Device Utilization Ratios Research Articles

Ultra-Wide Output Voltage Range Power Supply Based on Modular Switched-Converter Principle

A systematic method for developing ultra-wide output voltage range power supply based on modular switched-converter principle is proposed in this paper. The basic symmetric switched-converter (SSC) module is composed of two dc–dc modules, two diodes, and one active switch. Multi-stage SSC modules are generated by symmetric cascaded connection method. By controlling the active switches in multi-stage SSC modules, the connections of all the dc–dc modules’ output ports can be changed flexibly among series, parallel, and partial–parallel–partial-series connections. Then segmented regulation can be realized and system output voltage range can be widely extended. Meanwhile, the voltage range of each dc–dc module can be narrowed and the voltage/current stress can be reduced to simplify the design, increase device utilization ratio, and improve overall efficiency. A full-bridge isolated buck–boost converter with a semiactive rectifier, which features soft-switching and wide voltage adjustment range, is adopted as the dc–dc module to realize the proposed system. Input current sharing control strategy is adopted to ensure proper power balancing in all possible operating modes. The stability of the proposed system is also explored. Simulation and experimental results are provided to verify the effectiveness and advantages of the proposed system configuration, the switched-converter principle, and the control strategies.

The evolution of catheter-associated urinary tract infection (CAUTI): Is it time for more inclusive metrics?

Catheter-associated urinary tract infection (CAUTI) has long been considered a preventable healthcare-associated infection. Many federal agencies, the Centers for Medicare and Medicaid Services (CMS), and public and private healthcare organizations have implemented strategies aimed at preventing CAUTIs. To monitor progress in CAUTI prevention, the National Healthcare Safety Network (NHSN) CAUTI metric has been adopted nationally as the primary outcome measure and has been refined over the past decades. However, this surveillance metric may underestimate infectious and noninfectious catheter harm. We suggest evolving to more inclusive performance metrics to better reflect quality improvement efforts underway in hospitals. The standardized device utilization ratio (SUR) provides a good surrogate for preventable catheter harm. On the other hand, a population-based metric that combines both standardized infection ratio (SIR) and SUR would address both infectious and noninfectious harm, while adjusting for population risk. Finally, electronically captured catheter-associated bacteriuria may contribute essential information on local testing stewardship.

2106. What Metrics Should We Use to Evaluate CAUTI Performance for Inpatient Rehabilitation Units? An Evaluation of a Large, National Healthcare System

BackgroundThe National Healthcare Safety Network (NHSN)’s Targeted Assessment for Prevention (TAP) Strategy is a framework for quality improvement that offers a focused approach to infection prevention. The cumulative attributable difference (CAD) is used as a prioritization metric to identify areas with the highest burden of excess infections. The standardized utilization ratio (SUR) provides risk-adjusted urinary catheter metric beyond traditional device utilization ratios (DUR). We reviewed a TAP Report and SURs for all Inpatient Rehabilitation Facilities (IRF) within a large, national healthcare system.MethodsUsing the NHSN database, we generated a catheter-associated urinary tract infection (CAUTI) TAP Report for all IRFs across the system for calendar year 2017. The standardized infection ratio (SIR) goal was set at 0.75. CAD [observed events − (predicted events multiplied by SIR goal)] was calculated. A 12-month cumulative urinary catheter SUR was also computed in NHSN.ResultsData from 26 IRFs were reviewed. Total CAUTIs ranged from 0 to 5 (median = 0, mean = 0.88). DURs ranged from 3 to 17%; CAD, −0.70 to 4.10; 12-month cumulative SURs, 0.35–2.14. Statistically significant SIRs were only calculated for two IRFs. Several IRFs with 0 infections had SURs > 1, and two IRFs with multiple CAUTIs had an SUR of ≤1 (table).ConclusionCAD is an actionable prioritization metric for infection prevention in health systems and individual facilities. In populations where events are rare, however, the SUR can be an additional metric to reduce device-associated risks. Areas with high CAD/low SUR could be evaluated for other potential causal factors, including device insertion, care/maintenance techniques and accuracy of NHSN definition application.Table.TAP Report, including SURFacility TAP RankCAUTIsDUR %12-Month SURCADSIR15141.854.104.12460.723.40*3381.002.40*4491.122.001.55170.850.80*6150.630.80*7150.670.80*81101.290.70*9160.830.70*101172.140.60*111121.570.50*12070.92-0.10*13030.35-0.10*14060.78-0.20*15060.82-0.20*16030.35-0.20*17070.87-0.20*18081.07-0.20*19050.62-0.30*20070.96-0.30*21070.92-0.30*220101.31-0.30*23070.92-0.30*24070.95-0.40*25040.58-0.40*260121.50-0.70** Not calculated.Disclosures All authors: No reported disclosures.

