Central Venous Catheter Infection Research Articles

Early-cannulation arteriovenous grafts are safe and effective in avoiding recurrent tunneled central catheter infection

Abstract Objective Tunneled central venous catheter infection (TCVCi) is a common complication that often necessitates removal of the TCVC and a further TCVC. Theoeretically, insertion of an early-cannualtion graft (ecAVG) early after TCVC infection is possible but not widely practiced with concerns over safety and infection in the ecAVG. With 8 years of ecAVG experience, the aim of this study was to compare the outcomes following TCVC infection, comparing replacement with TCVC (TCVCr) versus immediate ecAVG (ecAVGr). Methods Retrospective comparison of two cohorts, who underwent replacement of an infected TCVC either by an early cannulation graft (n = 18) or by a further central catheter (n = 39). Data were abstracted from a prospectively completed electronic patient record and collected on patient demographics, TCVC insertion, duration and infection, including culture proven bacteriaemia and subsequent access interventions. Results 18/299 patients identified from 2012-2020 had an ecAVG implanted as treatment for a TCVCi. In a one-year time-period (1/1/2015 -31/12/2015) out of 222 TCVC inserted, 39 were as a replacement following a TCVCi. No patient with an ecAVGr developed an immediate infection, nor complication from the procedure. The rate of subsequent vascular access infection was significantly more frequent for those with TCVCr than with an ecAVGr (0.6 vs. 0.1/patient/ 1000 HD days, p < 0.000). The number of further TCVC required was significantly higher in the TCVCr group (7.1 vs. 0.4/patient/ 1000 HD days, p = 0.000). Conclusion An ecAVG early following a TCVC infection is safe, reduces the incidence of subsequent infectious complications and reduces the number of TCVC required, with a better functional patency.

Tissue adhesives for bacterial inhibition in extracorporeal membrane oxygenation cannulae

BackgroundOne of the most serious complications of extracorporeal membrane oxygenation (ECMO) therapy is ECMO cannulae infection, which can occur at quadruple the rate of central venous catheter infections, and significantly impact morbidity and paediatric mortality. The objective of this in vitro observational study was to assess antimicrobial properties of two n-butyl-2-octyl cyanoacrylate tissue adhesive (TA) formulations for bacterial inhibition at peripheral ECMO cannulae insertion sites.MethodsAntimicrobial properties were assessed using modified agar disk-diffusion (n = 3) and simulated agar cannulation insertion site (n = 20) models. Both assays used Staphylococcus epidermidis which was seeded at the edge of the TA or dressing. Microorganism inhibition was visually inspected and evidenced by the presence or absence of a TA bacterial inhibition zone at 24 and 72 h.ResultsBoth TAs provided effective barriers to bacterial migration under cannula dressings, to cannula insertion sites and down cannula tunnels. Additionally, both TAs demonstrated distinct zones of inhibition produced when left to polymerise onto agar plates seeded with S. epidermidis.ConclusionsN-Butyl-2-octyl cyanoacrylate TA appears to inhibit bacterial growth and migration of S. epidermidis. Application of TA to cannulae insertion sites may therefore be a potential bedside strategy for infection prevention in ECMO cannulae, but requires further testing before being used clinically for this purpose.

Early-Cannulation Arteriovenous Grafts Are Safe and Effective in Avoiding Recurrent Tunneled Central Catheter Infection

Tunneled central venous catheter infection (TCVCi) is a common complication that often necessitates removal of the TCVC and replacement by a further TCVC. Theoretically, insertion of an early - cannulation graft (ecAVG) early after TCVC infection is possible but not widely practiced with concerns over safety and infection in the ecAVG. With 8 years of ecAVG experience, the aim of this study was to compare the outcomes following TCVC infection, comparing replacement with TCVC (TCVCr) versus immediate ecAVG (ecAVGr). Retrospective comparison of 2 cohorts, who underwent replacement of an infected TCVC either by an early cannulation graft (n = 18) or by a further central catheter (n = 39). Data were abstracted from a prospectively completed electronic patient record and collected on patient demographics, TCVC insertion, duration and infection, including culture proven bacteriaemia and subsequent access interventions. Eighteen of 299 patients identified from 2012 to 2020 had an ecAVG implanted as treatment for a TCVCi. In a 1-year time-period (January 1, 2015-December 31, 2015) out of 222 TCVC inserted, 39 were as a replacement following a TCVCi. No patient with an ecAVGr developed an immediate infection, nor complication from the procedure. The rate of subsequent vascular access infection was significantly more frequent for those with a TCVCr than with an ecAVGr (0.6 vs. 0.1/patient/1000 HD days, P< 0.000). The number of further TCVC required was significantly higher in the TCVCr group (7.1 vs. 0.4/patient/1000 HD days, P= 0.000). An ecAVG early following a TCVC infection is safe, reduces the incidence of subsequent infectious complications and reduces the number of TCVC required, with a better functional patency.

