Incidence Of CLABSI Research Articles

Nursing practice of guidelines for prevention and control of vascular Catheter-Related bloodstream infections.

To apply the Ottawa Model of Research Use to translate the Guidelines for the Prevention and Control of Vascular Catheter-Associated Bloodstream Infections. The Ottawa model of research use is used to provide a framework and guidance. This study was organized by the Nursing Department of the Affiliated Hospital of Hebei Engineering University, and the Intravenous Therapy Group was responsible for the implementation of the study. The hospital's intravenous therapy administrators, members of the sedation team, and specialist nurses will be organized to evaluate the importance, exactness, and clinical practicability of 34 entries. Twelve clinical departments and IV therapy clinics with a high number of central venous catheters were used as sites for translating evidence from this project. The evidence-based team assessed the practice environment, potential practitioners, and clinical status of clinical translation of evidence through symposia, review of relevant systems, operational procedures, on-site inspections, and questionnaires. They compare evidence with existing processes and decide on change strategies. Before and after the application of the evidence, there was a significant increase in the knowledge, belief, and behavior of healthcare workers on CLABSI prevention and control, especially in the acquisition of related knowledge (χ2 = 26.648 p < 0.001). The associated implementation rate was also significantly improved, with a significant decrease in CLABSI incidence from 0.29 per 1000 to 0.11 per 1000 (χ2 = 8.625 p = 0.004). The assessment of the integration of issues showed that 8 aspects, including workflow, knowledge mastery, monitoring reports, and aseptic operations, do not meet the qualified standards. Through this clinical change, a perfect prevention and control system has been established, and the level of knowledge, belief, and behavior of medical staff in preventing CLABSI has been improved, while the incidence of CLABSI has been reduced.

High Proportion of Mucosal Barrier Injury- Laboratory Confirmed Bloodstream Infection Among Paediatric Oncology Patients in a Cancer Centre in Eastern India

Abstract Introduction Blood stream Infections (BSI) is associated with increased morbidity, mortality, health care costs and healthcare resource utilization. The 2022 version of CDC/NHSN criteria for mucosal barrier injury-associated laboratory-confirmed bloodstream infection (MBI-LCBI-1) included isolation of any intestinal organism from blood culture in a patient with absolute neutrophil count &amp;lt;500/mm3. Children with malignancy have a high risk for infections due to neutropenia, immunosuppressive therapy, individual immune and nutritional status, chemotherapy infusion, radiotherapy, impaired mucosal barrier, and presence of different types of indwelling catheters. CLABSI is defined as an LCBI where an eligible BSI organism is identified, and an eligible central line is present on the LCBI date of event or the day before. Device Utilisation Ratio (DUR) is a ratio comparing the number of device days to the number of patient days for the included time period. Methods A retrospective analysis of all BSI-s in the paediatric unit of a tertiary oncology hospital in a low-middle income country (LMIC) for 43 months (April 2019-October 2022) was performed. The primary objective was to assess the burden of MBI-LCBI-1 in children with cancer. The secondary objective was to assess the CLABSI rate and compare it to the DUR. MBI-LCBI-1, CLABSI and DUR were determined using the standard CDC/NHSN criteria. The adapted CDC/NHSN bloodstream infection case report form included microbiological (type of pathogen) and clinical (signs, symptoms, and underlying conditions such as neutropenia) information. Neutropenia (absolute neutrophil count &amp;lt;500 cells/mm3) was the underlying condition in the MBI-LCBI cases. Blood cultures were done using BACT-ALERT system and antibiotic susceptibility testing performed using VITEK2 system (Biomerieux). Results A total of 47 positive blood cultures were obtained from 46 patients during the study period. Thirty-three cases of MBI-LCBI-1 (33/47= 70%) from 28 patients (median age 14 years; range 4-20 years) and 3 cases of CLABSI (3/47= 6.3%) from 3 patients (median age 7 years; range 3-9 years) were detected giving a CLABSI rate of 0.60 per 1000 central line days. Total Patient days and central line days was 15,002 and 14,764 respectively. The device utilization ratio of central line was 0.98. There were 48 isolates from 47 cases of BSI. Forty-three (90%) were Gram negative bacilli (GNB), 2 (4%) Gram positive cocci (GPC) and 3 (6%) Candida species. Klebsiella pneumoniae (28%) was the commonest GNB. Amongst the multi-drug resistant organisms (MDRO) associated with MBI-LCBI-1, carbapenem-resistant enterobacterales (CRE) was detected in 14/43 (32.5%), carbapenem-resistant Acinetobacter baumanii complex (CRAb) in 1/43 (2.3%), carbapenem-resistant Pseudomonas aeruginosa (CRPseu) in 2/43 (4.7%). Candida auris was detected in 1/3 Candida isolates. Six out of 46 patients with BSI died within 30 days of BSI (all-cause mortality). Four of these patients had CRE, 1 had CRAb and 1 had Candida auris. There were no isolates of Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin resistant enterococci (VRE). Conclusion All patients who died had MDRO isolates. Strict adherence to standard and contact precautions, with high level of awareness is necessary for lowering the incidence of BSI. Low incidence of CLABSI is a good indicator of good infection control practices.

