Incidence Of Catheter-associated Bloodstream Infections Research Articles

P-233. Catheter-Related Bloodstream Infection (CRBSI) and Catheter-Associated Bloodstream Infection (CABSI) Outside of the Intensive Care Unit (ICU): Preliminary Insights from an Italian Monocentric Study

Abstract Background Vascular access device (VAD) placement is an increasingly performed procedure linked to hospital-acquired bloodstream infections. VADs comprise peripheral venous catheters (mid-tight, mini-midline, midline), centrally (CICC, FICC), and peripherally (PICC) inserted central venous catheters. CRBSI and CABSI definitions are often improperly used, and data beyond ICU settings are scarce. This study investigates risk factors and the prevalence and incidence of CABSI and CRBSI episodes in non-ICU wards.Table 1.Characteristics and outcomes of the study populationImmunosuppression: active onco-hematological, rheumatological disorder, solid organ transplant, hematopoietic stem-cell transplantation, or recent (<1 year) treatment, with chemotherapy or prolonged immunosuppressive treatment of any of these conditions.PiCC: Peripherally inserted Central venous Catheter, CiCC: Centrally inserted Central venous Catheter, FiCC: Femorally inserted Central venous Catheter Methods This retrospective, observational study (January 2021- December 2023) was conducted in Luigi Sacco Hospital, Milan. Clinical and demographic data of hospitalized non-ICU patients undergone VAD placement were retrieved from medical records. Continuous variables were described with median and interquartile [IQR], and categorical variables with counts and percentiles. A multivariable logistic regression accounting for patients’ and VADs’ characteristics was performed.Figure 1.Microbiological data of CABSI (top) and CRBSI (bottom) episodesMSSA: Methicillin-sensible S.aureus, MRSA: Methicillin-resistant S.aureus, MSSE: Methicillin-sensible S.epidermidis, MRSE: Methicillin-resistant S.epidermidis, Enterobacterales WT: sensible to III gen. cefalosporins, CP: carbapenemase-producing, VRE: Vancomycin-resistant Enterococci, CoNS: Coagulase-negative Staphylococci Results A total of 1999 VAD placements were included, patients’ characteristics and outcomes are outlined in Table 1. Peripheral devices were 66.4%, and 54 CRBSI and 86 CABSI events were identified, according to international guidelines. CABSI and CRBSI displayed prevalence rates of 0.049 and 0.033, and incidences of 1.85 and 1.16 episodes per 1000 catheter days respectively. Parenteral nutrition was the only factor associated with CABSI and CRBSI events (p< 0.0001). Coagulase-negative Staphylococci (CoNS) were isolated in 37.0% of CABSI, and 31.9% of CRBSI episodes, most frequently S.epidermidis (16%), followed by E.fecium, and E.fecalis, resistant to first-line agents in 59.2%, 35.3%, and 18.8% of cases respectively. Candida spp. was isolated in 12.4% of cases, and polymicrobial etiology was 17.9%. Pathogens’ prevalence and susceptibility profiles are depicted in Figure 1. Conclusion We observed low CRBSI and CABSI incidences in non-ICU wards. CoNs were most prevalent, and parenteral nutrition was associated with VAD-related infections, as already described. Despite the non-ICU setting, Candida, drug-resistant GNB, and polymicrobial infection rates were alarming, stressing the importance of correct VAD management in non-ICU wards to prevent difficult-to-treat infections. Disclosures All Authors: No reported disclosures

Catheter-related thrombosis in adults with cancer: a secondary analysis of a prospective randomized controlled trial