Genome Sequence of Staphylococcus epidermidis AUH4567, a Clinical Isolate from an Infected Central Venous Catheter.

Staphylococcus epidermidis is a common cause of implant-associated infections, and this is related to its ability to form biofilms. Strain-to-strain variability in biofilm formation is likely caused by genetic differences. Here, we present a draft genome of S. epidermidis AUH4567, which was isolated from a central venous catheter infection.

Recurrent Pseudomonas aeruginosa Bacteremia

Introduction As part of an institutional review board–approved quality improvement project reviewing 10 years of experience (2009–2018) with Pseudomonas aeruginosa bacteremia (PAB) at our institution, we identified 15 patients with recurrent Pseudomonas bacteremia. Because recurrent P. aeruginosa bacteremia (RPAB) is uncommon, we reviewed our patients with PAB to evaluate its occurrence, epidemiology, clinical characteristics, and outcomes of care. Methods This was an institutional review board–approved quality improvement project. We reviewed the medical records of all patients with PAB from January 1, 2009, to December 31, 2018, and identified the subset of patients with RPAB. We report the incidence, epidemiology, source of bacteremia, comorbid conditions, treatment, and outcome for patients with RPAB. We compare these data to previously published series of PAB patients with RPAB. Results We identified 268 episodes of PAB. One patient with 6 occurrences of PAB secondary to injection drug use–associated tricuspid valve endocarditis was excluded because of noncompliance with therapy. This left 262 episodes of PAB for evaluation. Fifteen patients had a total of 19 episodes of RPAB: 13 patients had 2 episodes (1 recurrence each), 1 patient had 3 episodes (2 recurrences), and 1 patient had 5 episodes (4 recurrences). The recurrence rate was 7.3% (19/262). The mean and median ages for patients with RPAB were 59 and 58 years, respectively. The time between episodes of PAB ranged from 26 to 688 days with a mean and median of 166 and 97 days, respectively. There were 3 patients (16%) with different sources of bacteremia for consecutive episodes of PAB: 1 with neutropenic sepsis followed by acute mastoiditis, 1 with cellulitis of the leg followed by an infected sacral pressure ulcer, and 1 with pneumonia and then an infected arteriovenous graft. The source of the recurrent episode was the same as the prior episode in 16 instances (84%): (1) skin and soft tissue infection (7 episodes), (2) central venous catheter infection (3 episodes), (3) genitourinary infection (2 episodes), (4) pneumonia (1 episode), (5) infected aortic vascular graft (1 episode), (6) obstructive cholangitis (1 episode), and (7) primary bacteremia (1 episode). All but 2 patients had multiple comorbid conditions, and all but 1 patient with RPAB had ≥1 of 5 risk factors for PAB as reported in the literature. Six (32%) of 19 episodes of RPAB resulted in death. Five of 6 patients with fatal RPAB received appropriate antimicrobial therapy at the initial presentation to the hospital for the second/fatal episode. Infectious disease consultation was obtained in all but 1 episode of RPAB. Conclusions Recurrent PAB accounted for 19 (7.3%) of 262 episodes of PAB in our 10-year study. It was associated with multiple comorbid conditions. The recurrent episode was usually from the same source as the prior episode of PAB. Sources of RPAB were diverse (as discussed previously), and mortality was 32% despite appropriate antipseudomonal antimicrobial therapy in all but 1 episode of those who died. We review the literature for patients with RPAB and compare these patients with those in our patient population.

