Device Utilization Rate Research Articles

Central Line Associated Bloodstream Infections Outside the Intensive Care Unit: A 2-Year Analysis

Objective: There is limited data on the rates of central line-associated bloodstream infections (CLABSI) in non-intensive care units (ICU). Our aim was to determine the rates and features of CLABSI in non-ICU units. Method: CLABSI surveillance is performed according to CDC criteria in Internal Medicine Nephrology, Pediatric/Adult Hematology, Oncology and hematopoietic stem cell transplant (HSCT) units. Hospital infections control committee surveillance data was used. Results: Totally, 70028 patient days(pd) and 22358 catheter days, 101 infections were detected in 94 patients. The CLABSI rate was 1.44/1000 pd, the incidence density was 4.2/1000 catheter days, and the device utilization rate was 0.32. The highest infection rate was observed in the adult HSCT unit (15.18/1000 pd). 56.4% of the patients were male (n=53) and the mean age of the patients was 32±2.5 years. The mean length of hospitalization was 27.7±2.5 days. Half of the patients (n=47) had permanent central lines. Hematologic cancer was found in 54.7% and hemodialysis in 19.2%. 21.8% of infections were polymicrobial. Of the 125 microorganisms isolated, 61.6% were Gram negative, 20.8% were fungi and 17.6% were Gram positive. The most frequent pathogen was E.coli (13.6%) followed by and K.pneumoniae (13.6%), Staphylococcus aureus (8%) and C.parapsilosis (7.2%). Crude mortality was 36.2%. Colistin and amikacin were the most effective antibiotics in E.coli and K.pneumoniae, oxacillin resistance was 60% in S. aureus. In Candida species, fluconazole resistance was 15.8%. Conclusion: CLABSI can also be seen outside intensive care units and surveillance in these units is necessary for infection control.

Triple-layer joint optimization of capacity and operation for integrated energy systems by coordination on multiple timescales

The introduction of energy conversion and storage devices, such as power-to-gas (P2G) and seasonal energy storage, can realize the multi-timescale electricity, heat and natural gas complementarity for integrated energy systems (IESs), promoting renewable energy consumption. However, this brings a large number of decision variables, strong coupling, and nonlinearity, increasing the complexity and difficulty of the optimal design for IESs. Therefore, this study proposes a generic triple-layer optimal design framework for IESs via coordination on multiple timescales. The proposed framework decomposes the optimal design of IESs into long-, medium-, and short-timescale optimization layers that are tractable. The long-timescale optimization layer realizes the seasonal source–load matching by incorporating a refined electricity–gas complementarity model; medium-timescale optimization layer utilizes the inter-day energy transfer to deal with extreme loads caused by rare weather conditions; and short-timescale optimization layer aims to realize real-time energy balances and gain economic benefits by intraday peak shaving. Each layer not only optimizes related capacity and operation variables jointly for its own timescale but also exchanges coupling information with adjacent layers via designed interactive iteration mechanisms. The implementation of the proposed framework is further investigated in the design of an electricity–gas–heating–cooling coupled IES. Finally, a case study is performed to verify the feasibility and effectiveness of the proposed optimal design method. Simulation results show that the proposed method realizes source–load matching across multiple timescales, reducing the annualized total cost of the IES by 2.4 % and 3.3 % compared to the conventional single-timescale optimal design method under the grid connection and off-grid modes, respectively. The renewable energy consumption and device utilization rate of the optimized IES exhibit obvious improvements. In particular, the wind energy consumption of the IES increases by 15 times after introducing P2G and seasonal energy storage. Furthermore, sensitivity analyses indicate that the natural gas price considerably affects the optimization of the capacity configuration and economic performance of the IES, far exceeding that of the electricity price.

