Central Line Utilization Research Articles

QAPI 140 - Infection Prevention Partners in Intensive Care Units: Participating in Multidisciplinary Rounds Decreases CLABSIs and Central Line Utilization Rates

QAPI 140 - Infection Prevention Partners in Intensive Care Units: Participating in Multidisciplinary Rounds Decreases CLABSIs and Central Line Utilization Rates

QAPI 145 - New Ways to Decrease Central Line Utilization Rates

QAPI 145 - New Ways to Decrease Central Line Utilization Rates

Reduction in Central Line Days, Central Line Utilization Ratio, and Central Line Associated Blood Stream Infections Through Hospital Based Intensivist Program

Purpose: We tracked the effect that a newly implemented intensivist program following a restrictive venous access policy emphasizing mid-lines and peripheral IVs over central lines had on central line days, central line utilization ratio, and central line associated blood stream infections in a non-academic hospital. Methods: Prior to June 2021, Mobile Infirmary’s intensive care units (ICU) were open units staffed with physicians with combined ICU, ward, and outpatient responsibilities. In June of 2021, an intensivist program was started to transition the hospital to a closed ICU model with intensivists whose sole responsibility was the ICU. Concurrently, a policy was implemented that emphasized avoidance of central lines unless indicated by defined criteria (MICAR Criteria). We tracked central line days (CLD), central line utilization ratio (CLUR) and central line associated blood stream infections (CLABSI) rates and compared it to these same unit for the 2 years prior to the start of the program. Results: There was a reduction in CLD from 628 per month to 425 per month (RRR of 32%), a reduction in CLUR from 0.62 to 0.46 (RRR of 26%), and a reduction in CLABSI rate from 1.65 to 0.78 (RRR of 51%). When looking at the number of central line infections per expected line days, there was a reduction from 20.2 to 6.6 (P=0.04). The central line infection rate relative to patient days showed a reduction from 10.3 to 3.6 (P=0.04). Conclusions: Over utilization of central lines and the subsequent increase in central line infections represents a major complication of ICU care. By combining an intensivist program with a venous access policy designed to reduce dependence on central lines, we showed a clinically significant reduction in central line infections and a reduction in central line days and central line utilization ratio without any significant increase in IV extravasations.

Innovative Approaches to Monitor Central Line Associated Bloodstream Infections (CLABSIs) Bundle Efficacy in Intensive Care Unit (ICU): Role of Device Standardized Infection Rate (dSIR) and Standardized Utilization Ratio (SUR)-An Italian Experience.

In several settings, the COVID-19 pandemic determined a negative impact on the occurrence of healthcare-associated infection, particularly for on central lines associated bloodstream infections (CLABSI). In our setting, we observed a significant increase in CLABSI in our intensive care unit (ICU) during 2020 and 2021 vs. 2018 to 2019. A refresher training activity on central venous catheter (CVC) management bundles was carried out in September-October 2021 for the ICU health staff. We assessed the impact of bundle implementation by means of standardized indicators, such as the Device Utilization Ratio (DUR), in this case, the Central Line Utilization Ratio, the Standardized Utilization Ratio (SUR), and the device Standardized Infection Ratio (dSIR). Standardized ratios for device use and infection ratio were computed using data from 2018 and 2019 as expectation data. After bundle implementation, we observed a significant reduction of dSIR (p < 0.001), which dropped from 3.23 and 2.99 in the 2020-2021 biennium to 1.11 in 2022 (CLABSI in the first quarter only); no more CLABSI were observed afterwards. Standardized ratios proved helpful in identify increasing trends of CLABSI in the ICU and monitoring the impact of a simple effective tool, i.e., training on and implementation of a bundle for CVC management.

Utilizing a Multi-disciplinary Approach to Reduce Central Line Utilization and Subsequent Elimination of CLABSI

Utilizing a Multi-disciplinary Approach to Reduce Central Line Utilization and Subsequent Elimination of CLABSI

Quality Improvement Initiative in a Community Hospital to Reduce Central Line Device Utilization Rate.

