Central Line-associated Bloodstream Infection Bundle Research Articles

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.

Novel strategies to reduce central-line–associated blood stream infection (CLABSI) events in the neonatal intensive care unit

Background: We describe the components of an improved and easy-to-implement strategy to reduce CLABSI events in the NICU implemented during July–September 2021 in a tertiary-care healthcare center. These strategies were added to an existing institutional protocol created following CDC guidelines. Methods: During the previous timeframe of the implementation of new strategies, CDC insertion-related prevention measures [ie, hand hygiene, use of personal protective equipment (PPE), catheter size selection, standard chlorhexidine gluconate (CHG) antisepsis, maintenance related Curos disinfecting caps, and scrubbing the hub] were part of an existing protocol at our institution. We introduced the following key elements along with the previous ones: decrease length of umbilical vein catheter (UVC) utilization from 14 days to 5–7 days, change of dressing materials from BIOPATCH to 3M Tegaderm CHG chlorhexidine gluconate IV securement transparent dressing, enhanced compliance of an existing artificial nail policy, and restricted blood draw from central lines. Results: After optimization of the previous protocol through these additional strategies, we achieved a significant reduction in the NICU CLABSI rates from 12 CLABSI events between July 2020 and June 2021 to only 3 CLABSI events between July 2021 and June 2022. Conclusions: Revision of CLABSI bundle prevention protocols should be performed frequently to allow improvement opportunities to be added to diminish infection rates. The addition of simple and easy-to-implement key elements interventions to the existing CLABSI bundle had an important impact on the CLABSI rate at our institution.Disclosures: None

PENGARUH EDUKASI PENERAPAN BUNDLE CLABSI TERHADAP PENGETAHUAN DAN KEPATUHAN PERAWAT DALAM PENCEGAHAN CLABSI PADA NEONATUS DENGAN VENA SENTRAL

Neonates have a high risk of infection due to central venous catheter placement. One of the complications is Central Line Associated Blood Stream Infection (CLABSI). CLABSI can be prevented by applying evidence-based guidelines during installation, maintenance and removal known as the CLABSI Bundle. Evidence-based policies and training help nurses improve their knowledge and practice of central vein care. The purpose of this study was to determine the educational effect of implementing the CLABSI Bundle on the knowledge and adherence of nurses in preventing CLABSI in neonates with central veins. This type of quantitative research with a Quasi Experiment approach. The research design used a pre and posttest design without a control group. The sample of this study were 56 nurses, using the Kertjie and Morgan tables, collecting data using questionnaires and direct observation. Nurses' knowledge before being given education on the application of the CLABSI Bundle, namely having sufficient knowledge (75.0%) and after being given education had good knowledge (71.4%). Nurse compliance before being given education on the application of the CLABSI Bundle, namely the majority were obedient (76.8%) and after being given education obedience increased (91.1%). There is an effect of education on the application of the CLABSI Bundle on knowledge and nurse compliance before and after being given nursing education with the Wilcoxons test obtained pvalue: 0,000 (α:<0,05) and pvalue: 0.005 (α: <0.05). It is hoped that hospital management can facilitate regular training, carry out routine and scheduled supervision and audits so that nurses are encouraged to understand the importance of specific policies and documents used in neonates with central veins.

"Nurse-The Archer" Fighting Against the Hidden Enemy.

The coronavirus disease-2019 (COVID-19) pandemic is a global threat spreading like a wildfire and taking the world by its storm. It has challenged the healthcare delivery systems and disrupted them in a way no one ever imagined before. We at Apollo Hospitals, Chennai, Tamil Nadu, India received many patients in the COVID critical care unit (CCU) and found a gradual lack of bundle care compliance resulting in an upsurge of central line-associated bloodstream infection (CLABSI) amid the patients. A qualitative research approach and quasi-experimental research design were selected to assess the knowledge of the 150 frontline COVID CCU nurses regarding the CLABSI bundle and its prevention strategies. This study revealed that 57% [mean (M) = 12.6; standard deviation (SD) = 2.37] of nurses had inadequate knowledge of the CLABSI bundle and its prevention strategies, in the pretest and scored 80% (M = 6.7; SD = 2.28) in the post-test, with "t" = 22.06 at p < 0.00001 after the hands-on training. The percentage of compliance to CLABSI bundle care increased to 83% and thereafter in an increasing trend. This was clearly evident through the reduction in the preventable CLABSI rate among critically ill COVID-19 patients. Nurses are on the frontline in preventing and controlling healthcare-associated infections (HAIs). Fighting with all the visible and invisible challenges, our research focused on hands-on training for frontline warriors to adhere to the CLABSI bundle care which drove us to the reduction in preventable CLABSI rate in our hospital through improved CLABSI bundle compliance. Premkumar S, Ramanathan Y, Varghese JJ, Morris B, Nambi PS, Ramakrishnan N, et al. "Nurse-The Archer" Fighting Against the Hidden Enemy. Indian J Crit Care Med 2023;27(4):246-253.

