Line-associated Bloodstream Infection Rates Research Articles

Importance of risk adjusting central line-associated bloodstream infection rates in children.

Central line-associated bloodstream infection (CLABSI) is one of the most prevalent pediatric healthcare-associated infections and is used to benchmark hospital performance. Pediatric patients have increased in acuity and complexity over time. Existing approaches to risk adjustment do not control for individual patient characteristics, which are strong predictors of CLABSI risk and vary over time. Our objective was to develop a risk adjustment model for CLABSI in hospitalized children and compare observed to expected rates over time. We conducted a prospective cohort study using electronic health record data at a quaternary Children's Hospital. We included hospitalized children with central catheters. Risk factors identified from published literature were considered for inclusion in multivariable modeling based on association with CLABSI risk in bivariable analysis and expert input. We calculated observed and expected (risk model-adjusted) annual CLABSI rates. Among 16,411 patients with 520,209 line days, 633 patients experienced 796 CLABSIs. The final model included age, behavioral health condition, non-English speaking, oncology service, port catheter type, catheter dwell time, lymphatic condition, total parenteral nutrition, and number of organ systems requiring ICU level care. For every organ system receiving ICU level care the odds ratio for CLABSI was 1.24 (95% CI 1.12-1.37). Although not statistically different, observed rates were lower than expected rates for later years. Failure to adjust for patient factors, particularly acuity and complexity of disease, may miss clinically significant differences in CLABSI rates, and may lead to inaccurate interpretation of the impact of quality improvement efforts.

Rates Of Patient Safety Indicators In Belgian Hospitals Were Low But Generally Higher Than In US Hospitals, 2016-18.

More than two decades ago, the Agency for Healthcare Research and Quality developed its Patient Safety Indicators (PSIs) to monitor potentially preventable and severe adverse events within hospitals. Application of PSIs outside the US was explored more than a decade ago, but it is uncertain whether they remain relevant within Europe, as no up-to-date assessments of overall PSI-associated adverse event rates or interhospital variability can be found in the literature. This article assesses the nationwide occurrence and variability of thirteen adverse events for a case study of Belgium. We studied 4,765,850 patient stays across all 101 hospitals for 2016-18. We established that although adverse event rates were generally low, with an adverse event observed in 0.1percent of medical hospital stays and in 1.2percent of surgical hospital stays, they were higher than equivalent US rates and were prone to considerable between-hospital variability. Failure-to-rescue rates, for example, equaled 23percent, whereas some hospitals exceeded nationwide central line-associated bloodstream infection rates by a factor of 8. Policy makers and hospital managers can prioritize PSIs that have high adverse event rates or large variability, such as failure to rescue or central line-associated bloodstream infections, to improve the quality of care in Belgian hospitals.

Reducing pediatric ambulatory central line-associated bloodstream infections in patients at a single institution home health agency

We conducted a quality improvement project from 2019 to 2021 at a single home health agency to reduce rates of central line-associated bloodstream infection in our ambulatory pediatric population. Annualized central line-associated bloodstream infection rates per 1,000 catheter line days decreased by 20% during the study period, from a rate of 1.023 to 0.810. This decrease was sustained in the 10-month post-study period with a center line shift of 1.090 to 0.658.

Evaluating the outcome of a bundle with 11 components and the INICC multidimensional approach in decreasing rates of central line-associated bloodstream infections across nine Asian countries.