Optimization of Curtain Wall Production Line Balance Based on Improved Genetic Algorithm

In recent years, construction engineering technology has been developing rapidly, and the application of curtain walls inside modern buildings is also increasing. However, with the increasing number of curtain wall orders, most factories are facing challenges in the market due to low productivity caused by a low balance rate of curtain wall production lines. This paper is useful in improving the balance rate of the curtain wall production line; firstly, we use the improved genetic algorithm to obtain the optimal sequencing scheme of the curtain wall production line. Then, the optimization plan is validated through FLEXSIM simulation, and the results show that the device utilization rate of each workstation reaches 80%. Finally, this paper designs an intelligent production factory for curtain walls, and then builds an intelligent production line for curtain wall columns for experiments. The experimental results show that the workstation operation time has been reduced from 360 s to 300 s; the production line balance rate has increased from 57.04% to 91.60%. Therefore, it can be concluded that the modified genetic algorithm is valid in improving the balance rate of curtain wall production lines and raising the production efficiency of enterprises.

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.

Surveillance of central line associated bloodstream infection (CLABSI) - comparison of current (CDC/NHSN) and modified criteria: A prospective study.

There is a huge load of central line-associated bloodstream infection (CLABSI) being reported in developing countries, with increased mortality and healthcare costs. Effective surveillance is a must to reduce the incidence of CLABSI. The current criteria (Centre for Disease Control and Prevention/National Healthcare Safety Network [CDC/NHSN]) for CLABSI surveillance have their own shortcomings. For diagnosing CLABSI, current CDC/NHSN CLABSI surveillance criteria are laborious and time consuming with low predictive power. Hence, modified criteria have been postulated, which are simple and implementable at resource-constrained setups. The primary objective was to compare modified criteria with CDC criteria. The secondary objective was to determine the prevalence of CRBSI. A total of 98 patients with central line in situ or having the central venous line removed ≤24 hrs prior to the date of the event were enrolled. Paired blood cultures were obtained and results were analyzed using differential time to positivity. The incidence of CLBSI was 8.16% and the device utilization rate was 11.6%. The negative predictive value of both the surveillance criteria was found to be excellent and comparable (96.2% for modified criteria and 97.1% for CDC criteria), therefore both can be used for screening purposes. AUC for current CDC/NHSN criteria was better than modified criteria (0.76 versus 0.66, P < 0.0001), suggesting it to be a better criterion for surveillance of CLABSI. Modified criteria were not superior to CDC/NHSN criteria for surveillance. Thus, there is a scope of improving the modified criteria for the purpose of surveillance. CLBSI load was higher; CLABSI bundle for prevention is thus highly recommended.

Dynamic Voltage-Balancing Method of Series Diode Rectifier in Inverter-Type AGPS

In negative ion-based neutral beam injector (N-NBI) system, acceleration grid power supply (AGPS) provides ultrahigh dc voltage for accelerator. Because the power supply often occurs in the ignition fault similar to the load short circuit, it will produce complex and violent electromagnetic transient process. The diode rectifier is the last stage of it and the diode rectifier is directly connected to the load of the AGPS. The working voltage of the rectifier reaches hundreds of kV, and a large number of diodes are used in the device in series. Therefore, it is necessary to fully consider the influence of distributed capacitance on voltage balancing and improve the static and dynamic voltage-balancing reliability of diodes. However, discussions about solutions for the dynamic voltage imbalance in the reverse recovery process caused by parasitic capacitance are not sufficient. This article presents a voltage-balancing method in the form of parameter relationships between non-isoparametric resistance-capacitance ( <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">RC</i> ) snubber circuits. Under the assumption of uniform voltage-sharing, the equivalent parallel circuit of each diode is obtained through constructing isoelectric points, accordingly, the parameter relationships are deduced. In this article, both the distributed capacitance to ground and the distributed capacitance to high voltage are considered in the derivation process; the derived non-equal parameter <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">RC</i> voltage-balancing method includes not only the buffer capacitance parameter relationship, but also the damping resistance parameter relationship and upper limit, which innovatively explores the important influence of damping resistance on the voltage-balancing effect. Dual-pulse tests on series-connected diodes prototype are carried out; experimental results show that voltage balance ratio <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\alpha $ </tex-math></inline-formula> of the prototype is only 0.80 with the traditional isoparametric <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">RC</i> circuit in parallel, while <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\alpha $ </tex-math></inline-formula> is up to 0.99 with the non-isoparametric <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">RC</i> circuit designed through the proposed method. The results will be valuable for improving the reliability and device utilization rate of series-connected diodes rectifiers in inverter-type AGPS.

