Incidence Of Central Line-associated Bloodstream Infections Research Articles

Impact of COVID-19 on an infection prevention and control program, Iowa 2020-2021

BackgroundThe COVID-19 pandemic has affected infection prevention and control (IPC) programs worldwide. We evaluated the impact of COVID-19 on the University of Iowa Hospitals & Clinics IPC program by measuring the volume of calls to the program, changes in healthcare-associated infection rates, and team member perceptions. MethodsWe retrieved the IPC call log and healthcare-associated infection trends for 2018-2020. We defined 2 periods: pre-COVID-19 (2018-2019) and COVID-19 (January-December 2020). We also conducted one-on-one interviews and focus group interviews with members of the IPC program and describe changes in their working conditions during the COVID-19 period. ResultsA total of 6,564 calls were recorded during 2018-2020. The pre-COVID-19 period had a median of 71 calls and/or month (range: 50-119). During the COVID-19 period, the median call volume increased to 368/month (range: 149-829), and most calls were related to isolation precautions (50%). During the COVID-19 period, the central line-associated bloodstream infection incidence increased significantly. Infection preventionists reported that the ambiguity and conflicting guidance during the pandemic were major challenges. ConclusionsOur IPC program experienced a 500% increase in consultation requests. Planning for future bio-emergencies should include creative strategies to increase response capacity within IPC programs.

Central Line Associated Blood Stream Infections and Effectiveness of Care Bundle Approach: A Prospective Cohort Study

Introduction: Insertion and maintenance of Central Venous Catheters (CVC) are integral components for the supportive care of critically ill neonates. Their use is often associated with the unavoidable risk of acquiring Healthcare Associated Infections (HAI) like Central Line Associated Blood Stream Infections (CLABSI) especially in resource limited public sector Neonatal Intensive Care Units (NICU). Adopting a care bundle approach to decrease CLABSI rates in such NICUs still remains a challenge. Aim: To determine the baseline CLABSI rate, identify the risk factors associated with it and also to determine the effectiveness of care bundle approach in decreasing CLABSI. Materials and Methods: An analytical prospective cohort study was conducted in Cheluvamba Hospital, attached to Mysore Medical College and Research Institute, Mysuru, Karnataka, India, from June 2018 to June 2020. In the preintervention phase (June 2018 to May 2019), the data of 307 neonates in whom Central Line (CL) was inserted were analysed to determine the baseline CLABSI rate and risk factors. CLABSI bundle involves a group of evidence-based practices which when implemented reliably and consistently have shown to significantly reduce CLABSI rates. CLABSI bundle was implemented in June 2019 and in the postintervention phase (July 2019 to June 2020), the data of 283 neonates were analysed and compared to those in the preintervention group in order to assess the effectiveness of the care bundle approach. Chi-square test was used to compare categorical variables whereas a two sample t-test was used to compare continuous variables. Results: A total of 41 CLABSI episodes were documented in the preintervention phase (Group 1) as compared to 12 in the postintervention phase (Group 2). Mean birth weight and gestational age was significantly lower in neonates with CLABSI as compared to neonates without CLABSI in both the groups. The incidence of CLABSI was significantly higher in neonates with a catheter dwell time of more than eight days and in those who received Total Parenteral Nutrition (TPN). Implementation of the CLABSI bundle resulted in the reduction of the baseline CLABSI rate from 16.25 to 8.3/1000 CL days; a significant reduction in the catheter dwell time and duration of NICU stay was also noted in group 2. Duration of NICU stay and death rate among neonates who developed CLABSI did not differ significantly between both the groups. Conclusion: Despite incorporating the care bundle approach, CLABSI rate remained to be high. Very preterm neonates with birth weight of <1500 grams and NICU stay of more than 25 days were more likely to develop CLABSI. Significant reduction in CLABSI rates can be achieved with widespread implementation of the CLABSI bundle in resource limited NICUs across India.