1763. Estimating Median Survival Time to Central Line-Associated Bloodstream Infection (CLABSI) Among Patients in Intensive Care Units Reported to National Healthcare Safety Network (NHSN)

BackgroundDuration free of central line-associated bloodstream infection (CLABSI) in a hospital may vary by type of patient population. We estimated patients’ median time to CLABSI by intensive care unit (ICU) type among acute care hospitals.MethodsThe study population was ICU patients whose CLABSI data were reported to National Healthcare Safety Network (NHSN) in 2016 under the reporting requirement of the Centers for Medicare and Medicaid. The unit of analysis was ICU location, not an individual patient. We conducted counting process survival analysis method to compute time (day) to a CLABSI beginning from day 1 of first reporting month in 2016 in a given ICU location. Once a CLABSI occurred in a location, the start time of follow-up was reset to day 1 after the date of event. The Cox regression method was used to explore the hospital and location-level characteristics that are potentially associated with the daily hazard of CLABSI for an ICU. We also assessed the proportionality hazard assumption of these factors. Adjusting for the vector of means of covariates, we then estimated median time to CLABSI by ICU location type, which is defined as follow-up time (days) by which 50% of events have happened in a given ICU type.ResultsIn 2016, 6,935 ICUs at 3,384 hospitals reported CLABSI data to NHSN, with a total of 10,985 CLABSIs and 2,449,361 follow-up time in days. Factors associated with an increased daily hazard of CLABSI were the following: admission to a hospital with a large bed size, major teaching status, and admission to a patient care location with a higher device utilization ratio (Table 1). Adjusted survival curves showed that median time to event (median CLABSI-free time) among ICUs ranged from 66 days (level III neonatal ICU), 90 days (burn units) to 275 days (oncology units), and 284 days (cardiothoracic units) (Table 2, Figure 1).ConclusionThe study demonstrated that ICUs with level III care for neonatal patients and ICUs with burn patients were least likely to achieve the target of “zero” infection in a defined period and may warrant further targeted interventions. Similar research to investigate infection control performance through estimating median infection-free time is needed beyond ICUs and across multiple HAI types and facility settings. Disclosures All authors: No reported disclosures.

Interventions to prevent urinary catheter–associated infections in children and neonates: a systematic review

Few data are available to inform strategies for the prevention of catheter-associated urinary tract infection (CAUTI) in children and neonates. Many recommendations are derived from studies in adults and cannot be applied to the paediatric population. This study was aimed to identify all studies that measured the efficacy of an intervention for the prevention of CAUTI in children and neonates. A systematic review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) was conducted. Eligible studies published between January 1st, 1995 and December 31st, 2017, were identified in PubMed, the Cochrane Database of Systematic Reviews, LILACS, SciELO and DOAJif applying an intervention with the aim of CAUTI prevention in inpatient children, infants or neonates. The following study designs were included: controlled and non-controlled before-and-after studies, (controlled) interrupted time series analyses and randomized controlled trials. Quantitative or qualitative studies on interventions in both adults and children were eligible if data on children could be extracted. Reviews, case series, letters, notes, conference abstractsand opinion articles were excluded. Of 99 articles identified, six were included in the final analysis, after consensus from three independent investigators. Four studies used a multimodal strategy (using at least four or more different components at the same time) as follows: aseptic rules during catheter insertion and removal; cleaning the urethral meatus with sterile water; use of a new silicone catheter per insertion with a closed sterile drainage system by a sterile technique; daily evaluation of catheter requirement; placement of indwelling urinary catheters only for approved indications; reducing of urinary catheter days and positioning of the patient and collection device to assist in urine drainage. One study tested periurethral cleaning intervention to reduce CAUTI. One study described the association of the presence of a physician safety champion with urinary catheter device utilization ratios. Catheter-associated UTI reduction rates were reported in four studies; three achieved statistically significant decreases in CAUTI rates. Positive results were achieved only when a multimodal strategy was used with at least four or more components. This strategy could be adopted for paediatric healthcare institutions to reduce CAUTI rates in children and neonates. Evidence exists to support the use of a multimodal strategy for CAUTI reduction in hospitalized children and neonates.

Impact of a Multidisciplinary Infection Prevention Initiative on Central Line and Urinary Catheter Utilization in a Long-term Acute Care Hospital.