Background The intensive care unit (ICU) in a community hospital insouthwest Minnesota saw a steady increase in central line-associated bloodstream infections (CLABSI)and an increase in the utilization of central lines. The baseline CLABSI rate was 11.36 at the start of the project, which was the highest in the last five years. The corresponding device utilization rate (DUR) was 64%, which increased from a pre-COVID pandemic rate of 45%. Aim The aim of this project was to decrease the ICU DUR by 37.5% from a baseline of 64% to 40% within six months without adversely impacting staff satisfaction. Methods A multidisciplinary team using the define, measure, analyze, improve, and control (DMAIC) methodology reviewed the potential causes of the increased use of central lines in the ICU. The team identified the following major causal themes: process, communication, education, and closed-loop feedback. Once the root causes were determined, suitable countermeasures were identified and implemented to address these barriers. These included reviewing current guidelines, enhanced care team rounding, staff education, and the creation of a vascular access indication algorithm. The team met biweekly to study the current state, determine the future state, evaluate feedback, and guide implementation. Results The pandemic saw a surge in the number of severely ill patients in the ICU, which may have caused an increase in the DUR. The project heightened the awareness of the increased DUR and its impact on the CLABSI rate. The initiation of discussion around this project led to an immediate decline in DUR via increased awareness and focus. As interventions were introduced and implemented, the DUR continued to decrease at a steady rate. Post implementation, the DUR met the project goal of less than 40%. The team continued to track progress and monitor feedback. The DUR continued to meet the goal for three months post implementation. Since the start of the project, there have been no CLABSI events reported. This effort has positively impacted safety and patient outcomes. Conclusions Through a defined process, the central line utilization rate in our ICU was decreased to 37.5% to meet the target goal and has been sustained.

Investigating potential drivers of increased central-line–associated bloodstream infections during the SARS-CoV-2 omicron-variant surge

Background: Central-line–associated bloodstream infection (CLABSI) rates increased nationally during COVID-19, the drivers of which are still being characterized in the literature. CLABSI rates doubled during the SARS-CoV-2 omicron-variant surge at our rural academic medical center. We sought to identify potential drivers of CLABSIs by comparing period- and patient-specific characteristics of this COVID-19 surge to a historical control period. Methods: We defined the study period as the time of highest COVID-19 burden at our hospital (July 2021–June 2022) and the control period as the previous 2 years (July 2019–June 2021). We compared NHSN CLABSI standardized infection ratios (SIRs), central-line standardized utilization ratios (SURs), completion of practice evaluation tools (PETs) for monitoring of central-line bundle compliance, and proportions of traveling nurses. We performed chart reviews to determine patient-specific characteristics of NHSN CLABSIs during these periods, including demographics, comorbidities, central-line characteristics and care, and microbiology. Results: The CLABSI SIR was significantly higher during the study period than the control period (0.89 vs 0.52; P = .03); the SUR was significantly higher during the study period (1.08 vs 1.02; P &lt; .01); the PET completion per 100 central-line days was significantly lower during the study period (23.0 vs 31.5; P &lt; .01); and the proportion of traveling nurses was significantly higher during the study period (0.20 vs 0.08; P &lt; .01) (Fig. 1). Patients with NHSN CLABSIs during the study period were more likely to have a history of COVID-19 (27% vs 3%; P = .01) and were more likely to receive a higher level of care (60% vs 27%; P = .02). During the study period, more patients had multilumen catheters (87% vs 61%; P = .04). The type of catheter, catheter care (ie, dressing changes and chlorhexidine bathing), catheter duration before CLABSI, and associated microbiology were similar between the study and control periods (Table 1). Conclusions: During the SARS-CoV-2 omicron-variant surge, the increase in CLABSIs at our hospital was significantly associated with increased central-line utilization, decreased PET completion, and increased proportion of traveling nurses. Critical illness and multilumen catheters were significant patient-specific factors that differed between CLABSIs from the study and control periods. We did not observe differences in catheter type, duration, or catheter care. Our study highlights key modifiable risk factors for CLABSI reduction. These findings may be surrogates for other difficult-to-measure challenges related to the culture of safety during a global pandemic, such as staff education related to infection prevention and daily review of central-line necessity.Disclosures: None

Central Line Associated Blood Stream Infection Reduction at an Academic Community Hospital During the COVID-19 Pandemic to Achieve Patient Safety

During the COVID-19 pandemic, many institutions saw an overall increase in central line associated blood stream infection (CLABSI) events. CLABSI events can be prevented by decreasing central line utilization, improving practices during central line insertion and maintenance phases, and daily surveillance for necessity. A belief that zero harm to patients is possible and development of a supportive organizational culture with visible leadership were key to reducing CLABSI events and creating long-lasting change, even during the pandemic.

