Incidence Of Central Line-associated Bloodstream Infections Research Articles

P-413. Epidemiology of Clostridioides difficile and Bloodstream Infection in Belgium: Insights from 2014-2022 Data

Abstract Background Healthcare-associated infections (HAI), like bloodstream infections (BSI) and Clostridioides difficile (CDI), strain Belgian hospitals. Since 2014, national surveillance requires data on hospital-associated (HABSI) and central line-associated bloodstream infections (CLABSI). Although CDI surveillance was obligatory until 2014, hospitals must join a surveillance program since 2015. This study delves into BSI and CDI trends in Belgium from 2014 to 2022. Mean incidence of central line-associated bloodstream infections,hospital-wide ans in intensive care, Belgium 2013-2022, (CLABSI,central line-associated bloodstream infections; CRBSI, catheter related bloodstream infection=Confirmed CLABSI) Methods Data from national surveillance programs were analyzed using negative binomial longitudinal regression models. Incidence changes in CLABSI between pre-pandemic (2013-2019) and 2020-2022 were assessed, along with CDI incidence calculations. Statistical analyses utilized SAS Enterprise Guide 7.13 and STATA 16. Insights into incidence and causative agents for both BSI and CDI were analyzed. Mean incidence of central line-associated bloodstream infections, hospital-wide,Belgium 2013-2022 ( CLABSI, central line-associated bloodstream infections; CRBSI, catheter related bloodstream infection=Confirmed CLABSI) Results Results show stable BSI incidence from 2014 to 2019. The 2020-2022 incidence calculation included 97, 99, and 95 participating hospitals, respectively. Hospital-wide CLABSI incidence increased from 2.0 to 2.6 per 10,000 patient-days in 2019 and then declined to 2.4 in 2022. ICU-only CLABSI incidence rose from 11.77 to 18.78 in 2020 and declined to 15.50 in 2022. The predominant microorganisms observed in total CLABSI since 2014 were S. epidermidis and E. faecium. In 2022 there was a statistically significant increase of HA-CDI incidence per 10,000 hospital-days compared to 2021, from 1.31 to 1.62. However, even though this increase was observed, most characteristics remain stable, such as percentage of recurrent episodes, age group of patients with infection. Since 2014, the most detected strain remained BR014. Mean incidence of HA-CDI/10, 000 Hospitalisation-days in hospitals, per region. Belgium, 2010-2022. Conclusion The analysis of BSI and CDI epidemiology reveals significant trends crucial for healthcare management. The impact of the COVID-19 pandemic on CLABSI rates underscores the importance of targeted interventions, while ongoing challenges in HA-CDI incidence highlight the need for continued surveillance improvement. Future efforts should focus on effective prevention and control strategies to mitigate HAIs in Belgian healthcare facilities. Disclosures All Authors: No reported disclosures

P-833. The trends of hospital-onset bacteremia at a tertiary care center and the impact of the establishment of infectious diseases department on its incidence: a 10-year longitudinal study

Abstract Background Hospital-onset bacteremia (HOB) is defined as the onset of bacteremia occurring three or more days after hospitalization. The incidence density of HOB has recently been used to assess the quality of overall hospital infection control practice in lieu of the central line-associated bloodstream infection incidence rate since the HOB incidence might better predict the length of stay, hospital costs, and mortality rates. At the study institution, Infectious Diseases (ID) department was established in April 2018. The present study aims to investigate the incidence density of HOB prior to and after the establishment of ID department. Change and trend of the incidence density of HOB before and after the establishment of ID department as determined by ITSA. Methods We investigated the monthly incidence density of HOB per 1,000 patient-days from 2013 through 2023 at Fujita Health University Hospital. The trends of overall incidence of HOB and HOB by causative pathogens group, including Streptococcus species (spp), Staphylococcus aureus, Coagulase-negative staphylococci (CNS), Enterococcus spp., Enterobacterales, and Candida spp. were tracked. Changes in the trend of HOB before (from July 2013 through March 2018) and after (from April 2018 through June 2023) the establishment of ID department were evaluated. Interrupted time series analysis was used for statistical analyses. Change and trend of the incidence density of HOB before and after the establishment of ID department as determined by ITSA. Results In total, 4,422 HOB events were identified during the study period. The overall incidence density of HOB was 0.94 per 1,000 patient-days. Comparison of the incidence of HOB between the period before and after the establishment of ID department revealed an immediate increase in the incidence of overall HOB (+0.3246; P< .001 for change in level) and HOB caused by S. aureus (+0.10; P< 0.001 for change in level), CNS (+0.12; P< 0.001 for change in level), and Candida spp. (+0.05; P=0.03 for change in level). A significant trend increase in the incidence of HOB was also observed in HOB due to S. aureus (+0.002; P< .001 for change in trend) Candida spp. (+0.002; P=0.002 for change in trend), and Enterobacterales (+0.002; P=0.002 for change in trend). Conclusion The overall incidence density of HOB has increased significantly in the last decade, and the trend was steeper after the establishment of ID department. Improvement in ID clinical practice may contribute to increasing the detection of HOB. Disclosures Yohei Doi, MD, PHD, AbbVie: Honoraria|Entasis: Grant/Research Support|Gilead: Advisor/Consultant|GSK: Advisor/Consultant|Meiji Seika: Advisor/Consultant|Moderna: Advisor/Consultant|Pfizer: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi: Honoraria Hitoshi Honda, MD, Moderna Inc: Honoraria|Pfizer: Honoraria|Shionogi: Honoraria