BackgroundProlonged central line (CL) and urinary catheter (UC) use can increase risk of central line–associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI).MethodsThis interventional study conducted in a 76-bed long-term acute care hospital (LTACH) in Southeast Michigan was divided into 3 periods: pre-intervention (January 2015–June 2015), intervention (July–November 2015), and postintervention (December 2015–March 2017). During the intervention period, a multidisciplinary infection prevention team (MIPT) made weekly recommendations to remove unnecessary CL/UC or switch to alternate urinary/intravenous access. Device utilization ratios (DURs) and infection rates were compared between the study periods. Interrupted time series (ITS) and 0-inflated poisson (ZIP) regression were used to analyze DUR and CLABSI/CAUTI data, respectively.ResultsUC-DUR was 31% in the pre- and postintervention periods and 21% in the intervention period. CL-DUR decreased from 46% (pre-intervention) to 39% (intervention) to 37% (postintervention). The results of ITS analysis indicated nonsignificant decrease and increase in level/trend in DURs coinciding with our intervention. The CAUTI rate per catheter-days did not decrease during intervention (4.36) compared with pre- (2.49) and postintervention (1.93). The CLABSI rate per catheter-days decreased by 73% during intervention (0.39) compared with pre-intervention (1.45). Rates again quadrupled postintervention (1.58). ZIP analysis indicated a beneficial effect of intervention on infection rates without reaching statistical significance.ConclusionsWe demonstrated that a workable MIPT initiative focusing on removal of unnecessary CL and UC can be easily implemented in an LTACH requiring minimal time and resources. A rebound increase in UC-DURs to pre-intervention levels after intervention end indicates that continued vigilance is required to maintain performance.

Multicenter Study of Device-Associated Infection Rates, Bacterial Resistance, Length of Stay, and Mortality in Intensive Care Units of 2 Cities of Vietnam: International Nosocomial Infection Control Consortium Findings.

The aim of the study was to report the results of the International Nosocomial Infection Control Consortium (INICC) study conducted from May 2008 to March 2015. A device-associated healthcare-acquired infection surveillance study in three adult intensive care units (ICUs) and 1 neonatal ICU from 4 hospitals in Vietnam using U.S. the Centers for Disease Control and Prevention's National Healthcare Safety Network (CDC/NHSN) definitions and criteria as well as INICC methods. We followed 1592 adult ICU patients for 12,580 bed-days and 845 neonatal ICU patients for 4907 bed-days. Central line-associated bloodstream infection (CLABSI) per 1000 central line-days rate was 9.8 in medical/surgical UCIs and 1.5 in the medical ICU. Ventilator-associated pneumonia (VAP) rate per 1000 mechanical ventilator-days was 13.4 in medical/surgical ICUs and 23.7 in the medical ICU. Catheter-associated urinary tract infection (CAUTI) rate per 1000 urinary catheter-days was 0.0 in medical/surgical ICUs and 5.3 in the medical ICU. While most device-associated healthcare-acquired infection rates were similar to INICC international rates (4.9 [CLABSI]; 16.5 [VAP]; 5.3 [CAUTI]), they were higher than CDC/NHSN rates (0.8 [CLABSI], 1.1 [VAP], and 1.3 [CAUTI]) for medical/surgical ICUs, with the exception of CAUTI rate for medical/surgical ICU and CLABSI rate for the medical ICU. Because of limited resources of our Vietnamese ICUs, cultures could not be taken as required by the CDC/NHSN criteria, and therefore, there was underreporting of CLABSI and CAUTI, influencing their rates. Most device utilization ratios and bacterial resistance percentages were higher than INICC and CDC/NHSN rates. Device-associated healthcare-acquired infection rates found in the ICUs of our study were higher than CDC/NHSN US rates, but similar to INICC international rates. It is necessary to build more capacity to conduct surveillance and prevention strategies.

Evaluation of the Prevalence of Nosocomial Infection in Different Wards of Be’sat Hospital of Hamedan

Background: The nosocomial infections are the ones that arise between 48 to 72 hours after patient’s reference to hospital, shortly after hospital discharge, or 30 days after an operation. This study aimed to evaluate the prevalence of nosocomial infection in different wards of Be’sat hospital of Hamedan. Methods: This prospective cross-sectional study was conducted (during April-July 2016) on admitted patients that suffered from nosocomial infections based on CDC (Centers for Disease Control and Prevention) criteria. During the time of the study, patients who referred to different wards of the hospital (except for the pediatric ward), showed clinical signs of nosocomial infection 48 hours after the admission. Their tracheal, urine, blood, and surgical wound samples were transferred to laboratory for culture and identification of infectious agent. Patients’ demographic information were encoded as confidential records, then, the data were analyzed using SPSS software. All ethical principles of the Helsinki Declaration were observed. Results: Out of a total of 10332 hospitalized patients, 266 (2.6%) of them acquired nosocomial infection of which 183 (69%) of them were males and 83 (31%) were females. The patients’ mean age was 58.14. There was no significant relationship between the age and the type of nosocomial infections (P=0.052). The mean period of hospitalization was 28.2 days. The most common nosocomial infection was ventilator associated pneumonia (VAP) with 110 cases (41.3%) and the rarest of them was catheter associated-urine tract infection (CA-UTI) with 23 (8.64%) cases. Fifty-nine cases (53.6%) out of 110 VAP patient cases survived and 51 (46.4%) of them died. The overall mortality rate was 30%. Among 242 bacterial strains isolated, Escherichia coli was the most common strain with a prevalence of 61 (22.9%). Most of the death cases (57.9%) were caused by Proteus nosocomial infections. Conclusion: The high values of nosocomial infections and mortality in Be’sat hospital represent a need to reinforce the preventive and control program on nosocomial infections. In future studies, in order for better presentation of nosocomial infection in terms of latest events, infection and organism type, and antibiotic resistance pattern, novel indexes like device utilization ratio (DUR) and incidence density of device-associated infections (IDDI) are suggested.