Reducing Central Line Utilization by Peripherally Infusing Vasopressors.

Central line-associated bloodstream infection is a preventable contributor to excess death and excess cost in the health care system. Vasopressor infusion is one of the primary reasons for central line placement. In the medical intensive care unit (MICU) at an academic medical center, there was no standard practice for peripheral versus central infusion of vasopressors. The objective of this quality improvement project was to implement an evidence-based, nurse-driven protocol to guide the peripheral infusion of vasopressors. The goal was to reduce central line utilization by 10%. Education on the protocol was provided to the MICU nurses, MICU residents, and crisis nurses, followed by a 16-week implementation period. Nursing staff were also surveyed preimplementation and postimplementation of the protocol. Central line utilization was reduced by 37.9%, and there were no central line-associated bloodstream infections recorded during project implementation. Most of the nursing staff indicated that use of the protocol increased their confidence in administering vasopressors without a central line. No significant extravasation events occurred. Although a causal link between implementation of this protocol and reduction of central line utilization cannot be established, the reduction is clinically meaningful given the known risks of central lines. Increased nursing staff confidence also provides support for continued use of the protocol. A nurse-driven protocol to guide the peripheral infusion of vasopressors can be effectively implemented into nursing practice.

Investigating potential drivers of increased central line...associated bloodstream infections during the coronavirus disease 2019 (COVID-19) Omicron surge

Central line...associated bloodstream infection rates increased during the Omicron surge at our rural academic medical center. To identify potential drivers of this increase, we investigated period- and patient-specific factors associated with the increase in central line...associated bloodstream infection. Increased central line utilization, decreased central line bundle compliance monitoring, increased proportion of traveling nurses, increased short-term venous catheter use in the internal jugular vein, increased multilumen catheter use, decreased port...associated infection, and increased patient acuity were significantly associated with the surge. Our results helped us target our local infection prevention efforts.

1213: A COMPARISON OF CORTICOSTEROIDS VERSUS VASOPRESSIN AS A SECOND-LINE ADD-ON AGENT IN SEPTIC SHOCK

Introduction: First-line hemodynamic support and the vasopressor of choice for septic shock is norepinephrine. There is considerable variability in practice and a paucity of data regarding when to add vasopressin or corticosteroids, and in what sequence. Defining which agent to administer secondarily to norepinephrine for escalation of hemodynamic support could reduce unnecessary adverse events from central line utilization, decrease adverse drug events, and may result in more economic management of patients. Methods: This is a single-center, retrospective cohort study of patients admitted to the intensive care unit (ICU) between October 2020 and January 2021. Patients were included if > 18 years of age and received norepinephrine plus either vasopressin or corticosteroids as second-line support for septic shock. Patients were excluded if they were on corticosteroids prior to admission. The primary outcome was the percentage of patients who required escalation of hemodynamic support after receipt of a second-line agent within 2 hours. Secondary outcomes included ICU length of stay (LOS), hospital LOS, in-hospital mortality, total hours on vasopressors, acute kidney injury (AKI), need for dialysis and/or renal replacement therapy, superinfection > 48 hours from time zero, and central line utilization. Results: Of 1287 patients screened for inclusion, 142 patients were included in the primary analysis. Eighty-three patients received vasopressin first, 43 patients received corticosteroids first, and 13 patients received both vasopressin and corticosteroids at the same time. For the primary outcome, 15.7%, 32.6%, 7.7% required escalation of norepinephrine within 2 hours, respectively. Respectively, mortality rates were 62.7%, 65.1%, and 76.9%. Central line utilization was on average 12.5 days, 6.6 days, and 5 days among the respective groups. Conclusions: There exists a lack of data when examining the utilization of vasopressin and corticosteroids as second-line add-on agents in septic shock. There was a higher mortality rate than expected among the population who received both corticosteroids and vasopressin at the same time. Central line utilization was lower in those who received corticosteroids first and for those who received both at the same time.

