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Elangovan S, Lo JJ, Xie Y, Mitchell B, Graves N, Cai Y. Impact of central-line-associated bloodstream infections and catheter-related bloodstream infections: a systematic review and meta-analysis. J Hosp Infect 2024; 152:126-137. [PMID: 39151801 DOI: 10.1016/j.jhin.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 08/02/2024] [Accepted: 08/06/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Accurate effect estimates are needed to inform input parameters of health economic models. Central-line-associated bloodstream infections (CLABSIs) and catheter-related bloodstream infections (CRBSIs) are different definitions used for central-line bloodstream infections and may represent dissimilar patients, but previous meta-analyses did not differentiate between CLABSIs/CRBSIs. AIM To determine outcome effect estimates in CLABSI and CRBSI patients, compared to uninfected patients. METHODS PubMed, Embase, and CINAHL were searched from January 2000 to March 2024 for full-text studies reporting all-cause mortality and/or hospital length of stay (LOS) in adult inpatients with and without CLABSI/CRBSI. Two investigators independently reviewed all potentially relevant studies and performed data extraction. Odds ratio for mortality and mean difference in LOS were pooled using random-effects models. Risk of study bias was assessed using ROBINS-E. FINDINGS Thirty-six studies were included. Sixteen CLABSI and 12 CRBSI studies reported mortality. The mortality odds ratios of CLABSIs and CRBSIs, compared to uninfected patients, were 3.19 (95% CI: 2.44, 4.16; I2 = 49%) and 2.47 (95% CI: 1.51, 4.02; I2 = 82%), respectively. Twelve CLABSI and eight CRBSI studies reported hospital LOS; only three CLABSI studies and two CRBSI studies accounted for the time-dependent nature of CLABSIs/CRBSIs. The mean differences in LOS for CLABSIs and CRBSIs compared to uninfected patients were 16.14 days (95% CI: 9.27, 23.01; I2 = 91%) and 16.26 days (95% CI: 10.19, 22.33; I2 = 66%), respectively. CONCLUSION CLABSIs and CRBSIs increase mortality risk and hospital LOS. Few published studies accounted for the time-dependent nature of CLABSIs/CRBSIs, which can result in overestimation of excess hospital LOS.
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Affiliation(s)
- S Elangovan
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - J J Lo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Y Xie
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - B Mitchell
- Faculty of Nursing and Health, Avondale University, Cooranbong, Australia
| | - N Graves
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - Y Cai
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore.
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Bushuven S, Bentele M, Bentele S, Trifunovic-Koenig M, Lederle S, Gerber B, Bansbach J, Friebel J, Ganter J, Nachtigall I, Scheithauer S. Hand hygiene in emergencies: Multiprofessional perceptions from a mixed methods based online survey in Germany. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2024; 6:100207. [PMID: 38783870 PMCID: PMC11111829 DOI: 10.1016/j.ijnsa.2024.100207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/08/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction Despite high vulnerability to infection, hand disinfection compliance in emergencies is low. This is regularly justified as the disinfection procedure delays life support, and instead, wearing disposable gloves is preferred. Simulation studies showed higher achievable compliance than detected in real-life situations. This study aimed to explore healthcare providers' attitudes toward hand disinfection and using gloves in emergencies. Methods We conducted an anonymous online survey in Germany on the attitude and subjective behavior in the five moments of hand hygiene in a closed environment and an open convenience sampling survey. Statistics included paired student's t-tests corrected for multiple testing. For qualitative analysis, we employed a single-coder approach. Results In 400 participants, we detected low priority of WHO-1 (before touching a patient) and WHO-2 (before clean/aseptic procedure) hand hygiene moments, despite knowing the risks of omission of hand disinfection. For all moments, self-assessment exceeded the assessment of colleagues (p < 0.001). For WHO-3, we detected a lower disinfection priority for wearing gloves compared to contaminated bare hands. Qualitative analyses revealed five themes: basic conditions, didactic implementations, cognitive load, and uncertainty about feasibility and efficacy. Discussion Considering bias, the study's subjective nature, the unknown role of emergency-related infections contributing to hospital-acquired infections, and different experiences of healthcare providers, we conclude that hand disinfection before emergencies is de-prioritized and justified by the emergency situation regardless of the objective feasibility. Conclusion This study reveals subjective and objective barriers to implementation of WHO-1 and WHO-2 moments of hand disinfection to be further evaluated and addressed in educational programs.