The impact of central line bundles on the timing of catheter-associated bloodstream infections and their microbiological distribution in critically ill children.

Catheter-associated bloodstream infection, also known as CLABSI, is the most serious consequence of central venous access devices. These infections increase the risk of mortality and morbidity. The use of central line bundles in clinical settings is increasing worldwide with the purpose of lowering the risk of catheter-associated bloodstream infections. In this study, we investigated the effect of implementing a central line bundle for the prevention of CLABSIs, the distribution of pathogens, and the duration of time it took for CLABSIs to develop in patients who had subclavian-inserted central venous catheters. This research project was a cross-sectional study investigation carried out in a pediatric tertiary teaching hospital. Participants consisted of children who had been admitted to the pediatric critical care unit with subclavian catheters during a period of 13years. We compared the prebundle period with the bundle period for CLABSI specifically focusing on the time to infection, the number of polymicrobial infections, the proportion of Candida parapsilosis, and the percentage of Coagulase-negative staphylococci (CoNS). The "prebundle period" included the period from May 2007 to May 2013, and the "bundle period" included the period from June 2013 to June 2020. Throughout the course of the study, a total of 286 cases of CLABSI were documented. Among these patients, 141 (49.3%) had CLABSIs associated with subclavian catheters. During the prebundle period, 55 CLABSIs were diagnosed in 5235 central line days, with an overall rate of 10.5 CLABSIs per 1000 central line days; after the implementation of central line bundle, 86 CLABSIs were diagnosed in 12,450 CL days, with an overall rate of 3.6 CLABSIs per 1000 CL days. This showed a statistically significantly lower rate in the bundle period (p = 0.0126). In the prebundle period, the mean time to develop CLABSI was 15days, whereas during the bundle period, the mean time to develop CLABSI was 27.9days, a significantly longer time to onset (p = 0.001). While the percentage of other microorganisms was not statistically different between the prebundle and bundle periods (p > 0.05), the percentage of C. parapsilosis was significantly higher in the prebundle period (p = 0.001). Conclusion: The results of this study imply that the use of central line bundles not only reduces the incidence of CLABSI but also delays the time to which CLABSI patients acquire an infection. In addition, as a direct consequence of the CLB, the number of CLABSIs caused by gram-positive cocci did not increase, while the proportion of CLABSIs caused by C. parapsilosis decreased. What is Known: • The most significant negative consequence of central venous access devices is catheter-associated bloodstream infections. • "Care bundles" for CLABSI prevention have been reported to reduce the CLABSI rate. What is New: • Consider what would happen if the "Care bundle" failed to prevent CLABSI. • The findings of this study imply that using central line bundles not only reduces the risk of CLABSI but also extends the time it takes for patients to develop CLABSI. While the number of CLABSIs caused by gram-positive cocci did not increase as a direct result of CLB, the rate of CLABSIs caused by C. parapsilosis, which has recently become a major problem, has decreased.

Impact of intensified prevention measures on rates of hospital-acquired bloodstream infection in medical-surgical intensive care units, Israel, 2011 to 2019.

BackgroundCentral line-associated bloodstream infection (CLABSI) is among the most common preventable infectious complications in patients in intensive care units (ICU). In 2011, the Israel National Center for Infection Control initiated a nationwide CLABSI prevention programme.AimTo evaluate the impact of different components of the programme on CLABSI and non-CLABSI rates in medical-surgical ICUs.MethodsWe included data collected from all 29 medical-surgical ICUs in Israel from November 2011 to December 2019. The study period was divided into three phases: I (baseline, initial CLABSI prevention guidelines introduced, initial feedback on rates provided), II (initial guidelines widely implemented, surveillance undertaken, feedback continued) and III (after implementation of additional prevention measures). Interrupted time series analysis was used to compare CLABSI and non-CLABSI rates during the three phases.ResultsThe pooled mean (SD) incidence of CLABSI per 1,000 central line-days dropped from 7.4 (0.38) in phase I to 2.1 (0.13) in phase III (p<0.001). The incidence rate ratio (IRR) was 0.63 (95% CI: 0.51-0.79) between phases I and II, and 0.78 (95% CI: 0.59-1.02) between phases II and III. The pooled mean (SD) incidence of non-CLABSI per 1,000 patient-days declined from 5.3 (0.24) in phase I to 3.4 (0.13) in phase III (p<0.001).ConclusionNational CLABSI prevention guidelines, surveillance and feedback resulted in significant reductions in CLABSI and non-CLABSI rates. In the wake of further interventions, significant reduction was achieved in ICUs reporting improvement in the uptake of additional prevention measures.