2018. Comparison of Trends in Hospital-Onset Bloodstream Infections (HOBSIs) and Central Line Associated Bloodstream Infections (CLABSIs) across a Three-Hospital Health System in the COVID Era

Abstract Background Hospital-onset bloodstream infection (HOBSI) incidence has been proposed as a complementary quality metric to central line-associated bloodstream infection (CLABSI) surveillance. Several recent studies have detailed increases in median HOBSI and CLABSI rates during the COVID-19 pandemic. We sought to understand trends in HOBSI and CLABSI rates at a single health system in the context of COVID-19. Methods We conducted a retrospective analysis of HOBSIs and CLABSIs at a three-hospital health system from 2017 to 2021 (Figure 1). We compared counts, denominators, and demographic data for HOBSIs and CLABSIs between the pre-pandemic (1/1/2017-3/30/2020) and pandemic period (4/1/2020-12/31/2021) (Table 1). We applied Poisson or negative binomial regression models to estimate the monthly change in incidence of HO-BSI and CLABSI rates over the study period. Figure 1:Definitions applied for hospital-onset bloodstream infections (HO-BSIs) and central line-associated bloodstream infections (CLABSIs). Potentially contaminated blood cultures were identified by microbiology laboratory technicians as any set of blood culture in which a single bottle was positive for organisms typically considered as skin contaminants. Uncertain cases undergo secondary review by senior lab technicians. Table 1:Count, denominator, and device utilization ratio data for hospital-onset bloodstream infections (HO-BSIs) and central line-associated bloodstream infections (CLABSIs)Note that central line utilization increased upon regression analysis (p&amp;lt;0.001). Results The median monthly HOBSI rate per 1,000 patient days increased from 1.0 in the pre-pandemic to 1.3 (p&amp;lt; 0.01) in the pandemic period, whereas the median monthly CLABSI rate per central line days was stable (1.01 to 0.88; p=0.1; Table 2). Our regression analysis found that monthly rates of HO-BSIs increased throughout the study, but the increase was not associated with the onset of the COVID-19 pandemic based on comparisons of model fit (Figure 2; Table 3). Despite an increase in central line utilization, regression modelling found no changes in monthly CLABSIs rates with respect to time and the COVID-19 pandemic. Incidence of HOBSIs and CLABSIs by common nosocomial organisms generally increased over this time period, though time to infection onset remained unchanged in our studied population (Table 2). Table 2:Epidemiology and demographic characteristics of hospital-onset bloodstream infections (HO-BSIs) and central line-associated bloodstream infections (CLABSIs).Figure 2:Regression analysis of monthly rates of HO-BSIs and CLABSIs over time per patient days (left) and CLABSIs per central line days (right). Gray areas denote COVID-19 pandemic period (April 2020 to December 2021). Provided p values refer to the statistical significance of the coefficient of the time variable in each model. Table 3:Likelihood ratio tests comparing regression models.No statistical significance was noted between models that included COVID-19 variables (including a time-trended post-pandemic variable) and models that were only time-dependent. Conclusion HOBSIs rates did not correlate with CLABSI incidence across a three-hospital health system from 2017 and 2021, as rates of HOBSI increased but CLABSI rates remained flat. Our observed increase in HOBSI rates did not correlate with the onset of the COVID-19 pandemic, and caution should be used in modeling the effects of COVID-19 without time-trended analysis. Further evaluation is needed to understand the etiology, epidemiology, and preventability of HO-BSI. Disclosures All Authors: No reported disclosures.