Evaluating the Adequacy of Central Line-Associated Bloodstream Infection As a Quality Measure: A Cross-Sectional Analysis at a Single Tertiary Care Center.

The current definition of central line-associated bloodstream infection (CLABSI) may overestimate the true incidence of CLABSI as it is often unclear whether the bloodstream infection (BSI) is secondary to the central line or due to another infectious source. We aimed to assess the prevalence and outcomes of central CLABSI at our institution, to identify opportunities for improvement, appropriately direct efforts for infection reduction, and identify gaps in the CLABSI definition and its application as a quality measure. Retrospective cross-sectional study of patients identified to have a CLABSI in the period 2018-2022 cared for at the value-based purchasing (VBP) units of a 1200-bed tertiary care hospital located in Cleveland, OH. Each CLABSI episode was assessed for relationship with central venous catheter (CVC), suspected secondary source of BSI, mortality associated with the CLABSI hospital encounter, and availability of infectious disease physician or primary physician documentation of infectious source. CLABSI episodes were classified as CVC related, CVC unrelated, and CVC relationship unclear. Mortality during the same encounter as the CLABSI event was assessed as an outcome measure. Descriptive statistics were performed. A total of 340 CLABSI episodes occurred in adult patients in VBP units. Majority of the CLABSI, 77.5% (266), occurred in the ICU. Of the CLABSI analyzed, 31.5% (107) were classified as unrelated to the CVC; 25.0% (85) had an unclear source; 43% (148) were classified as CVC related. For CVC-related cases, Staphylococcus and Candida were the predominant organisms. For the CVC unrelated and unclear groups Enterococcus was most prevalent. The mortality rate was lowest among patients classified with a CVC-related BSI. The positive predictive value (PPV) of the Centers for Disease Control and Prevention CLABSI definition to predict a true CVC-related infection was found to be 58.0%. The definition of CLABSI as a surrogate for catheter-related BSI is inadequate, with a PPV of 58.0% (43.1-67.6%). Efforts should be redirected toward revising the CLABSI definition and possibly reevaluating its criteria. Resources should be assigned to further investigate and systematically prevent BSIs from secondary sources while adhering to existing CLABSI prevention bundles.

Assessing the effect of implementing a central line care bundle on central line-associated bloodstream infections in a tertiary hospital in Saudi Arabia

Central line-associated bloodstream infections (CLABSIs) are severe bloodstream infections caused by catheter use and are often associated with a longer hospital stay, increased healthcare costs, and a higher mortality rate. However, catheter-related bloodstream infections can be successfully treated. It is essential that healthcare workers are aware of central line (CL) insertion and maintenance bundles to reduce and prevent the incidence of CLABSI. The objective of this study was to assess the impact of implementing CL care bundles on hospital-wide CLABSI incidence rates. This is a prospective study conducted at the King Faisal Specialist Hospital and Research Center in Saudi Arabia from January 2017 to December 2021. The research period was divided into two phases: the pre-intervention phase (January 1, 2017 to December 31, 2018) and the post-intervention phase (January, 2019 to December 31, 2020). During both phases, outcome variables, including CLABSI rate, were assessed. In the present study, the total number of CLABSIs is 439, of which 266 were in the pre-intervention phase and 173 were in the post-intervention phase. The overall CLABSI rate significantly decreased from 1.6±0.05 in the pre-intervention phase to 0.9±0.05 in the post-intervention phase. This decline in CLABSI was significant (p<0.0001) across all hospital settings, including critical care and non-critical care units. The implementation of care bundles is essential and has been shown to significantly reduce CLABSI rates in nearly all participating units.