Frequency, Causative Organisms, Excess Cost and Short-Term Outcomes of Peripheral and Central Line Associated Nosocomial Blood Stream Infection in Adult Patients Admitted in a Tertiary Care Hospital

Background: Hospital acquired Blood Stream Infections is one of the major type of nosocomial infection. As compared to 1.3-2.1 per 1000 central line days in high income nations, CLABSI occurs more frequently in middle- and low-income countries, with rates ranging from 7.4 to 12.2 per 1000 central line days. The incidence of both type of BSI is also reported to be different in different regions. Staphylococcus aureus, E. coli, enterococcus species, and candida species are some examples of common causative organisms. Objective: The primary objective: • To study the incidence of CLABSI per 1000 line days among patients with inserted central line during hospital stay • To study the incidence of PLABSI per 1000 line days among patients with inserted peripheral line during hospital stay The secondary objective: • Frequent pathogens isolated from patients • Additional length of stay in patients with blood stream infection (CLABSI and PLABSI) • Excess cost incurred from excess investigations and medications Material and Methods: Total 250 patients of age ≥15 years and acquired CLABSI or PLABSI during hospital stay after 48 hours of admission were included. Sensitivities of the cultured organism were recorded. Antibiotics and other drugs for management of blood stream infection were recorded with dosage, duration and excess cost. Excess length of hospital stay due to blood stream infection along with total length of in hospital stay was checked. Finally outcome of every patient was analyzed. Descriptive statistics were calculated. Independent T test / Man Whitney U test was applied to compare the length of hospital stay and cost among patients with and without BSI (CLABSI/PLABSI). P value of less than or equal to 0.05 was considered significant. Results: There were 44% male and 56% female patients. Mean hospital stay was 11.30±7.24 days. Mortality rate was 17.2% while 8.8% patients were found with infection. Most common isolated organisms were pseudomonas (31.8%), staphylococcus aureus (18.2%), klebsiella (9.1%), acenatobacter (9.1%) and candida tropicalis (9.1%). Sixteen patients have excess hospital stay from infection acquisition day with average of 9.31±4.97 days. Majority (40.9%) of patients spends more than 35,000 PKR (7,062 PKR to 70,988 PKR) as excess cost in terms of treatment. Mortality rate among infected patients was 50%. Conclusion: Patients had to bear a heavy burden as a result of infections contracted when using central venous catheters, which lengthened hospital stays and raised treatment costs. Keywords: Central line, Peripheral, Blood Stream Infections, pathogens, length of stay, excess cost

Analysis of healthcare-associated infection in patients with pulmonary arterial hypertension associated with congenital heart disease in PICU: Evidence from a tertiary hospital in western China.

The present study intends to analyze the targeted surveillance and risk factors for healthcare-associated infection (HAI) in patients with pulmonary arterial hypertension associated with congenital heart disease (CHD-PAH) in a Pediatric intensive care unit (PICU), and provide basis for formulating relevant prevention and control measures of HAI. Children (≤14 years old) who were admitted to the PICU for ≥2 calendar days from January 2018 to December 2021 were included. Targeted surveillance of HAI was described. A total of 7,828 patients in PICU were monitored, and the total hospitalization days of the patients were 36,174. 108 cases of HAI occurred, with a per-case infection rate of 1.38% and a per-thousand day infection rate of 2.99. 1,129 patients with CHD-PAH were included, among which the total hospitalization days were 1,483. In this subpopulation, 38 cases of HAI were diagnosed, with a per-case infection rate of 3.37% and a per-thousand day infection rate of 25.62. The main site of HAI was lower respiratory tract (43.51%), followed by blood infection (34.26%) and surgical site infection (9.26%). 36 strains of pathogenic bacteria were detected from patients with HAI. The top three pathogens with the highest detection rate were Klebsiella pneumoniae (6 episodes, 16.67%), Enterococcus faecium (6 episodes, 16.67%) and Acinetobacter baumannii (4 episodes, 11.11%). The incidence of VAP, CAUTI and CLABSI was 2.78, 0.08 and 1.66 per 1,000 catheter days respectively. Analysis revealed that patients with CHD-PAH were younger and prone to receive surgical corrections. CHD-PAH could significantly increase the length of ICU stay, ventilator days, times of central venous catheterization and central venous catheterization days. The choice of different central venous catheter types differed significantly between the two groups. Patients with CHD-PAH are characterized with excessive central venous catheterization operations, prolonged indwelling time, and more types of catheterization, which are considered to be risk factors for HAI, thus increasing the length of hospital stay. The clinical etiology is mainly G-bacteria, which requires reasonable selection of antibiotics and strict aseptic operation. Limiting unnecessary invasive procedures is helpful for reducing the incidence of postoperative HAI in PICU.

The downstream effects of the COVID-19 pandemic: The supply chain failure, a wicked problem

The failure of the global supply chain became rapidly apparent at the beginning of the COVID-19 pandemic when healthcare organizations were left without supplies needed to care for patients. The supply chain failure is one downstream effect of the pandemic and indirectly impacts patient morbidity and mortality. This column presents a case study of one staff nurse's experience working in a pediatric intensive care unit at a rural children's hospital two years into the pandemic and the toll the global supply chain failure continues to take on patients and healthcare professionals. Central Line Blood Stream Infections (CLABSIs) are used to showcase the severity of the supply chain failure at the point of care. Standardized central line insertion and care bundles have proven to be effective in reducing the incidence of CLABSI; however, they are dependent on the availability of materials and supplies. Health care providers face a “wicked problem" in preventing CLABSIs. The failure of the global supply chain must be examined by healthcare organizations, manufacturers, and government officials so that new systems can be put into place, so we are prepared for a public health emergency.

DOES CHLORHEXIDINE WIPE HELP IN REDUCING HOSPITAL ACQUIRED INFECTIONS (HAIS) AMONG CRITICALLY ILL CHILDREN ADMITTED TO A PAEDIATRIC INTENSIVE CARE UNIT?