Central Venous Catheter-Related Infectious Complications in Pediatric Surgical Patients: A Single-Center Experience.

The purpose of this study was to estimate the rate of central venous catheter (CVC) colonization and catheter-related bloodstream infections (CRBSIs) in pediatric surgical patients at our institute and to determine the various risk factors for their occurrence. The electronic medical records of 260 children undergoing surgery with simultaneous CVC insertion were retrospectively reviewed. Data on demographics, primary organ system involved, site of CVC, CVC dwell time, CVC colonization, CRBSI, and organisms isolated on culture were collated, categorized, and analyzed. The rate of CVC colonization and CRBSI was 32.8 per 1,000 catheter days (19.6%) and 17.4 per 1,000 catheter days (10.4%), respectively. Patients with CVC colonization and CRBSI had a significantly higher proportion of patients younger than 1 year of age ( p = 0.014). The CVC dwell time was significantly higher in both CVC colonization (7 [5-8] days) and CRBSI (6 [5-9] days) patients ( p = 0.005). The frequency of femoral catheterization was significantly higher in patients with CRBSI and CVC colonization ( p < 0.001). Coagulase negative staphylococcus was the commonest isolate in CVC infections. Age (adjusted odds ratio [OR] = 0.87; p = 0.009), CVC dwell time (adjusted OR = 1.28; p = 0.003), and femoral CVC (adjusted OR = 9.61; p < 0.001) were independent risk factors for CRBSI. Conclusion: This study reveals important observations regarding the infectious complications of CVC in pediatric surgical patients. The rates of CVC colonization and CRBSI in this study were found to be higher as compared with previously reported rates in Western literature. However, these findings are significant in view of paucity of existing literature in pediatric surgical patients. In our study, higher risk of CRBSI was associated with younger age, increasing CVC dwell time, and femoral venous catheterization. We recommend strict compliance with CVC insertion and maintenance practices and adherence to CVC care bundles to minimize these serious complications.

Predicting outcomes in central venous catheter salvage in pediatric central line-associated bloodstream infection.

Central line-associated bloodstream infections (CLABSIs) are a common, costly, and hazardous healthcare-associated infection in children. In children in whom continued access is critical, salvage of infected central venous catheters (CVCs) with antimicrobial lock therapy is an alternative to removal and replacement of the CVC. However, the success of CVC salvage is uncertain, and when it fails the catheter has to be removed and replaced. We describe a machine learning approach to predict individual outcomes in CVC salvage that can aid the clinician in the decision to attempt salvage. Over a 14-year period, 969 pediatric CLABSIs were identified in electronic health records. We used 164 potential predictors to derive 4 types of machine learning models to predict 2 failed salvage outcomes, infection recurrence and CVC removal, at 10 time points between 7 days and 1 year from infection onset. The area under the receiver-operating characteristic curve varied from 0.56 to 0.83, and key predictors varied over time. The infection recurrence model performed better than the CVC removal model did. Machine learning-based outcome prediction can inform clinical decision making for children. We developed and evaluated several models to predict clinically relevant outcomes in the context of CVC salvage in pediatric CLABSI and illustrate the variability of predictors over time.

Epidemiology of Central Venous Catheters Infection in Hemodialysis Patients

Background: Vascular access infections in hemodialysis patients increase by 2-3 folds in central venous catheters compared to arteriovenous fistula or graft. Among these infections exit site infections, tunnel infections and catheter- related bloodstream infections (CRBSI), are the most common complications. CRBSIs are major risk of hospitalization as well as mortality in hemodialysis patients. Objective: To study the epidemiology of central venous catheter related infections (CVC-RI), patterns of microbial infections and antibiotic sensitivity among our hemodialysis patients. Patients and methods: 94 ESRD patients on hemodialysis with temporary central venous catheter (CVC) inserted for more than 48 hours, monitored for the development of CVC related infections (CVC-RI) and divided into two main groups according to presence of catheter infection; (A) non-infected catheter patients and group (B) infected catheter patients Results: The rate of CVC-RI is high in our hemodialysis patients (42.5 %). There was a significant difference between the two studied groups as regard duration of HD and catheterization duration. Patients with evident catheter infections had significantly higher total leucocytic count (TLC) and C-reactive protein (CRP) values. There was a significant positive correlation between CRP with catheter duration and TLC. Staphylococcus aureus was the most prevalent isolated bacteria. Vancomycin was the most common used antibiotic among infected patients. Conclusion: CVC-RI rate is high in our hemodialysis patients (42.5 %). Prolonged duration of CVC usage and diabetes are major risk factors related to infections. Both S. aureus and Gram-negative micro-organisms were the most common organisms found in our study. Vancomycin and imipenem were the most common effective antibiotics according to our blood cultures.