Chlorhexidine gluconate bathing of adult patients in intensive care units in São Paulo, Brazil: Impact on the incidence of healthcare-associated infection

BackgroundThere is an increasing use of daily chlorhexidine gluconate (CHG) bathing to decrease healthcare associated infections (HAI). Daily bathing of patients with CHG has been successfully used to prevent multidrug-resistant organisms (MDROs) HAI in intensive care units (ICU). MethodsThis was a 12-month, single-center, open, cluster randomized trial, conducted at four ICUs of the University Hospital of Universidade Federal de São Paulo, Unifesp, Brazil. ICUs were randomized to either perform daily bathing of the patients with pH neutral soap and water – control units, or daily bathing with 2% CHG detergent solution – intervention units. We evaluated the incidence density rate of central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), catheter associated urinary tract infection (CAUTI), Klebsiella pneumoniae carbapenemase (KPC)-producing enterobacteria HAI, and death in the intervention and control units. ResultsA total of 1,640 admissions of 1,487 patients occurred during the study period (41.2% control group, and 58.8% intervention group). Incidence density rates of KPC-producing enterobacteria HAI were 5.01 and 2.25 infections/1000 patient-days in the control units and in the intervention units (p = 0.013) and mortality rates were 28.7% and 18.7% in the control units and in the intervention units (p<0.001), respectively. No difference between groups was observed in CLABSI incidence (p = 0.125), VAP incidence (p = 0.247) and CAUTI incidence (p = 0.435). No serious skin reactions were noted in either study group.Daily 2% CHG detergent solution bathing is a feasible, low cost option for HAI prevention in ICU.

Study of central venous catheter-related complications in major burn patients

Background: Routinely changing central venous catheters (CVCs) as a prevention strategy of bbloodstreaminfections in burns patients has been controversial due to the paucity of evidence for appropriate timings of line changes. This study aims to ascertain the risk factors associated with central line-associated sepsis and thrombosis and to evaluate the role of heparin lock, routine line changes, and thromboprophylaxis in reducing the risk of complications associated with central venous catheterization. Materials and Methods: A retrospective observational hospital-based study on 50 patients admitted with major burns (involving 40% or more total body surface area [TBSA] in burn intensive care unit/ward at Gandhi Medical College and Associated Hamidia Hospital from May 2021 to June 2022. Nontunneled, triple-lumen central lines were inserted usingthe Seldinger technique preferentially on healthy skin and secured with Tegaderm™ CHG Chlorhexidine Gluconate transparent dressing. The removal of central lines was done sepsis (persistent rise of fever unresponsive to antipyretics or empirical antibiotics) or when distal limb swelling edema) developed. Routine removal of the central line was also done when resuscitation was over and parenteral nutritional supplementation was no longer needed (after 12–15 days) or before shifting from HDU or on discharge. Data collection included: Demographics, co-morbidities, type and cause of burn, %TBSA, route (subclavian, femoral, and jugular line), access (healthy/burned) of line, duration of line in situ, complications (cellulitis, edema, venous thrombosis, and persistent high-grade fever), culture/sensitivity (c/s) reports, duration of hospital stay, heparin prophylaxis, or treatment. The data were processed with Chi-square test. The primary outcome of this observational study was a measure of catheter-related bloodstream infections and symptomatic deep vein thrombosis and their correlation with demographics and various comorbidities. Result: Central line duration and age were identified as independent risk factors for central line-associated bloodstream infection (CLABSI), with central line duration the most significant predictor (P &lt; 0.05). CLABSI occurred at 12.81 ± 2.967 days' postline insertion. Further research is needed to assess the role of routine line changes (every 12–15 days' postinsertion) in preventing CLABSI and heparin lock in reducing the incidence of venous thrombosis. Hospital stay was prolonged in the patients developing CVC-associated complications independently increasing morbidity in patients with severe burns, but was not found to be significant (P &lt; 0.05). Conclusion: Jugular venous route should be preferred as the site of CVC insertion (easier and associated with a lower complication rate) and the duration of line kept in situ should be reduced. The blood c/s (preferably central line tip c/s) should be sent routinely after 10 days or on the first suspicion of complications to reduce the incidence and severity of CLABSI in major burn patients.

Comparison of chlorhexidine impregnated dressing and standard dressing for the prevention of central-line associated blood stream infection and colonization in critically ill pediatric patients: A randomized controlled trial.