Optimal configuration of park-level integrated energy system considering integrated demand response and construction time sequence

Park-level integrated energy system (PIES) is a typical application of multi-energy coupling and supply, whose configuration can effectively improve its energy efficiency. A PIES optimal configuration model considering integrated demand response (IDR) and construction time sequence is proposed in this paper to further stimulate the multi-energy complementary and improve the planning economy of PIES. First, PIES considering IDR is modeled and the mathematical models of energy conversion and storage devices are established. Then, the PIES configuration model considering IDR and construction time sequence is established. Finally, a case study on an electric-heat coupling commercial PIES is carried out to demonstrate the effectiveness of the proposed model, which shows that the proposed model is effective in terms of improving the device utilization rate, cutting the planning costs of PIES and realizing “peak-cutting and valley-filling”.

Modular High-Power DC–DC Converter for MVDC Renewable Energy Collection Systems

Medium-voltage (MV) dc collection system is a promising solution for future integration of large-scale renewables at remote places. This requires a high-power dc–dc converter to step up the voltage and connect with the high voltage direct current transmission line. In this article, a novel modular high-power dc–dc converter is proposed, with the combination of half-bridge and full-bridge submodules (SMs), as well as thyristors and diodes. It alternatively configures the SMs into parallel connection with the MV side to effectively share high current stress while series connection with the high voltage side to share the high voltage stress. It presents attractive features such as high device utilization rate, low cost, high step-up ratio, high efficiency, and small footprint. The circuit structure, operation principle, and the control schemes are discussed. Simulation results demonstrate the effectiveness, and the experimental results from a scaled down prototype further prove the proposed concept.

Postpartum Intrauterine Device Utilization Rate at an Academic Institution [12F

INTRODUCTION: In the first year postpartum, 70% of pregnancies are unintended. Long acting reversible contraceptives, such as intrauterine devices (IUDs), are among the most effective forms of contraception and have been successful in reducing unintended pregnancy rates. Many institutions do not place IUDs until several weeks postpartum despite the American College of Obstetricians and Gynecologists’ recent Committee Opinion No. 670. METHODS: A retrospective cohort study was performed among women who delivered from 7/2014 through 6/2015 at our institution. Those who expressed desire to use an IUD as contraception prior to discharge from the hospital following delivery were included. Billing lists with ICD-10 codes for IUD insertion were used to cross reference inpatient lists from the postpartum hospital stays. Primary outcome measure was percentage of patients who had an IUD inserted by three months postpartum. Additional reasons for not receiving an IUD were examined. RESULTS: 196 patients were identified who desired an IUD for postpartum contraception, and 86 (43.9%) received one. The most common reason for not receiving an IUD was loss to follow up (60%). Other reasons included choosing to use another form of contraception: hormonal (28.1%), barrier (9.1%), or abstinence (1.8%). CONCLUSION: More than half of our patients do not receive their desired method of postpartum contraception. As loss to follow up is the most common reason, institution of immediate postplacental IUD placement may allow for increased utilization and fewer unintended pregnancies. Further study is necessary to elucidate the barriers to immediate postpartum contraception.

Reliability Analysis and Redundancy Configuration of MMC With Hybrid Submodule Topologies

Modular multilevel converter (MMC) has become the most promising converter technology for high-voltage direct current (HVdc) transmission systems. MMC submodule (SM) topologies with dc fault ride-through capabilities are emerging which are suitable for overhead line applications. The hybrid SM design of each converter arm can get the compromise of higher capability of handling dc fault and lower capital investments and losses. In this paper, the initial hybrid SM numbers design method for supporting the dc-link voltage and riding-through dc faults and the optimized hybrid SM redundancy configuration strategy for effectively increasing the reliability of MMC are proposed and calculated. In contrast with the previously proposed redundancy configuration for MMC with the single SM topology, this approach solves the curvature of three-dimensional surface to calculate the recommended redundant hybrid SM numbers which takes both the semiconductor device utilization rate and the reliability of MMC into consideration.