Epidemiology of Central Venous Catheters Infection in Hemodialysis Patients

Background: Vascular access infections in hemodialysis patients increase by 2-3 folds in central venous catheters compared to arteriovenous fistula or graft. Among these infections exit site infections, tunnel infections and catheter- related bloodstream infections (CRBSI), are the most common complications. CRBSIs are major risk of hospitalization as well as mortality in hemodialysis patients. Objective: To study the epidemiology of central venous catheter related infections (CVC-RI), patterns of microbial infections and antibiotic sensitivity among our hemodialysis patients. Patients and methods: 94 ESRD patients on hemodialysis with temporary central venous catheter (CVC) inserted for more than 48 hours, monitored for the development of CVC related infections (CVC-RI) and divided into two main groups according to presence of catheter infection; (A) non-infected catheter patients and group (B) infected catheter patients Results: The rate of CVC-RI is high in our hemodialysis patients (42.5 %). There was a significant difference between the two studied groups as regard duration of HD and catheterization duration. Patients with evident catheter infections had significantly higher total leucocytic count (TLC) and C-reactive protein (CRP) values. There was a significant positive correlation between CRP with catheter duration and TLC. Staphylococcus aureus was the most prevalent isolated bacteria. Vancomycin was the most common used antibiotic among infected patients. Conclusion: CVC-RI rate is high in our hemodialysis patients (42.5 %). Prolonged duration of CVC usage and diabetes are major risk factors related to infections. Both S. aureus and Gram-negative micro-organisms were the most common organisms found in our study. Vancomycin and imipenem were the most common effective antibiotics according to our blood cultures.

Effects of a Care Package on the Shelf Life and Incidence of the Infection of Central Peripheral Venous Catheter in the Premature Infants Admitted to the NICU

Background: Neonates require continuous and reliable intravenous routes to receive fluids, intravenous nutrition, and medications; accordingly, repeated interventions are essential to implant these routes. Percutaneous catheterization is a technology used for this purpose. Considering that central line infections are a major concern in neonatal intensive care units (NICUs), the present study aimed to assess the effects of using a care package on the incidence of infections and shelf life of peripheral central catheterization in the premature infants admitted to the NICU. Methods: This quasi-experimental study was a process assessment research conducted on 131 premature catheterized infants who were admitted to the NICU of Mofid Children’s Hospital affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran, in 2019. The study sample included 131 neonates who met the inclusion criteria. The neonates were enrolled in the study at two levels, including 53 subjects in the first four months before the intervention, and 78 in the second four months after application of the care package. The infants were selected via the convenience sampling method. Data were collected using the central line maintenance bundle and central line maintenance bundle daily checklists. The catheter insertion method and the degree of catheter tip infection were evaluated before and after the protocol training program for the nurses. The results of catheter tip culture after removal were considered as the training outcomes. Data analysis was performed in SPSS V. 16, using descriptive statistics, independent t test, the Fisher exact test, and the chi-squared test. Results: The results of the catheter tip culture confirmed the presence of pathogens in the catheter and culture of 18 samples (34%), before the intervention, while a reduction was denoted in 14 samples (17.9%) after the intervention; the reduction was statistically significant (P=0.036). Furthermore, the shelf life of the catheter increased after the intervention, however, the difference was not significant. Conclusion: According to the results, applying the care package reduces the incidence of central peripheral venous catheter infection in neonates admitted to the NICU. Therefore, it is suggested to incorporate this package into the care instructions of neonatal wards.