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Affiliation(s)
- Stefan Bushuven
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Freiburg, Germany
- Institute for Infection Control and Infection Prevention, Hegau-Jugendwerk Gailingen, Health Care Association District of Constance, Germany
- Institute for Medical Education, University Hospital, LMU Munich, Munich, Germany
| | - Michael Bentele
- Training Center for Emergency Medicine (NOTIS e.V), Engen, Germany
- Institute for Anesthesiology, Intensive Care, Emergency Medicine, and Pain Therapy, Hegau Bodensee Hospital Singen, Germany
| | - Stefanie Bentele
- Training Center for Emergency Medicine (NOTIS e.V), Engen, Germany
- Department for Emergency Medicine, University-Hospital Augsburg, University of Augsburg, Augsburg, Germany
| | | | - Sven Lederle
- St Johns Ambulance, Local Association Singen am Hohentwiel, Singen, Germany
| | - Bianka Gerber
- Institute for Infection Control and Infection Prevention, Hegau-Jugendwerk Gailingen, Health Care Association District of Constance, Germany
| | - Joachim Bansbach
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Freiburg, Germany
| | - Julian Friebel
- Emergency Medical Services Department, Berlin Fire and Rescue Service, Berlin, Germany
- Department of Cardiology Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC),Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Julian Ganter
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Freiburg, Germany
| | - Irit Nachtigall
- Helios, Region East Infectious Diseases and Antibiotic Stewardship and Medical School Berlin, Germany
| | - Simone Scheithauer
- Department of Infection Control and Infectious Diseases, University Medical Center Göttingen, Germany
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Marschollek M, Marquet M, Reinoso Schiller N, Naim J, Aghdassi SJS, Behnke M, Ehrenberg S, von Landesberger T, Misailovski M, Prasser F, Scherag A, Schlueter D, Wulff A, Pletz M, Scheithauer S. [Automated surveillance and risk prediction with the aim of risk-stratified infection control and prevention (RISK PRINCIPE)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:685-692. [PMID: 38753020 PMCID: PMC11166781 DOI: 10.1007/s00103-024-03882-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/15/2024] [Indexed: 06/12/2024]
Abstract
Healthcare-associated infections (HCAIs) represent an enormous burden for patients, healthcare workers, relatives and society worldwide, including Germany. The central tasks of infection prevention are recording and evaluating infections with the aim of identifying prevention potential and risk factors, taking appropriate measures and finally evaluating them. From an infection prevention perspective, it would be of great value if (i) the recording of infection cases was automated and (ii) if it were possible to identify particularly vulnerable patients and patient groups in advance, who would benefit from specific and/or additional interventions.To achieve this risk-adapted, individualized infection prevention, the RISK PRINCIPE research project develops algorithms and computer-based applications based on standardised, large datasets and incorporates expertise in the field of infection prevention.The project has two objectives: a) to develop and validate a semi-automated surveillance system for hospital-acquired bloodstream infections, prototypically for HCAI, and b) to use comprehensive patient data from different sources to create an individual or group-specific infection risk profile.RISK PRINCIPE is based on bringing together the expertise of medical informatics and infection medicine with a focus on hygiene and draws on information and experience from two consortia (HiGHmed and SMITH) of the German Medical Informatics Initiative (MII), which have been working on use cases in infection medicine for more than five years.
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Affiliation(s)
- Michael Marschollek
- Peter L. Reichertz Institut für Medizinische Informatik der TU Braunschweig und der Medizinischen Hochschule Hannover, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Mike Marquet
- Institut für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Jena, Deutschland
| | - Nicolás Reinoso Schiller
- Institut für Krankenhaushygiene und Infektiologie der Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - Joëlle Naim
- Peter L. Reichertz Institut für Medizinische Informatik der TU Braunschweig und der Medizinischen Hochschule Hannover, Medizinische Hochschule Hannover, Hannover, Deutschland
| | | | - Michael Behnke
- Institut für Hygiene und Umweltmedizin der Charité Berlin, Berlin, Deutschland
| | - Sandra Ehrenberg
- Institut für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Jena, Deutschland
| | | | - Martin Misailovski
- Institut für Krankenhaushygiene und Infektiologie der Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - Fabian Prasser
- Medizininformatik, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - André Scherag
- Institut für Medizinische Statistik, Informatik und Datenwissenschaften (IMSID), Universitätsklinikum Jena, Jena, Deutschland
| | - Dirk Schlueter
- Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Antje Wulff
- Big Data in der Medizin, Department für Versorgungsforschung, Fakultät VI Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | - Mathias Pletz
- Institut für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Jena, Deutschland
| | - Simone Scheithauer
- Institut für Krankenhaushygiene und Infektiologie der Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland.