Increase in catheter associated urinary tract infections in intensive care units at a tertiary care centre: a cause of concern

Aim: Health-care associated infections (HAIs) affect 5-20% of patients admitted in the hospitals. Catheter-associated urinary tract infections (CAUTI) are the commonest HAIs accounting for about 35-45% of these nosocomial infections due to lack of aseptic procedures and prolonged catheterization. The spectrum and antimicrobial resistance pattern of micro-organism that cause CAUTIs vary among institutions and can change from year to year. Materials and Methods: A retrograde analysis was performed on patients with indwelling catheters admitted in medical and surgical ICU. The patient’s demographic details (name, age,sex), date of hospital admission, provisional diagnosis, treatment details, time and date of catheter insertion and removal were recorded as per CDC criteria. CAUTI was diagnosed as per CDC guidelines. Results and Conclusions: A total of 687 patients were catheterized in ICU for an aggregate of 2748 patient days. The device utilization rate was 0.66. The prevalence of CAUTI per 1000 device days was 8.73.The causative uropathogens included Candida , E.coli , Enterococcus spp . A high degree of resistance was observed in all the isolates. There is a need to introduce appropriate measures aimed at proper use of catheters, to organise more frequent suitable personnel training and emphasis on hand washing procedures.

Novel low-resource intervention reduces urinary catheter use and associated urinary tract infections: Role of outcome measure bias?

Previous interventions targeting nosocomial urinary tract infections have reduced catheterization and infections, but they require significant resources and may be susceptible to misclassification and surveillance bias. We sought to determine the effectiveness of a novel intervention at reducing catheterization and infections while exploring the potential for bias. We conducted a prospective study of a brief monthly in-person educational intervention focusing on appropriate urinary catheter use. We studied 1,335 patients (13,753 patient days) on 1 control and 1 intervention ward. After the intervention, the device utilization rate was significantly reduced, with a relative risk of 0.49 (95% confidence interval [CI], 0.32-0.76; P = .001) versus 1.02 (95% CI, 0.58-1.82; P = .93) for controls. Both wards demonstrated a reduction in catheter-associated infections after intervention, with an intervention relative risk of 0.42 (95% CI, 0.16-1.08; P = .07) and 0.51 (95% CI, 0.22-1.20; P = .12) for controls. There was no change in the rate of all nosocomial urine infections, with an intervention relative risk of 0.79 (95% CI, 0.38-1.65; P = .53) and 0.89 (95% CI, 0.48-1.67; P = .72) for controls. Our study demonstrates that our novel educational intervention significantly reduces urinary catheter use in hospitalized patients. The trend towards reduced catheter-associated infections after intervention, coupled with the absence of an improvement in all nosocomial infections supports a potential role of misclassification bias. We suggest that future prospective investigations explore this phenomenon using more robust outcome measures.

Eliminating catheter-associated urinary tract infections in the intensive care unit: is it an attainable goal?

BackgroundPurpose of this study is to determine strategies to decrease catheter-associated urinary tract infection (CAUTI) in intensive care unit (ICU) patients. MethodsICU patients with an indwelling urinary catheter (UC) in one tertiary hospital were monitored for CAUTI. Interventions were implemented sequentially with quarterly data collection. Outcome measures were infection ratio (IR = number of infections/catheter days [CD] × 1000) and device utilization rate (DUR = catheter days/patient days). ResultsCDs and DUR decreased (fiscal year 2008: CD, 11,414; DUR, .85 vs fiscal year 2013: CD, 8,144; DUR, .70). IR increased with suspension of prepackaged baths (IR, 3.2 to 3.5 to 4.9 to 5.0), twice daily UC care (IR, 4.8 to 6.7), emptying UC bags at 400 mL (IR, 6.7 to 9.2). Two-person UC placement (IR, 5.6 to 4.8), physician notification of CAUTI (IR, 6.1 to 4.8), and reinstitution of prepackaged baths and daily UC care (IR, 4.8 to 3.7) decreased CAUTI rates. ConclusionsDecreasing CAUTI in the ICU requires diligent monitoring and constant practice re-evaluation. Elimination of CAUTI in the ICU may not be possible.