OBJECTIVE: To determine the effect of chlorhexidine wipes in reducing the incidence of hospital acquired infections (HAIs) among critically ill children admitted in Paediatric Intensive Care Unit (PICU). METHODS: An interventional study, wherein enrolled children were wiped with chlorhexidine after routine bath. The incidence of HAIs were noted and compared with data from historical controls of previous year during the same period (pre-intervention). RESULTS: One hundred and ninety nine children in the intervention period were compared with 271 children from pre-intervention period. The numbers of ventilator-days were 777 and 696 respectively for the intervention period and pre-intervention periods. Incidence of ventilator associated pneumonia (VAP) reduced from 12.9/1000 ventilator-days in the pre-intervention period to 6.4/1000 ventilator-days in the intervention period (p=0.1). VAP prevalence was 3.3% in the pre-intervention period as compared to 2.5% in the intervention period (p=0.6). The incidence of CLABSI was 3.6/1000 catheter-days (catheter days: 1377) with prevalence of 2.5% in the intervention period, whereas among the historic controls of the previous year it was 4.2/1000 days (catheter days 1432) with a prevalence of 2.2% (p= 0.8). No untoward effect was reported. CONCLUSION: The use of chlorhexidine wipes in ICU was feasible but did not signicantly decrease HAIs.

Pediatrik Yoğun Bakım Ünitesinde Santral Venöz Kateter Tipleri ve Kan Dolaşımı Enfeksiyonuyla İlişkisi: İki Yıllık Deneyimimiz

Objective: Central venous catheters (CVC) provides great convenience in pediatric intensive care units (PICUs). In this study, we aimed to prospectively examine patients who underwent CVC in the PICU in terms of catheter types and infections Methods: We conducted our monocentric, prospective, and cohort study by including patients between January 2019 and December 2020, involving all central catheters temporarily inserted, except port-line catheters, PICCs, indwelling catheters (cuffed and uncuffed tunnel catheters), and arterial catheters. The main issue we focus on is the rate of catheter-associated bloodstream infection (CLABSI). We analyzed the relationship between infection and risk factors using binary logistic regression analysis. Results: We included 26 CLABSIs with 196 CVCs. The incidence rate was 6.2/1000 catheter days. We found that the incidence of CLABSI increased in femoral catheters (OR: 0.04 p: 0.035, 95% CI: 0.49-3.49). Moreover, the incidence was increased in catheters with 3 lumens (OR: 0.06, p: 0.031, 95% CI: 0.34-1.69). The prolongation of the catheter also increases the risk of infection (OR: 0.06, p: 0.028, 95% CI: 0.56-2.36). Also, we found that the frequency of CLABSI increased in patients with underlying immunodeficiency (OR: 0.19, p: 0.007, 95% CI: 0.85-1.39) and in patients who were given total parenteral nutrition (OR: 0.02, p: 0.041, 95% CI: 0.063-2.38). Conclusion: The number of studies that directly compare catheter types in pediatric patients and their relationship with CLABSI is limited. Moreover, the comparison of unrelated studies is difficult because of heterogeneity in study populations. Multicenter pediatric prospective studies focused on identifying catheter-associated infections are needed.

1336. Alcohol Impregnated Caps and Ambulatory CLABSI: Multicenter Cluster Randomized, Crossover Trial

BackgroundCentral line-associated bloodstream infections (CLABSI) cause significant morbidity and mortality and occur more commonly in the ambulatory setting in pediatric oncology patients. Whether alcohol impregnated caps placed on central venous lines can prevent CLABSI in ambulatory pediatric oncology patients is unknown.MethodsWe performed a cluster-randomized, 2 period, crossover trial at 16 pediatric hematology/oncology clinics. Clinics were randomly assigned to usual ambulatory central line care per each institution (control) compared to use of 70% isopropyl alcohol-containing caps at home (intervention). Caps were only used in the ambulatory setting. The primary outcome was ambulatory CLABSI. Secondary outcomes included ambulatory mucosal barrier injury (MBI) CLABSI, secondary blood stream infections, single positive blood cultures, and positive blood cultures.ResultsOf the 16 participating clinics, 15 clinics completed both assignment periods. As assigned, there was no statistically significant reduction in incidence of ambulatory CLABSI in patients using 70% isopropyl alcohol-impregnated caps at home (1.23 per 1000 days, 95% CI 0.94, 1.60) compared with standard practices (1.38 per 1000 days, 95% CI 1.08, 1.77; adjusted incidence rate ratio [aIRR] 0.83, 95% CI 0.61, 1.12). There was no reduction in incidence of ambulatory MBI-CLABSI (aIRR 0.57, 95% CI 0.23, 1.40), single positive blood culture (aIRR 1.35, 95% CI 0.74, 2.48), or positive blood cultures (aIRR 0.80, 95% CI 0.60, 1.07). In the per protocol analysis, there was a reduction in incidence of positive blood cultures in ambulatory patients using 70% isopropyl alcohol-impregnated caps at home (1.51 per 1000 days, 95% CI 1.14, 2.00) compared with standard practices (1.88 per 1000 days, 1.47, 2.39; aIRR 0.72, 95% CI 0.51, 1.00).ConclusionIsopropyl alcohol- impregnated caps did not lead to a statistically significant reduction in CLABSI rates in ambulatory hematology/oncology patients, however, there was a reduction in positive blood cultures in the ambulatory setting in the per protocol analysis. Further research is needed to understand the clinical impact of alcohol-impregnated caps in the ambulatory setting.Disclosures All Authors: No reported disclosures