The aim of this study was to compare chlorhexidine gluconate (CHG)-impregnated dressing and standard dressing with respect to the frequency of central-line-associated bloodstream infection (CLABSI), catheter-related bloodstream infection, primary bloodstream infection, and catheter colonization in critically ill pediatric patients with short-term central venous catheters. Children who were admitted to the pediatric intensive care unit of a tertiary institution between May 2018 and December 2019 and received placement of a short-term central venous catheter were included in this single-center randomized controlled trial. Patients were grouped according to the type of catheter fixation applied. A total of 307 patients (151 CHG-impregnated dressing, 156 standard dressing), with 307 catheters (amounting to a collective total of 4,993 catheter days), were included in the study. The CHG-impregnated dressing did not significantly decrease the incidence of CLABSI (6.36 vs 7.59 per 1,000 catheter days; hazard ratio (HR): 0.93, P = 0.76), catheter related bloodstream infection (3.82 vs 4.18 per 1,000 catheter days; HR: 0.98; P = 0.98), and primary bloodstream infection (2.54 vs 3.42 catheter days; HR: 0.79; P = 0.67). The CHG-impregnated dressing significantly decreased the incidence of catheter colonization (3.82 vs 7.59 per 1,000 catheter days; HR: 0.40; P = 0.04). In both groups, the most frequent microorganisms isolated in CLABSI or catheter colonization were Gram-positive bacteria (the majority were coagulase-negative staphylococci). The use of CHG-impregnated dressing does not decrease CLABSI incidence in critically ill pediatric patients but it significantly reduced catheter colonization. Coagulase-negative staphylococci were the most common microorganisms causing CLABSI or catheter colonization.

Thrombosis and infections of peripherally inserted central catheters in burn patients: A 3-year retrospective study and a systematic review

AimsPeripherally inserted central catheters (PICCs) are becoming common and effective in acute and critical care settings recently. Burn patients need special considerations because of restricted insertion sites, burn wounds, hyper coagulation, high infection rates and others. However, the safety of PICCs in burn patients are not well elucidated and no related protocol has been formed. This study aims to investigate the thrombosis and infections of PICCs in burn patients. MethodsThis was a single center retrospective study and a systematic review. All the burn patients with PICCs between January 1, 2018 and December 31, 2020 were included. A systematic search of Medline, PubMed, EMBASE and Web of Science was performed from inception to 4 June 2021 following PRISMA guidelines. Upper extremity vein thrombosis (UEVT) and central line-associated bloodstream infection (CLABSI) were the main outcome. ResultsA total of 85 successful PICCs in 78 patients were included. Most patients were male (79.5%), adults(80.8%) and injured by flame(74.4%). The mean TBSA was 50.3% and 76.9% of patients had TBSA more than 30%. Most PICCs were punctured once (60.0%) and inserted less than 30 days after injury (80.0%) through basilar vein (70.6%). The overall line days were 2195 days and the mean line days was 25.8 ± 18.3 days. Six PICCs were complicated by UEVT (7.1%) in 21.2 ± 17.3 days after insertion. Patients with UEVT had significantly higher rate of bacteremia and later insertions than those without UEVT. One patient developed CLABSI and the CLABSI rate was 1.2% and 0.5 per 1000 line days. Six PICCs had catheter colonization. No significant risk factors were identified. Five articles involving 293 patients and 319 PICCs were ultimately evaluated in systematic review. The overall incidence of UEVT was 3.2% and CLABSI was 6.9% in burn populations. ConclusionPICCs in burn patients had acceptable incidence of UEVT and CLABSI with relative long line durations. A standardized PICC guideline for burn patients is required to further improve the feasibility and safety of PICCs.

Multi-center prospective study on central line-associated bloodstream infections in 79 ICUs of China

BackgroundChina has not yet established a national surveillance network such as NHSN from America, so there is still no large-scale investigations on central line-associated bloodstream infection (CLABSI) incidence. Several retrospective studies in China reported that the incidence of CLABSI varied due to inconsistent diagnostic criteria. We performed a nationwide survey to investigate the utilization rate of central venous catheters (CVCs) and the incidence of CLABSI in ICUs of different areas of China.MethodsThis is a prospective multi-center study. Patients admitted to ICUs with the use of CVCs between January 1, 2014 and December 31, 2018 were enrolled in this study. Hospitals were given the definition of catheter-related bloodstream infection as: a laboratory-confirmed bloodstream infection where CVC was in place on the date of event or the day before. The characteristics of patients, information of catheterization, implementation rates of precautions, and CLABSIs were collected. The statistical analysis was performed by SPSS 25.0 software and website of Open Source Epidemiologic Statistics for Public Health.ResultsA total of 38,212 patients and 466,585 catheter days were involved in surveillance. The average CLABSI incidence in a thousand catheter days was 1.50, the lowest incidence unit was in pediatric ICU (0/1000 catheter days), and the lowest incidence area was in Northeast China (0.77/1000 catheter days), while the highest incidence unit was in cardiac ICU (2.48/1000 catheter days) and the highest incidence area was in Eastern China (1.62/1000 catheter days). The average utilization rate of CVC was 42.85%, the lowest utilization rate was in pediatric ICU (5.85%) and in Central China (38.05%), while the highest utilization rate was in surgical ICU (64.92%) and in Western China (51.57%). Among the 702 CLABSI cases reported, a total of 735 strains of pathogens were cultured. Staphylococcus spp. was the most common organism isolated (27.07%), followed by Enterobacteriaceae (22.31%). The implementation rates of all precautions showed an upward trend during the study period (P ≤ 0.001).ConclusionThe average incidence of CLABSI in ICUs in China is 1.5/1000 catheter days, similar to the rates reported in developed countries but lower than previous reports in China. CLABSI incidence showed regional differences in China. It is necessary to implement targeted surveillance of CLABSI cases by using standardized CLABSI surveillance definitions and methodologies.