Surveillance of central line associated bloodstream infection (CLABSI) - comparison of current (CDC/NHSN) and modified criteria: A prospective study.

There is a huge load of central line-associated bloodstream infection (CLABSI) being reported in developing countries, with increased mortality and healthcare costs. Effective surveillance is a must to reduce the incidence of CLABSI. The current criteria (Centre for Disease Control and Prevention/National Healthcare Safety Network [CDC/NHSN]) for CLABSI surveillance have their own shortcomings. For diagnosing CLABSI, current CDC/NHSN CLABSI surveillance criteria are laborious and time consuming with low predictive power. Hence, modified criteria have been postulated, which are simple and implementable at resource-constrained setups. The primary objective was to compare modified criteria with CDC criteria. The secondary objective was to determine the prevalence of CRBSI. A total of 98 patients with central line in situ or having the central venous line removed ≤24 hrs prior to the date of the event were enrolled. Paired blood cultures were obtained and results were analyzed using differential time to positivity. The incidence of CLBSI was 8.16% and the device utilization rate was 11.6%. The negative predictive value of both the surveillance criteria was found to be excellent and comparable (96.2% for modified criteria and 97.1% for CDC criteria), therefore both can be used for screening purposes. AUC for current CDC/NHSN criteria was better than modified criteria (0.76 versus 0.66, P < 0.0001), suggesting it to be a better criterion for surveillance of CLABSI. Modified criteria were not superior to CDC/NHSN criteria for surveillance. Thus, there is a scope of improving the modified criteria for the purpose of surveillance. CLBSI load was higher; CLABSI bundle for prevention is thus highly recommended.

Major infections following pediatric cardiac surgery pre- and post-CLABSI bundle implementation.

Postoperative infection contributes to the worsening of congenital cardiac surgery (CCS) outcomes. Surgical site infection (SSI), bloodstream infection (BSI) and ventilator associated pneumonia (VAP) are common. An additional bundle of preventive measures against central-line associated bloodstream infection (CLABSI) bundle was implemented in April 2019. To compare the incidence of major infections after pediatric CCS before and after the implementation of the CLABSI bundle and to identify risk factors for major infections. We conducted a single-center, retrospective study to assess the incidence of major infections including bloodstream infection (BSI), surgical site infection (SSI), and ventilator-associated pneumonia (VAP) after pediatric CCS one year before and after implementation of the CLABSI bundle during April 2018-March 2020. The demographics and outcomes of the patients were explored, and risk factors for major infections were identified using multivariate analysis. A total of 548 children (53% male) underwent CCS with a median age of 1.9 years (range 0.01-17.5 years). The median Aristotle Basic Complexity score was 7.1 (range 3-14.5). The CLABSI bundle was applied in 262 patients. Overall mortality was 5.5%. 126 patients (23%) experienced major postoperative infections. During the year after the implementation of the CLABSI bundle, BSI was reduced from 8.4% to 3.1% (p=0.01), with a smaller reduction in VAP (21% to 17.6%; p=0.33). The incidence of SSI was unchanged (1.7% to 1.9%; p=0.77). The independent risk factors for major infections were age at surgery <6 months (p=0.04), postoperative ventilator usage >2 days (p<0.01), central line usage >4 days (p=0.04), and surgery during the pre-CLABSI bundle period (p=0.01). Following the implementation of the CLABSI prevention package in our pediatric CCS unit, the incidence of BSI was significantly reduced. The incidence of VAP tended to decrease, while the SSI was unchanged. Sustainability of the prevention package through nurse empowerment and compliance audits is an ongoing challenge.