Effectiveness of insertion care bundle to prevent Central-line-associated bloodstream infections at Pediatric ICU

Purpose: Central-line-associated bloodstream infections are the most common healthcare- associated- associated infections in Pediatric intensive care units worldwide. The aim of this survey was to quantify the impact of central-line care bundle insertion to the prevention Central-line-associated bloodstream infections in a Greek Pediatric Intensive Care Unit. Methods: All patients with non- tunneled central venous catheter admitted to the unit between October 2012 and October 2015 were included in the cohort study. After twenty-six months of surveillance, a Central-line-associated bloodstream infections prevention insertion bundle was introduced. The insertion bundle derived from the Centers for Disease Control and Prevention recommendations. Results: One hundred fifty one patients were enrolled in the present study. The incidence rates of CLABSIs decreased from 14.0 (pre-intervention period) to 4.8 (post-intervention period) per 1000 central venous catheter-days (p = 0.041, 95% Confidence Interval: 0.7023- 17.7), whilst the central-line utilization ratio was increased from 0.51 to 0.59 (p=&lt;0.002, 95% Confidence Interval: 0.039-0.1258). The insertion-bundle compliance was 95.3% in the post- intervention period. Conclusions: According to the results the implementation of insertion bundle has the potential to reduce the incidence of Central-line-associated bloodstream infections. A prevention strategy targeted on the insertion of vascular access can decrease the incidence rates of Central-line-associated bloodstream in pediatric intensive care units.

Reducing Central-Line-Associated Bloodstream Infections (CLABSI): An Improvement Project in a Specialized Tertiary Hospital.

Central-line-associated bloodstream infections (CLABSI) are preventable hospital-acquired infections that harm and prolong a patient's hospital stay and increase unnecessary hospital expenditure. In collaboration with infection control and hospital epidemiology, the quality management department initiated a performance improvement project to address 144 CLABSI events in 2017. The performance improvement project team used brainstorming to create change ideas presented in a driver diagram. The team then applied plan-do-study-act (PDSA) cycles to implement and monitor the improvements. Finally, the team applied a bundle of interventions that included the following: (a) policies and procedures for central line insertion, maintenance and removal processes standardization, (b) physicians training for line insertion by simulation, (c) an awareness campaign that included recognizing healthcare workers and enhancing patient engagement, (d) performing root cause analysis for the CLABSI events, and (e) automation of central line insertion, and (f) maintenance bundles documentation in the hospital information system. The CLABSI rate per 1000 patient days dropped from 1.5 per 1000 device days to 1.03 per 1000 device days. In addition, CLABSI events reduction was 24% by 2018. Then further reduction of 15% occurred by the end of 2019. Thus, the overall decrease in CLABSI events was 35% from the baseline number of events (i.e., 144 events) in 2017. Another achievement of the project is that 10 units reported zero CLABSI events in 2018 and 2019, of which four units had a high central line utilization rate, more than 40%. The implemented interventions effectively reduced the CLABSI events in the hospital. The project team will continue implementing more interventions with monitoring, aiming to achieve zero CLABSIs over time in all the hospital units.

Sustaining Improvements in CLABSI Reduction in a Pediatric Cardiac Intensive Care Unit.

Introduction:Central line-associated bloodstream infections (CLABSIs) are preventable events that increase morbidity and mortality. The objective of this quality project was to reduce the incidence of CLABSIs in a pediatric cardiothoracic intensive care unit.Methods:Institutional review of an unacceptably high rate of CLABSIs led to the implementation of 4 new interventions. These interventions included: the use of sequential cleaning between line accesses, Kamishibai card audits, central line utilization and entry audits, and proctored simulation of line access.Results:There was a reduction in CLABSI rate from 1.52 per 1,000 central line days in 2018 to 0.37 per 1,000 central line days in 2020 and 0.32 in 2021. Additionally, central line days per 100 patient days decreased from 77 to 70 days over the study period. The cardiothoracic intensive care unit went 389 days without a CLABSI from October 2020 to November 2021.Conclusions:Implementation of multiple interventions led to a successful reduction in the incidence of CLABSIs in our unit, with a sustained reduction over 1 year.

Hospital-acquired bloodstream infections in patients with and without hepatic failure