Central line-associated bloodstream infection (CLABSI) rates in intensive care units (ICUs) across Latin America exceed those in high-income countries significantly. We implemented the INICC multidimensional approach, incorporating an 11-component bundle, in 122 ICUs spanning nine Asian countries. We computed the CLABSI rate using the CDC/NSHN definition and criteria. The CLABSI rate per 1000 CL-days was calculated at baseline and throughout different phases of the intervention, including the 2nd month, 3rd month, 4-16 month, and 17-29 month periods. A two-sample t-test was employed to compare baseline CLABSI rates with intervention rates. Additionally, we utilized a generalized linear mixed model with a Poisson distribution to analyze the association between exposure and outcome. A total of 124,946 patients were hospitalized over 717,270 patient-days, with 238,595 central line (CL)-days recorded. The rates of CLABSI per 1000 CL-days significantly decreased from 16.64 during the baseline period to 6.51 in the 2nd month (RR = 0.39; 95% CI = 0.36-0.42; p < 0.001), 3.71 in the 3rd month (RR = 0.22; 95% CI = 0.21-0.25; p < 0.001), 2.80 in the 4-16 month (RR = 0.17; 95% CI = 0.15-0.19; p < 0.001), and 2.18 in the 17-29 month (RR = 0.13; 95% CI = 0.11-0.15; p < 0.001) intervals. A multilevel Poisson regression model demonstrated a sustained, continuous, and statistically significant decrease in ratios of incidence rates, reaching 0.35 (p < 0.0001) during the 17-29 month period. Moreover, the all-cause in-ICU mortality rate significantly decreased from 13.23% to 10.96% (p = 0.0001) during the 17-29 month period. Our intervention led to an 87% reduction in CLABSI rates, with a 29-month follow-up.

Decreasing central line-associated bloodstream infections rates in intensive care units in 30 low- and middle-income countries: An INICC approach

Central line (CL)-associated bloodstream infections (CLABSIs) occurring in the intensive care unit (ICU) are common and associated with a high burden. We implemented a multidimensional approach, incorporating an 11-element bundle, education, surveillance of CLABSI rates and clinical outcomes, monitoring compliance with bundle components, feedback of CLABSI rates and clinical outcomes, and performance feedback in 316 ICUs across 30 low- and middle-income countries. Our dependent variables were CLABSI per 1,000-CL-days and in-ICU all-cause mortality rates. These variables were measured at baseline and during the intervention, specifically during the second month, third month, 4 to 16 months, and 17 to 29 months. Comparisons were conducted using a two-sample t test. To explore the exposure-outcome relationship, we used a generalized linear mixed model with a Poisson distribution to model the number of CLABSIs. During 1,837,750 patient-days, 283,087 patients, used 1,218,882 CL-days. CLABSI per 1,000 CL-days rates decreased from 15.34 at the baseline period to 7.97 in the 2nd month (relative risk (RR)=0.52; 95% confidence interval [CI]=0.48-0.56; P<.001), 5.34 in the 3rd month (RR=0.35; 95% CI=0.32-0.38; P<.001), and 2.23 in the 17 to 29 months (RR=0.15; 95% CI=0.13-0.17; P<.001). In-ICU all-cause mortality rate decreased from 16.17% at baseline to 13.68% (RR=0.84; P=.0013) at 17 to 29 months. The implemented approach was effective, and a similar intervention could be applied in other ICUs of low- and middle-income countries to reduce CLABSI and in-ICU all-cause mortality rates.

Reducing the rate of central line-associated bloodstream infections; a quality improvement project

BackgroundThe burden of central line-associated bloodstream infections is significant and has negative implications for healthcare, increasing morbidity and mortality risks, increasing inpatient hospital stays, and increasing the cost of hospitalization. Efforts to reduce the incidence of central line-associated bloodstream infections have utilized quality improvement projects that implement, measure, and monitor outcomes. However, variations in location, healthcare organization, patient risks, and practice gaps are key to the success of interventions and approaches. This study aims to evaluate interventions of a quality improvement project on the reduction of central line-associated bloodstream infection rates at a university teaching hospital.MethodsThis was a retrospective review of a quality improvement project that was implemented using the Plan-Do-Study-Act quality improvement cycle. Active surveillance of processes and outcomes was performed in the critical care areas; compliance to central line care bundles, and central line-associated bloodstream infections. Interrupted time series was used to analyze trends pre and post-intervention and regression modeling to estimate data segments preceding and succeeding the interventions.ResultsThere were 350 central line insertions, 3912 catheter days, and 20 central line-associated bloodstream infection events during the intervention period. Compliance with central line care bundles was at 94%. There was a trend in the reduction of central line-associated bloodstream infections by 18% that did not reach statistical significance (p = 0.252).ConclusionsImprovement projects to reduce central line-associated bloodstream infections face challenges and complexities associated with implementing interventions in real-world healthcare settings. There is a great need to continuously monitor, evaluate, readjust, and adapt interventions to achieve desired results, sustain improvements in patient outcomes, and investigate reasons for non-adherence as keys to achieving desired outcomes.