Comparison of facilities with and without additional medical fees for nutrition support team activity during the COVID-19 pandemic

BackgroundThis study aimed to clarify the effectiveness of nutrition support team (NST) facilities for preventing central line-associated bloodstream infection (CLABSI).MethodsWe retrospectively analyzed the incidence of CLABSI as well as the presence or absence of additional medical fees for NST activity between 2019 and 2021, including the period before and after the COVID-19 pandemic. Subsequently, we performed between-group comparisons of the CLABSI incidence. CLABSI rates were compared based on cumulative per 1000 catheter uses during the relevant period.ResultsAmong 47 facilities that were registered for participation, there were 34 and 13 facilities with and without additional medical fees for NST activity (NST and non-NST groups, respectively). The CLABSI incidence rate was significantly lower in the NST group 0.96 [0.28–1.73] than in the non-NST group 1.25 [075–6.10] (p < 0.05). Before the pandemic, the NST group had a lower CLABSI rate per 1000 catheter uses than the non-NST group 2019: 0.70 [0.12–1.26] vs 2.10 [0.62–5.97]. During the pandemic, the CLABSI incidence showed no significant between-group difference 2020: 0.99 [0.51–1.61] vs 1.01 [0.80–4.16]; 2021: 1.24 [0.44–2.35] vs 1.96 [1.23–5.31]; however, the CLABSI rates in the NST group remained low.ConclusionDuring the COVID-19 pandemic, the incidence of CLABSI was lower in the NST group than in the non-NST group, indicating the effectiveness of NST in preventing the occurrence of CLABSI.

Can a Shorter Dwell Time Reduce Infective Complications Associated with the Use of Umbilical Catheters?

Umbilical venous catheters (UVCs) are the standard of care in neonatal intensive care units (NICUs) to administer fluids, parenteral nutrition and medications, although complications may occur, including central line-associated blood stream infections (CLABSIs). However, the dwell time to reduce CLABSI risk remains an open issue. We performed a single-center retrospective study of newborns hospitalized in the Modena NICU with at least one UVC inserted over a 6-year period (period 1: January 2011-December 2013; period 2: January 2019-December 2021). We selected a non-consecutive 6-year period to emphasize the differences in UVC management practices that have occurred over time in our NICU. The UVC dwell time and catheter-related complications during the first 4 weeks of life were examined. The UVC dwell time was shorter in period 2 (median 4 days vs. 5 days, p < 0.00001). Between the two periods, the incidence of CLABSIs remained unchanged (p = 0.5425). However, in period 2, there was an increased need for peripherally inserted central catheters (PICCs) after UVC removal, with a rise in PICC infections after UVC removal (p = 0.0239). In our NICU, shortening UVC dwell time from 5 to 4 days did not decrease the UVC-related complications. Instead, the earlier removal of UVCs led to a higher number of PICCs inserted, possibly increasing the overall infectious risk.

Trends in surveillance indicators for central-catheter-associated bloodstream infections in a tertiary hospital in Switzerland

Central line-associated bloodstream infections (CLABSIs) are associated with relevant morbidity and mortality. Longitudinal dynamics in CLABSI incidence and the spectrum of causative microorganisms are limited. To describe trends in CLABSI incidence, use of central lines, and causative pathogens. We analysed prospectively collected data on CLABSI at a Swiss tertiary care hospital between January 2016 and December 2023. We investigated longitudinal changes of incidence densities, catheter utilization and causative pathogens. A total of 707 CLABSIs were observed, corresponding to an incidence density of 1.69 (95% confidence interval 1.56-1.81) CLABSIs per 1000 catheter-days. There was no significant trend of CLABSI incidence density per 1000 catheter-days (z= 0.86, P=0.391), but an increase of catheter utilization ratio (z= 8.88, P<0.001). Coagulase-negative staphylococci (N= 207, 23.4%) and Enterococcus spp. (N= 134, 15.2%; E.faecium N= 94, 10.6%; E.faecalis N= 37, 4.1%; other Enterococcus spp. N= 3, 0.34%) were the most frequent causative pathogens. Over the years, the proportion of Enterococcus spp. (z= 3.4, P<0.001), driven by an increase of E.faecium (z= 3.2, P=0.001), and yeast (z= 2.3, P=0.020) increased, whereas coagulase-negative staphylococci decreased (z= -6.1, P<0.001). Prospective CLABSI surveillance indicated stable incidence densities per 1000 catheter-days, but there were significant shifts of causative microorganisms over time.