Impact of Training on Central Line Associated Blood Stream Infection Maintenance Bundle on Central Line Associated Blood Stream Infection Rates - A Retro-prospective Study in a Selected Hospital, Hyderabad

Background: Central line-associated bloodstream infections (CLABSI) are a very common cause of healthcare-associated infections (HAI). CLABSIs will not only increase mortality and morbidity but also increases length of stay (LOS) and financial burden to ICU patients. Infection control practices play a major role in preventing CLABSI. Research indicates that quality improvement initiatives have helped in reducing CLABSI rates. CLABSI rates have been successfully reduced in ICU settings however, there is still significant variability in practice due to poor adherence to evidence-based CLABSI maintenance bundle components. However, nurses frequently struggle to follow evidence-based preventive practices, thus it is necessary to understand better the behavioral influences on implementing CLABSI prevention measures. Additionally, it has been emphasized that implementation studies must consider or quantify the potential impact on CLABSI rates. Before taking up the study, we have noticed increase in CLABSI rates for 1month Period, for which the Retrospective data was collected and analyzed to understand the gaps to implement CLABSI maintenance bundle components. Therefore, this study helped us identifying gaps in maintenance bundle and observed infections rates before and after study Aim: To evaluate the effect of central line (CL) bundle compliance on central line-associated bloodstream infections (CLABSIs) To evaluate the knowledge and practices of physicians and nurses working in all ICUs and wards regarding the components of central line maintenance bundles (ref table I) Design: Used a retro prospective study, to reduce the CLABSI rates and to increase awareness on maintenance bundle components in intensive care units (ICU) and wards. we have initiated a structured training program to all nurses and doctors. Two tools were prepared. one is to assess the knowledge of nurses and doctors working in ICUs and wards on CLABSI. The second tool consists of components related to central line maintenance bundle to evaluate the effectiveness in reducing incidence of CLABSI. A total 489 Registered nurses and 10 intensivists and 15 ward doctors were included in the current study. Phase I was the pre-interventional period during this period audits were conducted, we observed lacunae in implementing CLABSI Maintenance bundle. Phase II was the intervention period lasting for 2 month, during this period, the entire nursing staff and doctors working in ICUs and Wards underwent a continuous teaching and training. Phase III was the post-intervention period- In this period questionnaire was given in September and again in December. This was to check for the impact of training on knowledge and awareness level which will further lead better implementation of the practices. Observed CLABSI rate reduced from17.2. to 6.8 per 1000 central line days. Result: Knowledge assessment- Comparison data between June 2021 and September 2021 mean knowledge score significantly higher in September (9.1) than June (6.4) .similarly, December (9.9) score significantly higher than June and September to determine the difference between the mean of various observations in the pre and post intervention period with 95% confidence interval, the difference in the knowledge level and CLABSI rate in the pre and post intervention period was found significant(p&lt;0.001) .During this 6 months period(July 2021 to December 2021) there were a total of 1120 patients on central lines, for all the patients line care was observed after implementation of structured training programme. The rate of CLABSI significantly declined from 17.2 per 1000 catheter days to 6.8 per 1000 catheter days. Conclusion: This study clearly indicated that the educational interventions in structured formats are imperative when imparting trainings in Infection control practices and should be implemented frequently to bridge the gap between knowledge and practice. With the dynamics of infection control and the challenges faced in its implementation continuing this type of trainings will ensure all use evidence-based interventions. Recommendations: Continues Training program should be carried out for nurses and doctors related to implementation of CLABSI Bundle. Keywords: CLABSI, Catheter hub care, Hand hygiene, Training, Maintenance bundle, Teaching, Implementing, Structured program.

Analyzing central-line associated bloodstream infection prevention bundles in 22 countries: The results of ID-IRI survey

Because central line-associated bloodstream infections (CLABSIs) are a significant complication of central venous access, it is critical to prevent CLABSIs through the use of central line bundles. The purpose of this study was to take a snapshot of central venous access bundles in various countries. The participants in intensive care units (ICUs) completed a questionnaire that included information about the health center, infection control procedures, and central line maintenance. The countries were divided into 2 groups: those with a low or low-middle income and those with an upper-middle or high income. Forty-three participants from 22 countries (46 hospitals, 85 ICUs) responded to the survey. Eight (17.4%) hospitals had no surveillance system for CLABSI. Approximately 7.1 % (n=6) ICUs had no CLABSI bundle. Twenty ICUs (23.5%) had no dedicated checklist. The percentage of using ultrasonography during catheter insertion, transparent semi-permeable dressings, needleless connectors and single-use sterile pre-filled ready to use 0.9% NaCl were significantly higher in countries with higher and middle-higher income (P < .05). Our study demonstrated that there are significant differences in the central line bundles between low/low-middle income countries and upper-middle/high-income countries. Additional measures should be taken to address inequity in the management of vascular access in resource-limited countries.