Identification of Potential Causes for Increased Central Line Associated Bloodstream Infection Rates in the NICU

The University of Utah Newborn Intensive Care Unit (UUNICU) has seen a recent increase in rate of Central Line Associated Bloodstream Infection (CLABSI) after an extended period of 965 days with no CLABSI’s. Unfortunately, in the last three years, infection rate has been on average 2.6 CLABSI per year. The goal of this study was to identify potential contributing factors leading to this substantial increase. To conceptualize these factors, we focused on the emergence of safety conflicts during the intravenous medication administration process. A safety conflict was defined as an interference between two separate pathways designed to protect the integrity of patient care (a ‘safety pathway’). A total of 30 structured health care worker observations of the intravenous medication administration process were conducted. Data analysis shows a notable increase in safety conflict frequency, and necessary LCs as the number of medications per administration event increases. Conversely, the average duration of a single vs. two medication administration events does not significantly increase, which indicates substantial batching of tasks. This batching increases the likelihood of safety conflicts, negatively affecting patient safety.

Using a Comprehensive On-Site Assessment Process to Reduce Central Line-Associated Bloodstream Infection Rates.

Central line-associated bloodstream infection (CLABSI) rates increased substantially in the United States following the emergence of COVID-19 and subsequent surges. The pandemic resulted in hospital capacities being exceeded and crisis standards of care being implemented for sustained periods. As COVID-19 rates in the United States began to stabilize, some facilities did not return to previous CLABSI rates, indicating a change in practices that had a longer-term impact on CLABSI prevention. The authors' large health care system observed similar increases in CLABSI following the emergence of COVID-19, prompting investigation and intervention in the form of a quality improvement project. To identify changes related to ongoing increases in CLABSI, an assessment team conducted standardized on-site assessments at 11 facilities. Site assessments were considered an intervention, as they involved rigorous preassessment investigations and interviews, case reviews, practice observations, on-site staff interviews, and postassessment support for additional interventions. Nine facilities had enough postassessment data to analyze the impact of intervention. The overall CLABSI rate (infections per 1000 line days) at the 9 facilities in the 6 months prior to intervention was 1.42, and the postassessment rate in the 6 months following intervention was 0.44. This indicates the effectiveness of facility-specific investigation followed by targeted performance improvements to reduce the rate of CLABSI.

Durable Vascular Access in Neonates in the Cardiac ICU: A Novel Technique for Tunneled Femoral Central Venous Catheters.

There is an ongoing need for a method of obtaining long-term venous access in critically ill pediatric patients that can be completed at the bedside and results in a durable, highly functional device. We designed a novel technique for tunneled femoral access to address this need. Herein, we describe the procedure and review the outcomes at our institution. A single-center retrospective chart review identifying patients who underwent tunneled femoral central venous catheter (tfCVC) placement between 2017 and 2021 using a two-puncture technique developed by our team. Academic, Quaternary Children's Hospital with a dedicated pediatric cardiac ICU (CICU). Patients in our pediatric CICU who underwent this procedure. Tunneled femoral central line placement. One hundred eighty-two encounters were identified in 161 patients. The median age and weight at the time of catheter placement was 22 days and 3.2 kg. The median duration of the line was 22 days. The central line-associated bloodstream infection (CLABSI) rate was 0.75 per 1,000-line days. The prevalence rate of thrombi necessitating pharmacologic treatment was 2.0 thrombi per 1,000-line days. There was no significant difference in CLABSI rate per 1,000-line days between the tfCVC and nontunneled peripherally inserted central catheters placed over the same period in a similar population (-0.40 [95% CI, -1.61 to 0.82; p = 0.52]) and no difference in thrombus rates per 1,000-line days (1.37 [95% CI, -0.15 to 2.89; p = 0.081]). tfCVCs can be placed by the intensivist team using a two-puncture technique at the bedside with a high-rate of procedural success and low rate of complications. Advantages of this novel technique of obtaining vascular access include a low rate of CLABSIs, the ability to place it at the bedside, and preservation of the upper extremity vasculature.