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Baykara Ulusan M, Meltem E, Mutlu IN, Ulusan K. The predictive value of systemic inflammatory markers in 902 patients with tunneled hemodialysis catheter. J Nephrol 2024; 37:1041-1049. [PMID: 38512368 PMCID: PMC11239775 DOI: 10.1007/s40620-023-01880-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/26/2023] [Indexed: 03/23/2024]
Abstract
AIM This study aimed to assess the predictive role of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and mean platelet volume, on catheter survival in chronic hemodialysis patients, analyzing both infectious and non-infectious complications. METHODS A retrospective analysis encompassed 1279 tunneled catheter insertion procedures involving 902 patients between March 2014 and October 2018. Patients were categorized into two main groups: (i) initial placement and (ii) exchange. The exchange group was further stratified into four subgroups: infection, dysfunction, displacement, and transitioning temporary hemodialysis catheters to long-term ones. Hematologic ratios were calculated from baseline hemogram data, including neutrophil, lymphocyte, monocyte, and platelet counts, while mean platelet volume was derived from the same hemogram. RESULTS The patients in the exchange group displayed significantly higher lymphocyte and monocyte values (p < 0.001), while lower values were noted for neutrophil-lymphocyte ratio and platelet-lymphocyte ratio (p < 0.001). The transition group displayed higher monocyte values and lower mean platelet volume and lymphocyte-monocyte ratio values (p < 0.05). In the infection-related exchange subgroup, higher neutrophil count, mean platelet volume, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio values were observed compared to other groups (p < 0.05). Cases related to catheter dysfunction exhibited increased lymphocyte-monocyte ratio but lower neutrophil, monocyte, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio values (p < 0.05). CONCLUSION This study highlights the interest of specific inflammatory markers, particularly monocytes, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio, in the management of tunneled catheters, notably in patients undergoing exchanges. However, cut-off values, essential for constructing management algorithms, are currently lacking, and prospective multicenter studies are needed for further elucidation.
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Affiliation(s)
- Melis Baykara Ulusan
- Department of Diagnostic and Interventional Radiology, Istanbul Training and Research Hospital, Samatya, Istanbul, Turkey.
| | - Emine Meltem
- Department of Diagnostic and Interventional Radiology, Istanbul Training and Research Hospital, Samatya, Istanbul, Turkey
| | - Ilhan Nahit Mutlu
- Department of Radiology, Department of Diagnostic and Interventional Radiology, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Kivilcim Ulusan
- Department of General Surgery, Department of Endocrine Surgery, Istanbul Training and Research Hospital, Samatya, Istanbul, Turkey
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Gao S, Albu E, Tuand K, Cossey V, Rademakers F, Van Calster B, Wynants L. Systematic review finds risk of bias and applicability concerns for models predicting central line-associated bloodstream infection. J Clin Epidemiol 2023; 161:127-139. [PMID: 37536503 DOI: 10.1016/j.jclinepi.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES To systematically review the risk of bias and applicability of published prediction models for risk of central line-associated bloodstream infection (CLA-BSI) in hospitalized patients. STUDY DESIGN AND SETTING Systematic review of literature in PubMed, Embase, Web of Science Core Collection, and Scopus up to July 10, 2023. Two authors independently appraised risk models using CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS) and assessed their risk of bias and applicability using Prediction model Risk Of Bias ASsessment Tool (PROBAST). RESULTS Sixteen studies were included, describing 37 models. When studies presented multiple algorithms, we focused on the model that was selected as the best by the study authors. Eventually we appraised 19 models, among which 15 were regression models and four machine learning models. All models were at a high risk of bias, primarily due to inappropriate proxy outcomes, predictors that are unavailable at prediction time in clinical practice, inadequate sample size, negligence of missing data, lack of model validation, and absence of calibration assessment. 18 out of 19 models had a high concern for applicability, one model had unclear concern for applicability due to incomplete reporting. CONCLUSION We did not identify a prediction model of potential clinical use. There is a pressing need to develop an applicable model for CLA-BSI.
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Affiliation(s)
- Shan Gao
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Elena Albu
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Krizia Tuand
- 2Bergen - Learning Centre Désiré Collen, KU Leuven Libraries, KU Leuven, Leuven, Belgium
| | - Veerle Cossey
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Infection Control and Prevention, University Hospitals Leuven, Leuven, Belgium
| | | | - Ben Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands; EPI-Center, KU Leuven, Leuven, Belgium.
| | - Laure Wynants
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; EPI-Center, KU Leuven, Leuven, Belgium; Care & Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Zhang Y, Wang Y, Sheng Z, Wang Q, Shi D, Xu S, Ai Y, Chen E, Xu Y. Incidence Rate, Pathogens and Economic Burden of Catheter-Related Bloodstream Infection: A Single-Center, Retrospective Case-Control Study. Infect Drug Resist 2023; 16:3551-3560. [PMID: 37305736 PMCID: PMC10256568 DOI: 10.2147/idr.s406681] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/25/2023] [Indexed: 06/13/2023] Open
Abstract
Purpose Indwelling central venous catheters (CVCs) can cause catheter related bloodstream infection (CRBSI). CRBSI occurring in intensive care unit (ICU) patients may lead to the worse outcomes and extra medical costs. The present study aimed to assess the incidence and incidence density, pathogens and economic burden of CRBSI in ICU patients. Patients and Methods A case-control study was retrospectively carried out in six ICUs of one hospital between July 2013 and June 2018. The Department of Infection Control performed routinely surveillance for CRBSI on these different ICUs. Data of the clinical and microbiological characteristics of patients with CRBSI, the incidence and incidence density of CRBSI in ICUs, the attributable length of stay (LOS), and the costs among patients with CRBSI in ICU were collected and assessed. Results A total of 82 ICU patients with CRBSI were included into the study. The CRBSI incidence density was 1.27 per 1000 CVC-days in all ICUs, in which the highest was 3.52 per 1000 CVC-days in hematology ICU and the lowest was 0.14 per 1000 CVC-days in Special Procurement ICU. The most common pathogen causing CRBSI was Klebsiella pneumoniae (15/82, 16.67%), in which 12 (80%) were carbapenem resistant. Fifty-one patients were successfully matched with control patients. The average costs in the CRBSI group were $ 67,923, which were significantly higher (P < 0.001) than the average costs in the control group. The total average costs attributable to CRBSI were $33, 696. Conclusion The medical costs of ICU patients were closely related to the incidence of CRBSI. Imperative measures are needed to reduce CRBSI in ICU patients.
