Central Line-associated Bloodstream Infections Prevention Research Articles

Targeting prolonged short-term central venous catheters to reduce hospital-wide catheter days and CLABSI rates

BackgroundThe risk of central-line associated bloodstream infection (CLABSI) is associated with central venous catheter (CVC) dwelling time. We implemented a hospital-wide intervention aimed to alert physicians to CVC-duration and necessity and to improve the monitoring of CLABSI prevention process-measures outside the intensive care unit (ICU). MethodsA retrospective, before-after study that evaluated short-term, non-hemodialysis CVCs in and out of the ICU. The intervention included enhanced bundle-prevention measures monitoring and staff 'sensitization' regarding prolonged (>7 days) CVCs (pCVCs). The ICU intervention also included daily CVC-stewardship visits. We assessed CVC-utilizations and CLABSI episodes 20 months before, to 19 months after the intervention using Mann-Whitney tests. ResultsOut of the ICU, CVC-utilization ratio (CVC-UR) and pCVC-UR reduced significantly (4.1 to 2.7/100 HD, p=0.005; and 28% to 21%, p=0.02, respectively). Bundle-prevention measures improved and CLABSI rates reduced post-intervention (7.9 to 3.6/1000 CVC days, p=0.03). In the ICU, pCVC-UR reduced significantly (29% to 15%, p<0.0001). Baseline ICU-CLABSI rates were low and did not reduce post-intervention. ConclusionsSensitizing physicians to the existence and duration of CVCs accompanied with improved bundle-prevention measures, resulted in reduction of pCVCs, and outside the ICU, also in reduction of CVC-UR and CLABSI rates.

Nurse-Driven Interventions Reduce Central Line-Associated Bloodstream Infection Close to Zero in One Pediatric Oncologic Facility: A Single-Center Retrospective Observational Study.

Central line-associated bloodstream infections (CLABSIs) are critical infectious complications among pediatric hematology-oncology patients, and the management of central venous catheters (CVCs) by healthcare personnel can significantly influence the incidence of these infections. This study evaluates the impact of nurse-led changes in CVC management on the incidence of CLABSIs. This single-center, retrospective observational study was conducted at an urban, tertiary referral, and academic center serving pediatric patients. The study cohort comprised 239 patients and 323 CVCs seen between 2012 and 2022. CLABSI was defined according to the Centers for Disease Control and Prevention definitions. Oncology nurse leaders developed CVC-specific educational modules for CLABSI prevention. All the relevant information during the CVC maintenance period was noted in the patient's CVC logbook. A total of 24 (7%) cases of confirmed CLABSI were identified. The incidence of CVC-related infections was 0.32 cases per 1000 catheter days (95%CI: 0.19-0.45). The incidence decreased by 40% between the first and second three-year study period. Documented exit-site infection was reported in 32 (10%) cases. The correlation between exit-site infection and CLABSI was found in 9 (28%) cases. Our CVC-related infection rates are significantly lower than the incidence reported by the Italian Association of Pediatric Hematology and Oncology, which settles at 3-5 cases per 1000 catheter days. Our data confirm the effectiveness of local CVC management guidelines in preventing CVC-related infectious complications.