Prospective surveillance of healthcare-associated infections and patterns of antimicrobial resistance of pathogens in an Italian intensive care unit

BackgroundThe study aimed to evaluate the distribution of healthcare-associated infections (HAIs), the incidence rates and device utilization ratio (DUR) of device-associated infections (DAIs), as well as the distribution and patterns of antimicrobial resistance of the responsible pathogens.MethodsEligible patients who were admitted to an adult Intensive Care Unit (ICU) from May 1, 2013 to December 31, 2016 were included in the surveillance. Demographics, intrinsic and extrinsic risk factors, information regarding infection and isolated pathogens with antibiogram results were collected.ResultsOne thousand two hundred eighty-three patients were included in the surveillance. One hundred forty-seven HAIs were detected with a cumulative incidence of 9.2 per 100 patients 4-year period and an incidence rate of 17.4 per 1000 patient days. Fifty-six out of 1283 patients were affected by at least one episode of ICU-acquired pneumonia, and 72.7% of these were associated with intubation. ICU-acquired bloodstream infections (BSIs) occurred in 4.4% of patients and 89.5% were catheter-related. ICU-acquired urinary tract infections (UTIs) occurred in 1% of patients, with 84.6% of the episodes being associated with the use of an urinary catheter. The pattern of antimicrobial-resistance in the isolates showed, among the Gram-positive bacteria, that 66.6% and 16.6% of Staphylococcus epidermidis were oxacillin and teicoplanin resistant, respectively. Among the Gram-negative bacteria, carbapenem resistance was found in 91.6% of Acinetobacter baumannii and 28.5% of Klebsiella pneumoniae isolates.ConclusionsThe majority of HAIs in the ICU studied were associated with the use of invasive devices. Since a significant proportion of these HAIs are considered preventable, reinforcement of the evidence-based preventive procedures are needed.

Device Utilization Ratios in Infection Prevention: Process or Outcome Measure?

The purpose of this review is to describe the role of device utilization as a component of surveillance for healthcare-associated infections and describe its potential role as a measurement of healthcare quality. Device utilization, while primarily a process-based measure in the prevention of device-associated infections can also serve as an important outcome in the evaluation of an infection prevention program. Device utilization can be an important and resource-efficient measurement when coupled with measurements of risk-adjusted infection rates. The measurement of the device utilization ratio can provide insight into the risk of device-associated harms, including non-infectious harms, which would not be captured with currently used infection-based surveillance metrics. Further study and validation of standardized, risk-adjusted device utilization measurements is an important area for future exploration.

Trends in device utilization ratios in intensive care units over 10-year period in South Korea: device utilization ratio as a new aspect of surveillance

Device-associated infection (DAI) is an important issue related to patient safety. It is important to reduce unnecessary device utilization in order to decrease DAI rates. To investigate the time trend of device utilization ratios (DURs) of voluntarily participating hospitals, collected over a 10-year period through the Korean National Healthcare-associated Infections Surveillance System (KONIS). DURs from 2006 to 2015 in 190 intensive care units (ICUs) participating in KONIS were included in this study. DURs were calculated as the ratio of device-days to patient-days. The pooled incidences of DAIs and DURs were calculated for each year of participation, and the year-wise trends were analysed. Year-wise ventilator utilization ratio (V-DUR) increased significantly from 0.40 to 0.41 (F=6.27, P<0.01), urinary catheter utilization ratio (U-DUR) increased non-significantly from 0.83 to 0.84 (F=1.66, P=0.10), and C-line utilization ratio (CL-DUR) decreased non-significantly from 0.55 to 0.51 (F=1.62, P=0.11). In the subgroup analysis, 'medical ICU' (F=2.79, P<0.01) and 'hospital with >900 beds' (F=3.07, P<0.01) were associated with the significant increase in V-DUR. In Korea, V-DUR showed a significant, year-wise increasing trend. The trends for U-DUR and CL-DUR showed no significant decrease. Efforts are required to ensure the reduction of DURs.