Central line-associated bloodstream infection trend in Brazilian adult intensive care units: an ecological study.

Central line-associated bloodstream infections are the second most frequent infection in intensive care units. It represents an adverse event of significant magnitude, thus threatening the patient safety. The aim of this study was to analyze the historical trend of central line-associated bloodstream infections in patients in intensive care units, the rate of infection, central venous catheter utilization ratio, type of pathogen and their antimicrobial resistance pattern. This ecological study was performed at 42 intensive care units from a state capital of the Midwest region of Brazil. Central line-associated bloodstream infections notifications were collected from two databases, the Municipal Coordination for Patient Safety and Infection Control at Healthcare Services, from 2012-2016, and the FormSUS (National Health System Data Processing Company), from 2014-2016. The incidence of central line-associated bloodstream infections was high and stationary in the period (incidence rate of 2.3 to 3.2 per 1,000 catheter days, central venous catheter utilization ratio average 56,9%). The most frequent microorganisms were coagulase-negative Staphylococcus, Klebsiella pneumoniae, Acinetobacter spp. and Pseudomonas aeruginosa. Resistance to 3rd and 4th generation cephalosporins and carbapenems were detected among Gram-negative bacteria, and resistance to oxacillin among Gram-positive bacteria. Central line-associated bloodstream infections incidence rates were high, however the historical trend remained stationary in adult intensive care units. Infections were mostly caused by coagulase-negative Staphylococcus, K. pneumoniae, Acinetobacter spp. and Pseudomonas aeruginosa, including multi-drug resistant organisms. These findings point to the need of educational strategies addressing the adherence to established preventive measures and to the rational use of antimicrobials.

Bridging the gap: introduction of an antimicrobial peripherally inserted central catheter (PICC) in response to high PICC central line-associated bloodstream infection incidence.

To reduce the incidence of central line-associated bloodstream infection (CLABSI) in peripherally inserted central catheters (PICC) through the introduction of an antimicrobial (AM) catheter as recommended in evidence-based guidelines and standards. Quality improvement project comparing incidence of infections pre-implementation and postimplementation of the new catheter. A 582-bed community teaching hospital in Northwest Indiana. Pre-implementation analysis of surveillance data indicated that 50% of CLABSIs occurred inpatients with PICCs in situ. A gap analysis was performed to review institutional practices against evidence-based recommendations. The use of an AM catheter was supported in each of the documents consulted. After introduction of the new device, performance was measured in a prospective manner using standardized Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) surveillance protocols for CLABSI and internal data sources for other measures. After 30 months of data collection, the PICC CLABSI incidence reduced from a baseline rate of 1.83/1000 PICC days to 0.162/1000 PICC days (91.15% reduction, P=0.0002). Combined with continued compliance with basic prevention strategies (ie use of a central line insertion checklist/insertion bundle) and optimization of device selection and lumen justification, the introduction of an antimicrobial/antithrombogenic (AM/AT) PICC was associated with a significant reduction in CLABSI.

