Contamination Of Central Venous Catheters Research Articles

In vitro assessment of effect of initial specimen diversion device on detection of central venous catheter contamination or colonization.

The role of initial specimen diversion devices (ISDDs) in preventing contamination of central venous catheter (CVC) blood cultures is undefined. A model to simulate CVC colonization and contamination compared standard cultures with ISDD technique. ISDD detected 100% of colonized CVCs while decreasing false-positive cultures from 36% to 16%.

Iterative Health Equity Analyses of Central Line-Associated Bloodstream Infection (CLABSI) Events at a Pediatric Hospital

Background: Per the Centers for Disease Control and Prevention, health equity stipulates all have a fair, just opportunity to attain their highest level of health. Limited evidence exists for disparities in health equity and healthcare-associated infections (HAI), with no evidence on language or primary insurance payor. While reviewing quality metrics, a disparity signal in central line-associated bloodstream infections (CLABSIs) prompted a multidisciplinary deep dive, with iterative analyses to understand potential inequities to identify improvement opportunities. Methods: CLABSI data was stratified and analyzed for evidence of disparity by race/ethnicity, primary insurance payor, and preferred spoken language utilizing an internal methodology. Subsequent analyses included a root cause analysis (RCA), case mix index (CMI) analysis, analysis of CLABSI Kamishibai card (K-card) rounding to monitor maintenance bundle reliability, and comparison of distribution of central venous catheter (CVC) line days to K-card audits [Figure 1]. Chi-square tests were used to test for significant differences for categorical variables in RCA and K-card analyses. ANOVA was used to compare CMI between demographic groups. Multiple logistic regression was used to compare K-card compliance rates by demographic groups. Results: When stratifying CLABSI rate by primary payor, pairwise comparisons indicated patients with a public payor had a statistically higher rate of CLABSI compared to private (p=0.02) [Figure 2A]. RCA analysis revealed when compared to patients with private payors, those with public had significantly higher rates of overdue needless connector changes (p = 0.03) and increased number of daily CVC entries (p = 0.05), while patients speaking another language (p = 0.02) were significantly more likely to have CVC contamination events. CMI analyses on CLABSI cases did not show patient acuity to vary significantly between demographics. Bivariate analysis of K-card data revealed minor differences in reliability with 7 Core Maintenance Bundle Elements by demographics; adjusting for all demographics and accounting for unit, pairwise comparisons indicated public payors had significantly higher compliance than international [Figure 2B]. We found no major differences in demographic distribution of CVC line days compared to K-card audits, suggesting we representatively audit maintenance bundle process measures. Conclusions: Our review of health equity in CLABSI events ultimately led to subsequent questions requiring analysis of other data sets. Utilizing an exploratory approach and assembling a multidisciplinary team to identify potential drivers of identified disparities adds value to health equity analyses. This is the first description of HAI data beyond race and ethnicity and can assist other institutions in their process of evaluating healthcare disparities and HAIs.

Reducing central line-associated bloodstream infection in contaminated central venous catheters: case studies of a pediatric contamination guideline

Healthcare organizations have prioritized patient safety and quality improvement efforts to reduce central line-associated bloodstream infections (CLABSIs). Implementation of central venous catheter (CVC) insertion and maintenance bundles have significantly reduced infection rates. Nevertheless, CLABSIs continue to be a significant cause of mortality and morbidity in hospitals, and further efforts are necessary to improve CVC care practices. A hospital-wide committee at a tertiary care pediatric hospital identified gaps in our CVC maintenance practices resulting from CVC contamination events from a patient's body fluids. A lack of published literature on the topic resulted in the need to create an institutional clinical practice guideline (CPG) to develop guidance to mitigate potential CLASBIs from CVC contamination. Utilization of the CVC CPG in all inpatient units and other reduction strategies resulted in a steady decline in our CLABSI rates, particularly in those related to CVC contamination events. Case reports illustrate the effectiveness of the CPG.

Risk Factors and Outcome of Multidrug-Resistant Infections after Heart Transplant: A Contemporary Single Center Experience.