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Affiliation(s)
- Yibo Zhang
- Department of Hospital Infection Management, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yichen Wang
- Department of Hospital Infection Management, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Zike Sheng
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Qun Wang
- Department of Hospital Infection Management, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Dake Shi
- Department of Hospital Infection Management, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Shirui Xu
- Department of Clinical Laboratory Medicine, Shanghai Fenglin Clinical Laboratory Co. Ltd, Shanghai, People’s Republic of China
| | - Yaping Ai
- Health Economics and Outcome Research, Becton & Dickinson Medical Device (Shanghai) Ltd, Shanghai, People’s Republic of China
| | - Erzhen Chen
- Department of Emergency Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yumin Xu
- Department of Hospital Infection Management, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
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Menger J, Kaase M, Schulze MH, Dudakova A, Rosin K, Moerer O, Scheithauer S. Central venous catheter contamination rate in suspected sepsis patients - an observational clinical study. J Hosp Infect 2023; 135:98-105. [PMID: 36907334 DOI: 10.1016/j.jhin.2023.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND More than 160,000 central-line-associated bloodstream infections (CLABSIs) are estimated for Europe each year leading to about 25,000 deaths. We aimed at characterising the contamination of administration sets in suspected CLABSI cases in the intensive care unit (ICU). METHODS In ICU patients (period 02/2017-02/2018) with suspected CLABSI, all sampled central venous catheters (CVCs) were examined in 4 segments (from CVC tip to connected tubing systems) for contamination. A risk factor analysis using binary logistic regression was performed. RESULTS 52 consecutively sampled CVCs with 1,004 elements were analysed with 45 elements being positive for at least one microorganism (4.48%). There was a significant association with the duration of catheterisation (p=0.038, n=50) with a daily increase of contamination risk by 11.5% (OR 1.115). The mean number of CVC manipulations was 40 within 72 hours (SD: 20.5), with no association with contamination risk (p=0.381). The contamination risk of the CVC segments decreased from proximal to distal. Non-replaceable components of the CVC had a high risk (14 times higher; p=0.01). A significant positive correlation was detected between positive tip cultures and microbial growth in the administration set (r(49)=0.437, p=0.001). CONCLUSION Although only a minority of CLABSI-suspect patients had positive blood cultures, the contamination rate of central venous catheters and administration set was high, possibly indicating a relevant under-reporting. The finding of identical species in adjacent segments underlines the role of upward or downward spread of microorganisms within the tubes, therefore aseptic tasks should be emphasized.
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Affiliation(s)
- Johanna Menger
- Department for Infection Control and Infectious Diseases, University Medical Center Goettingen, Goettingen, Germany; Department of Anesthesiology, University Medical Center Goettingen, Goettingen, Germany
| | - Martin Kaase
- Department for Infection Control and Infectious Diseases, University Medical Center Goettingen, Goettingen, Germany
| | - Marco H Schulze
- Department for Infection Control and Infectious Diseases, University Medical Center Goettingen, Goettingen, Germany
| | - Anna Dudakova
- Institute for Medical Microbiology and Virology, University Medical Center Goettingen, Goettingen, Germany
| | - Katharina Rosin
- Department for Infection Control and Infectious Diseases, University Medical Center Goettingen, Goettingen, Germany
| | - Onnen Moerer
- Department of Anesthesiology, University Medical Center Goettingen, Goettingen, Germany
| | - Simone Scheithauer
- Department for Infection Control and Infectious Diseases, University Medical Center Goettingen, Goettingen, Germany.