BackgroundCatheter-related thrombosis (CRT) is a complication of central venous access devices (CVADs). Evidence is variable regarding the significance of the side of catheter insertion. The role of the patient’s hand dominance in predisposition to CRT remains uncertain. ObjectivesIn a prospective randomized controlled trial, adult cancer patients were randomly allocated to either dominant or nondominant side CVAD insertion. The primary endpoint of this trial examined the incidence of catheter-associated bloodstream infection. Here, we report the secondary endpoint of the incidence of CRT. MethodsSix hundred forty CVADs were randomized to the dominant (n = 322) or nondominant (n = 318) side of insertion. Only symptomatic patients underwent ultrasound imaging to evaluate for CRT. ResultsThe median patient age was 58 years, 60% of patients had hematologic malignancies and 40% had solid tumors. CVADs used were peripherally-inserted central catheter line (67%), tunneled CVAD (23%), or nontunneled CVAD (10%). The CRT incidence rate was 0.65 versus 0.82 per 1000 line days in the dominant versus nondominant group (hazard ratio [HR], 1.2; 95% CI, 0.58-2.48; P = .63). There was no significant difference in CRT incidence rate between left- and right-sided insertions (HR, 0.63; 95% CI, 0.30-1.32; P = .22). The CRT incidence rate was lower in right-handed versus left-handed line inserters (HR, 0.29; 95% CI, 0.12-0.71; P = .007). ConclusionThe rate of CRT was not associated with whether CVAD insertion was on the patient’s dominant or nondominant side or the side of insertion. The role of inserter hand dominance requires further investigation.

The incidence of catheter-related bloodstream infections in different central venous access devices: a network meta-analysis of randomized controlled trials

IntroductionDirect paired meta-analyses and network meta-analysis were conducted to compare the incidence of Catheter-associated bloodstream infections (CRBSIs) in different types of central venous access devices (CVADs).Material and methodsThe PubMed, EMBASE, Web of Science, Cochrane databases, CNKI and CBM were systematically searched from inception to May 31, 2024 for randomized controlled trials (RCTs) comparing the incidence of CRBSIs across various types of CVADs. Literature screening, data extraction, and risk bias evaluation were all independently conducted by two individuals. Direct paired meta-analyses and network me-ta-analysis were performed using RevMan5.3 and Stata14.0 software, respectively.ResultsA total of five literatures were included. Paired meta-analyses revealed that the incidence of CRBSIs was lower in the peripherally inserted central catheters (PICCs) group compared to the central venous catheters(CVCs) group(RR=0.23, 95%CI(0.13-0.43), P<0.00001). The incidence of CRBSIs in PICCs group was observed to be lower compared to that in totally implantable venous access ports(TIVAPs) group (RR=0.45, 95%CI(0.23-0.87), P=0.02). Descriptive analysis revealed a higher incidence of CRBSIs in CVCs group compared to the TIVAP group (RR=2.97, 95%CI(1.65-5.17), P=0.0002). The network meta-analysis revealed a significantly lower incidence of CRBSIs in the PICCs group compared to the CVCs group. However, no statistically significant differences were observed in other comparisons. Based on the cumulative ranking curve test, the incidence of CRBSIs in various CVADs was ranked as follows: PICCs(97.20%)> TIVAPs(50.00%)>CVCs(2.80%).ConclusionsThe available evidence suggests that PICCs exhibit the lowest incidence of CVADs, followed by TIVAPs. Therefore, PICCs should be prioritized when selecting CVADs.

Risk factors for catheter-associated bloodstream infection in hemodialysis patients: A meta-analysis.

This meta-analysis aimed to elucidate the risk factors contributing to catheter-associated bloodstream infection in hemodialysis patients. Comprehensive literature searches were conducted in both English and Chinese databases, which encompassed PubMed, Cochrane Library, Embase, CNKI, Wanfang Data, VIP Database and China Biomedical Literature Database. The search timeframe extended from each database's inception to March 8, 2023. Two independent researchers executed literature screening, data extraction, and quality assessment using the Newcastle-Ottawa Scale. Statistical analysis of the data was performed using RevMan 5.3 software, facilitating the identification of significant risk factors associated with catheter-related bloodstream infections in hemodialysis patients. This meta-analysis is registered with PROSPERO under the registration number CRD42023406223. Forty-nine studies were incorporated into this meta-analysis, from which 22 risk factors were examined. Through the analysis, 17 risk factors exhibited statistical significance (P < 0.05): age (OR = 1.52, 95% CI [0.49, 4.68]), diabetes (OR = 2.52, 95% CI [1.95, 3.25]), kidney disease (OR = 3.45, 95% CI [1.71, 6.96]), history of catheter-associated infection (OR = 2.79, 95% CI [1.96, 3.98]), hypertension (OR = 1.43, 95% CI [1.08, 1.91]), dialysis duration (OR = 3.06, 95% CI [1.70, 5.50]), catheter placement site (OR = 1.91, 95%CI [1.35, 2.70]), catheter duration (OR = 2.06, 95% CI [1.17, 3.60]), number of catheterizations (OR = 4.22, 95% CI [3.32, 5.37]), catheter types (OR = 3.83, 95% CI [2.13, 6.87]), CD4+ cells (OR = 0.33, 95% CI [0.18, 0.63]), albumin (ALB, OR = 2.12, 95% CI [1.15, 3.91]), C-reactive protein (CRP, OR = 1.73, 95% CI [1.47, 2.03]), hemoglobin (Hb, OR = 1.48, 95% CI [0.54, 4.07]), procalcitonin (PCT, OR = 1.05, 95% CI [1.03, 1.06]), inadequate hand hygiene (OR = 5.32, 95% CI [1.07, 26.37]), and APACHE II scores (OR = 2.41, 95% CI [1.33, 4.37]). This meta-analysis suggests that age, diabetes, kidney disease, history of catheter-associated infection, hypertension, dialysis duration, catheter placement site, catheter duration, number of catheterizations, catheter type, CD4+ cells, albumin, C-reactive protein, hemoglobin, procalcitonin, inadequate hand hygiene, and APACHE II scores significantly influence the incidence of catheter-associated bloodstream infection in hemodialysis patients.

