Central Line-associated Bloodstream Infections Prevention Research Articles

A telehealth approach to central line-associated bloodstream infection prevention activities in nursing homes: the SAFER lines program.

To evaluate the impact of a mobile-app-based central line-associated bloodstream infection (CLABSI) prevention program in nursing home residents with peripherally inserted central catheters (PICCs). Pre-post prospective cohort study with baseline (September 2015-December 2016), phase-in (January 2017-April 2017), and intervention (May 2017-December 2018). Generalized linear mixed models compared intervention with baseline frequency of localized inflammation/infection, dressing peeling, and infection-related hospitalizations. Cox proportional hazards models compared days-to-removal of lines with localized inflammation/infection. Six nursing homes in Orange County, California. Adult nursing home residents with PICCs. CLABSI prevention program consisting of an actionable scoring system for identifying insertion site infection/inflammation coupled with a mobile-app enabling photo-assessments and automated physician alerting for remote response. We completed 8,131 assessments of 817 PICCs in 719 residents (baseline: 4,865 assessments, 422 PICCs, 385 residents; intervention: 4,264 assessments, 395 PICCs, 334 residents). The intervention was associated with 57% lower odds of peeling dressings (OR 0.43, 95% CI 0.28-0.64, P < .001), 73% lower local inflammation/infection (OR = 0.27, 95% CI: 0.13-0.56, P < .001), and 41% lower risk of infection-related hospitalizations (OR = 0.59, 95% CI: 0.42-0.83, P = .002). Physician mobile-app alerting and response enabled 62% lower risk of lines remaining in place after inflammation/infection was identified (HR 0.38, CI: 0.24-0.62, P < .001) and 95% faster removal of infected lines from mean (SD) 19 (20) to 1 (2) days. A mobile-app-based CLABSI prevention program decreased the frequency of inflamed/infected central line insertion sites, improved dressing integrity, increased speed of removal when inflammation/infection were found, and reduced infection-related hospitalization risk.

Healthcare Workers’ Knowledge, Practice and Associated Factors Towards Prevention of Central Line-associated Blood Stream Infections in Cardiac Centres of Addis Ababa, Ethiopia, 2024

Introduction: Preventing central line-associated bloodstream infections (CLABSIs) in healthcare settings reduces morbidity, mortality, and healthcare costs. This study aimed to assess healthcare workers’ (HCWs) knowledge, practice, and associated factors regarding CLABSIs prevention in Addis Ababa cardiac units. Methods: From January 10 to February 10, 2024, in seven cardiac centres in Addis Ababa, we employed a hospital-based cross-sectional study design and participants were chosen by simple random sampling. Data were entered using EpiData version 3.1 and exported and analysed using SPSS version 25. Multivariable logistic regression analysis and variables with p value &lt;.05 were considered statistically significant. Results: The magnitude of HCWs knowledge and practice towards the prevention of CLABSIs was 85.8% (95% CI: 82.38%, 89.22%) and 73.5% (95% CI: 69.17%, 77.83%), respectively. After adjusted analysis, a bachelor’s degree or higher (AOR: 2.086, 95% CI: 1.127, 3.860), participating in a peer education programme (AOR: 2.365, 95% CI: 1.274, 5.713), and training (AOR: 2.820, 95% CI: 1.392, 9.590) were factors associated with knowledge. Male sex (AOR: 2.059, 95% CI: 1.223, 3.467), more than five years of work experience (AOR: 2.073, 95% CI: 1.149, 3.739), and training (AOR: 3.857, 95% CI: 2.180, 6.826) were factors associated with practice. Conclusions: More than three-fourths and approximately three-fourths of healthcare workers in cardiac centres in Addis Ababa had good knowledge and good practice towards the prevention of CLABSIs. Healthcare professionals involved in patient care should receive ongoing, updated CLABSI prevention training integrated into professional development initiatives.

Evaluating the Adequacy of Central Line-Associated Bloodstream Infection As a Quality Measure: A Cross-Sectional Analysis at a Single Tertiary Care Center.