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Alotaibi NH, Barri AM, Somily AM. The Attributable Factors That Increase the Likelihood of Central Line Associated Blood Stream Infection Related In-Hospital 30-Day Mortality. Cureus 2023; 15:e35898. [PMID: 37033526 PMCID: PMC10081389 DOI: 10.7759/cureus.35898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 03/10/2023] Open
Abstract
OBJECTIVE The objective is to investigate the attributable factors associated with an increase in hospital 30-day mortality of central line bloodstream infection (CLABSI). METHODS A retrospective cohort study was conducted at King Saud University Medical City (KSUMC). The sample included adult patients who developed CLABSI between March 2016 and February 2018 after having a central line inserted at KSUMC in Riyadh, Saudi Arabia. RESULTS A total of 283 patients were involved in the study. The 30-day mortality rate was 18.8%. Patients were more likely to die if they were in the intensive care unit (ICU) or required ICU admission after infection (p<0.001). This was also observed in patients who required inotropes or intubation before or after culture (p<0.001). There was a statistically significant difference of 6.60±5.62 in the mean score on the Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II between before and after culture (p<0.001). The likelihood of death was significantly higher among patients with higher APACHE II scores before and after culture (p<0.001). The presence of CLABSI-related sequelae was not associated with increased mortality (p<0.595). CONCLUSIONS The clinical characteristics of CLABSI patients are variable and can increase the risk of mortality or complicate the treatment course. Physicians should be aware of the significance of these factors as potential causes of increased mortality.
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van der Kooi TII, Smid EA, Koek MBG, Geerlings SE, Bode LGM, Hopmans TEM, de Greeff SC. The effect of an intervention bundle to prevent central venous catheter-related bloodstream infection in a national programme in the Netherlands. J Hosp Infect 2023; 131:194-202. [PMID: 36414165 DOI: 10.1016/j.jhin.2022.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/13/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Central venous catheters (CVCs) can lead to central line-related bloodstream infections (CRBSIs). A six-item bundle was introduced in 2009 to prevent CRBSI in Dutch hospitals. AIM This study aimed to determine the impact of an intervention bundle on CRBSI risk. METHODS Data were obtained from hospitals participating in the national CRBSI surveillance between 2009 and 2019. Bundle compliance was evaluated as a total ('overall') bundle (all six items) and as an insertion bundle (four items) and a maintenance bundle (two daily checks). We estimated the impact of the overall and partial bundles, using multi-level Cox regression. FINDINGS Of the 66 hospitals in the CRBSI surveillance 56 (84.8%) recorded annual bundle (non)compliance for >80% of the CVCs, for one to nine years. In these 56 hospitals CRBSI incidence decreased from 4.0 to 1.6/1000 CVC days. In the intensive care units (ICUs), compliance was not associated with CRBSI risk (hazard ratio (HR) for the overall, insertion and maintenance bundle were 1.14 (95% confidence interval 0.80-1.64), 1.05 (0.56-1.95) and 1.13 (0.79-1.62)), respectively. Outside the ICU the non-significant association of compliance with the overall bundle (HR 1.36 (0.96-1.93)) resulted from opposite effects of the insertion bundle, associated with decreased risk (HR 0.50 (0.30-0.85)) and the maintenance bundle, associated with increased risk (HR 1.68 (1.19-2.36)). CONCLUSION Following a national programme to introduce an intervention bundle, CRBSI incidence decreased significantly. In the ICU, bundle compliance was not associated with CRBSI risk, but outside the ICU improved compliance with the insertion bundle resulted in a decreased CRBSI risk.
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Affiliation(s)
- T I I van der Kooi
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, the Netherlands.
| | - E A Smid
- Nextens, Book and Periodical Publishing, Amsterdam, the Netherlands
| | - M B G Koek
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, the Netherlands
| | - S E Geerlings
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity, Amsterdam Public Health, the Netherlands
| | - L G M Bode
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, the Netherlands
| | - T E M Hopmans
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, the Netherlands
| | - S C de Greeff
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, the Netherlands
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Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol 2022; 43:553-569. [PMID: 35437133 PMCID: PMC9096710 DOI: 10.1017/ice.2022.87] [Citation(s) in RCA: 93] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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11
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Al Nakib R, Toncheva A, Fontaine V, Vanheuverzwijn J, Raquez J, Meyer F. Thermoplastic polyurethanes for biomedical application: A synthetic, mechanical, antibacterial, and cytotoxic study. J Appl Polym Sci 2022. [DOI: 10.1002/app.51666] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Rana Al Nakib
- Laboratory of Polymeric and Composite Materials University of Mons, Faculty of Science Mons Belgium
- Microbiology, Bioorganic and Macromolecular Chemistry Unit Université Libre de Bruxelles (ULB), Faculty of Pharmacy Bruxelles Belgium
| | - Antoniya Toncheva
- Laboratory of Polymeric and Composite Materials University of Mons, Faculty of Science Mons Belgium
- Laboratory of Bioactive Polymers Institute of Polymers, Bulgarian Academy of Sciences Sofia Bulgaria
| | - Veronique Fontaine
- Microbiology, Bioorganic and Macromolecular Chemistry Unit Université Libre de Bruxelles (ULB), Faculty of Pharmacy Bruxelles Belgium
| | - Jérôme Vanheuverzwijn
- Microbiology, Bioorganic and Macromolecular Chemistry Unit Université Libre de Bruxelles (ULB), Faculty of Pharmacy Bruxelles Belgium
| | - Jean‐Marie Raquez
- Laboratory of Polymeric and Composite Materials University of Mons, Faculty of Science Mons Belgium
| | - Franck Meyer
- Microbiology, Bioorganic and Macromolecular Chemistry Unit Université Libre de Bruxelles (ULB), Faculty of Pharmacy Bruxelles Belgium
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12
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Zeng C, Wu A, Li L, Jia H. Multi-center prospective study on central line-associated bloodstream infections in 79 ICUs of China. BMC Infect Dis 2021; 21:1208. [PMID: 34863108 PMCID: PMC8642979 DOI: 10.1186/s12879-021-06871-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 11/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China 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. METHODS This 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. RESULTS A 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). CONCLUSION The 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.