Prospective surveillance of device-associated health care–associated infection in an intensive care unit of a tertiary care hospital in New Delhi, India

Surveillance of health care-associated infections (HAIs) plays a key role in the hospital infection control program and reduction of HAIs. In India, most of the surveillance of HAIs is reported from private sector hospitals that do not depict the situation of government sector hospitals. Other studies do not confirm with the Centers for Disease Control and Prevention's (CDC) National Healthcare Safety Network (NHSN) surveillance criterion, or deal with ventilator-associated pneumonia (VAP) instead of ventilator-associated event (VAE). The aim of this study was to identify the incidences of 3 device-associated HAIs (DA-HAIs) (VAE, central line-associated bloodstream infection [CLABSI], and catheter-associated urinary tract infection [CAUTI]) by active surveillance using CDC's NHSN surveillance criteria and to identify the pathogens associated with these DA-HAIs. This was a prospective surveillance study (January 2015-December 2016) conducted in an intensive care unit (ICU) of a large, tertiary care, government hospital situated in Delhi, India. Targeted surveillance was done as per the CDC's NHSN 2016 surveillance criteria. There were 343 patients admitted to the ICU that were included in the study. The surveillance data was reported over 3,755 patient days. A DA-HAIs attack rate of 20.1 per 100 admissions and incidence of 18.3 per 1,000 patient days was observed. The duration of use for each device for patients with DA-HAIs was significantly longer than for patients without DA-HAIs. The device utilization ratios of central line, ventilator, and urinary catheters were 0.57, 0.85, and 0.72, respectively. The crude excess length of stay for patients with DA-HAI was 13 days, and crude excess mortality rate was 11.8%. VAE, CLABSI, and CAUTI rates were 11.8, 7.4, and 9.7 per 1,000 device days, respectively. Among 69 DA-HAIs reported, pathogens could be identified for 49 DA-HAI cases. Klebsiella spp was the most common organism isolated, accounting 28.5% for all DA-HAI cases, followed by Enterococcus spp (24.4%). The most common organisms causing VAE, CAUTI, and CLABSI were Acinetobacter (6/15, 40%), Enterococcus spp (11/31, 35.4%), and Candida spp (5/19, 26.3%), respectively. Most of the gram-negative organisms were carbapenem resistant; however, none of the isolates were colistin resistant. To reduce the risk of infection in hospitalized patients, DA-HAI surveillance is of primary importance because it effectively describes and addresses the importance and characteristics of the threatening situation created by DA-HAIs. The present surveillance shows high rates of ICU-onset DA-HAIs and high resistance patterns of organisms causing HAIs, representing a major risk to patient safety.

A3 for Central Line-Associated Blood Stream Infections

SESSION TITLE: Quality Improvement 1 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: An estimated 30,000 central line associated blood stream infections (CLABSIs) occur in U.S. Intensive Care Units (ICUs) each year. Patient mortality rates associated with CLABSI range from 12-25% and the cost of CLABSIs ranges from $3,700 to $36,000 per episode of care. To address this issue, we collaborated with hospital management to create a multidisciplinary team to enhance the care of patients with central venous catheters (CVCs) by using A3. A3 is a problem solving and continuous improvement approach first employed by Toyota and based on Edward Denning’s PDSA (Plan-Do-Study-Act).We implemented an A3 problem solving methodology in order to systematically reduce CLABSI among the medical and surgical ICUs. METHODS: A review of CLABSI related events across the various adult ICUs was performed. Initial and target states were established. The goal was to achieve a zero CLABSI rate by standardizing workflow for insertion, implementing strict guidelines for maintenance, and emphasizing early removal of CVCs. Gap analysis was used to identify multiple areas for improvement, which fell into five major categories: workflow, education, documentation, assessment and visual management. During subsequent monthly meetings, multiple small experiments were developed and implemented. Some of the products of these experiments include the creation of standardized central line insertion and maintenance checklists, a CVC insertion and maintenance audit tool, and a decision algorithm for line insertion and maintenance. RESULTS: We reviewed a total of 14,960 ICU patient days. Mean patient-days per month was 298 (range 210-379). Following the implementation of insertion and maintenance checklists in ICUs, we were able bring down our CLABSI Rate (CLABSI events /1000 patient days) from 2.25 to 0.00 to achieve our target goal of zero. CLABSI rates were reduced by 100% among adult ICU patients (p<0.001). Despite emphasis to reduce the use of central lines by early removal and consideration of alternative access, the device utilization ratio (defined as device utilization days divided by patient days) remained relatively constant (mean 0.30; range 0.23-0.39). These rates were sustained over the next nine months and checklists are permanently embedded in ICU work protocol. CONCLUSIONS: Our data demonstrates the effectiveness of the A3 approach for improving quality and safety among the different ICUs. Using this methodology, we were able to serially introduce several interventions that acted synergistically to eliminate CLABSI in the ICU. CLINICAL IMPLICATIONS: A3 provides an effective appraoch to problem solving and can be used in clinical setting to decrease and sustain lower CLABSI rates. DISCLOSURE: The following authors have nothing to disclose: Sikander Zulqarnain, Anton Dela Cruz, Gem Snagg, Raymonde Elysee, Jacqueline Syrus, Samir Fahmy No Product/Research Disclosure Information