Background: The NHSN parameter estimate for predicted number of central-line–associated bloodstream infection (CLABSI) is the same for gastroenterology wards as other specialty wards, such as behavioral health and gerontology. We conducted this study to contribute to the body of knowledge surrounding the risk for hospital-acquired bloodstream infection (HABSI) in patients with and without hepatic failure. The Cleveland Clinic is a 1,200-bed, multispecialty hospital with a solid-organ transplant service. Patients with hepatic failure who do not require critical care are housed on 36-bed unit A. On unit A, 43% of patients are under hepatology or gastroenterology service, although 51% of patients are under general internal medicine. Overall, unit A has a high incidence of HABSI. Methods: Surveillance for HABSI and CLABSI is performed at the Cleveland Clinic per NHSN protocol. All patients with a midnight stay on unit A from January 2019 through September 2021 were dichotomized as having hepatic failure (yes or no) if they ever received the International Classification of Diseases Tenth Revision code for “hepatic failure, not elsewhere classified.” We joined the diagnostic code to patient days and central-line-days databases and summarized the data using Microsoft Excel software. We stratified the number of patients, patient days, device days, infection classification, and hospital length of stay by whether the patient had hepatic failure, and we compared the incidence of HABSI and CLABSI between the 2 groups using OpenEpi version 3.01 software. Results: We identified 72 HABSIs among 4,285 patients who stayed on unit A for 30,910 patient days during the study period. The incidences of HABSI in patients with and without hepatic failure were 39.0 and 13.9 per 10,000 patient days, respectively (P &lt; .001). The incidence of CLABSI was 5.4 and 1.9 per 1,000 line days, respectively (P = .01). Patients with hepatic failure stayed longer (11.5 vs 5.9 days), yet the central-line utilization ratios were not substantially different (0.25 vs 0.24). Enterococcus was the most common pathogen involved in CLABSI in both groups (Table 2). Conclusions: Patients with hepatic failure experienced CLABSI more frequently than patients without hepatic failure, stayed longer in the hospital, and were less likely have HABSI attributed to another primary focus of infection according to NHSN definitions. Although hepatic failure may be among the most severe conditions among patients in a gastroenterology ward, we have demonstrated that these units house a population uniquely susceptible to HABSI and CLABSI.Funding: NoneDisclosures: None

Preventing Health Care-Associated Infections Through Implementation of an Interprofessional Visual Management Safety Tracker.

The management of health care associated infections (HAIs) challenges acute care facilities due to variability in practices. The purpose of this quality improvement project was to decrease central line-associated bloodstream infection, catheter-associated urinary tract infection, and Clostridioides difficile infection in a high acuity care environment using a visual management (VM) tool to address practice variations. An acute care unit experienced increasing HAIs. An interprofessional team used Lean methodology to implement a VM tool reflective of evidence-based HAI prevention practices that staff had frequently omitted. A VM tool called the Safety Tracker was created. In 12 months, HAIs decreased from 9 events to 1, with a corresponding reduction in indwelling urinary catheter utilization and central line utilization. More than $160 000 were avoided in health care costs. Creating an interprofessional VM Safety Tracker could significantly reduce HAIs.

Abstract TP85: A Collaborative Approach In The Reduction Of Hospital Acquired Infections In A Neuroscience ICU

Intro: HAIs such as catheter associated urinary tract infections (CAUTIs) and central line associated bloodstream infections (CLABSIs) increase morbidity, mortality, healthcare cost, and account for a significant burden of patient harm. We describe efforts between nursing, Infection Prevention (IP), and clinicians in the reduction of HAI-CAUTIs and HAI-CLABSIs on a neuroscience intensive care unit (NeuroICU) in an academic acute care hospital. Methods: Using the Centers for Disease Control and Prevention’s (CDC) Targeted Assessment for Prevention (TAP) framework [Target, Assess, Prevent], IP identified the Neuro-ICU as having an excess burden of HAI-CAUTIs and HAI-CLABSIs and facilitated interdisciplinary engagement. In partnership, nursing, IP, and Neuro-ICU clinicians, developed action plans focused on foley catheter (FC) and central line (CL) utilization, FC bundle compliance, FC maintenance competency validation, and training on central line maintenance. Monthly meetings to discuss progress and identify barriers were performed. Neuro-ICU clinicians and nurse managers performed device rounds twice a day to discuss device necessity utilizing a nurse-driven protocol, and verified FC and CL removal. This project used the CDC’s National Healthcare Safety Network (NHSN) healthcare-associated infection (HAI) tracking system to compute standardized infection ratios, HAI events, FC utilization, and CL utilization. CLABSI and CAUTI bundle compliance were evaluated using an electronic audit tool. Staff competency validation and education attendance were tracked. The project period was from September 2020-July 2021 for CAUTI and January 2021-July 2021 for CLABSI. Results: HAI-CAUTI events decreased from 6 to 1, the standardized infection ratio (SIR) reduced from 3.003 to 0.593, and the FC utilization ratio decreased from 0.36 to 0.31 from October 2019- August 2020 to September 2020-July 2021. HAI-CLABSI events decreased from 1 to 0, CL utilization ratio decreased from 3.31 to 2.81 from June 2020- December 2020 to January 2021- July 2021. Conclusions: These results suggest that an interdisciplinary approach and robust IP practices may be an effective approach to improving patient safety and reducing patient harm.