Long-term maintenance-related complications of brachiocephalic vein cannulations in neonates: A retrospective evaluation.

Neonates are relatively prone to immediate, early, and late complications related to central venous cannulation (CVC). Ultrasound-guided brachiocephalic vein (BCV) cannulation has proven to be safe in neonates. Although studies addressed the immediate and early complications of CVC via BCV in neonates, few explored long-term maintenance-related complications. To evaluate the incidences of long-term maintenance-related complications including central line-associated blood stream infection (CLABSI), central line-associated thrombosis (CLAT), and mechanical complications (CLAMC) of nontunneled BCV cannulation in neonates and their relationship with patient and catheter-related factors. This study included BCV cannulations of neonates with postconceptional age of ≤44 weeks performed between January 2018 and January 2023. The incidences of complications were determined. Correlations between complications and postconceptional age, body weight, indication for catheter placement, the size and side of the catheter, as well as catheter dwell time were analyzed. In total, 89 BCV cannulations performed in 71 neonates. The incidences were 19.3 [95%CI: 12.88-28.76] total complications, 5.9 [95%CI: 2.84-12.06] CLABSI, 3.4 [95%CI: 1.30-8.58] CLAT and 10.1 [95%CI: 5.76-17.49] CLAMC in 1000 catheter days. There were 23 (25.8%) total complications; 7 (7.9%) were CLABSI, 4 (4.5%) were CLAT, and 12 (13.5%) were CLAMC. The multivariate analysis revealed that prolonged dwell time was associated with high incidence of total complications [OR: 1.07, 95% CI: 1.00-1.14, p = .047] and the catheter of smaller size (3F in this study) was associated with higher incidence of CLABSI [OR: 8.91, 95% CI: 1.03-77.45, p = .047]. In this study, the prolonged dwell time and smaller sized catheter was found to be independent predictors of total complications and CLABSI, respectively. The independent predictive effects of postconceptional age and body weight should be addressed in larger studies as potential risk factors.

Effect of Targeted Single-Dose Antibiotics to Reduce the Occurrence of Pediatric Central Line–Associated Bloodstream Infections Post Alteplase Administration

OBJECTIVE Previous studies have shown an association between alteplase for line clearance and central line–associated bloodstream infections (CLABSIs). The objective of this study was to evaluate the use of post-alteplase antibiotics as a CLABSI reduction strategy in pediatric intensive care unit (PICU) patients. METHODS This was a single center, retrospective, observational study evaluating PICU patients from ­January 1, 2014, through August 1, 2021, conducted at a tertiary academic PICU. Included in this study were critically ill patients who had 1 or more central venous lines (CVLs) requiring alteplase for line clearance. The primary objective was incidence of CLABSI occurrence post alteplase administration for CVL clearance, with or without targeted single-dose antibiotics (piperacillin-tazobactam or vancomycin) post alteplase. Secondary outcomes included evaluation of total alteplase administrations and risk factors associated with CLABSI occurrence. RESULTS Two hundred fifty patients were included, with 156 receiving alteplase only, 82 piperacillin-­tazobactam, and 12 vancomycin, and with median ages of 2.8, 3.8, and 3.8 years, respectively. Seven ­CLABSIs occurred in the alteplase-only group, with 0 incidences in both the piperacillin-tazobactam (exact OR, 0.12; exact 95% CI, &amp;lt;0.01–0.59; p &amp;lt; 0.01) and vancomycin (exact OR, 1.20; exact 95% CI, 0.03–9.80; p = 1.00) groups. Patients in the piperacillin-tazobactam group achieved statistical significance for CLABSI risk factors that may benefit by decreasing CLABSI incidence (p values &amp;lt;0.01–0.02). CONCLUSIONS Alteplase use has been associated with CLABSIs. Providing a single dose of post-alteplase antibiotics targeting the most likely site-specific pathogens may reduce the incidence of CLABSIs.