Pneumonia, urinary tract infection, bacteremia, and Clostridioides difficile infection following major head and neck free and pedicled flap surgeries

ObjectivesMedical postoperative infections (MPIs) are important causes of morbidity following major head and neck free and pedicled flap reconstruction, but the incidence, time of onset, and microbiology are not well characterized. Materials and methodsMedical records were reviewed of all head and neck flap surgeries performed 2009–2014 at an academic medical center. Postoperative pneumonia, urinary tract infection (UTI), bloodstream infection (BSI), Clostridioides difficile (CDI), and surgical site infections (SSI) were noted. Catheter-associated UTI (CAUTI), central line-associated BSI (CLABSI), and methicillin-resistant Staphylococcus aureus (MRSA) BSI were also evaluated. ResultsFollowing 715 free (540) or pedicled (175) flap surgeries, 14.1% of patients developed ≥one MPI including pneumonia (10.6%), UTI (2.1%), BSI (0.7%), and CDI (2.4%). Onset was ≤7 days in 77%. The MPI incidence in free vs pedicled flaps was similar. By multivariate analysis, age ≥65 and clindamycin perioperative prophylaxis were associated with increased MPI risk, clean class surgery with decreased risk. The incidence of CAUTI (<1.0%), CLABSI (0.1%), and hospital-onset MRSA BSI (0.1%) was low. SSI rate (7.8% overall) was higher in patients who developed pneumonia (18.4 vs 6.6, p = 0.004). MPI cultures grew gram-negative bacilli or S. aureus in 75%. The length of stay was longer in patients who developed a MPI than those who did not (17.4 vs 10.4 days, p < 0.0001). ConclusionsOne-seventh of major head and neck flap surgeries were complicated by MPIs, three-quarters of infections developed within 1 week postoperatively. Gram-negative bacilli and S. aureus were the predominant pathogens.

Targeting Risk Factors for the Control of Central Line-Associated Bloodstream Infection in the Neonatal Intensive Care Unit: A Single Tertiary Center Experience

Purpose: The aim of this study was to estimate the effect of targeting risk factors for the control of central line-associated bloodstream infection (CLABSI) among high-risk infants in a tertiary neonatal intensive care unit (NICU).Methods: Infants admitted to the NICU and diagnosed with CLABSI from January to December 2013 were eligible for inclusion to the study. The CLABSI group (n=47) was matched in a 1:2 ratio to the control group (n=94) based on gestational age, birth weight, and Score for Neonatal Acute Physiology-II. Risk factors for CLABSI were identified using the Cox proportional hazard model, and analysis of the effect of these risk factors targeting infection control was performed.Results: The risk factors associated with CLABSI were prolonged central line dwell days (adjusted hazard ratio [HR], 1.028; 95% confidence interval [CI], 1.011 to 1.045; P=0.001), use of a silicone catheter (adjusted HR, 5.895; 95% CI, 1.893 to 18.355; P=0.002), surgical treatment (adjusted HR, 3.793; 95% CI, 1.467 to 9.805; P=0.006), and less probiotic supplementation (adjusted HR, 0.254; 95% CI, 0.068 to 0.949; P=0.042). By targeting these risk factors with a quality improvement initiative, the mean CLABSI incidence rate per 1,000 catheter-days decreased from 6.6 to 3.1 (P=0.004).Conclusion: Targeting risk factors for infection control significantly reduced the rate of CLABSI among high-risk infants in the NICU.

Prevention of Central Line-Associated Bloodstream Infections Through Educational Interventions in Adult Intensive Care Units: A Systematic Review.

Central line-associated bloodstream infections (CLABSIs) represent a severe systemic threat to patients admitted in ICUs and contribute to increased mortality, prolonged length of stay in ICUs, and increased costs. The majority of CLABSIs are preventable. The current systematic review aimed to investigate the effectiveness of educational methods on CLABSI rates in adult ICUs.A systematic literature search was conducted using the electronic databases of Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, and Cochrane Database of Systematic Reviews for studies published from the beginning of 1995 to March 2020. The terms used for the search were as follows: central venous catheters, infection, central line-associated bloodstream infections, intensive care unit, and education intervention in all possible combinations and using the word ‘and’ between them. Data were extracted independently and crosschecked by two authors using a standard data collection form. The quality of the studies included in the review was assessed using the Methodological Index for Non-randomized Studies (MINORS).The current systematic review included 27 interventional studies of central line insertion or maintenance or both in adult ICU settings with documentation of the CLABSI incidence expressed per 1,000 catheter days. A large deviation between the length of time and type of educational interventions was found.Statistical significance was found in all studies (except one) in terms of CLABSI reduction despite the large variation of the length or the type of the educational intervention. Continuing education on infection prevention may be necessary to maintain the post-intervention results and improve clinical outcomes.