811. Utilizing IV team in Reducing the Central Line Associated Infections

BackgroundCentral Line-Associated Blood Stream Infections (CLABSI) are defined as the laboratory confirmed blood stream infections after 48 hours of the line placement and excluding other sources of infection. CLABSI can lead to prolonged hospital stay, increased risk of mortality and financial burden on the health care system. In our study, we aimed at evaluating the incidence of CLABSI after involving the IV team in both critically ill and non-critically ill patients.MethodsA retrospective chart review was performed from July 2011 to August 2019 at a 971 bedded community hospital. IV team has been involved in the central line care since 2013 and started changing the scheduled central line dressings. The interventions that were introduced since then include usage of Curos, wearing masks and gloves for any contact with central lines, flushing the central lines using pulsatile method, and not drawing the routine labs. Allpoints program was introduced in July 2018 which is a retraining program to the nurses emphasizing on central line dressing changes using a sterile technique, pulsatile flushing method and medication administration. CLABSI rate was calculated per 1,000 central line days yearly and quarterly and was compared before and after the involvement of IV team.ResultsTotal number of events from July 2011 to August 2019 were 275. Average central line days were 22,350. Most common organisms that were isolated are Staphylococcus aureus (13.45%) followed by Staphylococcus Epidermidis (9.8%), Candida Albicans (8.7%), E. Coli (8.72%) and Klebsiella Pneumonia (6.9%). The average CLABSI rates quarterly and yearly were 1.00 and 1.32 respectively, per 1000 central line days. Average CLABSI rates before and after the involvement of IV team were 1.32 and 1.18 respectively. CLABSI rate has decreased significantly after the involvement of the IV team in 2013. The largest impact on the CLABSI infection rate was between July 2018 to August 2019 which can be attributed to the Allpoints program. CLABSI rate in 2018 and 2019 were 0.86 and 0.6 respectively.ConclusionOur analysis showed that involving the IV team in the central line care and implementing the preventive strategies like usage of curos, pulsatile flush technique, wearing mask and gloves for any contact with central line helped in reducing CLABSI.Disclosures All Authors: No reported disclosures

Continuous Low-Dose Heparin Infusion for Catheter-Related Thrombosis Prophylaxis in Critically-Ill Children

Introduction: Central venous catheters (CVC) are often required in critical care settings to provide life-sustaining care. Their usage has improved the quality of care in pediatric patients by providing a secure point of access which minimizes the number of peripheral needle sticks. However, CVC usage is not without risks. Children can experience acute CVC-related complications such as venous thromboembolisms (VTEs) and infections. Over the past 20 years, CVC utilization has increased and its associated complications (VTE, central line associated blood stream infection [CLABSI], catheter dysfunction) result in increased lengths of stay and hospital costs. Clinical studies identify CVCs as the single most important risk for DVT in children. Incidence rates in critically-ill children are widely divergent with historical rates of 2.7-18% and 24.7-32.5 per 1000 catheter days. In addition, other historical rates for another CVC-related complication, CLABSI, are limited but demonstrate a rate of 1.21-6.5% and 14.4 per 1000 catheter days. Prevention of catheter-related thrombosis with prophylactic anticoagulants, such as unfractionated heparin, low molecular weight heparin or warfarin, have been tested in several studies in specific subgroups of patients and the majority of studies in pediatric populations were not able to clearly demonstrate a benefit. Despite this, nearly 50% of surveyed Pediatric Intensive Care Unit (PICUs) utilize various forms and doses of heparin prophylaxis to prevent CVC-associated complications. The Penn State Health Children's Hospital PICU utilizes low dose unfractionated heparin infusions (LDUFHI) at 5-15 units/kg/hr for catheter patency and for the prevention of CVC associated complications. Methods: A retrospective chart review of all CVCs, which include non-tunneled CVC (NT-CVC), tunneled lines (TL) and peripherally inserted central catheters (PICC), utilized in the PICU at The Penn State Health Children's Hospital in 2015 was performed to determine if the usage of LDUFHI in critically ill children to maintain catheter patency results in a lower incidence of VTE and CLABSI without increasing bleeding complications in comparison to historically reported data (Beck et al.,J Pediatr. 1998;133(2):237-241; Faustino et al.,J Pediatr. 2013;162(2):387-391; Krishnaiah et al.,Pediatr Crit Care Med. 2012;13(3):e176-e180.). Results: We identified 178 subjects who had CVC which received LDUFHI in 2015. There were a total of 228 CVCs with the majority being non-tunneled CVCs (54%) followed by tunneled lines (34%) and PICCs (12%). Combined, these catheters resulted in 2086 days of use. There was a total of 5 VTEs events for an overall incidence rate of 2.19% and 2.39 per 1000 catheter days. NT-CVC had the lowest rate (1.63%) followed by TL (2.56%) and PICCs (3.7%). However, PICCs has a slightly lower rate when measuring by catheter days (NT-CVC = 2.2 per 1000 catheter days; TL = 4.01 per 1000 catheter days; PICC = 1.46 per 1000 catheter days). There were 3 CLABSI events for an incidence rate of 1.32% and 1.43 per 1000 catheter days (NT-CVC = 1.63% and 2.2 per 1000 catheter days; TL no events; PICC = 3.7% and 1.46 per 1000 catheter days). There were no episodes of heparin induced thrombocytopenia or major bleeding. Overall, the VTE and CLABSI incidence rates are dramatically lower than historical comparisons (VTE = 2.19% and 2.39 per 1000 catheter days versus 15.8-18% and 24.7-32.5 per 1000 catheter days; CLABSI = 1.32% and 1.43 per 1000 catheter days versus 6.5% and 14.4 per 1000 catheter days). In addition, this study can offer more accurate rates as incidence was also measured as a factor in catheter days. Conclusion: This study used a single tertiary pediatric intensive care site in a non-randomized fashion. These data suggest an overall lower incidence of catheter related VTE and CLABSI in critically-ill children who received LDUFHI when compared to published with comparable pediatric study populations. The incidence of complications such as CLABSI were also lower with LDUFHI usage when compared to published data involving critically ill children. The incidence rates were even lower than recently published data involving non-critically ill children. These findings suggest that a multicenter randomized study should be pursued. Disclosures No relevant conflicts of interest to declare.