Prefilled Saline Syringes versus Those Prepared at Bedside for Flushing Central Venous Catheters in Neonatal ICU

Abstract Background A central line-associated bloodstream infection (CLABSI) is defined as a laboratory-confirmed bloodstream infection not related to an infection at another site that develops within 48 hours of a central line placement. CLABSI is the most common type of nosocomial infection in this population and is a leading cause of morbidity and mortality in NICU. Therefore, more efforts are needed to reduce the incidence of CVC-related infections among NICU patients, and to enhance their survival and prognosis. Aim of the Work To compare the effect of using of prefilled saline syringes prepared in the laminar flow under complete aseptic conditions vs using ones prepared at bedside for central venous access flushing regarding risk of CLABSI, catheter permanence time, risk of thrombosis, and length of stay in our NICU. Patients and Methods This prospective randomized controlled trial in Ain Shams University Hospital NICU over a 6-month period from January 2023 till July 2023. They were selected through simple random sampling method to be divided into 2 groups: Group 1 (cases): 50 patients had their CVCs flushed by 3ml syringe prefilled with saline 0.9% prepared in the laminar flow on the same day. Group 2 (controls): 50 patients had their CVC flushed through manually prepared 3 ml syringe prepared at bedside from a common bottle of saline 0.9%. Results It was found that Group 1 patients had significantly lower incidence of CLABSI than Group 2 patients (4 versus 13 neonates) (p-value &amp;lt;0.0001). The incidence of CVC thrombosis was shown to be less in Group 1, however, this difference was non-significant (2 versus 1 neonate) (p-value 0.557). This study showed there was no statistically significant difference between both groups regarding the catheter permanence time (8.56 ± 6.52 versus 10.46 ± 6.29) (p-value 0.146). There was no statistically significant difference between both groups regarding the length of hospital stay in studied patients, 26.5 (14 – 37) in Group 1 versus 25 (12 – 32) in Group 2 (p-value 0.704). Conclusion The use of prefilled saline syringes for flushing of central venous catheters in neonates has shown to significantly reduce the risk of CLABSI, reduce incidence of catheter- related thrombosis, and flushing time, thus improve quality of care in neonatal ICU.

Nurse-Driven Interventions Reduce Central Line-Associated Bloodstream Infection Close to Zero in One Pediatric Oncologic Facility: A Single-Center Retrospective Observational Study.

Central line-associated bloodstream infections (CLABSIs) are critical infectious complications among pediatric hematology-oncology patients, and the management of central venous catheters (CVCs) by healthcare personnel can significantly influence the incidence of these infections. This study evaluates the impact of nurse-led changes in CVC management on the incidence of CLABSIs. This single-center, retrospective observational study was conducted at an urban, tertiary referral, and academic center serving pediatric patients. The study cohort comprised 239 patients and 323 CVCs seen between 2012 and 2022. CLABSI was defined according to the Centers for Disease Control and Prevention definitions. Oncology nurse leaders developed CVC-specific educational modules for CLABSI prevention. All the relevant information during the CVC maintenance period was noted in the patient's CVC logbook. A total of 24 (7%) cases of confirmed CLABSI were identified. The incidence of CVC-related infections was 0.32 cases per 1000 catheter days (95%CI: 0.19-0.45). The incidence decreased by 40% between the first and second three-year study period. Documented exit-site infection was reported in 32 (10%) cases. The correlation between exit-site infection and CLABSI was found in 9 (28%) cases. Our CVC-related infection rates are significantly lower than the incidence reported by the Italian Association of Pediatric Hematology and Oncology, which settles at 3-5 cases per 1000 catheter days. Our data confirm the effectiveness of local CVC management guidelines in preventing CVC-related infectious complications.

Efficacy of antimicrobial-impregnated catheters in preventing sepsis post epicutaneo-caval catheter (ECC) removal in neonates: A retrospective study.

Epicutaneo-caval catheters (ECC) are vital in neonatal intensive care units (NICU) in enabling prolonged venous access. Despite their benefits, central line-associated bloodstream infections (CLABSI) pose a potential risk. The ECC removal procedure may contribute to an increased risk of post removal sepsis through biofilm release. Antimicrobial-impregnated ECCs have been proposed as a potential solution to prevent this complication, but research on their effectiveness in neonates is limited. To compare post-ECC or neonatal peripherally inserted central catheter (n-PICCs) removal sepsis rates when using conventional or antimicrobial-impregnated catheters in neonates. A retrospective, single center cohort analysis using 2019 data from 421 neonates after successful ECC insertion at the Women's Wellness and Research Center, a large tertiary level NICU in Qatar. The study systematically collected data on demographics, insertion, and removal as well as microbiology, and infection data. Statistical analyses compared conventional and antimicrobial ECCs, with a focus on the incidence of sepsis within 72 hr post-removal. After excluding non-eligible, 349 cases were included in the analysis (138 conventional, 211 antimicrobial-impregnated). There were no significant demographic differences between the two groups. The CLABSI incidence was higher amongst the antimicrobial ECC group (4% vs 0.6%, p = 0.031). Among the included neonates, the confirmed post-removal sepsis incidence was 4.3% (6 cases) for the conventional and 10% (21 cases) for the antimicrobial ECC groups, which was not statistically significant (p = 0.055). The study noted a higher, but statistically insignificant, incidence of post removal sepsis when using antimicrobial-impregnated ECCs. This finding raises questions about the effectiveness of antimicrobial ECCs in preventing post-removal sepsis in this patient population. Further randomized trials are needed to assess the role of antimicrobial ECCs amongst neonates and to refine neonatal ECC care strategies.