Epidemiology of device-associated infections in an intensive care unit of a teaching hospital in Nepal: A prospective surveillance study from a developing country

Device-associated health care-acquired infections (DA-HAIs) in intensive care unit patients are a major cause of morbidity, mortality, and increased health care costs. A prospective, structured clinicomicrobiological surveillance was carried out for 3 common DA-HAIs: ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI) present in the patients of an intensive care unit of a teaching hospital in Nepal. DA-HAIs were identified using the Centers for Disease Control and Prevention definitions, and their rates were expressed as number of DA-HAIs per 1,000 device-days. Overall incidence rate of DA-HAIs was 27.3 per 1,000 patient-days occurring in 37.1% of patients. The device utilization ratio for mechanical ventilation, central line catheter, and urinary catheter was 0.83, 0.63, and 0.78, respectively. The rates of VAP, CLABSI, and CAUTI were 21.40, 8.64, and 5.11 per 1,000 device-days, respectively. Acinetobacter spp (32.7%), Klebsiella spp (23.6%), Burkholderia cepacia complex (12.7%), and Escherichia coli (10.9%) were the common bacterial pathogens. Most of the bacterial isolates associated with DA-HAIs were found to be multidrug-resistant. Incidence of DA-HAIs in the study intensive care unit was high compared with that of developed countries. Formulation and implementation of standard infection control protocols, active surveillance of DA-HAIs, and antimicrobial stewardship are urgently needed in our country.

Clinico-microbiological profile of health-care associated infections in a paediatric intensive care unit of tertiary care hospital

Background: The study was undertaken to determine the total burden of health-care associated infections, microbiological profile and their impact on length of stay and mortality in a PICU of a tertiary care Hospital by prospective surveillance.Methods: All children ≥ one month and ≤ twelve years of age admitted in PICU for more than 48 hours from December 2009 to November 2010 were followed according to CDC/NHSN surveillance definitions of HCAI. Incidence rates, incidence densities and device utilization ratio were measured for different HCAI. Length of stay and mortality of HCAI were compared with non-HCAI patients. Antibiotic susceptibility pattern of isolated micro-organism was analyzed. Results: Out of total 618 patients admitted in PICU during study period 324 fulfilled study criteria. In those 324 patients 58 patients developed 68 episodes of HCAI. The CIR and IDs’of HCAI were17.9/100 patients and 22.14/1,000 patient-days, respectively. Of the 68 episodes of HCAI, there were 36 VAP, 17 BSI, 8 UTI, 2 pneumonia, 2 LRI-LUNG and 1each of SSI-MED, SST-Skin and GI-IAB. The most common microorganism isolated was Acinetobacter spp. followed by Pseudomonas spp. HCAI increased the average length of PICU stay (20 days versus 5 days, P&lt;0.01) and Hospital stay (28 days versus 12 days, P&lt;0.01). Overall mortality was significantly higher in patients who developed HCAI than non-HCAI (50.9% versus 21.3%, P&lt;0.01).Conclusions: HCAI rates were higher than developed countries. VAP was the most common HCAI followed by BSI. HCAI increased the length of stay and mortality (P&lt;0.01). Organisms isolated in HCAI were more resistant than non-HCAI isolates.

Improving Patient Outcomes and Health Care Provider Communication with a Small, Yellow Plastic Band: the Patient URinary Catheter Extraction (PURCE) Protocol©