HOCl Production Modelling for an Electrochemical Catheter

Intravascular catheters are used in critically ill patients to deliver fluids and lifesaving medications, and for hemodynamic monitoring. These catheters are at risk for infection, especially when in place for prolonged periods of time. The management of catheter-related infections are challenged by both the presence of biofilms and the frequent association with multidrug-resistant organisms. Efforts to mitigate central line-associated bloodstream infections (CLABSIs) have focused on preventive measures. Several strategies to prevent intraluminally sourced CLABSI have been developed and used, including antimicrobial agent locks and antimicrobial-impregnated catheter lumens. Although antimicrobial locks have reduced CLABSI rates, this strategy is prone to complications, including resistance selection, allergic reactions, catheter damage, and host toxicity due to the high concentrations of agents needed. Largely because of these factors, antimicrobial locks are infrequently used for CLABSI prevention in clinical practice. Antimicrobial impregnated catheter lumens have also shown variable effects against CLABSI and are likewise not regularly used. Therefore. innovative therapeutic solutions are necessary, especially those that allow catheter retention. In this context, the integration of electrochemical technologies for hypochlorous acid (HOCl) production within intravascular catheters emerges as a promising strategy to combat CLABSIs. HOCl is a strong oxidizing agent that damages microbial cells by interacting with lipids, nucleic acids, sulfur-containing amino acids, and membrane components. It is found in all mammals as an endogenous substance produced by the immune system to protect the body from pathogens. In this study, electrochemical generation of HOCl in an electrochemical catheter (e-catheter) was simulated using a model called Electrochemical Hypochlorous Acid Production (EHAP), implemented in COMSOL Multiphysics®. The e-catheter has two components, a hub and a tube, both filled with 0.9% saline solution. Titanium wires are used as working and counter electrodes.The model was used to define critical variables that may impact HOCl generation and distribution. In addition to predicting HOCl concentrations, the EHAP model was used to monitor effects of 1) a waiting period after constant polarization, 2) operational voltage, 3) working electrode length and 4) working electrode surface area. Findings using the EHAP model revealed the following: 1) Diffusion limitations predominate when the electrodes are localized to the hub, yielding a lower HOCl concentration in the tube compared to the hub. Increasing the voltage between the working and the reference electrodes increases HOCl generation, however concentrations are not enough to deliver HOCl to the tube. 2) HOCl concentrations are higher in the tube compared to hub when the working electrode extends the entire length of the tube. 3) HOCl concentration distributions can be tuned by changing the surface area of the working electrode within different compartments of the e-catheter.

Implementing a Compliance Monitoring Process to Promote Chlorhexidine Gluconate Bathing and Hand Hygiene: An Initiative to Decrease Central Line–Associated Bloodstream Infections

Background Chlorhexidine gluconate (CHG) bathing has proven to reduce central line–associated bloodstream infections (CLABSI) in hospitalized patients. The aim of this study is to evaluate whether the implementation of a compliance monitoring process for CHG bathing and strict hand hygiene as part of the traditional CLABSI prevention bundle will reduce the overall hospital CLABSI standardized infection ratio (SIR). Methods A quasi-experimental study was conducted in intensive care and non-intensive care inpatient hospital units in an urban 361-bed teaching hospital in Western Pennsylvania. The pre-intervention period consisted of January–August 2021, the intervention period consisted of September–November 2021, and the post-intervention and sustainability period consisted of December 2021–June 2022. A compliance monitoring process for the initiation of a daily bath using a 4% CHG solution and strict hand hygiene surveillance was implemented as part of the standard CLABSI prevention bundle (which includes standardized insertion checklists and processes, daily necessity assessment, dressing change and integrity standards, five moments hand hygiene standards, CHG disk [Biopatch], end caps [Curos], and care of tubing). Outcomes A statistically significant increase in hand hygiene (p=&lt;0.001) and in CHG bathing compliance (p=0.014) helped reduce the overall hospital CLABSI SIR from 1.45 to 0.82, standing for an overall 43.4% decrease. Cost reduction was statistically significant (p=0.011) and was an estimated $1.4 million dollars in savings for the hospital. Next Steps Incorporate the compliance monitoring component for CHG bathing and hand hygiene as part of the best strategy for CLABSI bundle prevention within the healthcare system.

Choice of needleless connector technology as a risk reduction strategy for catheter related bloodstream infection, mortality, and cost: A secondary data analysis.

To compare relative risk (RR) of central line-associated bloodstream infection (CLABSI) between hospitals using Clave needleless connector technologies (NCT) and comparator hospitals using non-Clave NCT. And, to estimate avoided CLABSIs, mortality, and cost savings. Needleless connectors, while protective against needlestick injury, have long been implicated as a potential risk for CLABSI. Significant RR reduction of CLABSI among the many NCT has not been clinically demonstrated. The U.S. Healthcare-Associated Infections database was accessed for CLABSI data for calendar year 2019 via the Centers for Medicare and Medicaid Services website. This dataset was merged with the Clave NCT manufacturer's 2019 database to identify hospitals purchasing Clave NCT (MicroClave™, NanoClave™, Clave Neutron™, Clave™, Microclave™ Clear) and non-Clave NCT comparator hospitals. Sub-analysis of Clave NCT hospitals included: (1) Clave NCT mixed-use and (2) Clave high-volume use hospitals. The standardized infection ratio (SIR) was generated to estimate CLABSI RR after adjusting for intern/resident-to-bed-ratio (IRB), care location, and hospital demographics. Using the RR, avoided CLABSIs, mortality, and cost savings were calculated. A total of 2987 eligible hospitals (1288 Clave NCT, 1699 non-Clave NCT) with 17,452,575 central line-days were evaluated. All three Clave NCT hospital groups showed a statistically significant reduction in RR compared to the non-Clave NCT hospitals. The RR in Clave NCT hospitals was 0.93, a 7% decrease in CLABSI risk (p = 0.02). In the Clave NCT subgroups, mixed-use hospitals RR was 0.93, a 7% reduction (p = 0.04), while the Clave NCT high-volume hospitals experienced a 19% reduction, RR 0.81 (p = 0.04). An estimated 563 CLABSIs and 84 related deaths were avoided with use of Clave NCT and $27,095,231 in cost savings. The use of the Clave NCT, in and of itself, is an effective risk reduction strategy for CLABSI prevention, reduced mortality, and substantial cost savings.