Precisely Structured Nitric-Oxide-Releasing Copolymer Brush Defeats Broad-Spectrum Catheter-Associated Biofilm Infections In Vivo.

Gram-negative bacteria cannot be easily eradicated by antibiotics and are a major source of recalcitrant infections of indwelling medical devices. Among various device-associated infections, intravascular catheter infection is a leading cause of mortality. Prior approaches to surface modification, such as antibiotics impregnation, hydrophilization, unstructured NO-releasing, etc., have failed to achieve adequate infection-resistant coatings. We report a precision-structured diblock copolymer brush (H(N)-b-S) composed of a surface antifouling block of poly(sulfobetaine methacrylate) (S) and a subsurface bactericidal block (H(N)) of nitric-oxide-emitting functionalized poly(hydroxyethyl methacrylate) (H) covalently grafted from the inner and outer surfaces of a polyurethane catheter. The block copolymer architecture of the coating is important for achieving good broad-spectrum anti-biofilm activity with good biocompatibility and low fouling. The coating procedure is scalable to clinically useful catheter lengths. Only the block copolymer brush coating ((H(N)-b-S)) shows unprecedented, above 99.99%, in vitro biofilm inhibition of Gram-positive and Gram-negative bacteria, 100-fold better than previous coatings. It has negligible toxicity toward mammalian cells and excellent blood compatibility. In a murine subcutaneous infection model, it achieves >99.99% biofilm reduction of Gram-positive and Gram-negative bacteria compared with <90% for silver catheter, while in a porcine central venous catheter infection model, it achieves >99.99% reduction of MRSA with 5-day implantation. This precision coating is readily applicable for long-term biofilm-resistant and blood-compatible copolymer coatings covalently grafted from a wide range of medical devices.

Candida albicans adhesion to central venous catheters: Impact of blood plasma-driven germ tube formation and pathogen-derived adhesins

ABSTRACT Candida albicans-related bloodstream infections are often associated with infected central venous catheters (CVC) triggered by microbial adhesion and biofilm formation. We utilized single-cell force spectroscopy (SCFS) and flow chamber models to investigate the adhesion behavior of C. albicans yeast cells and germinated cells to naïve and human blood plasma (HBP)-coated CVC tubing. Germinated cells demonstrated up to 56.8-fold increased adhesion forces to CVC surfaces when compared to yeast cells. Coating of CVCs with HBP significantly increased the adhesion of 60-min germinated cells but not of yeast cells and 30-min germinated cells. Under flow conditions comparable to those in major human veins, germinated cells displayed a flow directional-orientated adhesion pattern to HBP-coated CVC material, suggesting the germ tip to serve as the major adhesive region. None of the above-reported phenotypes were observed with germinated cells of an als3Δ deletion mutant, which displayed similar adhesion forces to CVC surfaces as the isogenic yeast cells. Germinated cells of the als3Δ mutant also lacked a clear flow directional-orientated adhesion pattern on HBP-coated CVC material, indicating a central role for Als3 in the adhesion of germinated C. albicans cells to blood exposed CVC surfaces. In the common model of C. albicans, biofilm formation is thought to be mediated primarily by yeast cells, followed by surface-triggered the formation of hyphae. We suggest an extension of this model in which C. albicans germ tubes promote the initial adhesion to blood-exposed implanted medical devices via the germ tube-associated adhesion protein Als3.

Effects of a Quality Improvement Program to Reduce Central Venous Catheter-Related Infections in Hemodialysis Patients

BackgroundCentral catheter infections are of concern in patients on hemodialysis because of the high risk of catheter-related bloodstream infections, sepsis, and death. Adequate nursing is critical for the prevention of such infections. This study aimed to use the PDCA (plan-do-check-act) method to reduce the incidence of central venous catheter infection using management in the maintenance of central venous catheter in patients on hemodialysis, compared with routine care. MethodsThis pilot study recruited patients on hemodialysis via central venous catheterization at the Blood Purification Center of Ruijin Hospital between November 2017 and November 2018. The patients were randomized to the routine and PDCA groups. All participants received routine nursing. The PDCA group received central venous catheter management by PDCA. The incidence of central venous catheterization-related infections, nursing satisfaction, and quality of life were compared between the two groups. ResultsA total of 122 participants were enrolled in each group. The incidence of central catheter-related bloodstream infection, as the primary outcome, was 0.8 and 8.8 cases per 1000 catheter days in the PDCA and routine groups, respectively (P < 0.001). In addition, as the secondary outcomes, the scores of nursing satisfaction (health guidance, nursing technology, and therapeutic effects) score and quality of life (physiological, psychological, social, and environmental status) were better in the PDCA group than in the routine group (all P < 0.01). ConclusionsThis pilot study suggests that the PDCA cycle model can effectively reduce the incidence of central venous catheter-related infections and improve satisfaction and quality of life in patients on hemodialysis.