(1) Background: The aim of this study was to assess risk factors for multidrug-resistant/extensively drug-resistant (MDR/XDR) bacterial infections in heart transplant (HT) patients within three months after surgery and its impact on patient outcome. (2) Methods: Retrospective analysis of clinical, hemato-chemical, imaging, treatment and outcome data from 47 heart transplant recipients from January 2016 to December 2018. MDR/XDR infections were compared to non-MDR/XDR and noninfected patients. (3) Results: Most participants were males, median age 51 years: 35 (74.5%) developed an infection after HT; 14 (29.8%) were MDR/XDR infections. Prolonged hospital stay before HT correlated to MDR/XDR infection (p < 0.001). Sequential organ failure assessment (SOFA) score at sampling day was higher in MDR/XDR (p = 0.027). MDR/XDR were mostly blood-stream (BSI) (p = 0.043) and skin-soft tissue (SSTI) (p = 0.047) infections. Gram-negative infections were the most frequent, specifically carbapenem-resistant Klebsiella pneumoniae. Antibiotic therapy duration for MDR/XDR infections was longer (p = 0.057), eradication rate lower (p = 0.083) and hospital stay longer (p = 0.005) but not associated with a worse outcome. (4) Conclusions: MDR/XDR infections affect compromised HT recipients with a history of prolonged hospitalization, causing a lower rate of eradication and increased hospital stay. These frequently present as BSI and SSTI. We emphasize the need to prevent contamination of central venous catheters and the surgical site.

Reducing Central Line-Associated Bloodstream Infection in Contaminated Central Venous Catheters: Case Studies of a Pediatric Contamination Guideline

Highlights Abstract Healthcare organizations have prioritized patient safety and quality improvement efforts to reduce central line-associated bloodstream infections (CLABSIs). Implementation of central venous catheter (CVC) insertion and maintenance bundles have significantly reduced infection rates. Nevertheless, CLABSIs continue to be a significant cause of mortality and morbidity in hospitals, and further efforts are necessary to improve CVC care practices. A hospital-wide committee at a tertiary care pediatric hospital identified gaps in our CVC maintenance practices resulting from CVC contamination events from a patient’s body fluids. A lack of published literature on the topic resulted in the need to create an institutional clinical practice guideline (CPG) to develop guidance to mitigate potential CLASBIs from CVC contamination. Utilization of the CVC CPG in all inpatient units and other reduction strategies resulted in a steady decline in our CLABSI rates, particularly in those related to CVC contamination events. Case reports illustrate the effectiveness of the CPG.

Bacillus cereus biofilm formation on central venous catheters of hospitalised cardiac patients

Formation of bacterial biofilms is a risk with many in situ medical devices. Biofilm-forming Bacillus species are associated with potentially life-threatening catheter-related blood stream infections in immunocompromised patients. Here, bacteria were isolated from biofilm-like structures within the lumen of central venous catheters (CVCs) from two patients admitted to cardiac hospital wards. Isolates belonged to the Bacillus cereus group, exhibited strong biofilm formation propensity, and mapped phylogenetically close to the B. cereus emetic cluster. Together, whole genome sequencing and quantitative PCR confirmed that the isolates constituted the same strain and possessed a range of genes important for and up-regulated during biofilm formation. Antimicrobial susceptibility testing demonstrated resistance to trimethoprim-sulphamethoxazole, clindamycin, penicillin and ampicillin. Inspection of the genome revealed several chromosomal β-lactamase genes and a sulphonamide resistant variant of folP. This study clearly shows that B. cereus persisting in hospital ward environments may constitute a risk factor from repeated contamination of CVCs.

Incidence of central venous catheter hub contamination

PurposeTo investigate microorganisms causing central venous catheter contamination and how this contamination differs across different catheter metrics. Materials and methodsAfter obtaining IRB approval and informed consent, 830 cultures were prospectively obtained from 45 ICU patients with central venous catheter or peripherally inserted central catheter. Bacterial colonies were identified by mass spectrometry. ResultsBacterial contamination of central catheter hubs occurred 44% of the time in this study in the ICU setting. Coagulase-positive staphylococci cultures had higher median (±interquartile range) CFUs (12±232) versus coagulase-negative (3±10) and other bacteria (1±3; P<0.001). Bacterial contamination was associated with various metrics. Higher incidence (P<0.05) of coagulase-positive staphylococci cultures was associated with hub-only connections (a “hub” being a female connection; 10.9% vs. 7.9% male connections), connections without a manifold (1lumen device that mixes multiple infusions together; 9.7% vs. 0% with manifold); and central venous pressure monitoring connections (25.8% vs. 7.1% without). Internal jugular sites (10.0% vs. 2.7% femoral, 6.2% PICC, P=0.031) and medial lumens of triple lumen catheters (11.9% vs. 5.6% distal, 7.0% proximal, P=0.049) had increased incidence of higher bacteria loads (>15 CFUs). ConclusionsThis study found a high incidence of central access catheter hub bacterial contamination, which correlated with positive blood cultures in 2 of 3 total bacteremia cases identified in the 45 patients.