Disparities in central line-associated bloodstream infection and catheter-associated urinary tract infection rates: An exploratory analysis.

This retrospective review of 4-year surveillance data revealed a higher central line-associated bloodstream infection (CLABSI) rate in non-Hispanic Black patients and higher catheter-associated urinary tract infection (CAUTI) rates in Asian and non-Hispanic Black patients compared with White patients despite similar catheter utilization between the groups.

The impact on central line-associated bloodstream infection rates following the introduction of a closed system transfer device in oncology wards

Prevention of hazardous drug exposure is essential in averting unnecessary health risks to health care workers (HCW). To address the risk to HCWs when handling hazardous drugs, engineering controls can be utilized to reduce the exposure. A closed system transfer device (CSTD) was introduced for hazardous drugs administration in 6 oncology wards; this new CSTD was associated with a significant increase in CLABSI rates.

2019. Understanding the Impact of COVID-19 Pandemic on Central Line-Associated Bloodstream Infections (CLABSIs): Expanding Analysis to the Microbiologic Level

Abstract Background Increases in central line-associated bloodstream infection (CLABSI) rates have been reported in association with the COVID-19 pandemic, particularly among Candida species and coagulase-negative Staphylococcal species (CoNS). We sought to further validate the impact of the COVID-19 pandemic on CLABSI trends and perform a microbiologic analysis. Methods This is an IRB-approved retrospective analysis of CLABSIs across a network of 38 community hospitals in southeastern United States. CLABSI rates were compared between pre-pandemic (1/1/2018-3/30/2020) and pandemic periods (4/1/2020-12/31/2021). Regression models were developed to evaluate CLABSI incidence over time. Likelihood ratio tests were used to compare models that were exclusively time-dependent to segmented regression models that also accounted for the COVID-19 pandemic. Results A total of 1,167 CLABSIs over 1,345,062 central line days were analyzed (Table 1). The mean monthly CLABSI rate per hospital increased from 0.63 to 1.01 per 1,000 central line days (p&amp;lt; 0.001) in the pandemic period (Table 1). CLABSIs secondary to Candida (0.16 to 0.33, p&amp;lt; 0.001), CoNS (0.09 to 0.22, p&amp;lt; 0.001), and Enterococcal species (0.06 to 0.18, p=0.001) increased, while Escherichia coli CLABSIs decreased (0.04 to 0.01, p&amp;lt; 0.001). Upon regression modeling, the COVID-19 pandemic was associated with increases in monthly CLABSI rates by Candida and Enterococcus species (Figure 1). In contrast, the changes in CoNS and Escherichia coli CLABSI rates were better explained by exclusively time-dependent models (Figure 1; Table 2). Non-sustained changes in Staphylococcus aureus and Klebsiella pneumoniae CLABSI rates were also noted (Table 2). Table 1:Count data, central line days, and mean monthly CLABSI incidence by organism per hospital. Rates are provided as CLABSIs per 1,000 central line days. Figure 1:Regression analysis of monthly CLABSI rates by pathogen. Gray areas denote COVID-19 pandemic period. Statistically significant level changes in CLABSI rates were observed among Candida and Enterococcus spp. (RR=1.92, CI 1.16-3.20 and 2.42, CI 1.09-5.38). Staphylococcus aureus CLABSI rates had a non-sustained but significant increase at the onset of COVID-19 (RR 2.20, CI 1.16-4.20). CoNS and E. coli rate changes occurred independent of COVID-19 (see Table 2). Table 2:Coefficient table of regression analyses for CLABSI rates by pathogen. Exclusively time-dependent models were compared to segmented regression models for each organism and, if no significant difference was noted between models, only the time-dependent model was applied. Conclusion The COVID-19 pandemic was associated with substantial increases in CLABSIs, driven in part by Candida and Enterococcus species across this network of hospitals. However, the observed increase in CoNS CLABSIs and decrease in Escherichia coli CLABSIs appear to have occurred independently of COVID-19, which only became apparent upon regression analysis. Interpretation of pre-post statistics without assessment of pre-existing trends should be done cautiously. Additional analyses may help elucidate other factors influencing these CLABSI trends by organism. Disclosures Sonali D. Advani, MBBS, MPH, FIDSA, Locus Biosciences: Advisor/Consultant|Locus Biosciences: Honoraria|Sysmex America: Advisor/Consultant Melissa D. Johnson, PharmD, MHS, AAHIVP, Charles River Laboratories: Grant/Research Support|Entasis: Honoraria|Merck: Grant/Research Support|Pfizer: Honoraria|Scynexis: Grant/Research Support|Theratechnologies: Honoraria|UpToDate: Honoraria.