Incidence rate and risk factors of central line-associated bloodstream infections among neonates and children admitted to a tertiary care university hospital

Central-line associated bloodstream infection (CLABSI) is a common healthcare-associated infection in patients indwelling central venous catheter (CVC). This study examined the incidence rates, risk factors, and clinical outcomes of CLABSI among neonates (aged < 1 month) and children (aged ≥ 1 month) admitted to a tertiary care university hospital. An overall CLABSI incidence rate was 3.2 per 1,000 catheter-days. Number of CVC lumen and place of catheter insertion were a significant risk factor among our neonates and children, respectively. CLABSI prolonged hospitalization and increased hospital costs.

Comparing Hospital Healthcare-Associated Infection Incidence During Pre-COVID-19 Pandemic and Pandemic Eras

Background: Diversion of resources from infection prevention activities, personal protective equipment supply shortages, conservation (extended use and reuse) or overuse with multiple gown and glove layers, and antimicrobial prescribing changes during the COVID-19 pandemic might increase healthcare-associated infection (HAI) incidence and antimicrobial resistance. We compared the incidences of Clostridioides difficile infection (CDI), methicillin-resistant Staphyloccocus aureus bloodstream infection (MRSA BSI), and vancomycin-resistant enterococci bloodstream infection (VRE BSI) reported by California hospitals during the COVID-19 pandemic with incidence data collected prior to the pandemic. Methods: Using data reported by hospitals to the California Department of Health via the NHSN, we compared incidences in the second and third quarters of 2020 (pandemic) to the second and third quarters of 2019 (before the pandemic). For CDI and MRSA BSI, we compared the standardized infection ratios (SIRs, based on the 2015 national baseline), and we calculated the P values. No adjustment model is available for VRE BSI; thus, we measured incidence via crude incidence rates (infections per 100,000 patient days). We calculated incidence rate ratio (IRR) with 95% CI for VRE BSI. To examine the possible effect of missing data during the pandemic, we performed a sensitivity analysis by excluding all facilities that had incomplete data reporting at any time during either analysis period. Results: Incidence measures and numbers of facilities contributing data in prepandemic and pandemic periods are shown in Table 1. There were no statistically significant changes in SIRs at P = .05 for either MRSA BSI or CDI between the prepandemic and pandemic periods (MRSA BSI P = .17; CDI P = .08). Crude VRE BSI incidence increased during the pandemic compared to the prepandemic period (IRR, 1.40; 95% CI, 1.16–1.70). Excluding facilities with incomplete data had minimal effect. Conclusions: We found insufficient evidence that MRSA BSI or CDI incidence changed in California hospitals during the pandemic relative to the prepandemic period; however, there was a significant increase in the crude incidence of VRE BSI. Next, we will include interrupted time series analyses to assess departure from long-term trends, including a risk-adjusted model for VRE BSI. Additionally, we will evaluate for changes in central-line–associated bloodstream infection incidence and antimicrobial resistance among HAI pathogens.Funding: NoDisclosures: None

Sustainable Neonatal CLABSI Surveillance: Consensus Toward New Criteria in the Netherlands

Group Name: Working Group on Neonatal Infectious Diseases of the Section of Neonatology of the Dutch Paediatric SocietyBackground: Central-line–associated bloodstream infections (CLABSIs) are a main focus of infection prevention and control initiatives in neonatal care. Standardized surveillance of neonatal CLABSI enables intra- and interfacility comparisons, which can contribute to quality improvement. To date, there is no national registration system for CLABSI in neonatal care in the Netherlands. Across neonatal intensive care units (NICUs), several different sets of CLABSI criteria and surveillance methods are used for local monitoring of CLABSI incidence rates. To achieve standardized CLABSI surveillance, we conducted a consensus procedure with regard to nationwide neonatal CLABSI surveillance criteria. Method: A modified Delphi consensus procedure for the development of nationwide neonatal CLABSI surveillance criteria was performed between January 2016 and January 2017 in the Netherlands. An expert panel was formed by members of the Working Group on Neonatal Infectious Diseases of the Section of Neonatology of the Dutch Paediatric Society. The consensus procedure consisted of 3 expert panel rounds. Figure 1 shows a detailed description of the consensus procedure. Result: The expert panel achieved consensus on Dutch neonatal CLABSI surveillance criteria, which are summarized in Figure 2. Neonatal CLABSI is defined as a bloodstream infection occurring &gt;72 hours after birth, associated with an indwelling central venous or arterial line and laboratory confirmed by 1 or more blood cultures. In addition, the blood culture finding should not be related to an infection at another site and one of the following criteria can be applied: (1) a bacterial or fungal pathogen is identified from 1 or more blood cultures; (2) the patient has clinical symptoms of sepsis and (2A) a common commensal is identified in 2 separate blood cultures or (2B) a common commensal is identified by 1 blood culture and C-reactive protein (CRP) level is &gt;10 mg/L in the first 36 hours following blood culture collection. Conclusion: The newly developed Dutch neonatal CLABSI surveillance criteria are concise, are specific to the neonatal population, and comply with a single blood-culture policy in actual neonatal clinical practice. International agreement upon neonatal CLABSI surveillance criteria is needed to identify best practices for infection prevention and control.Funding: NoDisclosures: None