Role of Staphylococcus aureus Protein A in Adherence to Silastic Catheters

Communities of bacteria, termed biofilms, frequently develop on central venous catheters, and bacterial contamination of central venous catheters is the most common cause of nosocomial bloodstream infections. Little is known about the initial events in bacterial adherence to the catheter surface, and experiments were designed to clarify the role of staphylococcal protein A, serum, and immunoglobulin in adherence of Staphylococcus aureus to silastic catheters. We hypothesized that S. aureus protein A in the presence of serum and immunoglobulin would alter S. aureus adherence to silastic catheters. Three strains of S. aureus with varying expression of staphylococcal protein A were incubated 15 min at room temperature with silastic catheters, and bacterial adherence to the catheter surface was quantified. In addition, the effects of serum, albumin, and purified IgG on bacterial adherence were assessed. Both serum and albumin had an inhibitory effect on S. aureus adherence to the catheter surface, and protein A expression did not appreciably modulate these effects. Purified serum IgG also inhibited S.aureus adherence, with IgG having a greater inhibitory effect on the adherence of an S. aureus strain deficient in protein A compared with an S. aureus strain expressing high levels of protein A. S. aureus adherence to silastic catheters was inhibited by whole serum, albumin, and purified IgG. Expression of staphylococcal protein A interfered with IgG mediated inhibition of bacterial binding to the catheter surface. Protein A altered S.aureus adherence to silastic catheters in the presence of immunoglobulin, but not in the presence of serum or albumin.

Deposits on the intraluminal surface and bacterial growth in central venous catheters

Central venous catheter (CVC) tip and blood cultures are generally used to diagnose a catheter-related infection. Such methodology does not confirm the presence of bacterial colonisation on parts of CVCs other than the CVC tip. In order to assess the extent of bacterial colonisation, 10 catheters were examined in detail from patients admitted to intensive care unit. Swabs from the lumen at several sites (hub, indwelling and non-indwelling) were cultured and the intraluminal surface of the device subjected to scanning electron microscopy (SEM). Bacteria were detected on five out of 10 catheters (50%), and bacterial contamination of CVCs was common in the hub area of the device. Deposits (crystallisation) that differed from bacterial colonisation or biofilm were observed on the intraluminal surface of used CVCs. SEM showed bacteria firmly anchored to the deposits. Experimental flow studies demonstrated that deposits were more likely to appear after exposure to solutions such as total parenteral nutrition rather than distilled water. These deposits facilitated bacterial colonisation 30 times more than CVCs free from deposits.

Use of cultivation-dependent and -independent techniques to assess contamination of central venous catheters: a pilot study

BackgroundCatheters are the most common cause of nosocomial infections and are associated with increased risk of mortality, length of hospital stay and cost. Prevention of infections and fast and correct diagnosis is highly important.MethodsIn this study traditional semiquantitative culture-dependent methods for diagnosis of bacteria involved in central venous catheter-related infections as described by Maki were compared with the following culture-independent molecular biological methods: Clone libraries, denaturant gradient gel electrophoresis, phylogeny and fluorescence in situ hybridization.ResultsIn accordance with previous studies, the cultivation of central venous catheters from 18 patients revealed that S. epidermidis and other coagulase-negative staphylococci were most abundant and that a few other microorganisms such as P. aeruginosa and K. pneumoniae occasionally were found on the catheters. The molecular analysis using clone libraries and sequencing, denaturant gradient gel electrophoresis and sequencing provided several important results. The species found by cultivation were confirmed by molecular methods. However, many other bacteria belonging to the phyla Proteobacteria, Firmicutes, Actinobacteria and Bacteroidetes were also found, stressing that only a minor portion of the species present were found by cultivation. Some of these bacteria are known to be pathogens, some have not before been described in relation to human health, and some were not closely related to known pathogens and may represent new pathogenic species. Furthermore, there was a clear difference between the bacterial species found in biofilm on the external (exluminal) and internal (luminal) side of the central venous catheter, which can not be detected by Maki's method. Polymicrobial biofilms were observed on most of the catheters and were much more common than the cultivation-dependent methods indicated.ConclusionThe results show that diagnosis based on molecular methods improves the detection of microorganisms involved in central catheter-related infections. The importance of these microorganisms needs to be investigated further, also in relation to contamination risk from improper catheter handling, as only in vivo contaminants are of interest. This information can be used for development of fast and more reliable diagnostic tools, which can be used in combination with traditional methods.