Changes in Central Line-Associated Bloodstream Infection (CLABSI) Rates Following Implementation of Levofloxacin Prophylaxis for Children and Adolescents With High-Risk Leukemia.

Background: Despite initiatives to reduce central line-associated bloodstream infection (CLABSI), children and adolescents with hematologic malignancies, as well as those with relapsed disease, remain at the greatest risk for infection. This single-institution project evaluated changes in CLABSI rates following implementation of antibacterial prophylaxis with levofloxacin for patients with high-risk hematologic malignancies. Methods: Positive blood culture events meeting National Health Safety Network surveillance criteria to be classified as CLABSIs from January 1, 2006, to December 31, 2019, were included. Data were organized into four time periods for comparison based on implementation of CLABSI-reduction interventions. Conditional Poisson regression models were used to evaluate the effect of time (intervention period) on CLABSI rates with post hoc Tukey pairwise comparisons between each of the four time periods. Results: From 2006 and 2019, 227 patients experienced 310 CLABSIs. Clinically important decreases in CLABSI rates from baseline (4.84 per 1,000 line days) occurred with implementation of Children's Hospital Association (CHA) bundles (3.29 per 1,000 line days); however, this difference was not significant (p = .16). CLABSI rates decreased from baseline with the addition of formalized supportive cares (2.66 per 1,000 line days; incidence rate ratio [IRR] = 0.60; p < .01), and with the use of antibacterial prophylaxis (1.66 per 1,000 line days; IRR = 0.35; p < .01). Post hoc comparisons indicated decreased CLABSI rates with the use of antibacterial prophylaxis compared with CHA bundles alone (IRR = 0.49; p = .011) and CHA bundles plus formalized supportive cares (IRR = 0.58; p = .046). Discussion: Results demonstrate sustained success using a practice-based evidence approach to guide CLABSI-reduction interventions. Follow-up research, applying machine learning algorithms, may identify additional risk factors and inform future interventions.

Safety and Efficacy of Ceftriaxone in the Treatment of Methicillin-Susceptible Staphylococcus aureus Bloodstream Infections: A Noninferiority Retrospective Cohort Study.