Incidence of Catheter-Associated Bloodstream Infections in Stem Cell Recipients-Should We Be "PICCy"?

The management of patients undergoing HSCT requires a multipurpose central venous catheter. Peripheral catheters (PCs), such as peripherally inserted central catheters (PICCs) and MidLine catheters (MLCs), appear to be adequate vascular catheters to be used for stem cell infusion, although their utilization in this indication is not yet common. We analyzed the infectious complications such as blood stream infection (BSI), febrile neutropenia (FN) and central line-associated bloodstream infection (CLBSI) in patients undergoing stem cell infusion through PC and conventionally inserted central catchers (CICCs), and evaluated their impacts on transplantation outcomes. Our results reveal no statistically significant differences between different types of catheter in terms of FN, BSI and CLABSI. Moreover, transplantation outcomes were comparable between the groups. Interestingly, according to our data, there were no differences in terms of abovementioned infectious complications between individuals who received antibiotic prophylaxis and those who did not. Our study has shown that infection complications are independent of the intravenous device and antibiotic prophylaxis. Considering that PCs are not associated with life-threatening complications, they should be considered more frequently in the stem cell transplantation setting.

Catheter-associated bloodstream infection incidence and outcomes in congenital cardiac surgery.

Catheter-associated bloodstream infections complicate and prolong hospitalizations. The incidence of catheter-associated bloodstream infections in children undergoing congenital cardiac surgery has not been reported. This study sought to define the incidence of catheter-associated bloodstream infections after congenital cardiac surgery in neonates and infants ≤12 months old and compare hospital outcomes and costs to those who underwent surgery and did not have a catheter-associated bloodstream infections. Retrospective review of hospital admissions between October 2013 and November 2015 for neonates and infants ≤12 months old at admission with ICD-9 codes for congenital cardiac surgery from discharge data from Vizient Clinical Data Base/Resource Manager (formerly University HealthSystem Consortium), an analytic platform for performance improvement. Hospitals were included if they had >100 congenital cardiac surgery admissions during the study period. Admissions were stratified by age at admission: Neonates (<1 month) and Infants (1-12 months). Established database flags for catheter-associated bloodstream infections were utilized. Length of stay, mortality, and direct costs were compared between admissions with and without catheter-associated bloodstream infections using t test or χ2 , as appropriate. Catheter-associated bloodstream infections incidence after congenital cardiac surgery was higher in Neonates than Infants (1.5 vs 0.8%, P = .024). Length of stay and direct costs were significantly higher for patients with catheter-associated bloodstream infections in both groups. Mortality was higher in the Infant group with catheter-associated bloodstream infections compared to those without catheter-associated bloodstream infections. Neonates develop catheter-associated bloodstream infections at nearly twice the rate of older infants. For those who develop infection, mortality is 2-8-fold greater and hospital costs are 4-6-fold higher, which further highlight the importance of catheter-associated bloodstream infections prevention in this population.