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Affiliation(s)
- Cui Zeng
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, China.,Department of Infection Control, Xiangya Hospital, Central South University, Changsha, China
| | - Anhua Wu
- Department of Infection Control, Xiangya Hospital, Central South University, Changsha, China.
| | - Liuyi Li
- Department of Infection Control, Peking University First Hospital, Beijing, China
| | - Huixue Jia
- Department of Infection Control, Peking University First Hospital, Beijing, China
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13
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Guo Q, Lv Z, Wang H, Song L, Liu Y, Chen H, Zhou C. Catheter lock solutions for reducing catheter-related bloodstream infections in paediatric patients: a network meta-analysis. J Hosp Infect 2021; 118:40-47. [PMID: 34560168 DOI: 10.1016/j.jhin.2021.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/08/2021] [Accepted: 09/13/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Different catheter lock solutions (CLSs) are used to reduce catheter-related bloodstream infection (CRBSI) for paediatric patients with central venous catheters (CVCs), but the most effective CLS is unknown. AIM To compare the effectiveness of different CLSs for the prevention of CRBSI in paediatric patients. METHODS Potential studies were searched and selected through the PubMed, Embase, Web of Science and Cochrane Library up to May 2021. Randomized controlled trials that assessed the effects of CLSs for preventing CRBSI in paediatric patients were included. We performed a random-effects network meta-analysis to estimate risk ratio (RR) with 95% confidence interval (CI). FINDINGS Thirteen studies comprising 1335 patients were included in the network meta-analysis. Taurolidine + heparin was effective in the prevention of CRBSI compared with heparin in paediatric patients (RR: 0.21, 95% CI: 0.09-0.51). No significant difference was found between the other CLSs (such as vancomycin, ethanol, fusidic acid, amikacin, and amikacin and vancomycin) and heparin or between different intervention lock solutions for CRBSI prevention. Based on the surface under the cumulative ranking curve, taurolidine + heparin (85.3%) appeared to be the most effective solution for effectiveness on CRBSI prevention, followed by fusidic acid + heparin (77.0%) and amikacin + heparin (65.7%). There was no statistical global inconsistency among the included studies after design by treatment test (χ2 = 2.22, P=0.137). CONCLUSION The study showed that taurolidine lock solution seemed to be the most effective for the prevention of CRBSI in paediatric patients. Well-designed randomized trials in paediatric patients are needed to provide more reliable evidence in the effectiveness of different CLSs.
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Affiliation(s)
- Q Guo
- Department of Nosocomial Infection Prevention and Control, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Z Lv
- Department of Laboratory Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - H Wang
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - L Song
- Department of Nosocomial Infection Prevention and Control, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Y Liu
- Department of Nosocomial Infection Prevention and Control, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - H Chen
- Department of Nosocomial Infection Prevention and Control, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - C Zhou
- Department of Nosocomial Infection Prevention and Control, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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14
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Manoukian S, Stewart S, Graves N, Mason H, Robertson C, Kennedy S, Pan J, Kavanagh K, Haahr L, Adil M, Dancer SJ, Cook B, Reilly J. Bed-days and costs associated with the inpatient burden of healthcare-associated infection in the UK. J Hosp Infect 2021; 114:43-50. [PMID: 34301395 DOI: 10.1016/j.jhin.2020.12.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Healthcare-associated infection (HAI) is associated with increased morbidity and mortality resulting in excess costs. AIM To investigate the impact of all types of HAI on the inpatient cost of HAI using different approaches. METHODS The incidence, types of HAI, and excess length of stay were estimated using data collected as part of the Evaluation of Cost of Nosocomial Infection (ECONI) study. Scottish NHS reference costs were used to estimate unit costs for bed-days. Variable (cash) costs associated with infection prevention and control (IPC) measures and treatment were calculated for each HAI type and overall. The inpatient cost of HAI is presented in terms of bed-days lost, bed-day costs, and cash costs. FINDINGS In Scotland 58,010 (95% confidence interval: 41,730-74,840) bed-days were estimated to be lost to HAI during 2018/19, costing £46.4 million (19m-129m). The total annual cost in the UK is estimated to be £774 million (328m-2,192m). Bloodstream infection and pneumonia were the most costly HAI types per case. Cash costs are a small proportion of the total cost of HAI, contributing 2.4% of total costs. CONCLUSION Reliable estimates of the cost burden of HAI management are important for assessing the cost-effectiveness of IPC programmes. This unique study presents robust economic data, demonstrating that HAI remains a burden to the UK NHS and bed-days capture the majority of inpatient costs. These findings can be used to inform the economic evaluation and decision analytic modelling of competing IPC programmes at local and national level.