IntroductionGreat efforts are being made to reduce catheter associated urinary tract infections as they increase patient morbidity and are costly to health care centers. Although various catheter associated urinary tract infection prevention initiatives exist, efficient communication between physicians and nurses continues to be a significant barrier. In an effort to enhance communication and reduce catheter associated urinary tract infections, we implemented a novel Patient URinary Catheter Extraction (PURCE) Protocol© and in this study we evaluate the utility of the PURCE Protocol. MethodsThe PURCE Protocol was implemented for all urology and vascular surgical patients admitted to 1 surgical specialty unit between January and December 2014 (treatment group, 901 patients). The control group consisted of urology and vascular surgical patients admitted to the same surgical specialty unit during the 12-month period (January to December 2013) before protocol implementation (926). End points included annual catheter associated urinary tract infection rates, device utilization ratio and protocol deviations. ResultsThe majority of urology/vascular surgery patients in both groups underwent catheter placement (control 55.4% vs treatment 58.9%). The annual catheter associated urinary tract infection rate for urology/vascular surgery patients in the control group was 2.5 compared to 0.0 in the treatment group. The annual device utilization ratio increased slightly from 0.15 in the control to 0.17 in the treatment group. Within the first 6 months of implementation there were 405 patient audits and 28 protocol deviations (6.9%), and no additional deviations occurred in the last 6 months of the study. ConclusionsAccording to our findings implementation of the PURCE Protocol led to a reduction in catheter associated urinary tract infections in a highly susceptible surgical patient population.

Trends of Device Utilization Ratios in Intensive Care Units During 10 Years in South Korea: Results from the Korean National Healthcare-Associated Infections Surveillance System

BackgroundDevice-associated healthcare-associated infection (DA-HAI) is an important issue related to safety of patients. It is important to reduce unnecessary device utilization in order to decrease DA-HAI rates. Therefore, we investigate to the time trend of device utilization (DU) ratios and DA-HAI rates to analyzed collected data for 10 years through the Korean National Healthcare-associated Infections Surveillance System (KONIS) which is voluntarily participating in hospitals.MethodsWe investigate the time trend of DU ratios and DA-HAI rates from 2006 through 2015 in KONIS participating intensive care units (ICUs). DA-HAI rates were calculated as the numbers of infections per 1,000 device-days and DU were calculated as a ratio of device-days to patient-days. The pooled incidences of DAIs and DU ratios were calculated for each year of participation.ResultsData were collected on 5,325,176 catheter-days and 6,358,829 patient-days in the 190 participating ICUs between July 2006 and June 2016. From 2006 to 2015, year-wise ventilator utilization ratio (V-UR) per 1000 patients-days increased significantly from 0.40 to 0.454 (F = 6.27, P < 0.0001), year-wise urinary catheter utilization ratio (UC-UR) show gradually increased trend from 0.83 to 0.84 but non-significantly (F = 1.66, P = 0.0951), and year-wise c-line utilization ratio (CL-UR) was gradually decreased non-significantly from 0.55 to 0.52 (F = 1.62, P = 0.1059). In subgroup analysis, Medical ICU (F = 2.79, P = 0.0034) or hospital with more than 900 beds (F = 3.07, P = 0.0015) related to increased significantly V-UR. Rate of ventilator associated pneumonia significantly decreased from 3.48 in 2006 to 1.00 in 2015 (per 1000 ventilator-days, F = 27.62, P < 0.0001). Also, rates of catheter associated UTI and c-line associated blood stream infection significantly decreased from 1.85 to 0.88 (per 1000 catheter-days, F = 10.14, P < 0.0001) and from 3.40 to 2.20 (per 1000 catheter-days, F = 14.17, P < 0.0001).ConclusionIn Korea, all of the DA-HAIs have shown a significant reduction in the last 10 years, however V-UR has year-wise significantly increased trend for past 10-years, also UC-UR and CL-UR have not decreased trend significantly. We need effort to make reduction of device utilization ratios.Disclosures E. J. Kim, Korean Nosocomial Infections Surveillance System (KONIS): Investigator, Research support; Y. HOURS. Choi, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research grant; H. Y. Kim, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research support; Y. G. Kwak, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research support; T. H. Kim, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research grant; H. B. Kim, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research grant; S. H. Park, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research grant; M. Lee, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research grant; S. O. Lee, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research grant; J. Y. Choi, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research grant; P. G. Choe, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research grant; S. K. Lim, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research grant; S. R. Kim, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research support; M. J. Shin, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research support; S. Y. Yoo, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research support; H. Yoo, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research support; J. Y. Choi, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research support; S. H. Han, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research support

The Intern Intervention: The Effect of Daily Rounding on Reducing Indwelling Urinary Catheter Device Utilization