Risk Analysis of Catheter-related Bloodstream Infection and Thrombosis in Patients with Blood Diseases Undergoing Peripheral Introvascular Central Catheter (PICC)

To evaluate the effects of peripheral introvascular central catheters (PICC) on the catheter-associated bloodstream infections (CRBSI) and the formations of catheter-related bloodstream infections. Total of 483 patients with hematologic malignancies admitted in our hospital from January 2013 to December 2016 were enrolled in this study, and 612 PICC catheterization were conducted. The median time of catheterization was 101 d (48 ∼ 184 d) . The incidence rates of CRBSI and CRTC were observed, and the CRBSI and CRTC associated variables were also analyzed. There were 47 cases of CRBSI (7.7%), and the incidence was 0.59‰ PICC days, and there were 16 cases of CRTC (2.6%), with the incidence of 0.20‰ PICC days. Meanwhile, no other related serious complications found. The Cox regression analysis of CRBSI and CRTC-associated variables showed that the acute leukemia was significantly related with a higher incidence of CRBSI as compared with the other type of disease, however, which was not significantly related with the CRTC. Compared with the traditional CVAD catheterization, the PICC is more safe and effective for the patients with malignant tumors, thus which may become a alternative method for CVAD.

INCIDENCE, OUTCOMES AND COSTS OF CATHETER-ASSOCIATED BLOODSTREAM INFECTIONS IN CHILDREN UNDERGOING CONGENITAL CARDIAC SURGERY

Catheter-associated bloodstream infections (CABSI) complicate and prolong hospitalizations. The incidence of CABSI has not been reported for children undergoing congenital cardiac surgery (CCS). This study sought to define the incidence of CABSI after CCS in children ≤12 months old and compare

ISQUA16-2831EFFECTIVENESS OF INFECTION CONTROL FOR PREVENTING CATHETER-ASSOCIATED BLOODSTREAM INFECTION

Catheter-associated bloodstream infections (CABSI) are related to neonatal mortality and morbidity. Incidence of CABSI among neonates in Hung Vuong Hospital was high. An intervention study was conducted to evaluate effectiveness of the intervention for CABSI and to identify risk factor associated with CABSI. All nurses caring for neonates in study setting were trained prevention …

Risk of Infection Using Peripherally Inserted Central and Umbilical Catheters in Preterm Neonates.

To compare the rates of catheter-associated bloodstream infection (CABSI) in preterm infants born at <30 weeks' gestation who received a peripherally inserted central catheter (PICC) versus an umbilical venous catheter (UVC) immediately after birth as their primary venous access. This retrospective matched cohort study examined data from infants born at <30 weeks' gestation and admitted between January 2010 and December 2013 to neonatal units in the Canadian Neonatal Network. Eligible infants who received a PICC on the first day after birth (day 1) were matched with 2 additional groups of infants, those who received a UVC on day 1 and those who received a UVC on day 1 that was then changed for a PICC after 4 days or more. The primary outcome was number of infants with CABSI per 1000 catheter days, which was compared between the 3 groups using multivariable analyses. Data from 540 eligible infants were reviewed (180 per group). There was no significant difference in infants with CABSI/1000 catheter days between the 3 groups (9.3 vs 7.8 vs 8.2/1000 catheter days, respectively; P > .05) despite lower rates of late onset sepsis in the group of infants who received only a UVC. There was no significant difference in the incidence of CABSI between very preterm neonates who received a PICC, UVC, or UVC followed by PICC as the primary mode of venous access after birth. A prospective randomized controlled trial is justified to further guide practice regarding primary venous access and reduction of infection.

Incidence of Catheter-Associated Bloodstream Infection After Introduction of Minocycline and Rifampin Antimicrobial-Coated Catheters in a Pediatric Burn Population