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Affiliation(s)
- S Manoukian
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - S Stewart
- Safeguarding Health through Infection Prevention Research Group, Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, UK.
| | - N Graves
- Duke-NUS Medical School, Singapore
| | - H Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - C Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - S Kennedy
- HPS Stats Support, Public Health Scotland, Glasgow, UK
| | - J Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - K Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - L Haahr
- Safeguarding Health through Infection Prevention Research Group, Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, UK
| | - M Adil
- Public Health Scotland, Edinburgh, UK
| | - S J Dancer
- Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire, UK; School of Applied Science, Edinburgh Napier University, Edinburgh, UK
| | - B Cook
- Departments of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - J Reilly
- Safeguarding Health through Infection Prevention Research Group, Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, UK; National Services Scotland (NSS), UK
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15
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Tien KL, Sheng WH, Shieh SC, Hung YP, Tien HF, Chen YH, Chien LJ, Wang JT, Fang CT, Chen YC. Chlorhexidine Bathing to Prevent Central Line-Associated Bloodstream Infections in Hematology Units: A Prospective, Controlled Cohort Study. Clin Infect Dis 2021; 71:556-563. [PMID: 31504341 DOI: 10.1093/cid/ciz874] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/30/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Chlorhexidine (CHG) bathing decreases the incidence of bloodstream infections in intensive care units, but its effect has been understudied in patients with hematological malignancies in noncritical care units. METHODS Adults with hematological malignancies hospitalized for cytotoxic chemotherapy in noncritical care units were offered daily 2% CHG bathing. We compared outcomes of patients who chose CHG bathing (CHG group) with outcomes of those who did not choose CHG bathing (usual-care group). The primary outcome was gram-positive cocci-related, skin flora-related, or central line-associated bloodstream infection. The negative control outcome was gut-origin bacteremia. RESULTS The CHG group (n = 485) had a crude incidence rate of the primary outcome that was 60% lower than the rate for the usual-care group (n = 408; 3.4 vs 8.4 per 1000 patient-days, P = .02) but had a similar crude incidence rate of the negative control outcome (4.5 vs 3.2 per 1000 patient-days; P = .10). In multivariable analyses, CHG bathing was associated with a 60% decrease in the primary outcome (adjusted hazard ratio [HR], 0.4; P < .001). In contrast, CHG bathing had no effect on the negative control outcome (adjusted HR, 1.1; P = .781). CHG bathing was well tolerated by participants in the CHG group. CONCLUSIONS CHG bathing could be a highly effective approach for preventing gram-positive cocci-related, skin flora-related, or central line-associated bacteremia in patients with hematological malignancies who are hospitalized for cytotoxic chemotherapy in noncritical care units.
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Affiliation(s)
| | | | - Shiouh-Chu Shieh
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Ping Hung
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Yi-Hsuan Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Li-Jung Chien
- Division of Infection Control and Biosafety, Centers for Disease Control, Taipei, Taiwan
| | - Jann-Tay Wang
- Center for Infection Control, Taipei, Taiwan.,Department of Internal Medicine, Taipei, Taiwan
| | - Chi-Tai Fang
- Department of Internal Medicine, Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yee-Chun Chen
- Center for Infection Control, Taipei, Taiwan.,Department of Internal Medicine, Taipei, Taiwan
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16
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Alenazi AO, Alhalimi ZM, Almatar MH, Alhajji TA. Safety of Peripheral Administration of 3% Hypertonic Saline in Critically Ill Patients: A Literature Review. Crit Care Nurse 2021; 41:25-30. [PMID: 33560431 DOI: 10.4037/ccn2021400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Hyponatremia and neurocritical injury are life-threatening conditions requiring immediate management with consideration of the safety concerns related to peripheral intravenous administration of hypertonic solutions. Although a central intravenous catheter is the preferred route of administration, central intravenous catheters have many complications and can potentially delay medication administration in urgent situations. OBJECTIVE To evaluate the safety and efficacy of continuous infusion of 3% hypertonic saline via peripheral intravenous administration in critically ill adult patients. METHODS Data were collected from PubMed and Web of Science from database inception to April 7, 2019. Included studies involved adult patients with hyponatremia and/or neurocritical situations and compared administration of 3% hypertonic saline via peripheral administration with standard supportive care (administration through a central intravenous catheter). RESULTS Of 502 articles identified, 7 were included in the review. Three articles were retrospective studies, 2 were prospective studies, 1 was a case series, and 1 was a case report. Infusion-related adverse events and electrolyte abnormalities due to 3% hypertonic saline administration through a peripheral intravenous catheter were minimal and were limited to phlebitis, erythema, edema, hyperchloremia, and hypokalemia with administration at a high infusion rate (83.3 mL/h) and for a prolonged duration (≥ 6 hours). Infusion rate, duration, catheter gauge, and catheter placement may have a role in infusion-related adverse events. CONCLUSIONS Current recommendations to administer continuous infusions of 3% hypertonic saline through a central intravenous catheter should be reassessed. Peripheral intravenous administration can be used safely and effectively in patients in critical situations.