Antimicrobial bathing of the critically ill for the prevention of healthcare-associated infection at a hospital in California

Background: Patients in the intensive care unit (ICU) have invasive lines increasing their risk for healthcare-associated infections (HAIs). Our objective was to determine if antimicrobial bathing with 2% chlorhexidine gluconate (CHG) compared to the colloidal silver-based antimicrobial product would reduce the incidents of central line–associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI). Methods: We performed a before-and-after study in four adult ICUs at a two-hospital facility in California. Prospective surveillance of CLABSI and CAUTI prevention bundles monitoring was established. The intervention consisted of daily bathing with CHG for all patients in the ICUs. A baseline period of one year was followed by an intervention period of one year. The incidence rates of CLABSIs and CAUTIs were compared between the baseline and intervention periods utilizing a t-test analysis. Results: A total of 10103 patients were included. At Facility A, a mean CLABSI rate of 2.43/1000 central line catheter days (CL) with 2149 patients days (Mean differences 95% CI -0.5–3.1; P&gt;0.0975), during the baseline period followed by 1.11/1000 CL days with 2193 patient days in the intervention period. At Facility B, the mean CLABSI rate of 1.82/1000 CL days with 2976 patient days (Mean differences 95% CI -0.6–2.31; P&gt;0.161) during the baseline period was followed by 1.01/1000 CL days with 2785 patient days in the intervention period. At Facility A, the mean CAUTI rate of 1.37/1000 indwelling catheter days (IUC) with 2149 ICU patient days (Mean difference 95% CI is 0.28–1.97; P 0.2160) was noted in the baseline period, followed by 0.45/1000 IUC days with 2785 in the intervention period. Conclusion: Daily bathing with CHG significantly reduced the incidence of CAUTI at Facility A. It is unclear why Facility A saw a statistically significant reduction in CAUTI, but Facility B did not. The difference in outcomes may be related to hospital size, service lines, supply constraints, and discrepancies in staffing. CHG bathing was not directly associated with a reduced risk of CLABSI at Facility A and B during our limited study, but it was encouraging enough that our organization will continue this intervention to obtain additional data to determine if bathing with CHG will reduce CLABSI and CAUTI.

Associations between hospital-level socioeconomic patient mix and rates of central line-associated bloodstream infections in short bowel syndrome: A retrospective cohort study.

Low neighborhood income is linked with increased hospitalizations for central line-associated bloodstream infections (CLABSIs) in pediatric short bowel syndrome (SBS). We assessed whether this relationship varies by hospital center. We performed a retrospective cohort study using the Pediatric Health Information System (2018-2023) database for patients <18 years old with SBS (N = 1210) at 24 hospitals in the United States. Using 2015 US Census data, we determined the estimated median household income of each patient's zip code. Hospital-level neighborhood income was defined as the median of the estimated median household income among patients at each hospital. We applied an extension of Cox regression to assess risk for CLABSI hospitalization. Among 1210 children with 5255 hospitalizations, most were <1 year on initial admission (53%), male (58%), and publicly insured (69%). Hospitals serving low-income neighborhoods served more female (46% vs 39%), Black (29% vs 22%), and Hispanic (22% vs 16%) patients with public insurance (72% vs 65%) residing in the southern United States (47% vs 21%). In univariate analysis, low hospital-level neighborhood income was associated with increased risk of CLABSI hospitalization (rate ratio [RR], 1.48; 95% CI, 1.21-1.83; P < 0.001). These findings persisted in multivariate analysis (RR, 1.43; 95% CI, 1.10-1.84; P < 0.01) after adjusting for race, ethnicity, insurance, region, and patient-level neighborhood income. Hospitals serving predominantly low-income neighborhoods bear a heavier burden of CLABSI hospitalizations for all their patients across the socioeconomic spectrum. Hospital initiatives focused on CLABSI prevention may be pivotal in addressing this disparity.