Experience of a vascular ultrasound-guided program: from the ICU to the hospital

Abstract Background The use of peripherally inserted central venous catheters (PICCs) has increased worldwide in the last decade. However, PICCs are associated to catheter-related thrombosis (CRT) and central line-associated bloodstream infections (CLABSIs). We describe the characteristics of patients requiring a PICC, estimate the incidence rate, and identify potential risk factors of PICC-related complications. Methods All adult patients requiring a PICC at our institution (Fundación Santa Fe de Bogotá, Bogota, Colombia) from September 2022 to May 2024 were included in the analysis. The database from active PICC monitoring collected demographic and PICC-related information. The incidence rate of CLABSI and CRT, and crude odds ratios (cORs) were estimated. Results Overall, 1936 individuals were included in the study. The median age was 67 years (IQR: 50–78 years), and 51.5% were females. The median duration of PICC lines was 10 days (IQR: 4–17). Seventy-nine patients had catheter-related complications, mostly in the Intensive Care Unit (ICU). The CLABSI and CRT institutional incidence rates per 1000 catheter-days were 2.03 (2.96 in the ICU) and 0.58 (0.61 in the ICU), respectively. Prolonged catheter use (≥ 6 days), PICC insertion in the intensive care unit, and postoperative care after cardiac surgery were identified as potential risk factors for CLABSI, while a catheter insertion into the brachial vein was associated with CRT. Conclusion Daily PICC assessment, particularly in patients with prolonged catheter use, PICC insertion into the brachial vein, or in postoperative care after cardiac surgery may significantly reduce CLABSI and CRT cases. Implementing Vascular Access Teams, venous catheter care bundles, and institutional insertion protocols optimize clinical outcomes.

Cost-effectiveness of a new multi-lumen infusion device to reduce central-venous-line-associated bloodstream infections in neonates

A new medical device was developed for multi-infusion in neonatal intensive care units (NICUs) with the aim of addressing issues related to drug incompatibilities and central-line-associated bloodstream infections (CLABSIs). To assess the cost-effectiveness of implementing this new perfusion system in an NICU setting. This single-centre, observational study was conducted in all infants admitted to the NICU within 3 days of birth, and who required a central venous line, to evaluate the cost and effectiveness before (2019) and after (2020) implementation of the new perfusion system. Costs were calculated from the hospital perspective, and the incidence of CLABSIs was examined over a time horizon from NICU admission to discharge. Resource utilization was measured (infusion device, infection-treating drugs and biological analyses), and corresponding costs were valued using tariffs for 2019. The incremental cost-effectiveness ratio (ICER) was calculated, expressed as Euros per CLABSI avoided, and one-way and multi-variate sensitivity analyses were conducted. Among 609 infants selected, clinical characteristics were similar across both periods. The CLABSI rate decreased significantly (rate ratio 0.22, 95% confidence interval 0.07-0.56), and total costs reduced from €65,666 to €63,932 per 1000 catheter-days (P<0.001) after implementation of the new perfusion system, giving an ICER of €251 saved per CLABSI avoided. The majority of sensitivity analyses showed that the new intervention remained economically dominant. This single-centre study showed a significant decrease in the incidence of CLABSIs after implementation of the new perfusion system, without incurring additional costs. Further prospective multi-centre randomized studies are needed to confirm these results in other NICUs.

Central lines, aseptic batching services, and infection rates: A pharmacy-led initiative of intravenous tube priming within a NICU.

Central line-associated bloodstream infections (CLABSIs) are hospital-acquired, serious complications that greatly affect many vulnerable neonates throughout their hospital stay. This article describes the implementation of a unique practice in which pharmacy primes continuous infusions through medication tubing for neonatal central lines in a cleanroom at Children's Hospital Colorado - Colorado Springs (CHCO-CSH). This institution is a freestanding children's hospital with a level III neonatal intensive care unit (NICU) that opened in April 2019. Since then, the pharmacy department has been priming central line tubing for continuous infusions for all patients in the NICU. Neonates are at increased risk for developing CLABSIs due to their immature immune systems and frequent need for central line placement. With that in mind, the pharmacy department decided to focus efforts on this population. Pharmacists and pharmacy technicians received training on how to properly prime tubing, document when a patient received a new central line, document if a central line was removed, and record when new tubing was due based on a department policy. This novel, pharmacy-led priming procedure resulted in a low CLABSI incidence, offering a promising strategy to reduce CLABSIs in a NICU.