Antistaphylococcal penicillins and cefazolin are the treatments of choice for methicillin-susceptible Staphylococcus aureus (MSSA) infections, requiring multiple doses daily. At Parkland, eligible uninsured patients with MSSA bloodstream infections (BSI) receive self-administered outpatient parenteral antimicrobial therapy (S-OPAT). Ceftriaxone was used in a cohort of S-OPAT patients for ease of once-daily dosing. A retrospective study was conducted to evaluate clinical outcomes for patients discharged with ceftriaxone versus cefazolin to treat MSSA BSI. A retrospective cohort noninferiority study design was used to assess treatment efficacy of ceftriaxone versus cefazolin among Parkland S-OPAT patients treated from April 2012 to March 2020. Demographic, clinical, and treatment-related adverse events data were collected. Clinical outcomes included treatment failure as defined by repeat positive blood culture or retreatment within 6 months, all-cause 30-day readmission rates, and central line-associated bloodstream infection (CLABSI) rates. Of 368 S-OPAT patients with MSSA BSI, 286 (77.7%) received cefazolin, and 82 (22.3%) received ceftriaxone. Demographics and comorbidities were similar for both groups. There were no treatment failures in the ceftriaxone group compared with 4 (1%) in the cefazolin group (P = 0.58). No difference in 30-day readmission rate between groups was found. The CLABSI rates were lower in ceftriaxone group (2%) compared with cefazolin (11%; P = 0.02). Limitations include retrospective cohort design. Ceftriaxone was found to be noninferior to cefazolin in this study. Our findings suggest that ceftriaxone is a safe and effective treatment of MSSA BSI secondary to osteoarticular or skin and soft tissue infections when used in the S-OPAT setting. OFID on 2018 Nov; 5(Suppl 1): S316: doi: 10.1093/ofid/ofy210.894.

Health-care-associated bloodstream and urinary tract infections in a network of hospitals in India: a multicentre, hospital-based, prospective surveillance study

Health-care-associated infections (HAIs) cause significant morbidity and mortality globally, including in low-income and middle-income countries (LMICs). Networks of hospitals implementing standardised HAI surveillance can provide valuable data on HAI burden, and identify and monitor HAI prevention gaps. Hospitals in many LMICs use HAI case definitions developed for higher-resourced settings, which require human resources and laboratory and imaging tests that are often not available. A network of 26 tertiary-level hospitals in India was created to implement HAI surveillance and prevention activities. Existing HAI case definitions were modified to facilitate standardised, resource-appropriate surveillance across hospitals. Hospitals identified health-care-associated bloodstream infections and urinary tract infections (UTIs) and reported clinical and microbiological data to the network for analysis. 26 network hospitals reported 2622 health-care-associated bloodstream infections and 737 health-care-associated UTIs from 89 intensive care units (ICUs) between May 1, 2017, and Oct 31, 2018. Central line-associated bloodstream infection rates were highest in neonatal ICUs (>20 per 1000 central line days). Catheter-associated UTI rates were highest in paediatric medical ICUs (4·5 per 1000 urinary catheter days). Klebsiella spp (24·8%) were the most frequent organism in bloodstream infections and Candida spp (29·4%) in UTIs. Carbapenem resistance was common in Gram-negative infections, occurring in 72% of bloodstream infections and 76% of UTIs caused by Klebsiella spp, 77% of bloodstream infections and 76% of UTIs caused by Acinetobacter spp, and 64% of bloodstream infections and 72% of UTIs caused by Pseudomonas spp. The first standardised HAI surveillance network in India has succeeded in implementing locally adapted and context-appropriate protocols consistently across hospitals and has been able to identify a large number of HAIs. Network data show high HAI and antimicrobial resistance rates in tertiary hospitals, showing the importance of implementing multimodal HAI prevention and antimicrobial resistance containment strategies. US Centers for Disease Control and Prevention cooperative agreement with All India Institute of Medical Sciences, New Delhi. For the Hindi translation of the abstract see Supplementary Materials section.

A quality improvement initiative to reduce necrotizing enterocolitis in high-risk neonates.