Knowledge &amp; Practice of Nurses Regarding Central Line-Associated Bloodstream Infection &amp; Prevention

Background: Central venous catheters (CVCs) are crucial in medical care but pose a significant risk for bloodstream infections, leading to increased morbidity, mortality, and healthcare costs. Effective knowledge and practices among nurses are essential for preventing central line-associated bloodstream infections (CLABSI). Objective: To assess the knowledge and practices of nurses regarding the prevention of CLABSI at Sughra Shafi Medical Complex Narowal and identify factors influencing these practices. Methods: This descriptive cross-sectional study involved 200 staff nurses selected from a population of 400 using a non-probability convenient sampling technique. Data were collected via a self-administered questionnaire covering demographics, professional experience, and specific knowledge and practices related to CLABSI prevention. The study was conducted over six months, and data analysis was performed using SPSS version 25, with chi-square and Fisher exact tests applied to determine associations between variables. Ethical approval was obtained, and all participants provided informed consent. Results: The study included 200 nurses, predominantly female (90%), with ages ranging from 18 to 37 years (mean age 25 ± 3.9 years). Professional experience varied, with 36.5% having 1-5 years, 41% having 6-10 years, and 22.5% having 11-15 years of experience (mean experience 7.31 ± 3.0 years). Knowledge assessment revealed that 68.5% knew CVCs should be routinely replaced, and 88.5% were aware of disinfecting catheter insertion sites with 10% povidone-iodine. However, only 43% regularly performed hand hygiene before inserting a central line, and 48.5% used chlorhexidine for skin preparation. Conclusion: While nurses demonstrated satisfactory knowledge regarding CLABSI prevention, their practices were inadequate, indicating a need for enhanced training and adherence to infection prevention protocols.

Practices to prevent central line-associated bloodstream infection: A 2021 survey of infection preventionists in US hospitals.

To determine prevalence of technical and behavioral interventions aimed at preventing central line-associated bloodstream infection (CLABSI) following the COVID19 pandemic. Cross-sectional survey. US acute care hospitals. Infection preventionists at participating hospitals. Surveys were sent to infection preventionists from a national random sample of 881 US acute care hospitals. Questions covered use of technical interventions to prevent CLABSI (eg, alcohol-containing chlorhexidine gluconate [CHG] for skin antisepsis, use of coated catheters), socio-adaptive interventions (eg, feedback of CLABSI rates, use of appropriateness criteria), and leadership support for CLABSI prevention. Survey response rate was 47% (415/881). Technical interventions such as maximal sterile barriers (99%) or CHG-impregnated dressings (92%) were highly prevalent, but routine use of CHG bathing was less common (68% indicated regular use in intensive care unit [ICU] vs 18% in non-ICU settings). Although 97% of respondents indicated use of systems to monitor CLABSI, feedback to providers on CLABSI events was reported by 89%. Only 53% of respondents indicated regular use of tools to determine appropriateness of central venous catheters (CVC). Three-quarters of respondents indicated their hospital assessed CVC necessity daily, but only 23% reported strategies to reduce routine blood cultures. CLABSI prevention was extremely important to hospital leadership at 82% of responding hospitals. Most US hospitals continue to use evidence-based methods to prevent CLABSI as recommended by leading organizations. Opportunities to focus on socio-adaptive interventions such as feedback of infection rates, use of appropriateness criteria for CVC placement, and improving the "culture of pan-culturing" remain.

Characterizing Patients Presenting on Hospital Admission With Central Line-Associated Bloodstream Infections: A Multicenter Study.