Development of best evidence-based practice protocols for central venous catheter placement and maintenance to reduce CLABSI.

Although evidence-based interventions can reduce the incidence of central line-associated bloodstream infection (CLABSI), there is a large gap between evidence-based interventions and the actual practice of central venous catheter (CVC) care. Evidence-based interventions are needed to reduce the incidence of CLABSI in intensive care units (ICU) in China. Professional association, guidelines, and database websites were searched for data relevant to CLABSI in the adult ICUs from inception to February 2020. Checklists were developed for both CVC placement and maintenance. Based on the Integrated Promoting Action on Research Implementation in Health Services framework, a questionnaire collected the cognition and practice of ICU nursing and medical staff on the CLABSI evidence-based prevention guidelines. From January 2018 to December 2021, ICU CLABSI rates were collected monthly. Ten clinical guidelines were included after the screening and evaluation process and used to develop the best evidence-based protocols for CVC placement and maintenance. The CLABSI rates in 2018, 2019, and 2020 were 2.98‰ (9/3021), 1.83‰ (6/3276), and 1.69‰ (4/2364), respectively. Notably, the CLABSI rate in 2021 was 0.38‰ (1/2607). In other words, the ICU CLABSI rate decreased from 1.69‰ to 0.38‰ after implementation of the new protocols. Additionally, our data suggested that the use of ultrasound-guidance for catheter insertion, chlorhexidine body wash, and the use of a checklist for CVC placement and maintenance were important measures for reducing the CLABSI rate. The evidence-based processes developed for CVC placement and maintenance were effective at reducing the CLABSI rate in the ICU.

The CATERPILLAR study: an assessor-blinded randomized controlled trial comparing a taurolidine–citrate–heparin lock solution to a heparin-only lock solution for the prevention of central-line-associated bloodstream infections in paediatric oncology patients

Taurolidine-citrate(-heparin) lock solutions (TCHL) are suggested as a promising and safe method for the prevention of central-line-associated bloodstream infections (CLABSI). To investigate the efficacy of TCHL for the prevention of CLABSI in paediatric oncology patients. An assessor-blinded randomized controlled trial at the Princess Máxima Centre for paediatric oncology, the Netherlands, was performed from 2020 to 2023. Paediatric oncology patients receiving a tunnelled central venous access device (CVAD) were eligible. A total of 462 patients were required to compare the TCHL to the heparin-only lock (HL). Patients were followed-up for the first 90 days after CVAD insertion. The primary outcome was the incidence of the first CLABSI from CVAD insertion until the end of follow-up. Intention-to-treat and per-protocol analyses were performed. In total, 232 were randomized in the HL and 231 in the TCHL group. A total of 47 CLABSIs were observed. The intention-to-treat analysis showed that a CLABSI was observed in 26 (11.2%) of the HL group patients versus 21 (9.1%) of the TCHL group patients; incidence rate ratio (IRR) of 0.81 (95% confidence interval (CI): 0.46-1.45) in favour of the TCHL group. The per-protocol analysis showed that a CLABSI was observed in 10 (7.9%) of the HL group patients versus 6 (4.8%) of the TCHL group patients; IRR of 0.59 (95% CI: 0.21-1.62) in favour of the TCHL group. Adverse events were more common in the TCHL group but rarely reported. No difference was detected between the TCHL and HL in the incidence of CLABSI in paediatric oncology patients.

Monitoring and Outcomes of Central Line-Associated Bloodstream Infections in a Tertiary Care Intensive Care Unit.