Reduction of central line-associated bloodstream infections in a large acute care hospital in Midwest United States following implementation of a comprehensive central line insertion and maintenance bundle.

Central line-associated bloodstream infection (CLABSI) is a preventable medical condition that results in increased patient morbidity and mortality. We describe the impact of various quality improvement interventions on the incidence of CLABSI in an 848-bed community teaching hospital from 1 January 2013 to 31 December 2017. To reduce CLABSI rates after implementation of a comprehensive central line insertion and maintenance bundle. A comprehensive bundle of interventions was implemented incorporating the standard US Centers for Disease Control and Prevention bundle with additional measures such as root-cause analysis of all CLABSI cases, use of passive disinfection caps on vascular access ports, standardisation of weekly central venous catheter (CVC) site dressing changes, and use of antithrombotic and antimicrobial-coated CVCs with fewer lumens. A retrospective study evaluated CLABSI rates and time of CLABSI onset after CVC placement in both intensive care unit (ICU) and non-ICU settings. The annual number of CLABSI cases declined 68% (34 to 11 patients) from 2013 to 2017. There was a 30% decline in CVC days from years 2014 to 2017. Over the same period, CLABSI cases per 1000 CVC days decreased from 0.624 to 0.362: a 42% decline. Following the implementation of a comprehensive bundle of interventions for CVC insertion and maintenance, we found a reduction in rates of CLABSI.

The burden of central line-associated bloodstream infections in children with medical complexity.

Central line-associated bloodstream infections (CLABSI) are significant cause of complications in pediatric intensive care units (PICUs). An emerging challenge are CLABSIs in children with medical complexity (CMC) admitted to PICU. CMC are patients with chronic conditions with or without neurological impairment needing for tracheostomy and/or home mechanical or non-invasive ventilation and/or gastrostomy/jejunostomy. We evaluate CLABSI incidence in a PICU with high prevalence of CMC. This was a retrospective study in the PICU of the Bambino Gesù Children Hospital from January 2017 to December 2020. The medical records were reviewed and demographic, clinical and microbiological data were extracted. CLABSI were defined according to the Center for Disease Control and Prevention's National Healthcare Safety Networks (NHSN) surveillance. A total of 101 children with 125 central lines (CLs) were included; 79/101 (78%) patients were CMC and 50/101 (50%) had a thracheostomy. CLABSI incidence was 2.75/1000 CL-days (9 cases/3269 CL-days); incidence was 0 in patients without underling conditions and 3.14/1000 in CMC (p < 0.001). CLABSI were due to gram negative bacteria in five patients, Candida spp in three and Staphylococcus hominis in one. CLs were removed in eight cases while in the later one, with CLABSI due to Pseudomonas aeruginosa, a conservative strategy was adopted cause of unavailable alternative venous access and removed at discharge with negative culture. All patients recovered. A target 0% CLABSI was possible in critically ill children without underling condition while a high incidence was reported in CMC and sustained by a peculiar CLABSI ecology. This ecology should be considered when a CLABSI was suspected in CMC for prompt antibiotics stewardship.

Does continuity in nursing staff matter? A pilot study on correlation of central line-associated bloodstream infections and employee turnover