There are no systematic measures of central line-associated bloodstream infections (CLABSIs) in patients maintaining central venous catheters (CVCs) outside acute care hospitals. To clarify the burden of CLABSIs in these patients, we characterized patients with CLABSI present on hospital admission (POA). Retrospective cross-sectional analysis of patients with CLABSI-POA in 3 health systems covering 11 hospitals across Maryland, Washington DC, and Missouri from November 2020 to October 2021. CLABSI-POA was defined using an adaptation of the acute care CLABSI definition. Patient demographics, clinical characteristics, and outcomes were collected via record review. Cox proportional hazard analysis was used to assess factors associated with the all-cause mortality rate within 30 days. A total of 461 patients were identified as having CLABSI-POA. CVCs were most commonly maintained in home infusion therapy (32.8%) or oncology clinics (31.2%). Enterobacterales were the most common etiologic agent (29.2%). Recurrent CLABSIs occurred in a quarter of patients (25%). Eleven percent of patients died during the hospital admission. Among patients with CLABSI-POA, mortality risk increased with age (hazard ratio vs age <20 years by age group: 20-44 years, 11.2 [95% confidence interval, 1.46-86.22]; 45-64 years, 20.88 [2.84-153.58]; ≥65 years, 22.50 [2.98-169.93]) and lack of insurance (2.46 [1.08-5.59]), and it decreased with CVC removal (0.57 [.39-.84]). CLABSI-POA is associated with significant in-hospital mortality risk. Surveillance is required to understand the burden of CLABSI in the community to identify targets for CLABSI prevention initiatives outside acute care settings.

Preparation of Patients for Central Venous Catheter Care in the Home: Perspectives From Health Care Personnel.

Patients managing central venous catheters (CVCs) outside of hospitals need training in CVC care. Using 3 focus groups, the study identified themes in how health care personnel (HCP) prepare patients and their caregivers for CVC care at home. Four major themes and 25 nested subthemes were identified: (1) providing the right amount of education at the right time, (2) tailoring education to patient needs, (3) developing patient education tools, and (4) managing differences in recommendations to patients. HCPs in the study ensured patients and caregivers learn what they need to know when they need to know it, using appropriate patient education tools. Patients and caregivers are largely responsible for CVC care and central line-associated bloodstream infection prevention outside of acute care hospitals and long-term care settings, and HCP take seriously their obligation to provide them with appropriate education and tools to best enhance their ability to keep themselves safe.

Vascular Access Team Central Line Dressing Changes to Reduce Infection Risk: A Focused Two-Person Approach in High-Risk Patients.

Due to low compliance by bedside nursing with a central line-associated bloodstream infection (CLABSI) prevention bundle and increased CLABSI rates, a mandatory re-education initiative at a 1200-bed university-affiliated hospital was undertaken. Despite this, 2 units, housing high-risk immunocompromised patients, continued to experience increased CLABSI rates. A quality improvement before-after project design in these units replaced bedside nursing staff with 2 nurses from the vascular access team (VAT) to perform central vascular access device (CVAD) dressing changes routinely every 7 days or earlier if needed. The VAT consistently followed the bundled components, including use of chlorhexidine gluconate (CHG)-impregnated dressings on all patients unless an allergy was identified. In this case, a non-CHG transparent semipermeable membrane dressing was used. There were 884 patients with 14 211 CVAD days in the preimplementation period and 1136 patients with 14 225 CVAD days during the postimplementation period. The VAT saw 602 (53.0%) of the 1136 patients, performing at least 1 dressing change in 98% of the patients (n = 589). The combined CLABSI rate for the 2 units decreased from 2.53 per 1000 CVAD days preintervention to 1.62 per 1000 CVAD days postintervention. The estimated incidence rate ratio (IRR) for the intervention was 0.639, a 36.1% reduction in monthly CLABSI rates during the postimplementation period.

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.

Effects of organizational and individual factors on nurses’ practice of central line-associated bloodstream infection prevention

This study explored rarely investigated organizational factors (resource support and organizational culture) in conjunction with well-established individual factors (demographic characteristics, knowledge, and awareness) that impact nurses' practice of central line-associated bloodstream infection (CLABSI) prevention. Self-reported questionnaire data were collected from 173 nurses recruited from departments that use central venous catheters (ie, intensive care units, emergency rooms, hemodialysis rooms, and oncology wards) in tertiary hospitals in South Korea. Multiple regression analyses were performed to examine the effects of individual and organizational factors. Organizational culture (ß=0.350) had the greatest association with CLABSI prevention practice, followed by awareness (ß=0.328) and department (ß=-0.217; all ps<0.01). These variables explained 41.1% of the variance in CLABSI prevention practice (F=20.996, P<.001). Higher self-reported CLABSI prevention practice was associated with a favorable organizational culture and higher awareness. Emergency room nurses' CLABSI prevention practice was notably inferior as compared to nurses in other departments. Organizational culture is the most significant factor affecting nurses' practice of CLABSI prevention. An organizational culture with environmental improvements and resource support as well as infection prevention education and awareness-building programs should be fostered.