Improving practice in accessing haemodialysis central venous catheters.

In children, haemodialysis is used as a form of renal replacement therapy and is typically delivered via a central venous catheter (CVC). It is necessary to access the CVC for dialysis and blood sampling regularly, and safe line practice is essential to minimise complications associated with CVCs, including infection. The authors had concerns about the rate of CVC infection in their children's haemodialysis unit, which prompted a practice review. A questionnaire was emailed to all other children's haemodialysis units in the UK, which identified variations in practice and training. The authors subsequently modified their unit's CVC access guidelines and blood sampling technique, and developed a new competency-based 'haemodialysis CVC access only' training programme for nursing staff. A willingness to review practice in the unit, supported by comparison and communication with other units, assisted in implementing this change in practice.

Discovery of hemocompatible bacterial biofilm-resistant copolymers

Blood-contacting medical devices play an important role within healthcare and are required to be biocompatible, hemocompatible and resistant to microbial colonization. Here we describe a high throughput screen for copolymers with these specific properties. A series of weakly amphiphilic monomers are combinatorially polymerized with acrylate glycol monomers of varying chain lengths to create a library of 645 multi-functional candidate materials containing multiple chemical moieties that impart anti-biofilm, hemo- and immuno-compatible properties. These materials are screened in over 15,000 individual biological assays, targeting two bacterial species, one Gram negative (Pseudomonas aeruginosa) and one Gram positive (Staphylococcus aureus) commonly associated with central venous catheter infections, using 5 different measures of hemocompatibility and 6 measures of immunocompatibililty. Selected copolymers reduce platelet activation, platelet loss and leukocyte activation compared with the standard comparator PTFE as well as reducing bacterial biofilm formation in vitro by more than 82% compared with silicone. Poly(isobornyl acrylate-co-triethylene glycol methacrylate) (75:25) is identified as the optimal material across all these measures reducing P. aeruginosa biofilm formation by up to 86% in vivo in a murine foreign body infection model compared with uncoated silicone.

Unintended consequences of long-sleeved gowns in a critical care setting during the COVID-19 pandemic

At the peak of the coronavirus disease 2019 (COVID-19) pandemic, hand hygiene audits indicated decreased compliance in a 12-bed critical care (CC) area with ventilated COVID-19 patients, where staff used personal protective equipment (PPE), including sessional use of long-sleeved gowns in accordance with the recommendations of Public Health England. There was also a cluster of three central venous catheter (CVC) infections along with increases in the number of patients from whom enteric Gram-negative bacteria (GNB) were isolated from sterile sites. Environmental sampling of near-patient surfaces and frequently touched sites demonstrated that 11.5% of areas were contaminated with enteric GNB in the COVID-19 CC area, compared with 2.6% and 2.7% in COVID-19 and non-COVID-19 general wards, respectively. Following a risk assessment, hospital policy was changed to replace long-sleeved gowns with short-sleeved gowns. The CC unit underwent enhanced cleaning with hypochlorite-based disinfectant and was resampled 8 days later. On resampling, no GNB were isolated from the CC unit. Following this change in PPE, hand hygiene compliance returned to baseline standards and no further CVC infections were identified. Staff reported a preference for short-sleeved gowns. No evidence currently exists that PPE beyond that recommended for pandemic influenza (respiratory protection plus standard PPE) adds to the protection of healthcare workers (HCWs) from severe acute respiratory syndrome coronavirus-2. Long-sleeved gowns prevent HCWs performing hand hygiene effectively. While it is imperative that HCWs are adequately protected, protection of patients from infection hazards is equally important. Further studies are necessary to establish risks from PPE to inform a review of current guidance.