Prompted by an acute increase in necrotizing enterocolitis (NEC) rates, we aimed to decrease the rate of stage 2 or greater NEC in infants born at <1500 grams or <30 weeks gestational age from 19.5% to less than 9.7% (a 50% reduction) within 18 months, without adversely affecting central line-associated bloodstream infection (CLABSI) rates. We utilized Define, Measure, Analyze, Improve, and Control (DMAIC) as our improvement model. Informed by our key driver diagram and root cause analyses, six Plan-Do-Study-Act cycles were completed. 147 infants in the QI initiative had a median gestational age of 28.1 weeks and a median birthweight of 1070 grams. NEC rates decreased from the QI baseline of 19.5% to 6% (p = 0.03). Oral care administration increased, and maximal gavage tube dwell time decreased. NEC rates decreased during this QI initiative through a combination of multidisciplinary interventions aimed at reducing dysbiosis.

A Recipe for Success: Conducting a Gap Analysis to Decrease Central Line-associated Bloodstream Infection (CLABSI) Rates in a Post-COVID-19 World

BackgroundDuring the 2020 COVID-19 pandemic hospitals nationwide saw significant increases in central line-associated bloodstream infections (CLABSIs). Factors that likely influenced this include staffing challenges, personal protective equipment practices and drift in compliance with infection prevention bundles. To prevent further infections in 2021, a 788-bed teaching hospital established a multidisciplinary team to conduct a gap analysis to identify practice drifts that may have resulted due to the COVID-19 pandemic and develop targeted interventions.MethodsA team composed of infection prevention, nursing, physicians, and environmental services conducted a gap analysis that included re-evaluation of policies, procedures, and infection prevention bundles in conjunction with a frontline staff survey of current practices to assess for practice drift. Inconsistent use of a central line insertion checklist and nursing maintenance handoff tool and lack of frontline staff participation in a CLABSI committee were identified and targeted for modification & re-implementation in January 2021. To assess intervention effectiveness 2020 pre-implementation CLABSI rate and standardized infection ratio (SIR) (January – December) were compared to 2021 post-implementation CLABSI rate (January -September) and SIR using the exact binomial test and mid-p 95% confidence.ResultsDuring the pre-implementation period, there were 34 CLABSIs with a rate 0.745 CLABSIs per 1,000 central-line days and an SIR of 0.691. After implementation, 18 CLABSIs occurred with rate of 0.494 per 1,000 central-line days and SIR of 0.463. While not statistically significant this represented a 47.0% decrease in CLABSI events, a 33.7% decrease in rate (IDR p-value: 0.1583) and 33.0% decrease in SIR (two-tailed p-value: 0.1679, 95% Conf. Interval: 0.371 – 1.178) between the two periods.ConclusionsMultidisciplinary gap analysis identified practice drifts in use of evidence-based tools during the COVID-19 pandemic. Re-implementation of these modified tools and improved participation in the CLABSI committee lead to an approximate 33% reduction in CLABSI rate and SIR.

Implementation of Evidence-based Maintenance Bundles to Reduce Central Line-Associated Bloodstream Infection (CLABSI) and Catheter-Associated Urinary Tract Infection (CAUTI) Rates