Zakażenia szpitalne — problem nowo otwartego oddziału intensywnej terapii

Health-care associated infections (HAI) are common complications in ICU patients as an effect of high invasive device utilization rate. The aim of the study was to analyze the epidemiology of ventilator - associated pneumonia (VAP), blood stream infections (BSI), urinary tract infections (UTI) and surgical site infections (SSI) in newly opened medical-surgical intensive care unit. VAP, BSI, UTI and SSI were detected and registered by hospital Infection Control Team according to CDC criteria during first 12 months following opening of new ICU. During 12-month period HAI was diagnosed in 44 out of 168 patients (26%). The ventilator utilization rate was 72%. The incidence density of VAP was 15.5/1000 ventilator days. The central line utilization was 100%. The BSI rate was 5/1000 catheter days. The urinary catheter utilization was 95%. The UTI rate was 1.9/1000 catheterization days. In 8 out of 60 surgical patients SSI occurred (13%). The most common isolates were Gram negative bacteria. The incidence of VAP was higher than the mean values reported for USA, western Europe and similar to the mean value reported for developing countries. BSI and UTI rate was comparable to those given in NNIS and HELICS reports. Effective prevention strategies should be introduced in order to reduce high VAP rates

Construction Scheme &amp; Application of IaaS-Based Shared Server Farm

Currently, most domestic colleges &amp; universities have the problems of overlapping IT resource investment, low device utilization rate and poor operation &amp; maintenance etc. For this purpose, this article is to analyze the core idea, value and product of the cloud computing, explain the architecture of the cloud computing, and provide IaaS-based shared server farm solution and its application at colleges &amp; universities.

Catheter-Related Bloodstream Infection and Antimicrobial Resistance Pattern in a Colombian Tertiary Intensive Care Unit

BACKGROUND/OBJECTIVES: Catheter-related Bloodstream infections (CRBSI) remain an important cause of Nosocomial infection in the ICU (Intensive Care Unit). In addition, Bacterial resistance to commonly used antimicrobial agents is a commonly problem on the ICU. The aim of this study was to determine the rate of CRBI and the antimicrobial resistance pattern for the bacteria responsible for catheter related Nosocomial infections. METHODS: This prospective study was conducted on the ICU of a tertiary care Hospital in Bogota-Colombia over a period of 11 months. CRBI were identified using the Centers for Disease Control definitions; the CRBI and device-utilization rates were calculated and compared with results of the adult ICU surveillance component of the annual report of the NNIS (National Nosocomial Infections Surveillance) of October 2004. Bacterial identification and the antimicrobial susceptibility were determined by the MicroScan system and were interpreted according to the criteria of the CLSI (Clinical and Laboratory Standards Institute). Results were included in a database and analysed with WHONET 5.3 software. RESULTS: The study included 388 patients. There were 27 episodes of CRBSI, with a rate of 3.55 per 1000 central-line-days and a device-utilization rate of 0.93. Compared with the annual report of the NNIS, our CRBI rate was between the 50th and 75th percentile and the device-utilization rate was higher than 90th percentile. Of these 27 episodes, 13 (48.1%) were due to Gram-negative organisms, 12 (44.4%) were due to Gram-positive organisms, and 2 (7.4%) were fungal. The most common organisms isolated were Acinetobacter baumannii (N = 8, 30%), Staphylococcus aureus (N = 8, 30%) and Klebsiella pneumoniae (N = 3, 11%). The table 1 illustrates the antimicrobial resistance pattern for the most common organism isolated. CONCLUSIONS: The CRBSI rate at our hospital is in a normal rank; even though the high device-utilization rate. Nevertheless, the isolated of multiresistant microorganisms is a threatening problem. Efforts on reducing the use or duration of invasive devices and surveillance of antimicrobial resistance must become a priority in our institution. Table 1 Antibiotic name Acinetobacter baumannii (n = 8) Staphylococcus aureus (n = 8) Klebsiella pneumoniae (n = 3) Ampicillin/Sulbactam 50 - 66.7 Ampicillin - - 100 Aztreonam 75 - 33.3 Cefepime 62.5 - 66.7 Cefotaxime 75 - 66.7 Ceftazidime 0 - 66.7 Ceftriaxone 75 - 66.7 Chloramphenicol - 12.5 NT Ciprofloxacin 87.5 87.5 0 Clindamycin - 75 - Erythromycin - 75 - Gentamicin 87.5 75 0 Imipenem 62.5 - 0 Meropenem 62.5 - 0 Oxacillin - 87.5 - Piperacillin/Tazobactam - - 0 Rifampin - 0 - Tetracicline NT 0 NT Trimethoprim/Sulfamethoxazole 87.5 0 33.3 Vancomycin - 0 - - = not aplicable NT = no tested.