Catheter Complications in Patients Undergoing Extracorporeal Photopheresis for Management of Graft-Versus-Host Disease

<h3>Introduction</h3> Complications associated with central vascular access (VA) in patients (pts) undergoing extracorporeal photopheresis (ECP) may limit therapy. VA options often include dual lumen vortex (DLV) implantable and tunneled trifusion/other (TF) catheters. There is limited data about VA associated complications such as infection, thrombosis, and equipment failure in those undergoing ECP. <h3>Objectives</h3> Our primary aim was to describe VA associated complications during ECP. <h3>Methods</h3> We retrospectively reviewed pts who received ECP at our institution from January 2011 to October 2019. We examined episodes of cellulitis, catheter associated bacterial infection (CLABSI), catheter removal/exchange (CRE), and discontinuation of ECP. <h3>Results</h3> Fifty-two pts had at least 4 ECP sessions using VA. 12 were treated for acute and 40 for chronic/overlap GvHD (cGvHD). Overall, median # ECP sessions (ES) was 35 (range 4-311), median # ECP months (EM) was 7 (range 0.5 to 86). Total number of VA events = 21. In cGvHD (n=40), Median ES was 50 (range 14-311). With DLV catheters (16/40 pts), total VA events = 8 (1 event every 133 ES). 5 events required CRE, and 3 pts resumed ECP after event. With TF catheters (24/40 pts), total VA events = 8 (1 event every 142 ES). 2 events required CRE, and 4 pts restarted ECP after event. In acute GVHD (n=12), median ES was 15 (range 4-83). 11/12 used a TF catheter. CLABSI was diagnosed in 5/12 pts, all of whom were already hospitalized for GvHD therapy. 3/5 required CRE. ECP was discontinued in all events due to progressive GvHD or infection. <h3>Conclusion</h3> During ECP for cGvHD treatment, DLV and TF catheters have similar number of complications (p=0.81) when adjusted for total ES and EM. VA events are a major cause of ECP discontinuation. In aGvHD, the high incidence of CLABSI is attributed to severe immunosuppression from therapy rather than specific catheter related events.

1168. Trends in Central-Line-Associated Blood Stream Infections in a Community Teaching Hospital: A Multi-Intervention Quality Improvement Project

BackgroundCentral line-associated bloodstream infection (CLABSI) is a preventable medical condition that results in increased patient morbidity and mortality as well as increased medical costs. We sought to describe the impact of various quality improvement interventions on the incidence of CLABSI in a large 990-bed community teaching hospital from the period of January 1, 2013 to December 31, 2017.MethodsRetrospective study of CLABSI events as defined by the CDC’s National Healthcare Safety Network was completed. Between 2013 to 2017, we introduced mandatory real-time root cause analysis for each CLABSI event to identify defects that could be used for quality improvement interventions. We implemented a bundle of interventions for proper central venous catheter (CVC) insertion and maintenance based on CDC recommendations and the results of the internal analysis. Interventions included utilizing chlorhexidine gluconate (CHG) skin preparation and maximum sterile barrier precautions, optimal site selection (avoiding femoral site), using antimicrobial-coated CVCs and antithrombotic Bioflo peripherally inserted central catheters (PICC), minimizing multi-lumen CVC and PICC use, de-escalating CVC to midline or preferential use of midline catheters while minimizing unnecessary PICC and CVC insertion, adding Curos disinfection caps on central lines and other vascular access sites, weekly scheduled CVC site dressing changes with Tegaderm CHG I.V. Securement Dressing, CHG baths for patients with CVCs, avoidance of blood culture draws from central lines, and daily review of line necessity with timely removal. Medical staff members received ongoing education on the implementation of the CLABSI bundle. Both ICU and non-ICU CLABSI cases in the adult patient population were analyzed.ResultsA comparison of 2013 with 2017 shows a 69% decline in a number of CLABSI cases from 36 to 11 patients (Figure 1). There was a 30% decline in CVC days from years 2014 to 2017 (No CVC days data for 2013 due to change in data collection system). Over the same period, CLABSI events per 1,000 CVC days decreased from 0.624 to 0.362 (Figure 2)—a 42% decline.ConclusionStudy findings show that our comprehensive bundle of interventions for CVC insertion and maintenance resulted in decreased rates of CLABSI. Disclosures All authors: No reported disclosures.