The Centers for Disease Control and Prevention guidelines for prevention of intravascular catheter-related infections suggest that antimicrobial-coated catheters can decrease the risk of developing catheter-related bloodstream infection in a variety of adult patient populations. There are limited data on their efficacy in the pediatric population, particularly among children with burn injuries. A study was conducted at Shriners Hospitals for Children®, Boston, to determine whether minocycline/rifampin (MR)-coated catheters could decrease the incidence of catheter-associated bloodstream infection (CABSI) in a pediatric burn population. A historical control group included all patients with double- or triple-lumen catheters inserted in the 18-month period from January 2006 to June 2007. The study group included all patients with MR antimicrobial double- or triple-lumen catheters inserted in the subsequent 18-month period, July 2007 to December 2008. Data collected included name, age, date of burn/injury, date of admission, percent TBSA area burn injury or other diagnosis, catheter site (subclavian, internal jugular, or femoral), method of insertion (new percutaneous stick or guidewire), type of catheter (double or triple lumen), date inserted, duration of catheter placement (days), and positive blood cultures recovered while the central venous catheter was in place. CABSI was defined using the Centers for Disease Control and Prevention definition of laboratory-confirmed bloodstream infection. There were a total of 66 patients with 252 catheters (1780 catheter days) in the control group and 75 patients with 263 catheters (1633 catheter days) in the study group. Age, percent burn injury, catheter site, and method of insertion were not statistically different between the two groups. The percentage of infected catheters and the rate of infection were significantly different for the two groups, with the MR antimicrobial catheters only half as likely to become infected. In a subset of these patients with catheters in place for more than 4 days, the percentage of infected catheters and rate of infection were also significantly different with results similar to those in the entire group. MR antimicrobial-coated catheters significantly reduced the incidence of CABSI in this pediatric burn population compared with noncoated catheters.

Incidence of Adrenal Insufficiency and Impact of Corticosteroid Supplementation in Critically Ill Children with Systemic Inflammatory Syndrome and Vasopressor-Dependent Shock: Hebbar KB, Stockwell JA, Leong T, Fortenberry JD. Crit Care Med 2011;39:1145–50.

The importance of diagnosing adrenal insufficiency in pediatric patients with the Systemic Inflammatory Response Syndrome (SIRS) has not been validated, nor has the subsequent treatment with corticosteroids. This study was a retrospective review of 78 patients with a median age of 84 months, who were treated at the Atlanta Pediatric Intensive Care Unit (PICU) with a protocol for steroid supplementation in patients meeting SIRS criteria. The primary outcome was decrease in vasopressor requirements after initiation of steroid treatment. All PICU patients requiring intravenous fluids and vasopressors for treatment of shock were tested for adrenal insufficiency with a standardized corticotrophin stimulation test. Patients were then classified as having absolute adrenal insufficiency (AAI) if a basal cortisol level < 18 mg/dL was measured vs. relative adrenal insufficiency (RAI) if the corticotrophin stimulation test induced a change in measured cortisol levels. Of the initial 78 patients, 44 (56%) had AAI and 39 (50%) had RAI, for a total of 69 (88%) with some degree of adrenal dysfunction. These patients were then treated with weight-based doses of hydrocortisone, with the addition of enteral 9-alpha-fludricortisone at the discretion of the treating physician. A diagnosis of AAI was shown to be associated with increased patient age, higher incidence of Staphylococcus aureus bacteremia, increased mechanical ventilation requirements, and higher vasopressor requirements. A statistically significant decrease in duration of vasopressor use was found in those treated with steroids. Dopamine use decreased from 24 h to 8 h (p < 0.01), norepinephrine from 27.5 h to 8 h, (p = 0.0001). There was no difference found between steroids being initiated before or after 12 h of vasopressor initiation. Overall, 98% (43/44) of patients with AAI and 92% (36/39) with RAI showed a > 50% reduction in vasopressor dosage within 4 h of initiating corticosteroids. Importantly, the study found no incidence of catheter-associated bloodstream infections, ventilator-associated pneumonias, gastric bleeding, or critical illness myopathy/polyneuropathy, some of the often-reported side effects of steroids, although 14 patients (18%) had rebound hypotension after steroid discontinuation requiring additional fluid boluses. Mortality was very low in the entire cohort (5%), so comparisons could not be made between the groups.

Characterization of Posthospital Bloodstream Infections in Children Requiring Home Parenteral Nutrition