Central Line Associated Blood Stream Infections and Effectiveness of Care Bundle Approach: A Prospective Cohort Study

Introduction: Insertion and maintenance of Central Venous Catheters (CVC) are integral components for the supportive care of critically ill neonates. Their use is often associated with the unavoidable risk of acquiring Healthcare Associated Infections (HAI) like Central Line Associated Blood Stream Infections (CLABSI) especially in resource limited public sector Neonatal Intensive Care Units (NICU). Adopting a care bundle approach to decrease CLABSI rates in such NICUs still remains a challenge. Aim: To determine the baseline CLABSI rate, identify the risk factors associated with it and also to determine the effectiveness of care bundle approach in decreasing CLABSI. Materials and Methods: An analytical prospective cohort study was conducted in Cheluvamba Hospital, attached to Mysore Medical College and Research Institute, Mysuru, Karnataka, India, from June 2018 to June 2020. In the preintervention phase (June 2018 to May 2019), the data of 307 neonates in whom Central Line (CL) was inserted were analysed to determine the baseline CLABSI rate and risk factors. CLABSI bundle involves a group of evidence-based practices which when implemented reliably and consistently have shown to significantly reduce CLABSI rates. CLABSI bundle was implemented in June 2019 and in the postintervention phase (July 2019 to June 2020), the data of 283 neonates were analysed and compared to those in the preintervention group in order to assess the effectiveness of the care bundle approach. Chi-square test was used to compare categorical variables whereas a two sample t-test was used to compare continuous variables. Results: A total of 41 CLABSI episodes were documented in the preintervention phase (Group 1) as compared to 12 in the postintervention phase (Group 2). Mean birth weight and gestational age was significantly lower in neonates with CLABSI as compared to neonates without CLABSI in both the groups. The incidence of CLABSI was significantly higher in neonates with a catheter dwell time of more than eight days and in those who received Total Parenteral Nutrition (TPN). Implementation of the CLABSI bundle resulted in the reduction of the baseline CLABSI rate from 16.25 to 8.3/1000 CL days; a significant reduction in the catheter dwell time and duration of NICU stay was also noted in group 2. Duration of NICU stay and death rate among neonates who developed CLABSI did not differ significantly between both the groups. Conclusion: Despite incorporating the care bundle approach, CLABSI rate remained to be high. Very preterm neonates with birth weight of &lt;1500 grams and NICU stay of more than 25 days were more likely to develop CLABSI. Significant reduction in CLABSI rates can be achieved with widespread implementation of the CLABSI bundle in resource limited NICUs across India.

A Prospective Study of Family Engagement for Prevention of Central Line-associated Blood Stream Infections.

We sought to determine if a family-centered care (FCC) handout intervention designed to encourage family engagement (FE) in the prevention of central line-associated bloodstream infections (CLABSIs) would alter parental perceptions of FCC and improve staff compliance with CLABSI bundle components. A prospective quasiexperimental study of 121 legal guardians of children with a central venous catheter (CVC) admitted to the pediatric intensive care unit (PICU). Baseline (n = 59) and intervention (n = 62) groups of parents completed an 18-question online survey assessing basic CLABSI care practices and FCC principles. The intervention group received an FE handout before completing the survey with information about CLABSI prevention practices designed to encourage active participation in their child's CVC care. Independent sample t-tests found significant improvements in the intervention parents responses compared to the baseline group (no handout) on survey items assessing CLABSI knowledge (P < 0.001) and on parental perceptions of FCC in the domains of dignity and respect, information sharing, participation, and partnership (all with a P < 0.001). An improvement was observed in staff CLABSI maintenance bundle compliance in the postintervention period, increasing from 89% to 94%. Educating parents on CLABSI prevention strategies and encouraging family participation in CVC care was associated with improved parental perceptions of participation in their child's care, medical team's listening, attention, honesty, and explanation of treatment plans and was associated with an increase in staff compliance with CLABSI maintenance bundle practices.

Development and Implementation of a Real-time Bundle-adherence Dashboard for Central Line-associated Bloodstream Infections.

Introduction:Central line-associated bloodstream infections (CLABSIs) are the most common hospital-acquired infection in pediatric patients. High adherence to the CLABSI bundle mitigates CLABSIs. At our institution, there did not exist a hospital-wide system to measure bundle-adherence. We developed an electronic dashboard to monitor CLABSI bundle-adherence across the hospital and in real time.Methods:Institutional stakeholders and areas of opportunity were identified through interviews and data analyses. We created a data pipeline to pull adherence data from twice-daily bundle checks and populate a dashboard in the electronic health record. The dashboard was developed to allow visualization of overall and individual element bundle-adherence across units. Monthly dashboard accesses and element-level bundle-adherence were recorded, and the nursing staff’s feedback about the dashboard was obtained.Results:Following deployment in September 2018, the dashboard was primarily accessed by quality improvement, clinical effectiveness and analytics, and infection prevention and control. Quality improvement and infection prevention and control specialists presented dashboard data at improvement meetings to inform unit-level accountability initiatives. All-element adherence across the hospital increased from 25% in September 2018 to 44% in December 2019, and average adherence to each bundle element increased between 2018 and 2019.Conclusions:CLABSI bundle-adherence, overall and by element, increased across the hospital following the deployment of a real-time electronic data dashboard. The dashboard enabled population-level surveillance of CLABSI bundle-adherence that informed bundle accountability initiatives. Data transparency enabled by electronic dashboards promises to be a useful tool for infectious disease control.