Fractured pediatric central venous catheters — Repair or replace?

IntroductionCentral venous catheter (CVC) fracture is a common complication. The aim of this study is to examine risk factors resulting in CVC fracture and compare outcomes of children undergoing CVC repair versus replacement. MethodsA retrospective chart review was conducted from 2000 to 2016 for children with tunneled CVCs. Children with CVC fractures were compared to those without to identify risk factors resulting in fracture. Children with fractured CVCs were divided into repair or replacement treatment groups and outcomes compared. A logistic regression model determined independent predictors of CVC-associated bloodstream infections (CLABSI) after fracture. ResultsIn the 236 children with CVCs, the fracture rate was 29.2%. Fractured CVCs were more common with double lumen CVC (p = 0.040) and children whose indication was total parenteral nutrition (p = 0.003). Given children often underwent multiple repairs or replacements. 98 CVC repairs and 41 replacements were analyzed. CVC replacements had longer durability than repair (181.98 vs. 98.9 days, p = 0.038). There were no differences in CLABSI incidence for repair vs. replacement (OR 0.5 CI 0.05–4.97) after controlling for other factors. ConclusionsCVC fracture is a frequent complication in children with tunneled CVCs. CVC repair has no increased incidence of CLABSI but eliminates the intraoperative and anesthetic risks of CVC replacement. Type of studyRetrospective cohort study. Level of evidenceLevel III.

A protocol for quality improvement programme to reduce central line-associated bloodstream infections in NICU of low and middle income country

IntroductionCentral line-associated bloodstream infections (CLABSI) are the most important cause of morbidity and mortality in critically ill patients. Evidence-based interventions when used in form of a bundle have proven to...

THE USE OF 2% CHLORHEXIDINE GLUCONATE (CHG) AS A DAILY BATHING TO REDUCE BACTEREMIA IN CHILDREN WITH CRITICAL ILLNESS AT PICU/NICU

Background: Bacteremia frequently occurs because of nosocomial infection that actually could be preventable. In children who are hospitalized ussually have a higher risk to experience it. Especially in children with critical illness at Pediatric Intensive Care Unit (PICU) at which the state of children to get an indication of central venous catheters (CVC). Objective: To analyze the use of 2% Chlorhexidine Gluconate (CHG) as a daily bathing treatment to reduce bacteremia in critically ill children in the PICU/NICU. Discussion: The study of the use 2% CHG as a daily bathing treatment for critically ill patients admitted to the intensive care unit has been carried out. However, only performed in adult patients. Developing research conducted in children, this study recommends the use of 2% CHG as a daily bathing treatment can be used in selected patients in the NICU when there is an effort by other measures, but still failed to reduce the incidence of CLABSI. Conclusions: Implementation of recommendations will involve approval by the appropriate organizational structure in charge of monitoring the evolution of the practice. Need staff whom known the instructions on the use of CHG to develop procedures daily bathing with 2% CHG in intensive care and decrease the incidence of bacteremia,.Keywords: Chlorhexidine Gluconate, Daily Bathing, Bacteremia in children, PICU/NICU.

Incidence of bloodstream infections in small bowel transplant recipients receiving selective decontamination of the digestive tract: A single-center experience.

Pediatric patients undergoing small bowel transplantation are susceptible to postoperative CLABSI. SDD directed against enteric microbes is a strategy for reducing CLABSI. We hypothesized that SDD reduces the frequency of CLABSI, infections outside the bloodstream, and allograft rejection during the first 30 days following transplant. A retrospective chart review of 38 pediatric small bowel transplant recipients at CCHMC from 2003 to 2011 was conducted. SDD antimicrobials were oral colistin, tobramycin, and amphotericin B. The incidence of CLABSI, infections outside the bloodstream, and rejection episodes were compared between study periods. The incidence of CLABSI did not differ between study periods (6.9 CLABSI vs. 4.6 CLABSI per 1000 catheter days; p = 0.727), but gram positives and Candida predominated in the first 30 days. Incidence of bacterial infections outside the bloodstream did not differ (p = 0.227). Rejection occurred more frequently during the first month following transplant (p = 0.302). SDD does not alter the incidence of CLABSI, bacterial infections outside the bloodstream, or allograft rejection in the immediate 30 days post-transplantation. However, SDD does influence CLABSI organism types (favoring gram positives and Candida) and Candidal infections outside the bloodstream.