Rate, risk factors and outcomes of catheter-related bloodstream infection in a paediatric intensive care unit in Saudi Arabia

The aim of this study was to determine the rate, risk factors and outcomes of catheter-related bloodstream infections (CRBSIs) in patients in a paediatric intensive care unit (PICU). A prospective cohort study was performed in King Abdulaziz Medical City, Riyadh, Saudi Arabia; a 650-bed academic/tertiary care centre with a combined 10-bed medical and surgical PICU. All patients admitted to the PICU from July 2000 to February 2003 who had a central line placed were monitored for the development of bloodstream infection (BSI) from insertion until 48 h after removal. Four hundred and forty-six patients with 2493 central-line-days were documented; 273 (55%) were male and the mean age was 2.6 years. Of the 446 patients, 278 (56%) had congenital heart disease, 108 (22%) had genetic disorders and/or congenital malformations, 55 (11%) had respiratory disease, and 42 (8%) had trauma. There were 50 episodes of CRBSI in 46 patients with a rate of 20.06 per 1,000 central-line-days and a device-utilization rate of 57%. Of these 50 episodes, 24 (48%) were polymicrobial, 16 (32%) were due to Gram-negative organisms, five (10%) were due to Gram-positive organisms, and five (10%) were fungal. The most common organisms isolated were Klebsiella pneumoniae (N=12, 16%), coagulase-negative staphylococci (N=10, 14%) and Pseudomonas aeruginosa (N=8, 11%). The mean duration of line insertion was 11.8 days for CRBSI patients and 4.22 days for non-BSI patients (P<0.0001). The mean PICU stay was 30.20 days for CRBSI patients and 6.35 days for non-BSI patients (P<0.0001). BSI occurred more often in catheters inserted in the PICU compared with the operating room, and in the femoral site compared with jugular or subclavian sites (P<0.001). In multiple logistic regression analysis of the risk factors, CRBSI patients were more likely to have multiple central lines [odds ratio (OR) 9.19; 95% confidence intervals (CI): 3.76-22.43), the line was more likely to be used for total parenteral nutrition (OR: 8.69; 95% CI: 3.5-21.4), and guidewire exchange was more likely to be performed on the line. CRBSI was not associated with a higher mortality rate. The CRBSI rate in our hospital is high compared with that reported by the National Nosocomial Infection Surveillance system. This study has established a benchmark for future comparisons. Additional studies from Saudi Arabia are necessary for national comparison and development of preventive measures.

Prevalence of Primary Bloodstream Infections in Representative German Hospitals and their Association with Central and Peripheral Vascular Catheters

The prevalence of noncentral and central lines and the prevalence of nosocomial primary bloodstream infections was investigated in 72 representative German hospitals (NIDEP Study). Data from a total of 14,966 patients were documented. On the prevalence day, it amounted to 23.9% for noncentral and 5.1% for central lines. The total prevalence of nosocomial primary bloodstream infections was 0.3%, 8.3% of all nosocomial infections recorded were primary bloodstream infections. The device utilization rate of vascular catheters was retrospectively observed for both the prevalence day and another 6 days. The device utilization rate was 27.3% for peripheral and 6.1% for central catheters with higher rates in west Germany. The associated incidence density of primary nosocomial bloodstream infections per 1000 catheter-days was 0.3 for noncentral and 0.8 for central lines. In 61.4%, the primary bloodstream infections were microbiologically confirmed. In 52.6% of cases, Gram-positive bacteria were isolated (Staphylococcus aureus: 15.8%, other coagulase negative Staphylococcus species: 34.2%) and in 47.4%, Gram-negative ones (mostly: Escherichia coli: 13.2% and Klebsiella species: 10.5%). Prevention to reduce nosocomial bloodstream infections is possible by antimicrobial establishing specially trained infusion therapy teams, using antimicrobial or antiseptic impregnated bloodstream catheters and a strict review of the indication for a vascular catheter together with a minimization of catheter days.