Sustained Low Incidence Rates of Central Line-Associated Blood Stream Infections in the Intensive Care Unit.

BackgroundCentral line-associated bloodstream infection (CLABSI) is an important cause of increased morbidity and mortality in ICUs. The occurrence of CLABSI in significantly higher in developing countries and contributes to the burden of healthcare-associated infections.MethodsThis prospective study was carried out from January 2016 to December 2019 in the intensive care unit at King Faisal Medical Complex in Taif, Saudi Arabia. The Society for Healthcare Epidemiology of America/Infectious Diseases Society of America (SHEA/IDSA) recommendations were introduced and implemented during 2017–2019. In the post-intervention period, observation of hand hygiene, CLABSI bundle compliance, and benchmarking of CLABSI rates were carried out.ResultsThe CLABSI incidence rate was 1.12/1,000 central-line days, with a 0.51 utilization ratio in the pre-intervention period. This dropped to 0.46/1,000 central line days with a 0.44 utilization ratio in the post-intervention period. This reduction was also confirmed in benchmarking with National Healthcare Safety Network (NHSN) (50th–75th) percentile pre-intervention vs (25th–50th) percentile post-intervention. Institutional risk assessment revealed a formal educational program as a potential need for improvement. The CLABSIs were caused predominantly by multidrug-resistant Klebsiella pneumoniae.ConclusionWe observed a reduction and sustained low incidence rate of CLABSI benchmarking to NHSN for 3 years after implementation of the basic SHEA/IDSA recommendations.

The Efficacy of Passive Valve Antimicrobial Swab Caps Against Existing Clabsi Prevention Bundle in an Adult Hematology Inpatient Population: A Quality Improvement Initiative