A helping hand: The impact of a central line insertion support team

As part of a central line-associated bloodstream infections prevention initiative, our academic medical center formed a dedicated nursing team to assist with central line insertions and provide support with caring for difficult lines and dressings. During the program's first 3 years, the proportion of insertion-related central line-associated bloodstream infections occurring in areas within the team's scope declined overall by 47%.

Incidence Rateand Risk Factors of Central Line-Associated Bloodstream Infection

Objective: Determination of incidence rates and some risk factors for Central Line-Associated Bloodstream Infection (CLABSI) at the Neonatal Center of Vietnam National Children's Hospital. Methods: 416 neonates who were inserted central line from 01/01/2021 to 30/06/2022 were enrolled in our study. CLABSI was defined as CDC 2017 criteria (LCBI3). The primary factors included obstetric history, perinatal history, characteristics of catheters, duration of catheter placement, etc. Result: A total of 672 central lines were placed in 416 infants. Of these, 32 CLABSI cases were identified. Rates of CLABSI was 5.7 infections per 1000 catheter days. Predisposing factors included duration of catheter placement of more than 28 days (OR = 2.9; 95% CI: 1.03 – 8), abdominal condition (OR = 5.3; 95% CI: 1.5 – 18.6) and steroid used (OR 5.3; CI 1.98 – 14.3). Conclusion: The “CLABSI prevention package” was effective in reducing the CLABSI rate and could be applied in other hospitals.

INTENSIVE CARE NURSES' KNOWLEDGE, PRACTICE AND ATTITUDE IN PREVENTION OF CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTION (CLABSI)

Central line-associated bloodstream infections (CLABSI) are mainly preventable with evidence-based guidelines. However, it needs to be made clear how well these guidelines are followed in critical care units in Malaysia. Therefore, this study evaluates critical care nurses’ knowledge, practices, and attitude toward evidence-based guidelines for preventing CLABSIs issued by the Centers for Disease Control and Prevention and the Malaysia Ministry of Health. This study aims to identify the level of knowledge, practice, and attitudes regarding preventing CLABSI among critical care nurses in a teaching hospital. A cross-sectional descriptive study was carried out among 203 nurses working in seven units consisting of the Intensive Care Unit (ICU), Coronary Care Unit (CCU), Intermediate Dependency care Unit (IDCU), Neonatal Intensive Care Unit (NICU), Neurosurgery Intensive Care Unit (Neuro ICU), Cardiac Intensive Care Unit (CICU), and Pediatric Intensive Care Unit (PICU) in University Malaya Medical Center in Kuala Lumpur. Nurses completed online questionnaires regarding their demographic characteristics, knowledge, practices, and attitudes toward evidence-based guidelines for preventing CLABSIs from December 2022 to January 2023. The data was analyzed using T-Test, ANOVA, and Fisher’s Exact Test. 203 ICU nurses completed the questionnaire, and none correctly answered all the knowledge-related questions. The response rate of the correct answer regarding the knowledge question was only 49.7%. Mean scores for 11 questions regarding knowledge of evidence-based guidelines for preventing CLABSI were low, 5.85 (± 1.29). Meanwhile, individual total scores were significantly associated with time spent as a nurse in the ICU (2–4 years). The mean score for eight questions related to CLABSI prevention was 4.19 (± 0.50), which was acceptable for the compliance score. There was an association between nurses’ gender (p-value: 0.01) and their duration of working experiences in the ICU (p-value: 0.04) with the practice regarding the prevention of CLABSI. The overall mean score for nurses’ attitudes toward the guidelines was high; 8.63 (± 1.37). However, there was no association between the demographic characteristic and attitude regarding preventing CLABSI. The knowledge and practice of ICU nurses need to be improved. Regular training with the implementation of available guidelines and protocols was essential to improve the knowledge and compliance on preventing CLABSIs in ICUs.

Using a Comprehensive On-Site Assessment Process to Reduce Central Line-Associated Bloodstream Infection Rates.