Central Venous Catheter (CVC) related infections: a local retrospective study

Background. Central venous catheter (CVC) related infection is associated with significant increases in morbidity, mortality, and health care cost.This local surveillance study was carry out to monitor the frequency of occurrence of CVC-related blood stream infections. Materials and methods. During the period January – December 2005, 226 CVC specimens were analyzed (quantitative method) and microrganism identification from positive samples was performed by Vitek II. In 53 patients it was possible to compare quantitative results with those obtained from blood cultures. Results. Positive CVC samples were 125 (55%) and 130 microrganisms were isolated: 109 Gram-positives (84%), 4 Gram-negatives (3%), and 17 mycetes (13%). Among pathogens collected simultaneously from CVC and blood samples, the most frequently isolated were Staphylococcus spp. (30% coagulase-negative staphylococci and 20%. S. aureus) and Candida spp. (45%). In the group of patients that presented positive CVC and negative blood samples the most frequently recovered microrganisms were staphylococci. Many isolates (33%) were polymicrobial. Conclusions. Catheter-related infections occurred in those patients who presented the same pathogen in both CVC and blood cultures. These infections were principally caused by staphylococci and Candida spp. On the contrary, a possible CVC contamination could be suspected when positive CVC and negative blood cultures were found.

Bacterial contamination of central venous catheters during insertion: a double blind randomised controlled trial

Static electricity within sterile packaging may result in bacterial contamination of central venous catheters (CVCs) prior to insertion. To prevent this, some surgeons inject saline into the pack before opening it. This trial was designed to determine the effect of this procedure. A double blind randomised controlled trial of 47 CVCs comparing injection of 2 ml of sterile saline into the pack prior to opening with no injection was performed. Five centimetre lengths cut from the tip of the catheter before and after subcutaneous tunnelling were sent for microbiological culture. Eight catheters (17%) showed evidence of bacterial contamination prior to insertion into the vein. Two (4.2%) were contaminated prior to tunnelling and seven (14.9%) afterwards. One catheter was contaminated before and after tunnelling. All but one of the contaminating bacteria were coagulase negative staphylococci. There was no significant difference in the contamination rate between catheters from packs that had been injected (5/25) and those that had not (3/22), P = 0.56. Just under one-fifth of the catheters were contaminated with bacteria prior to insertion into the vein but this was not influenced by prior injection of saline into the pack. We conclude that there is no evidence to support the practice of injecting the catheter pack prior to opening.

An Outbreak of Bacteremias Associated With Mycobacterium mucogenicum in a Hospital Water Supply

To investigate and determine the cause of an outbreak of Mycobacterium mucogenicum bacteremias in bone marrow transplant (BMT) and oncology patients. Case-control study and culturing of hospital water sources. Isolates were typed using molecular methods. University-affiliated, tertiary-care medical center. Case-patients were adult and pediatric BMT patients or hematopoietic stem cell transplant (BMT) (n = 5) and oncology (n = 1) patients who were diagnosed as having M. mucogenicum bacteremia during the study period of August through November 1998. Two control-patients were selected for each case-patient matched by age, time of hospitalization, inpatient unit, and type of patient (BMT or oncology). There were no significant differences between case-patients and control-patients regarding intravenous products received or procedures performed, frequency of bathing, neutropenia, or steroid use. Nontuberculous mycobacteria were isolated from several water sources at the medical center including tap water from sinks and showerheads, the hospital hot water source, and the city water supply to the hospital. Analysis by multilocus enzyme electrophoresis and randomly amplified polymorphic DNA showed a match between one patient's blood isolate and an isolate from shower water from that patient's prior hospital room. The cause of the outbreak seemed to be water contamination of central venous catheters (CVCs) during bathing. A recommendation in early 2001 that CVCs be protected from water during bathing was followed by no M. mucogenicum bacteremias during the second half of 2001, only one in 2002, and none at all during 2003.

DNA fingerprinting analysis of coagulase negative staphylococci implicated in catheter related bloodstream infections

Aims: The epidemiological assessment of cases of coagulase negative staphylococcal catheter related bloodstream infection. Methods: Two hundred and thirty patients with suspected catheter related bloodstream infection were evaluated over a...

Contamination of central venous catheters in immunocompromised patients: a comparison between two different types of central venous catheters

Catheters impregnated with silver have been proposed as a means of reducing catheter-related infection. We therefore performed a prospective randomized study to compare a new silver-impregnated central venous catheter (CVC) with a commercially available CVC in a cohort of immunocompromised patients. We studied 157 patients of whom 97 could be analysed. The median indwelling time in the study group (SC) was 10.5 days and 11 days in the control group (CC). The incidence of contamination in the SC group was 15.6 vs 24.6 in the CC group referring to 1000 catheter days. In both groups, we found 6% of catheter-related infections according to the definitions of a published scoring system. The differences between the two groups were not significant. We conclude that the SC decrease the incidence of catheter contamination and may have a positive effect on the reduction of CVC-related infections.