Background : Central line associated blood stream infections (CLABSI) have been the costliest of all healthcare associated infections. The average CLABSI cost is approximately $46,000 (Haddadin &amp; Regunath, 2019). Most cases may be preventable with utilization of aseptic techniques, surveillance, and management through local protocols. The majority of CLABSI occur more than five days after central vascular access (CVA); therefore, there has been a growing focus on central line handling and maintenance techniques. CLABSI prevention data has been largely focused on the intensive care unit (ICU) patient population where an average of about half of patients have CVA. There have been few studies exploring the rates of CLABSI in the adult hematology population, a population with unique risk factors due to their immunosuppressing treatments and prolonged immunocompromised states. There has been emerging data that suggests the use of new technology in addition to existing central line maintenance recommendations by the Center for Disease Control may further reduce the rate of CLABSI occurrences in high-risk patient populations. Aim: To determine the efficacy of passive valve antimicrobial swab caps on the reduction of CLABSI in an inpatient hematology patient population when compared to current existing local practices. Outcomes of reported incidents of CLABSI have been evaluated against pre-interventional data for this setting. Methods : Retrospective analysis of medical records from January 2016 - September 2019 identified the existing rate of CLABSI occurrence among inpatient hematology patients at a single institution. We utilized the intervention of antimicrobial swab caps for 10 months and tracked the rate of CLABSI during this time. The nursing staff were educated on the quality improvement project, the use of the new equipment, and expectations that existing standard practices per local policy for CLABSI prevention bundles would be adhered to prior to the start of the intervention. To evaluate the impact of the antimicrobial swab caps on the rate of CLABSI we compared the number of infections pre- and post-intervention. Randomized audits, including chart reviews for compliance with existing standard CLABSI bundle practices were performed during the initial 3 months of the intervention. Results : Prior to the introduction of the passive valve antimicrobial swab cap to the existing CLABSI prevention protocol, CLABSI rates on the hematology unit exceeded the standardized infection ratio 75th percentile on 9 of the previous 15 calendar quarters. The intervention was observed for 6,674 central line days. The CLABSI rate during the intervention was 0.4495 per 1,000 central line days. The CLABSIs identified were due to nosocomial opportunistic infection in setting of immunosuppressed status (66%) and gastrointestinal translocation (33%). The common diagnosis in setting of CLABSI was refractory/relapse diffuse large B-cell lymphoma (66%) and active acute myeloid leukemia (33%). The two patients who were diagnosed with CLABSI were neutropenic with an absolute neutrophil count of 0 at time of CLABSI diagnosis. The organisms identified at time of CLABSI diagnosis were Clostridium ramosom, Enterococcus faecium, Staphylococcus epidermisis, and Candida parapsilosis. When considering the cost of a CLABSI to be about $46,000 per event and the annual cost for the inpatient hematology unit's use of the caps of approximately $19,710, the implementation of the antimicrobial swab cap reduced the cost associated with CLASBI in the hematology unit by approximately $26,290 annually. Conclusions : The introduction of the passive valve antimicrobial swab caps appears to demonstrate potential for reduced costs due to CLABSI when implemented into current CLABSI prevention bundles. This resulted in a 25% reduction in rates of CLABSI in the adult hematology patient population when compared to the previous year. The prevention of CLABSI in hematology patients with central vascular access remains challenging, however, standardized protocols for CLABSI prevention and use of antimicrobial swab caps may help further reduce the rate of CLABSI in hematology patients. Disclosures: No relevant conflicts of interest to declare. Disclosures Glennie: Pharmacyclics: Speakers Bureau; Janssen: Speakers Bureau. Bensinger:BMS: Consultancy, Honoraria, Research Funding, Speakers Bureau; Sanofi: Consultancy, Honoraria, Research Funding, Speakers Bureau; Janssen: Consultancy, Honoraria, Research Funding, Speakers Bureau; Amgen: Consultancy, Honoraria, Research Funding, Speakers Bureau; GSK: Consultancy, Honoraria, Research Funding, Speakers Bureau; Regeneron: Consultancy, Honoraria, Research Funding, Speakers Bureau. Patel:Celgene/BMS: Consultancy, Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy, Speakers Bureau; AstraZeneca: Consultancy, Research Funding, Speakers Bureau; BeiGene: Consultancy; Adaptive Biotechnologies: Consultancy; Genentech: Consultancy, Speakers Bureau; Kite: Consultancy; Pharmacyclics: Consultancy, Speakers Bureau.

Reduction of Central-Line–Associated Bloodstream Infections in a Spinal Cord Injury Unit

Background: Central-line–associated bloodstream infections (CLABSIs) are a complication of indwelling central venous catheters, which increase morbidity, mortality, and cost to patients. Objective: Due to increased rates in a spinal cord injury unit (SCIU), a performance improvement project was started to reduce CLABSI in the patient population. Methods: To reduce the incidence of CLABSI, a prevention bundle was adopted, and a peer-surveillance tool was developed to monitor compliance with the bundle. Staff were trained to monitor their peers and submit weekly surveillance. Audits were conducted by the clinical nurse leader with accuracy feedback. Bundle peer-surveillance was implemented in February of 2018 with data being fed back to leadership, peer monitors, and stakeholders. Gaps in compliance were addressed with peer-to-peer education, changes in documentation requirements, and meetings to improve communication and reduce line days. In addition, the use of an antiseptic-impregnated disc for vascular accesses was implemented for dressing changes. Further quality improvement cycles during the first 2 quarters of fiscal year 2019 included service-wide education reinforcement, identification in variance of practice, and reporting to staff and stakeholders. Results: CLABSI bundle compliance increased from 67% to 98% between February and October 2018. The weekly audit reporting accuracy improved from 33% to 100% during the same period. Bundle compliance was sustained through the fourth quarter of 2019 at 98%, and audit accuracy was 99%. The initial CLABSI rates the quarter prior to the intervention were 6.10 infections per 1,000 line days for 1 of the 3 SCIUs and 2.68 infections per 1,000 line days for the service overall. After the action plan was initiated, no CLABSIs occurred for the next 3 quarters in all SCIUs despite unchanged use of central lines (5,726 line days in 2018). The improvement was sustained, and the line days decreased slightly for 2019, with a fiscal year rate of 0.61 per 1,000 line days (ie, 3 CLABSIs in 4,927 central-line days). Conclusions: The incidence of CLABSI in the SCIU was reduced by an intensive surveillance intervention to perform accurate peer monitoring of bundle compliance with weekly feedback, communication, and education strategies, improvement of the documentation, and the use of antiseptic-impregnated discs for dressings. Despite the complexity of the patient population requiring long-term central lines, the CLABSI rate was greatly impacted by evidence-based interventions coupled with reinforcement of adherence to the bundle.Funding: NoneDisclosures: None