The current definition of central line-associated bloodstream infection (CLABSI) may overestimate the true incidence of CLABSI as it is often unclear whether the bloodstream infection (BSI) is secondary to the central line or due to another infectious source. We aimed to assess the prevalence and outcomes of central CLABSI at our institution, to identify opportunities for improvement, appropriately direct efforts for infection reduction, and identify gaps in the CLABSI definition and its application as a quality measure. Retrospective cross-sectional study of patients identified to have a CLABSI in the period 2018-2022 cared for at the value-based purchasing (VBP) units of a 1200-bed tertiary care hospital located in Cleveland, OH. Each CLABSI episode was assessed for relationship with central venous catheter (CVC), suspected secondary source of BSI, mortality associated with the CLABSI hospital encounter, and availability of infectious disease physician or primary physician documentation of infectious source. CLABSI episodes were classified as CVC related, CVC unrelated, and CVC relationship unclear. Mortality during the same encounter as the CLABSI event was assessed as an outcome measure. Descriptive statistics were performed. A total of 340 CLABSI episodes occurred in adult patients in VBP units. Majority of the CLABSI, 77.5% (266), occurred in the ICU. Of the CLABSI analyzed, 31.5% (107) were classified as unrelated to the CVC; 25.0% (85) had an unclear source; 43% (148) were classified as CVC related. For CVC-related cases, Staphylococcus and Candida were the predominant organisms. For the CVC unrelated and unclear groups Enterococcus was most prevalent. The mortality rate was lowest among patients classified with a CVC-related BSI. The positive predictive value (PPV) of the Centers for Disease Control and Prevention CLABSI definition to predict a true CVC-related infection was found to be 58.0%. The definition of CLABSI as a surrogate for catheter-related BSI is inadequate, with a PPV of 58.0% (43.1-67.6%). Efforts should be redirected toward revising the CLABSI definition and possibly reevaluating its criteria. Resources should be assigned to further investigate and systematically prevent BSIs from secondary sources while adhering to existing CLABSI prevention bundles.

The adoption and compliance to central line-associated bloodstream infection insertion and maintenance bundle programs in intensive care unit settings across Canada.

Evidence-based insertion and maintenance bundles are effective in reducing the incidence of central line-associated bloodstream infections (CLABSI) in intensive care unit (ICU) settings. We studied the adoption and compliance of CLABSI prevention bundle programs and CLABSI rates in ICUs in a large network of acute care hospitals across Canada.

Prevention and control status of central line-associated bloodstream infection in intensive care unit in Shandong province: a cross-sectional survey analysis