Use of Pulsed Field Gel Electrophoresis to Determine the Source of Microbial Contamination of Central Venous Catheters

Use of Pulsed Field Gel Electrophoresis to Determine the Source of Microbial Contamination of Central Venous Catheters

Use of pulsed field gel electrophoresis to determine the source of microbial contamination of central venous catheters.

Microorganisms detected in situ on the distal tip of central venous catheters (CVC) within 90 min of insertion were investigated using pulsed-field gel electrophoresis to analyse genomic fragments obtained with the SmaI restriction enzyme. Thirty patients received a triple lumen CVC, which was inserted directly through the skin using the Seldinger technique. In a further 30 patients a triple lumen CVC was inserted through a Swan sheath, thereby avoiding direct contact of the CVC with the skin. Staphylococci were isolated from the distal tips of the catheters in 6 patients (5 who had the CVC inserted directly through the skin and 1 who had the CVC inserted via a Swan sheath.) Twenty-three staphylococcal isolates were also isolated from the insertion equipment and the skin swabs surrounding the insertion site of these six patients. All the isolates were genotyped. In one of the patients the organisms isolated from the skin were identical to those on the CVC tip. In two further patients similar organisms were isolated from the insertion equipment and the patients' skin. These results, in addition to the reduced colonisation rates observed when catheters were introduced through a Swan sheath, support the hypothesis that microorganisms from the skin are impacted onto the CVC tip and the CVC insertion equipment at catheter insertion.

Novel approach to investigate a source of microbial contamination of central venous catheters.

The potential route of contamination by skin microorganisms onto the distal tip of central venous catheters during insertion was investigated. Thirty patients undergoing cardiac surgery who required a central venous catheter (CVC) as part of their clinical management were studied. Following catheter placement, the device insertion equipment and the skin at the insertion site were sampled for microorganisms. The distal tips of the CVCs were also sampled in situ within 90 min post insertion. Bacteria were isolated from 20 of 30 (66%) CVC skin insertion sites, from 15 of 30 (50%) guidewires, and from five of 30 (16%) catheter distal tips in situ. These findings suggest that despite rigorous skin disinfection and strict aseptic technique, viable microorganisms are impacted during insertion onto the distal tip of the CVC, which may act as a subsequent nidus of infection.

Contamination of central venous catheters. The skin insertion wound is a major source of contamination

In a prospective controlled trial we compared the rates of catheter-tip contamination in central venous catheters inserted with or without skin contact. The study was designed so that each patient was their own control. All patients had a single-lumen central venous catheter and a Swan-Gantz sheet inserted through the skin. A Swan-Gantz catheter was inserted and retracted through the sheet thus avoiding contact with skin or subcutaneous tissue. Catheter-tip cultures were performed on removal of catheters. Thirty-three Swan-Gantz catheters were cultured and all were sterile. In the corresponding 33 sheets 16 (48·6%) yielded bacterial growth. Four of the sheets showed growth of more than 15 cfu. In the 26 singlelumen catheters, eight (30·8%) catheter-tips grew bacteria, and four of them had more than 15 colonies. The study supports the theory that the skininsertion wound is a major source of catheter-contamination.

The potential reduction of microbial contamination of central venous catheters

The microbial contamination of stopcock entry ports attached to central venous catheters (CVC) was determined using a specially designed swab. The swab was made of a highly porous material, Porex, and was designed to fit exactly into the entry port of stopcocks. The swab was used to determine the frequency of microbial contamination of entry ports attached to CVC in patients located on an Intensive Care Unit. Of the 200 swabs obtained 44 (22%) contained microorganisms. Coagulase-negative staphylococci were recovered from 43 of the swabs and diphtheroid bacilli from 1 swab. In vitro studies were carried out to investigate the efficiency of the swab in removing excess residual fluid and organisms from entry ports. The swab absorbed relatively large numbers of bacteria within seconds. When entry ports were inoculated with between 10(3) and 10(5) cfu of either Staphylococcus epidermidis or Klebsiella pneumoniae greater than 99% of the organisms were absorbed by the swab (P < 0.01). The absorbent swab was more efficient at removing S. epidermidis from the entry port when compared to a standard cotton swab (P < 0.01). In vitro this absorbent swab reduced the potential for catheter contamination resulting from migration of organisms from the entry port via the intraluminal route. The use of the swab in the clinical situation may reduce the incidence of CVC-related infections.