Harnessing implementation science to optimize harm prevention in critically ill children: A pilot study of bedside nurse CLABSI bundle performance in the pediatric intensive care unit

Central-line associated bloodstream infection (CLABSI) is associated with increased mortality, morbidity, and cost in hospitalized children. An evidence-based bundle of care can decrease CLABSI, but bundle compliance is imperfect. We explored factors impacting bundle performance in the pediatric intensive care unit (PICU) by bedside nurses. Single-center cross-sectional electronic survey of PICU bedside nurses in an academic tertiary care center; using the COM-B (capability, opportunity, motivation) and TDF (theoretical domains framework) behavioral models to explore CLABSI bundle performance and identify barriers to compliance. We analyzed 160 completed surveys from 226 nurses (71% response rate). CLABSI knowledge was strong (capability). However, challenges related to opportunity were identified: 71% reported that patient care requirements impact bundle completion; 32% described the bundle as stressful; and CLABSI was viewed as the most difficult of all bundles. Seventy-five percent reported being highly impacted by physician attitude toward the CLABSI bundle (motivation). PICU nurses are knowledgeable and motivated to prevent CLABSI, but face challenges from competing clinical tasks, limited resources, and complex family interactions. Physician engagement was specifically noted to impact nurse motivation to complete the bundle. Interventions that address these challenges may improve bundle performance and prevent CLABSI in critically ill children.

A study of microbiome and its antimicrobial susceptibility patterns among central line-associated bloodstream infections

Introduction: Central line-associated bloodstream infections (CLABSIs) are the most frequent cause of health-care-associated infections and significantly increase cost and hospital length of stay. Methods: We retrospectively studied hospitalised patients having a central line access during the period 2016-2018, to study patients with CLABSI at our tertiary care hospital. Results: Average CLABSI rate was 16.7 per 1000 central line days for 3 years. Most of the infections were caused by Staphylococcus aureus (18.9%), followed by non-fermentative Gram-negative bacilli (NFGNB) (16%), Klebsiella spp. (15.1%), Acinetobacter spp. (14.2%) and coagulase-negative Staphylococcus ( CoNS) (13.2%). A higher proportion of CLABSI was observed with femoral lines (59.7%), followed by jugular lines (35.8%) and subclavian lines (9.4%). This study showed multidrug-resistant pathogens as a causative agent of CLABSI. Conclusion: CLABSI is a common entity, especially in intensive care unit settings. S. aureus, NFGNB, Klebsiella spp., Acinetobacter spp. and CoNS were the common pathogens isolated in our study. Strict implementation of CLABSI bundle care plays an important role to minimise the CLABSI rate.

Incidence, Microbiological Profile, and Impact of Preventive Measures on Central Line-associated Bloodstream Infection in Liver Care Intensive Care Unit.

ABSTRACTAims and objectivesCentral line-associated bloodstream infection (CLABSI) is among one of the preventable healthcare-associated infections (HAIs). The data for the CLABSI rate in liver care intensive care unit (LCICU) patients are scarce, so the present study was conducted to ascertain the CLABSI rate, the microbiological profile, and the impact of preventive measures for reduction of infection.Materials and methodsThis is a prospective observational study done on LCICU patients during the period of January 2017–December 2018. We followed up patients on the central venous catheter for the development of CLABSI as a part of routine surveillance of HAIs. The impact of introduction and implementation of the CLABSI bundle to reduce the CLABSI rate was analyzed and the microbiological profile of infection was determined.ResultsDuring the study period, the total number of patients admitted in LCICU were 1,336 (648 in 2017 and 688 in 2018) and a total of 995 central lines were inserted for various indications. A total of 57 patients were meeting the CLABSI criteria among 7,324 central line catheter days of surveillance. In year 2017, rate of CLABSI was 11.78/1,000 catheter days and after implementation of the bundle in 2018 the rate reduced to 3.99/1,000 catheter days. Gram-negative organisms (86%) predominated with Pseudomonas aeruginosa being the most common pathogen (19.3%). Out of 49 isolates of gram-negative bacilli (GNB), 40 (81.6%) were multidrug resistant (MDR) and 9 (18.4%) were pan-drug resistant.ConclusionWe found significant reduction in the CLABSI rate after implementation of the bundle of care. Gram-negative bacilli were the most common pathogen in our study and antimicrobial resistance was very high, which suggest hospital environment as a source of infection.Clinical significanceKnowledge of the microbiological profile and the preventive strategy of CLABSI is essential for prevention and timely initiation of the most appropriate anti-infective therapy, if it happens.How to cite this articleKhodare A, Kale P, Pindi G, Joy L, Khillan V. Incidence, Microbiological Profile, and Impact of Preventive Measures on Central Line-associated Bloodstream Infection in Liver Care Intensive Care Unit. Indian J Crit Care Med 2020;24(1):17–22.