770. Impact of COVID-19 Pandemic on Central Line-associated Bloodstream Infections in Metropolitan Detroit

BackgroundRecent publications suggest that central line-associated bloodstream infection (CLABSI) rates have increased in US hospitals during the COVID-19 pandemic. The objective of this study was to evaluate the impact of COVID-19 pandemic on CLABSIs.MethodsThis was a retrospective cross-sectional study comparing CLABSI rate per 1,000 central line (CL) days, blood culture (BC) utilization rate per 1,000 CL days, CL utilization rate per 1,000 patient days, Standardized Infection Ratio (SIR) and Standardized Utilization Ratio (SUR) in the pre-COVID-19 period from January 1, 2019 to December 31, 2019 to the COVID-19 period from April 1, 2020 to March 31, 2021 at an 877-bed tertiary care hospital in Detroit, Michigan. CLABSI, and BC and CL utilization rate were extracted from the electronic medical record (Epic™ Bugsy). SIR and SUR data were extracted from National Healthcare Safety Network (NHSN).ResultsThe average CLABSI rate per 1,000 CL days increased 24% from 1.66 to 2.06. Twenty percent of patients were hospitalized for COVID-19. The BC utilization rate per 1,000 CL days decreased from 0.43 to 0.32 with a 26% reduction. However, CL utilization increased by 28% from 0.25 to 0.32 (Figure 1). However, CLABSIs due to common commensals decreased from 13.8% to 10.9%. The SIR increased significantly from 1.055 to 1.795 (P-value 0.008), resulting in a 70% increase. The overall SUR also increased from 0.900 to 0.988 (P-value < 0.001). Figure 2 is a control chart of the CLABSI rate from July 2019 to April 2021. Figure 1. CLABSI, blood culture utilization and central line utilization rates pre-and during COVID-19 pandemic Figure 2. CLABSI control chart pre-and during COVID-19 pandemicConclusionDuring the COVID-19 pandemic, there was a significant increase in CL utilization, CLABSI rate, SIR and SUR likely due to higher acuity in COVID-19 patients despite a decrease in BC orders. Disclosures All Authors: No reported disclosures

Central Line Utilization and Complications in Infants with Congenital Diaphragmatic Hernia.

Infants with congenital diaphragmatic hernia (CDH) require multiple invasive interventions carrying inherent risks, including central venous and arterial line placement. We hypothesized that specific clinical or catheter characteristics are associated with higher risk of nonelective removal (NER) due to complications and may be amenable to efforts to reduce patient harm. Infants with CDH were identified in the Children's Hospital's Neonatal Database (CHND) from 2010 to 2016. Central line use, duration, and complications resulting in NER are described and analyzed by extracorporeal membrane oxygenation (ECMO) use. A total of 1,106 CDH infants were included; nearly all (98%) had a central line placed, (average of three central lines) with a total dwell time of 22 days (interquartile range [IQR]: 14-39). Umbilical arterial and venous lines were most common, followed by extremity peripherally inserted central catheters (PICCs); 12% (361/3,027 central lines) were removed secondary to complications. Malposition was the most frequent indication for NER and was twice as likely in infants with intrathoracic liver position. One quarter of central lines in those receiving ECMO was placed while receiving this therapy. Central lines are an important component of intensive care for infants with CDH. Careful selection of line type and location and understanding of common complications may attenuate the need for early removal and reduce risk of infection, obstruction, and malposition in this high-risk group of patients. · Central line placement near universal in congenital diaphragmatic hernia infants.. · Mean of three lines placed per patient; total duration 22 days.. · Clinical patient characteristics affect risk..