To provide evidence for further reducing the incidence of central line-associated bloodstream infection (CLABSI) according to investigation of the prevention and control of CLABSI in intensive care unit (ICU) in Shandong Province. The questionnaire was developed by experts from Shandong Critical Care Medical Quality Control Center, combining domestic and foreign guidelines, consensus and research. A convenient sampling method was used to recruit survey subjects online from October 11 to 31, 2023 in the province to investigate the management status of central venous catheter (CVC) in ICU units of secondary and above hospitals. A total of 201 valid data were collected, involving 186 hospitals in the province, with a total of 201 ICU units, mainly comprehensive ICU (91%). The beds in ICU units were mainly single rooms (89%) and triple rooms (79%), and the ratio of doctors to total beds was 0.54 : 1. The training on the knowledge and operation of intravascular catheter-associated bloodstream infection in each ICU unit was mainly irregular (49%), and 96% of the catheter operators were authorized by the hospital. In terms of CVC selection, 89% of ICU units used dual-chamber CVC, and 86% of ICU units used catheters without antibiotic coating. When selecting the placement site, for conventional CVC catheterization, 65% preferred subclavian vein. Femoral vein was preferred in 87% of ICU units undergoing continuous renal replacement therapy. 95% of ICU units had established standardized operation procedure (SOP) for CVC placement. 86% of ICU units were capable of ultrasound positioning or guided puncture at the time of catheterization. During catheterization, 88% of ICU units met the sterile dress code. Before and after catheterzation, 81% and 77% of ICU units standardized hand hygiene. Only 31% of ICU units were covered from head to toe by aseptic wipes. For the choice of skin disinfectant, the majority of ICU units (72%) only used iodophor. After tube placement, 54% of ICU units chose sterile transparent dressing and 25% chose sterile gauze dressing. 98% of ICU units were sutured to secure the catheter. Regarding catheter replacement and removal, 45% of ICU units could not be removed or replaced within 2 days in emergency situations where the principle of sterility was not guaranteed. When CLABSI was suspected, 55% of ICU units were able to obtain the catheter tip, transcatheter blood culture, and contralateral peripheral vein blood culture at the same time. For CVC replacement frequency, most ICU units (75%) would not be replaced regularly, and some ICU units would be replaced regularly, but the frequency of replacement was different. For CLABSI prevention and control, 82% of ICU units developed a verification form or supervision form. When analyzing the sources of CLABSI data, most of them were filled in by themselves (60%). As for the frequency of data analysis, 57% were once a month. All ICU units in Shandong Province are standardized in terms of the authorization of operators, the formulation of SOP, the formulation and implementation of verification form and supervision form, ultrasound-guided puncture, and hand hygiene before and after catheterization. However, there are still deficiencies in the training on knowledge and operation of intravascular catheter-associated bloodstream infections, maximum aseptic coverage, catheter replacement and removal, and the reporting sources of CLABSI data, which need to be strengthened in the follow-up work. At present, the selection of CVC, the selection of catheterization site, the selection of skin disinfectant and the selection of dressings after catheterization still need further research.

Improving Maintenance of Central Line Dressing to Reduce Risk of Central Line-Associated Bloodstream Infections in an Acute-Care Setting.

Central line-associated bloodstream infections (CLABSI) increase morbidity, mortality, and healthcare costs. Central venous access device (CVAD) dressing integrity is critical to prevent CLABSI. From the First Quarter to the Third Quarter of 2023, CLABSI rates related to disruption in CVAD dressing integrity increased significantly at our facility. Despite the delivery of education, competency validation, and checklist implementation, CLABSI rates remained high, making this our top strategic priority.The purpose of this quality improvement initiative was to determine if gum mastic adhesive and hemostatic powder would improve dressing integrity and decrease CLABSI rates related to disruption of central line dressings. With pre- and post-CVAD dressing data, utilizing rapid Plan-Do-Study-Act methodology to drive improvement, this quality improvement initiative was conducted in a 603-bed, tertiary level I trauma center. A multidisciplinary team was formed consisting of infection prevention, quality, nursing, and vascular access personnel, with the goal of improving central line dressing integrity and increasing dressing life. In-depth training included standardized CLABSI prevention bundles and central line dressing change guidelines to include the application of gum mastic adhesive and topical hemostatic product, and was tested on pilot units before implementation. Bleeding at the central line insertion site reduced by 23.6% with the use of a hemostatic powder. Central line dressing integrity was improved by 33.5% with the use of a liquid gum mastic adhesive and dressing life improved by 140.7%. Additionally, there was only 1 CLASBI and no medical adhesive-related skin injuries reported since the implementation of the bundle (October 2023). Topical hemostatic powder and liquid gum mastic adhesive paired with the adhesive remover for safe removal were shown to be effective in improving integrity in central line dressings for the prevention of CLABSIs. In October 2023, the dressing change integrity bundle was scaled to all units within the facility.

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

The 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). A retrospective, before-after study that evaluated short-term, nonhemodialysis 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. Out of the ICU, CVC-utilization ratio (CVC-UR) and pCVC-UR reduced significantly (4.1-2.7/100 hospital days, P=.005; and 28%-21%,P=.02, respectively). Bundle-prevention measures improved, and CLABSI rates reduced postintervention (7.9-3.6/1,000 CVC days, P=.03). In the ICU, pCVC-UR reduced significantly (29%-15%, P<.0001). Baseline ICU-CLABSI rates were low and did not reduce postintervention. Sensitizing physicians to the existence and duration of CVCs accompanied by 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.