Improving Patient and Health Care Provider Safety: Implementing a Quality Improvement Program for Identifying Patients on Isolation Precautions

Isolation precautions have become an essential intervention for preventing the spread of multidrug resistant organisms (MDRO) in health care settings. While verbal reporting of such precautions should be standard practice during patient hand-off, this vital information often goes unspoken. Non-verbal methods used for alerting health care providers (HCP) to a patient’s condition can be effective, and have become commonplace in many institutions. Our quality improvement program was implemented in a 250-bed acute care facility in Southern California serving a diverse population, spanning all age ranges from a number of cultural and ethnic backgrounds.

Defining Central Line-Associated Blood Stream Infections Following Hematopoietic Cell Transplantation in Acute Myeloid Leukemia and Myelodysplastic Syndrome.

AbstractAbstract 3042Central line-associated blood stream infection (CLABSI) surveillance is increasingly utilized as an objective measure of quality of care provided by individual hospitals. CLABSI is defined by the National Healthcare Safety Network (NHSN) as a primary bloodstream infection (BSI) in a patient with a central line within the 48-hour period before the development of the BSI (NHSN CLABSI). This traditional definition of CLABSI includes pathogens better described as hospital-acquired blood stream infections (HABSI), such as enteric gram-negative bacilli (GNB) and streptococcus viridans - pathogens inherently more common in patients undergoing hematopoietic cell transplantation (HCT) due to the resultant neutropenia and disruption of mucosal barriers, and unlikely to be line-related. To avoid this misclassification, we have developed a modified CLABSI definition (MCLABSI) which excludes HABSI (DiGiorgio, Infect Control Hosp Epidemiol. 33: 865–8, 2012). MCLABSI includes all of the pathogens under the NHSN definition of CLABSI except Viridans group streptococci species in patients with mucositis, and Enterococcus, Enterobacteriaceae, or Candida species in patients with neutropenia or graft-vs-host disease of the gut. We compared the incidence of CLABSI and its impact on survival using both definitions in acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) patients undergoing SCT.AML and MDS patients undergoing HCT between August 2009 and December 2011 were identified from the Cleveland Clinic Unified Transplant Database, and NHSN CLABSI and MCLABSI rates were obtained from the infection control database. CLABSI incidence was estimated using Kaplan-Meier method, and risk factors for mortality were identified using stepwise Cox proportional hazards analyses. Of the 73 patients identified (median age 52, range 16–70), 48 were male, 44 had AML, and 29 MDS. Patients received a median of 2 prior chemotherapy regimens (range 0–6), 3 had prior radiation, and 6 had prior transplant. 54 underwent myeloablative and 19 reduced-intensity preparative regimens; stem cell source included bone marrow (BM, n=34), peripheral stem cells (PSC, n=24), and cord blood cells (CBC, n=15). The median CD34+ count was 2.42 × 106/kg and median time to neutrophil recovery (absolute neutrophil count > 500/μL) was 14 days (range 6–24) with BM/PSC and 28 days (range 19–77) with CBC. Most (88%) had mucositis, including 17 (28%) with grade 3 or 4. Twenty-three (31.5%) developed NHSN CLABSI, compared to 8 (11.0%) who developed MCLABSI following HCT, of whom 16 (69.6%) and 7 (87.5%) died, respectively. The majority (16/23) of NHSN CLABSI occurred within 14 days (median 9 days, range 2–211 days) of HCT (Figure), varying from a median of 5 days (range 2–12 days) for CBC and 78 days for BM/PSC (range 7–211 days, p<.001). Pathogens in NHSN CLABSI included 11 enteric Gram-negative bacilli, 7 Streptococcus viridans group, 6 enterococcus (3 vancomycin resistant), 5 Staphylococcus (3 methicillin resistant), 2 fungal species, 2 Gram-positive bacilli, 1 Pseudomonas, 1 other Streptococcus species, and 1 Stenotrophomonas. MCLABSI occurred a median of 12 days (range 5–176 days) from HCT (Figure), 7 days for CBC (range 5–12 days) compared to 77 days (range 13–176 days) for BM/PSC (p<.001). Pathogens isolated in MCLABSI included 5 Staphylococcal species (3 MRSE), 2 Streptococcus viridans group, 2 GPB, 1 VRE, and 1 Pseudomonas. 4 NHSN CLABSI and 2 MCLABSI were polymicrobial, and 4 patients had recurrent CLABSI (all of whom died, including 3 MCLABSI). When NHSN CLABSI was analyzed as a time-varying covariate in univariable analysis, it was associated with an increased risk of mortality (HR 3.72, 95% CI 1.88 – 7.36, p<.001), as was MCLABSI (HR 2.96, CI 1.27–6.89, p=.012). CLABSI remained a significant risk factor for mortality in multivariable analysis, by both the NHSN (HR 7.14, CI 3.31 – 15.31, p<.001) and MCLABSI (HR 6.44, CI 2.28–18.18, p<.001) definitions.CLABSI is a common complication in AML and MDS patients undergoing SCT, and is associated with decreased survival. CLABSI is identified less commonly with the exclusion of HABSI in the modified definition, which more precisely identifies patients with BSI related to their central lines. The distinction between these definitions is important to guide preventative infectious control measures, particularly given CLABSI's role as a quality measure influencing reimbursement. [Display omitted] Disclosures:Hill:Teva Pharmaceuticals: Honoraria, Speakers Bureau.