Central line-associated bloodstream infection (CLABSI) rates increased substantially in the United States following the emergence of COVID-19 and subsequent surges. The pandemic resulted in hospital capacities being exceeded and crisis standards of care being implemented for sustained periods. As COVID-19 rates in the United States began to stabilize, some facilities did not return to previous CLABSI rates, indicating a change in practices that had a longer-term impact on CLABSI prevention. The authors' large health care system observed similar increases in CLABSI following the emergence of COVID-19, prompting investigation and intervention in the form of a quality improvement project. To identify changes related to ongoing increases in CLABSI, an assessment team conducted standardized on-site assessments at 11 facilities. Site assessments were considered an intervention, as they involved rigorous preassessment investigations and interviews, case reviews, practice observations, on-site staff interviews, and postassessment support for additional interventions. Nine facilities had enough postassessment data to analyze the impact of intervention. The overall CLABSI rate (infections per 1000 line days) at the 9 facilities in the 6 months prior to intervention was 1.42, and the postassessment rate in the 6 months following intervention was 0.44. This indicates the effectiveness of facility-specific investigation followed by targeted performance improvements to reduce the rate of CLABSI.

Implementation of Supportive Care Program to Decrease CLABSI in a Middle East Pediatric Hematology and Oncology Inpatient Unit.

Background: Central venous catheters (CVCs) support the administration of chemotherapy and other medications, blood products, fluids, and nutrient infusions, and reduce the need for peripheral blood sampling in children with cancer. CVC use is also associated with the risk of central-line-associated bloodstream infection (CLABSI). Despite the implementation of CLABSI care bundles, CLABSI prevention remains challenging. Method: This project implemented supportive preventive care interventions to decrease CLABSI in pediatric hematology/oncology patients in a tertiary hospital in the Middle East region. Interventions included bathing or skin care once daily, oral care twice daily, and ambulating patients three times daily. Parent and staff education materials were developed. The project moniker was Step 1-2-3, inspired by successful implementations of such measures in a U.S. cohort showing reduced CLABSI rates. The project used a mixed methods approach. We report outcomes through August 2022. Results: Pre-project (12/2019-05/2020) five CLABSIs occurred in the inpatient unit. Following the implementation of Step 1-2-3, Pediatric Oncology achieved 492 CLABSI-free days. Six CLABSIs then occurred over a short period of time between October 2021 and January 2022, which was associated with high levels of patient acuity and staff sick leave. The inpatient ward remained CLABSI-free from January 9, 2022, through August 2022. Discussion: Extended periods of CLABSI-free care in a pediatric hematology/oncology unit are achievable. A variety of factors contribute to the sustainability of being CLABSI-free. Data collection and analysis are important factors which aided in our understanding of our own CLABSI events.

Compliance With Central Line Maintenance Bundle and Infection Rates.

Reliable bundle performance is the mainstay of central line-associated bloodstream infections (CLABSI) prevention despite an unclear relationship between bundle reliability and outcomes. Our primary objective was to evaluate the correlation between reported bundle compliance and CLABSI rate in the Solutions for Patient Safety network. The secondary objective was to identify which hospital and process factors impact this correlation. We examined data on bundle compliance and monthly CLABSI rates from January 11 to December 21 in 159 hospitals. The correlation (adjusting for temporal trend) between CLABSI rates and bundle compliance was done at the network level. Negative binomial regression was done to detect the impact of hospital type, central line audit rate, and adoption of a comprehensive safety culture program on the association between bundle compliance and CLABSI rates. During the study, hospitals reported 27 196 CLABSI on 20 274 565 line days (1.34 CLABSI/1000 line days). Out of 2 460 133 observed bundle opportunities, 2 085 700 (84%) were compliant. There was a negative correlation between the monthly bundle reliability and monthly CLABSI rate (-0.35, P <.001). After adjusting for the temporal trend, the partial correlation was -0.25 (P = .004). On negative binomial regression, significant positive interaction was only noted for the hospital type, with Hospital Within Hospital (but not freestanding children's hospitals) revealing a significant association between compliance ≥95% and lower CLABSI rates. Adherence to best practice guidelines is associated with a reduction in CLABSI rate. Hospital-level factors (hospitals within hospitals vs freestanding), but not process-related (central line audit rate and safety culture training), impact this association.