BackgroundUnderstaffing has been previously reported as a risk factor for central line-associated bloodstream infections (CLABSI). No previous study addressed the question whether fluctuations in staffing have an impact on CLABSI incidence. We analyzed prospectively collected CLABSI surveillance data and data on employee turnover of health care workers (HCW) to address this research question.MethodsIn January 2016, a semiautomatic surveillance system for CLABSI was implemented at the University Hospital Zurich, a 940 bed tertiary care hospital in Switzerland. Monthly incidence rates (CLABSI/1000 catheter days) were calculated and correlations with human resources management-derived data on employee turnover of HCWs (defined as number of leaving HCWs per month divided by the number of employed HCWs) investigated.ResultsOver a period of 24 months, we detected on the hospital level a positive correlation of CLABSI incidence rates and turnover of nursing personnel (Spearman rank correlation, r = 0.467, P = 0.022). In more detailed analyses on the professional training of nursing personnel, a correlation of CLABSI incidence rates and licensed practical nurses (Spearman rank correlation, r = 0.26, P = 0.038) or registered nurses (r = 0.471, P = 0.021) was found. Physician turnover did not correlate with CLABSI incidence (Spearman rank correlation, r = −0.058, P = 0.787).ConclusionsProspectively determined CLABSI incidence correlated positively with the degree of turnover of nurses overall and nurses with advanced training, but not with the turnover of physicians. Efforts to maintain continuity in nursing staff might be helpful for sustained reduction in CLABSI rates.

Bridging the Gap: Introduction of an Antimicrobial Peripherally Inserted Central Catheter (PICC) in Response to High PICC Central Line-Associated Bloodstream Infection Incidence

Highlights Abstract Objective: To reduce the incidence of central line-associated bloodstream infection (CLABSI) in peripherally inserted central catheters (PICC) through the introduction of an antimicrobial (AM) catheter as recommended in evidence-based guidelines and standards. Design: Quality improvement project comparing incidence of infections pre-implementation and postimplementation of the new catheter. Setting: A 582-bed community teaching hospital in Northwest Indiana. Methods: Pre-implementation analysis of surveillance data indicated that 50% of CLABSIs occurred in patients with PICCs in situ. A gap analysis was performed to review institutional practices against evidence-based recommendations. The use of an AM catheter was supported in each of the documents consulted. After introduction of the new device, performance was measured in a prospective manner using standardized Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) surveillance protocols for CLABSI and internal data sources for other measures. Results: After 30 months of data collection, the PICC CLABSI incidence reduced from a baseline rate of 1.83/1000 PICC days to 0.162/1000 PICC days (91.15% reduction, P = 0.0002). Conclusion: Combined with continued compliance with basic prevention strategies (i.e., use of a central line insertion checklist/insertion bundle) and optimization of device selection and lumen justification, the introduction of an antimicrobial/antithrombogenic (AM/AT) PICC was associated with a significant reduction in CLABSI.

Assessment of potential differences between pre-filled and manually prepared syringe use during vascular access device management in a pediatric intensive care unit.

Central line-associated bloodstream infection is one of the four primary health-care-associated infections applicable to pediatric intensive care units defined by The Centers for Disease Control and Prevention. According to current guidelines, it is essential to flush vascular access devices before each infusion to assess catheter function and prevent catheter-related complications. This prospective trial aimed to assess the potential differences between pre-filled and manually prepared saline syringe use during vascular access device management in a pediatric intensive care unit. Volunteered registered pediatric intensive care unit nurses were asked to implement the flushing solution to an extension line of a central venous catheter in vitro. After the randomization process with opaque sealed envelopes, they have started either with manual preparation or used sterile pre-filled saline syringes. Sterile application steps forms were used for monitoring the manual preparation of saline syringes versus the pre-filled saline syringes phase. Each volunteer repeated the steps for 3, 5, and 10 mL syringe volumes with the manually prepared and pre-filled saline syringes. After completing the procedures, failed steps and durations were transferred into a database to be analyzed by a blinded investigator. A total of 41 nurses volunteered and 123 forms for three attempts per one nurse were filled for each group. In the manual preparation group, the number of at least one failure in the necessary steps was 89 (72.3%) and the same number in the pre-filled syringe group was 6 (4.9%), and significantly lower in the pre-filled saline syringe group (p < 0.001). The overall time for preparing to flush was 86.0 ± 22.3 s (ranging from 46 to 173 s) for manual prepared syringes and 35.2 ± 9.4 s (ranging from 18 to 100 s) (p < 0.001) for pre-filled saline syringes. Our results demonstrate that the risk for breaking the aseptic no-touch technic was higher in the manual preparation group. We have also demonstrated that the flushing time was shorter with pre-filled syringes compared to manually prepared ones, which may contribute to decreasing the workload of the nurses and may increase the quality of care in the intensive care units. The use of pre-filled saline syringes may decrease the central line-associated bloodstream infections incidence and may increase the quality of care by saving extra time in the pediatric intensive care unit.