Background Central line-associated bloodstream infections (CLABSIs) are significant healthcare-associated infections that increase morbidity, mortality, and healthcare costs. This study aims to analyze the frequency, microbiology, risk factors, and outcomes of CLABSI in an adult intensive care unit. Methods We conducted a hospital-based, prospective surveillance study in the critical care unit of a tertiary care hospital. We included patients with a central line (CL) from admission until discharge or line removal. Data collection focused on patient demographics, comorbidities, CL insertion site, and CLABSI rates. The incidence of CLABSI was calculated per 1,000 CL-days, and statistical analysis was performed using the Chi-square test. Results Of the 169 patients enrolled, 123 episodes of bloodstream infections were recorded, 56 (45.5%) of which were CLABSIs. The organisms most frequently isolated were Klebsiella pneumoniae (n = 14; 24.6%), Enterobacter cloacae complex (n = 11; 19.3%), Klebsiella species (n = 7; 12.28%), and Acinetobacter baumannii (n = 7; 12.28%). The overall CLABSI rate was 24.70 per 1,000 CL-days. No significant association was found between CLABSI and patient age, gender, or the site of CL insertion. However, a significant relationship was observed between CLABSI and the presence of comorbid conditions (p = 0.001). The study also noted a high rate of antibiotic resistance among the isolated pathogens. Conclusions Our results emphasize the need for stringent infection control measures and suggest that comorbid conditions significantly increase the risk of CLABSI. Addressing antibiotic resistance and implementing effective prevention strategies are essential for reducing the burden of CLABSIs.

Surveillance of catheter-associated bloodstream infections: development and validation of a fully automated algorithm

BackgroundMost surveillance systems for catheter-related bloodstream infections (CRBSI) and central line-associated bloodstream infections (CLABSI) are based on manual chart review. Our objective was to validate a fully automated algorithm for CRBSI and CLABSI surveillance in intensive care units (ICU).MethodsWe developed a fully automated algorithm to detect CRBSI, CLABSI and ICU-onset bloodstream infections (ICU-BSI) in patients admitted to the ICU of a tertiary care hospital in Switzerland. The parameters included in the algorithm were based on a recently performed systematic review. Structured data on demographics, administrative data, central vascular catheter and microbiological results (blood cultures and other clinical cultures) obtained from the hospital’s data warehouse were processed by the algorithm. Validation for CRBSI was performed by comparing results with prospective manual BSI surveillance data over a 6-year period. CLABSI were retrospectively assessed over a 2-year period.ResultsFrom January 2016 to December 2021, 854 positive blood cultures were identified in 346 ICU patients. The median age was 61.7 years [IQR 50–70]; 205 (24%) positive samples were collected from female patients. The algorithm detected 5 CRBSI, 109 CLABSI and 280 ICU-BSI. The overall CRBSI and CLABSI incidence rates determined by automated surveillance for the period 2016 to 2021 were 0.18/1000 catheter-days (95% CI 0.06–0.41) and 3.86/1000 catheter days (95% CI: 3.17–4.65). The sensitivity, specificity, positive predictive and negative predictive values of the algorithm for CRBSI, were 83% (95% CI 43.7–96.9), 100% (95% CI 99.5–100), 100% (95% CI 56.5–100), and 99.9% (95% CI 99.2–100), respectively. One CRBSI was misclassified as an ICU-BSI by the algorithm because the same bacterium was identified in the blood culture and in a lower respiratory tract specimen. Manual review of CLABSI from January 2020 to December 2021 (n = 51) did not identify any errors in the algorithm.ConclusionsA fully automated algorithm for CRBSI and CLABSI detection in critically-ill patients using only structured data provided valid results. The next step will be to assess the feasibility and external validity of implementing it in several hospitals with different electronic health record systems.

Disinfection of needleless connectors for catheters in one second using a hand-held UV device

The standard of care for disinfecting needleless connectors (NCs) of central venous catheters includes alcohol-containing caps or up to a 15-second scrub with alcohol or chlorhexidine. Due to the clinical impact and high cost of treating Central line-associated bloodstream infections (CLABSI), reducing the incidence of CLABSI is a priority for public health and of the Centers for Disease Control. Alcohol-containing caps have been demonstrated to disinfect external NC surfaces, but not the internal surface. Ultraviolet light (UV-C) is a strategy for disinfection of NC internal and external surfaces. Four clinically relevant bacteria (Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli,Pseudomonas aeruginosa) and Candida albicans were inoculated on NCs. Disinfection efficacy was measured after exposure to one second of 285nm UV-C light at 48mW/cm2 in a proprietary handheld device and UV-C transparent NC or standard of care. Disinfection of internal and external surfaces of NC inoculated with S aureus using alcohol caps, and UV-C was also compared. A 4-log reduction in colony forming units (CFUs) on the interior and exterior surfaces of the UV-transparent NC of clinically relevant pathogens was observed with UV-C light at this power for 1second. We demonstrated the efficacy of UV-C for the disinfection of NCs in one second using the UV-C device in benchtop studies. This device holds promise for reducing CLABSI, and clinical studies are planned.