Background In 2021, an increase in central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) rates was observed at an academic medical center. CLABSI and CAUTI have a significant impact on patient outcomes including mortality, length of stay, and healthcare costs. Reduction of CLABSI and CAUTI incidence can be achieved through implementation of standardized, evidence-based maintenance bundles for central lines and foley catheters. Methods A multidisciplinary team began meeting weekly in July 2021 to review CLABSI and CAUTI rates, insertion and maintenance practices, product utilization, and education initiatives. Standardized central line and foley catheter maintenance bundles were developed based on current infection prevention evidence-based guidelines. In August 2021, the maintenance bundles were implemented on every unit and education was provided to nursing unit leaders and staff by the infection prevention department. The maintenance bundles are maintained through daily audits by nursing unit leaders and weekly validation audits by the infection prevention department. Observations from the weekly validation audits are documented and reviewed on a weekly basis by the multidisciplinary team and influence ongoing education topics. Results Between August and November 2021, a 4% reduction in CLABSI rate (2.2 per 1,000 device days) and a 19% reduction in CAUTI rate (2.9 per 1,000 device days) was observed compared to the baseline period. The central line maintenance bundle compliance increased by 21% from August to November with a maximum monthly compliance of 84%. The foley catheter maintenance bundle compliance increased by 23% with a maximum monthly compliance of 79% during the same time period. Conclusions A standardized, evidence-based maintenance bundle for central lines and foley catheters contributes to the reduction of CLABSI and CAUTI rates. Continuous monitoring and validation of the maintenance bundles provides guidance, accountability, and feedback for staff and highlights issues and trends that can be addressed through education. In 2021, an increase in central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) rates was observed at an academic medical center. CLABSI and CAUTI have a significant impact on patient outcomes including mortality, length of stay, and healthcare costs. Reduction of CLABSI and CAUTI incidence can be achieved through implementation of standardized, evidence-based maintenance bundles for central lines and foley catheters. A multidisciplinary team began meeting weekly in July 2021 to review CLABSI and CAUTI rates, insertion and maintenance practices, product utilization, and education initiatives. Standardized central line and foley catheter maintenance bundles were developed based on current infection prevention evidence-based guidelines. In August 2021, the maintenance bundles were implemented on every unit and education was provided to nursing unit leaders and staff by the infection prevention department. The maintenance bundles are maintained through daily audits by nursing unit leaders and weekly validation audits by the infection prevention department. Observations from the weekly validation audits are documented and reviewed on a weekly basis by the multidisciplinary team and influence ongoing education topics. Between August and November 2021, a 4% reduction in CLABSI rate (2.2 per 1,000 device days) and a 19% reduction in CAUTI rate (2.9 per 1,000 device days) was observed compared to the baseline period. The central line maintenance bundle compliance increased by 21% from August to November with a maximum monthly compliance of 84%. The foley catheter maintenance bundle compliance increased by 23% with a maximum monthly compliance of 79% during the same time period. A standardized, evidence-based maintenance bundle for central lines and foley catheters contributes to the reduction of CLABSI and CAUTI rates. Continuous monitoring and validation of the maintenance bundles provides guidance, accountability, and feedback for staff and highlights issues and trends that can be addressed through education.

Analysis of transition from intravenous iron sucrose to ferric carboxymaltose infusions in pediatric patients with intestinal failure.

Iron supplementation is required for pediatric patients with intestinal failure (IF). There is a paucity of literature on optimal iron formulation and outcomes in this patient population that requires ongoing supplementation. The aim of this study was to assess outcomes in pediatric patients with IF receiving iron sucrose (IS) vs ferric carboxymaltose (FCM) iron infusions. This was a single-center observational cohort study of pediatric patients with IF requiring ongoing intravenous iron supplementation. Patients were transitioned from IS to FCM as iron therapy. Longitudinal linear mixed-effects models and generalized estimating equations were used to compare outcomes, including hematologic, iron, and growth parameters for 12-month treatment duration on each iron formulation. Adverse effects were descriptively summarized. Twenty-three patients were included. Sixteen received IS and later switched to FCM, five received IS only, and two received FCM only. Most patients' etiology of IF was short bowel syndrome (FCM: 81%, IS: 83%). No differences were seen over time for iron, hematologic, and growth metrics between IS and FCM. The median number of infusions over 12 months for those taking IS was 15 (interquartile range [IQR] = 13-26) and 2 for FCM (IQR = 1-2). Asymptomatic hypophosphatemia was noted in both groups. Similar central line-associated bloodstream infection rates were noted. IS and FCM infusions both maintained hematologic and iron parameters with no significant difference noted between the two types of iron, though the number of FCM infusions was significantly less. No significant adverse effects were noted.

Reducing central line-associated bloodstream infection (CLABSI) rates with cognitive science-based training

There have been many tactics throughout the years aimed at reducing central line-associated bloodstream infections (CLABSI) in the healthcare setting. To reduce CLABSI rates at this facility, we employed cognitive science-based online training directed at nursing departments. Following implementation, we found significant reductions in CLABSI rates that were sustained for a minimum of 9 months. These results demonstrate that this learning methodology can be used to help decrease CLABSI and potentially other health care-associated infections.