CVC maintenance bundle was implemented, after which there were 5 consecutive months with no infections. After enhancements to the care bundle and tote, special cause variation was noted, and the average monthly community-acquired CLABSI rate declined by 66% to 4 per 1000 community catheter-days. Special cause variation was noted at 2 other time points without an identifiable cause. Conclusion: A lower community-acquired CLABSI rate has been sustained for 24 months and reflects approximately 12 fewer infections per year in this at-risk population.

Safety of non-cuffed tunneled central venous catheters in adults with cystic fibrosis

BackgroundPeripherally inserted central catheters (PICCs) are the most common route of intravenous (I.V.) access for treatment of cystic fibrosis (CF) pulmonary exacerbations, but repeated PICC placement can result in upper extremity peripheral venous stenosis. Once peripheral stenosis develops, a non-cuffed tunneled central venous catheter (NcTCVC) is an alternative route for IV access. While these are regularly used at some CF centers, the safety and complication rate compared to PICCs in adults with CF has not been reported. This study aims to describe the safety of NcTCVCs in adults with CF. MethodsA retrospective cohort study was performed at a CF Foundation accredited institution including adults with CF who received NcTCVCs in interventional radiology from 7/19/2007 to 3/09/2020. Complications analyzed included catheter related deep venous thrombosis (DVT), central line associated blood stream infection (CLABSI), and catheter related central venous stenosis. Complications were considered attributable if they occurred while the catheter was in place or within 30 days of catheter removal. ResultsDuring the study duration, 386 NcTCVCs were placed in 60 unique patients (55 % female) with a mean of 6.4 catheters per patient. Majority of NcTCVCs placed were 4 French (61.4 %). Average duration of indwelling NcTCVC was 16.2 days. No patients demonstrated catheter attributable symptomatic DVT. The incidence of DVT, CLABSI, and central venous stenosis was 0 (0 %), 4 (1 %), and 1 (0.3 %), respectively. ConclusionsMany adults with CF have required insertion of numerous PICCs for the treatment of recurrent pulmonary exacerbations. In those adults that develop PICC-associated peripheral vein stenosis precluding PICC placement, these results indicate NcTCVCs are a safe alternative.