Laparoscopic versus open hemihepatectomy: comprehensive comparison of complications and costs at 90\xa0days using a propensity method

Laparoscopic hemihepatectomy (LHH) may offer advantages over open hemihepatectomy (OHH) in blood loss, recovery, and hospital stay. The aim of this study is to evaluate our recent experience performing hemihepatectomy and compare complications and costs up to 90 days following laparoscopic versus open procedures. Retrospective evaluation of patients undergoing hemihepatectomy at our center 01/2010–12/2018 was performed. Patient, tumor, and surgical characteristics; 90-day complications; and costs were analyzed. Inverse probability of treatment weighting (IPTW) was used to balance covariates. A total of 141 hemihepatectomies were included: 96 OHH and 45 LHH. While operative times were longer for LHH, blood loss and transfusions were less. At 90 days, there were similar rates of liver-specific and surgical complications but fewer medical complications following LHH. Medical complications that arose with greater frequency following OHH were primarily pulmonary complications and urinary and central venous catheter infections. Complications at 90 days were lower following LHH (Clavien–Dindo grade ≥ III OHH 23%, LHH 11%, p = 0.130; Comprehensive Complication Index OHH 20.0 ± 16.1, LHH 10.9 ± 14.2, p = 0.001). While operating costs were higher, costs for hospital stay and readmissions were lower with LHH. Patients undergoing LHH experience a significant reduction in postoperative medical complications and costs, resulting in 90-day cost equity compared with OHH.

Impact of a structured educational programme for caregivers of children with cancer on parental knowledge of the disease and paediatric clinical outcomes during the first year of treatment.

To assess the impact of a structured educational programme for caregivers of children with cancer on their level of knowledge about the disease and patient's clinical outcome. This prospective, non-randomised, experimental study included caregivers of recently diagnosed children at two hospitals in Chile. Caregivers whose children were treated at the first centre were the structured education programme group (EPG), while the second hospital provided the standard care (SCG). We evaluated caregivers' level of knowledge on days 1, 10 and 90 as well as the children's clinical outcomes over 1year of treatment. A total of 102 caregivers were enrolled between 2014 and 2015. Only the EPG showed a significant increase in knowledge between days 1 and 90. The rate of central venous catheter infections was significantly lower in the EPG versus SCG (7% versus 26%; p=.01). The risk ratio was 0.35 (95% CI=0.13-0.94), and a log-rank test showed a statistically significant difference between the two groups (p=.018). There were also fewer Emergency Department visits in the EPG for fever episodes. Providing a structured education to caregivers increased their level of knowledge and improved the clinical outcome of their children during the first year of treatment.

Antibiotic Administration Prior to Central Venous Catheter Removal in Neonates

Background: Central venous catheter infection and sepsis are significant causes of morbidity and mortality in neonatal intensive care unit patients. This complication may result in a significant cost burden, prolonged antibiotic treatment, and increased length of stay. Objectives: The objective of this study was to determine the difference in post-catheter removal clinical sepsis (PCRCS) in neonatal intensive care unit patients who received antibiotics prior to central venous catheter removal when compared to those who did not. Methods: This was a retrospective cohort study of 200 critically ill neonates comparing those who received one-time doses of vancomycin and cefazolin prior to central venous catheter removal to those who did not. Results: There was no statistically significant association between antibiotic treatment and PCRCS when the analysis was controlled for gender, time the catheter was in place, birth weight, gestational age, or type of central catheter (OR 1.19; 95% CI: 0.18-8.00; P = .8558). No statistical difference was seen in adverse renal outcomes or total antibiotic treatment received for the treatment of PCRCS. Conclusions: Administration of one-time doses of vancomycin and cefazolin did not reduce the incidence of PCRCS when administered to critically ill neonates prior to umbilical venous catheter or peripherally inserted central catheter removal.

Evidence-based Practices in the Prevention of Central Venous Catheter Infections: Knowledge of Intensive Care Nurses

Evidence-based Practices in the Prevention of Central Venous Catheter Infections: Knowledge of Intensive Care Nurses