BackgroundUrinary tract infections (UTIs) are the 4thleading type of healthcare-associated infection. According the Centers for Disease Control and Prevention, catheter associated urinary tract infections (CAUTIs) account for 75% of healthcare-associated UTIs with approximately 15–25% of patients receiving urinary catheters (UCs) during their hospital stay.PurposeTo determine the effect of daily line assessment rounds and education on increasing appropriate use of UC indications and reducing urinary catheter use in hospitalized patients.MethodsThe infection prevention and control department (IPand C) was assigned an intern from January 30, 2017- May 15, 2017. The IP&C educated her on the basics of indwelling UCs, the hospital’s nurse driven protocol for removal of indwelling UCs, and the location of the patient’s charted indication for the UC. The intern was asked to use a daily list of patients with indwelling UCs generated by the facility’s electronic medical record and to verify the patient had a daily indication for the UC. After verification, the intern contacted every nurse caring for a patient with a UC. Patients with UCs in place > 5 days, those lacking indications, and those with inappropriate indications were specifically targeted. During daily rounds, the intern questioned the necessity for the UC, provided education on appropriate indications, as well as reminding about the importance of UC documentation. Monthly device utilization ratio (DU) was calculated (urinary catheter days / patient-days) and analyzed using Statistical Analysis Software (SAS).ResultsHospital wide urinary catheter (DU) decreased 33% from January to April. ICU DU decreased 19% and non ICU DU decreased 32% in the same time span. Overall hospital CAUTI rate decreased 94%. This change was determined to be statistically significant.ConclusionDaily inquiries into the necessity of UCs and performing one on one education with nurses dramatically decreased our DU over the 3 month study period. Due to this rounding, IP&C was able to target nurses that consistently failed to document in a timely manner, provide education on the nurse driven protocol to remove UCs along with appropriate indications for UC use. No other practice changes took place during the study period.Disclosures All authors: No reported disclosures.

Multicenter prospective study on device-associated infection rates and bacterial resistance in intensive care units of Venezuela: International Nosocomial Infection Control Consortium (INICC) findings.

Device-associated healthcare-acquired infections (DA-HAI) pose a threat to patient safety in the intensive care unit (ICU). A DA-HAI surveillance study was conducted by the International Nosocomial Infection Control Consortium (INICC) in two adult medical/surgical ICUs at two hospitals in Caracas, Venezuela, in different periods from March 2008 to April 2015, using the US Centers for Disease Control and Prevention's National Healthcare Safety Network (CDC/NHSN) definitions and criteria, and INICC methods. We followed 1041 ICU patients for 4632 bed days. Central line-associated bloodstream infection (CLABSI) rate was 5.1 per 1000 central line days, ventilator-associated pneumonia (VAP) rate was 7.2 per 1000 mechanical ventilator days, and catheter-associated urinary tract infection (CAUTI) rate was 3.9 per 1000 urinary catheter days, all similar to or lower than INICC rates (4.9 [CLABSI]; 16.5 [VAP]; 5.3 [CAUTI]), and higher than CDC/NHSN rates (0.8 [CLABSI]; 1.1 [VAP]; and 1.3 [CAUTI]). Device utilization ratios were higher than INICC and CDC/NHSN rates, except for urinary catheter, which was similar to INICC. Extra length of stay was 8 days for patients with CLABSI, 9.6 for VAP and 5.7 days for CAUTI. Additional crude mortality was 3.0% for CLABSI, 4.4% for VAP, and 16.9% for CAUTI. DA-HAI rates in our ICUs are higher than CDC/NSHN's and similar to or lower than INICC international rates.

Active Surveillance of Health Care Associated Infections in Neurosurgical Patients

Health Care Associated Infections (HCAI) are frequent complications in neurosurgery. There is limited data available on the incidence and burden of HCAI in neurosurgical patients of Southeast Asian region. To identify various HCAIs, associated aetiological agents and their antimicrobial susceptibility pattern among the patients admitted in the neurosurgery unit. An observational prospective study was carried out for three months duration on all neurosurgical patients admitted to a tertiary-care center. The site-specific nosocomial infection rates and device utilization ratios were calculated. Data on demographic profiles, invasive procedures, HCAI, isolated microorganisms and antimicrobial susceptibilities were recorded. Statistical analysis of all the variables was done. The association between categorical variables was assessed by Chi-square/Fisher-exact test. Continuous variables such as infected and non-infected were compared by Wilcoxon rank-sum test. A p-value of less than 0.05 was considered significant. A total of 330 patients with 4054 patient-days were analysed for HCAI. Twenty-two HCAIs were identified in 21 patients. The overall rate of HCAI was 6.67% and 5.42 per 1000 patient-days. Urinary Tract Infection (UTI) was most common (71.4%) followed by Laboratory Confirmed Blood-Stream Infection (LCBI) (28.5%) and pneumonia (4.7%). No central line-associated blood stream infection was identified. Klebsiella pneumoniae and Escherichia coli were the most common organisms causing UTI and LCBI. All the isolates (100%) were found to be multidrug resistant. This study generates a baseline data for records of device-associated infection in neurocritical care patients, which will further help monitoring its trend of infection and antimicrobial resistance pattern. Moreover, it will help in the formulation of the antibiotic policy and the preventive measures which may reduce morbidity and mortality.