Home parenteral nutrition (HPN) is lifesaving for children with intestinal failure. Catheter-associated bloodstream infections (CA-BSI) are common in hospitalized patients receiving parenteral nutrition (PN), but data evaluating CA-BSI in children receiving HPN are limited. To determine the incidence and characteristics of CA-BSI in children receiving HPN. Medical records of 44 children receiving HPN during a 3-year period were reviewed. End points were CA-BSI during the initial 6 months after discharge. CA-BSI was defined as isolation of pathogens from blood requiring antimicrobial therapy. The primary indication for HPN was short bowel syndrome (46%), and 59 BSI were documented during the initial 6 months of HPN in 29 (66%) children. Of CA-BSI, polymicrobial infections accounted for 52%; gram-positive, 29%; gram-negative, 17%; and fungal, 2%. CA-BSI incidence per 1000 catheter-days was highest during the first month posthospital discharge (72 episodes; 95% confidence interval [CI], 45.4-109.6). CA-BSI incidence density ratio for children receiving HPN for >90 days compared with those receiving HPN for <30 days was 2.2 (P < .05). Logistic regression revealed that Medicaid insurance and age <1 year were associated with increased risk for CA-BSI (odds ratio [OR], 4.4 [95% CI, 1.13-16.99] and 6.6 [1.50-28.49], respectively; P < .05). The incidence of CA-BSI in children receiving HPN is highest during the first month posthospital discharge. Strategies to address care in the immediate posthospital discharge period may reduce the burden of infectious complications of HPN.

Catheter-Associated Bloodstream Infection Incidence and Risk Factors in Adults with Cancer: A Prospective Cohort Study.

Abstract 1382Poster Board I-404 Background:Central venous catheter-associated blood stream infections (CA-BSI) cause considerable morbidity in adult patients with hematologic cancers and solid tumors. A range of central venous access devices (CVAD) may be used across differing patient diagnoses and for varying indications. The aim of our study was to determine the incidence and risk factors for CA-BSI. Methods:A prospective observational cohort study of consecutive adult patients requiring a CVAD in a hematology-oncology unit (including autologous but not allogeneic transplantation) was performed. All CVADs were inserted under ultrasound guidance in a dedicated interventional radiology facility with peripherally inserted central venous catheters (PICCs) inserted in the basilic or cephalic vein and tunnelled lines, non-tunnelled lines and implantable ports inserted via the internal jugular vein. Standardized surveillance methods for CA-BSI were applied and data on CVAD complications were recorded. Results:1119 CVADs were assessed in 723 patients over 50,478 line days. Median patient age was 55yrs and 56% were male. Patient diagnoses included aggressive hematologic malignancies (48%, includes AML (17%), MDS (1%), NHL (22%) and MM (8%)), Hodgkin lymphoma (3%), other hematologic malignancies (3%), oesophageal/colon/rectal cancers (26%), and all other solid tumors (20%). CVAD types included PICCs (71%), non-tunnelled lines (14%), tunnelled lines (14%), and implantable ports (1%). 291 lines were removed due to a clinical suspicion of infection, 133 of these had CA-BSI and 34 of these had a positive tip culture in addition to meeting the definition of CA-BSI. The four most common bacterial isolates were S. epidermidis (n=23), S. aureus (n=15), Pseudomonas sp (n=12) and Stenotrophomonas sp (n=10). The rate of CA-BSI per 1,000 line days was 2.63. In multivariate analysis, factors associated with CA-BSI included: type of CVAD (greatest for non-tunnelled lines (HR 3.67, p<0.0001) and tunnelled lines (HR 1.83, p=0.0062) compared to PICC lines); patient diagnosis (greatest for aggressive haematological malignancies (HR 2.95, p=0.0031) and least for oesophageal, colon and rectal cancers (HR 0.26, p=0.014) compared to other solid tumours); side of insertion (greatest for right-sided lines (HR 1.61, p=0.024)); and number or prior line insertions (HR1.2, p=0.016). In a subgroup analysis of patients with aggressive hematologic malignancies, the association between CA-BSI and line type (greater infection for tunnelled (HR 1.46, p=0.09) and non-tunnelled lines (HR 3.73, p<0.001) compared to PICCs) and side of line insertion (more infection with right sided lines (HR1.66, p=0.035)) remained. 4.8% of lines were complicated by symptomatic thrombosis which was less common in patients with oesophageal, colon and rectal cancer (HR 0.43, p=0.027) and in lines inserted in the internal jugular vein (HR 0.2, p=0.0083) compared to PICC lines. Conclusions:Incidence of CA-BSI in an Australian adult cancer population is comparable to other reports in the literature. This study highlights the utility of a standardised CA-BSI surveillance strategy in adult patients with cancer, provides further data to support the use of PICC lines in such patient populations, including patients with hematological malignancies, and suggests that the side of line insertion may influence CA-BSI. Disclosures:No relevant conflicts of interest to declare.