Decreasing Central Line-associated Bloodstream Infections Through Quality Improvement Initiative

To study the impact of a quality improvement (QI) initiative using care bundle approach on Central-line associated bloodstream infections (CLABSI) rates. A QI team for infection control in NICU was formed in a tertiary-care neonatal intensive care unit (NICU) from June 2015 to August 2016. Baseline data were collected over first 3 months followed by the intervention period of 1 year. Measures with respect to strengthening hand hygiene and central line bundle care were implemented during the intervention period. Audits assessing the compliance to hand hygiene and CLABSI bundle protocols were used as process indicators. Multiple PDSA cycles were used to strengthen the practices of proposed interventions, documentation of data and audits of the processes during the study period. The QI initiative achieved a 89% reduction in CLABSI from the baseline rate of 31.7 to 3.5 per 1000 line-days. The blood stream Infections reduced from 7.3 to 2.3 per 1000 patient-days. The overall mortality showed a reduction from 2.9% to 1.7% during the intervention period. There was a significant improvement in compliance with hand hygiene protocol and compliance with CLABSI protocols. This study demonstrated that simple measures involving hand hygiene and strengthening of the care bundle approach through quality improvement could significantly reduce the blood stream Infections and CLABSI rates.

Differences in work environment for staff as an explanation for variation in central line bundle compliance in intensive care units.

Central line-associated bloodstream infections (CLABSIs) are a common and costly quality problem, and their prevention is a national priority. A decade ago, researchers identified an evidence-based bundle of practices that reduce CLABSIs. Compliance with this bundle remains low in many hospitals. The aim of this study was to assess whether differences in core aspects of work environments-workload, quality of relationships, and prioritization of quality-are associated with variation in maximal CLABSI bundle compliance, that is, compliance 95%-100% of the time in intensive care units (ICUs). A cross-sectional study of hospital medical-surgical ICUs in the United States was done. Data on work environment and bundle compliance were obtained from the Prevention of Nosocomial Infections and Cost-Effectiveness Refined Survey completed in 2011 by infection prevention directors, and data on ICU and hospital characteristics were obtained from the National Healthcare Safety Network. Factor and multilevel regression analyses were conducted. Reasonable workload and prioritization of quality were positively associated with maximal CLABSI bundle compliance. High-quality relationships, although a significant predictor when evaluated apart from workload and prioritization of quality, had no significant effect after accounting for these two factors. Aspects of the staff work environment are associated with maximal CLABSI bundle compliance in ICUs. Our results suggest that hospitals can foster improvement in ensuring maximal CLABSI bundle compliance-a crucial precursor to reducing CLABSI infection rates-by establishing reasonable workloads and prioritizing quality.

Epidemiology of Central Line-Associated Bloodstream Infection (CLABSI) Among Patients in the Intensive Care Units (ICUs) at a Teaching Hospital in Saudi Arabia from Year 2011-2016

Background: The burden of central line-associated blood stream infections (CLABSI) in Saudi Arabia intensive care units (ICUs) is not will reputable. The present study aimed to describe CLABSI epidemiology in teaching hospital from 2011-2016. Methods: This is retrospective cohort study. The data were collected based on prospective targeted surveillance, which was conducted to estimate the rate of CLABSI in MICU and SICU during the study period (2011-2016). Result: Out of 36,469 central lines, a total of 85 got CLABSI, of which 67 were identified among MICU patients with 24,759 central line days. The CLABSI rate was 3.2 per 1,000 central line days over six years of surveillance. The mean rate of CLABSI in MICU was 2.7 per 1,000 central line days and a sharp decrease in the rate from 6 per 1,000 central line days (year 2011) to 0.3 per 1,000 central line days (year 2016) in MICU over six years. The rate in SICU was 3.3 per 1000 central line days (year 2011) to 0.3 per 1,000 central line days (year 2016) and these differences are statistically significant (p ≤ 0.05). There is a significant difference in HAIs among ICUs patient before and after implantation CLABSI bundle. Conclusion: Despite the emergence of gram-negative predominant organisms, we believe that is possible to achieve a zero CLABSI rate in Saudi Arabia. To achieve desired outcomes, additional strategies such as alcoholimpregnated port protector may be used; this will help increase bundles successfulness.