Incidence of Catheter-Related Bloodstream Infection Among Patients With a Needleless, Mechanical Valve–Based Intravenous Connector in an Australian Hematology-Oncology Unit

There are few Australian data on the incidence of catheter-associated bloodstream infection (BSI) among patients in hematology-oncology units. We found an increase in catheter-associated BSI rates coincident with the introduction of a mechanical valve connector (2.6 infections vs 5.8 infections per 1,000 catheter-days; incidence rate ratio, 2.2; P=.031).

Barriers to and Facilitators of Implementing an Intervention to Reduce the Incidence of Catheter-Associated Bloodstream Infections

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A Multicenter Intervention to Prevent Catheter-Associated Bloodstream Infections

Education-based interventions can reduce the incidence of catheter-associated bloodstream infection. The generalizability of findings from single-center studies is limited. To assess the effect of a multicenter intervention to prevent catheter-associated bloodstream infections. An observational study with a planned intervention. Twelve intensive care units and 1 bone marrow transplantation unit at 6 academic medical centers. Patients admitted during the study period. Updates of written policies, distribution of a 9-page self-study module with accompanying pretest and posttest, didactic lectures, and incorporation into practice of evidence-based guidelines regarding central venous catheter (CVC) insertion and care. Standard data collection tools and definitions were used to measure the process of care (ie, the proportion of nontunneled catheters inserted into the femoral vein and the condition of the CVC insertion site dressing for both tunneled and nontunneled catheters) and the incidence of catheter-associated bloodstream infection. Between the preintervention period and the postintervention period, the percentage of CVCs inserted into the femoral vein decreased from 12.9% to 9.4% (relative ratio, 0.73; 95% confidence interval [CI], 0.61-0.88); the total proportion of catheter insertion site dressings properly dated increased from 26.6% to 34.4% (relative ratio, 1.29; 95% CI, 1.17-1.42), and the overall rate of catheter-associated bloodstream infections decreased from 11.2 to 8.9 infections per 1,000 catheter-days (relative rate, 0.79; 95% CI, 0.67-0.93). The effect of the intervention varied among individual units. An education-based intervention that uses evidence-based practices can be successfully implemented in a diverse group of medical and surgical units and reduce catheter-associated bloodstream infection rates.

The Effect of an Education Program on the Incidence of Catheter-Associated Bloodstream Infection in a Medical Intensive Care Unit

PURPOSE: Primary blood stream infections resulting from central venous catheter placement are a common cause of excess morbidity, mortality, and increased medical care costs in the intensive care unit. Several recent studies have shown that education programs directed towards health care workers can significantly decrease the incidence of catheter-associated bloodstream infections. Accordingly, our study examines the ability of an education program directed towards nurses and physicians in a medical intensive care unit to decrease the rate of catheter-associated bloodstream infection in a teaching hospital.

An educational intervention to prevent catheter-associated bloodstream infections in a nonteaching, community medical center.

To evaluate the effectiveness of an evidence-based intervention to prevent catheter-associated bloodstream infections among intensive care unit patients at a nonteaching, community hospital. Nonrandomized pre/post observational trial. Two intensive care units at Missouri Baptist Medical Center, Saint Louis, MO. Nurses and critical care physicians. A ten-page, self-study module on the prevention of catheter-associated bloodstream infections, lectures, and posters given between July and September 1999. The incidence of nosocomial catheter-associated bloodstream infection and patient demographics were measured for patients admitted between March 1998 and July 2000. Thirty cases of catheter-associated bloodstream infections during 6110 catheter-days were noted in the preintervention period (4.9 cases/1000 catheter-days) vs. 11 cases during the 5210 catheter-days in the postintervention period (2.1 cases/1000 catheter-days). The relative risk for catheter-associated infection in the postintervention period was 0.43 (95% confidence interval, 0.22-0.84). Among catheterized patients, Acute Physiology and Chronic Health Evaluation II score (25.2 preintervention vs. 25.1 postintervention; p =.86), hemodialysis (91 of 647 [14%] patients vs. 69 of 541 [13%]; p =.70), and the mean number of catheter days per patient (9.1 vs. 9.6 days; p =.46) did not differ between the pre- and postintervention periods. A focused, educational intervention among nurses and physicians in a nonteaching community hospital resulted in a significant, sustained reduction in the incidence of catheter-associated bloodstream infection.