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Affiliation(s)
- Ahmed O Alenazi
- Ahmed O. Alenazi is a critical care clinical pharmacist, Al Imam Abdulrahman Bin Faisal Hospital, Dammam, Saudi Arabia
| | - Zahra M Alhalimi
- Zahra M. Alhalimi was a PharmD student at Al Imam Abdulrahman Bin Faisal University, Dammam, at the time of writing this article
| | - Manar H Almatar
- Manar H. Almatar was a PharmD student at Al Imam Abdulrahman Bin Faisal University, at the time of writing this article
| | - Taha A Alhajji
- Taha A. Alhajji is an inpatient pharmacist, Al Imam Abdulrahman Bin Faisal Hospital
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17
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Buetti N, Ruckly S, Lucet JC, Bouadma L, Garrouste-Orgeas M, Schwebel C, Mimoz O, Souweine B, Timsit JF. Local signs at insertion site and catheter-related bloodstream infections: an observational post hoc analysis using individual data of four RCTs. Crit Care 2020; 24:694. [PMID: 33317594 PMCID: PMC7737269 DOI: 10.1186/s13054-020-03425-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/04/2020] [Indexed: 11/24/2022] Open
Abstract
Background Little is known on the association between local signs and intravascular catheter infections. This study aimed to evaluate the association between local signs at removal and catheter-related bloodstream infections (CRBSI), and which clinical conditions may predict CRBSIs if inflammation at insertion site is present. Methods We used individual data from four multicenter randomized controlled trials in intensive care units (ICUs) that evaluated various prevention strategies for arterial and central venous catheters. We used multivariate logistic regressions in order to evaluate the association between ≥ 1 local sign, redness, pain, non-purulent discharge and purulent discharge, and CRBSI. Moreover, we assessed the probability for each local sign to observe CRBSI in subgroups of clinically relevant conditions. Results A total of 6976 patients and 14,590 catheters (101,182 catheter-days) and 114 CRBSI from 25 ICUs with described local signs were included. More than one local sign, redness, pain, non-purulent discharge, and purulent discharge at removal were observed in 1938 (13.3%), 1633 (11.2%), 59 (0.4%), 251 (1.7%), and 102 (0.7%) episodes, respectively. After adjusting on confounders, ≥ 1 local sign, redness, non-purulent discharge, and purulent discharge were associated with CRBSI. The presence of ≥ 1 local sign increased the probability to observe CRBSI in the first 7 days of catheter maintenance (OR 6.30 vs. 2.61 [> 7 catheter-days], pheterogeneity = 0.02). Conclusions Local signs were significantly associated with CRBSI in the ICU. In the first 7 days of catheter maintenance, local signs increased the probability to observe CRBSI.
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Affiliation(s)
- Niccolò Buetti
- University of Paris, INSERM, IAME, 75006, Paris, France. .,Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | | | - Jean-Christophe Lucet
- University of Paris, INSERM, IAME, 75006, Paris, France.,AP-HP, Infection Control Unit, Bichat- Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France
| | - Lila Bouadma
- University of Paris, INSERM, IAME, 75006, Paris, France.,Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France
| | - Maité Garrouste-Orgeas
- University of Paris, INSERM, IAME, 75006, Paris, France.,Medical Unit, French British Hospital, Levallois-Perret, France
| | - Carole Schwebel
- Medical Intensive Care Unit, Grenoble University Hospital, Grenoble 1 University, La Tronche, France.,Inserm U1039, Radiopharmaceutiques Biocliniques, Domaine de la Merci, 38700, La Tronche, France
| | - Olivier Mimoz
- Services Des Urgences Adultes and SAMU 86, Centre Hospitalier Universitaire de Poitiers, 86021, Poitiers, France.,Université de Poitiers, Poitiers, France.,Inserm U1070, Poitiers, France
| | - Bertrand Souweine
- Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France
| | - Jean-François Timsit
- University of Paris, INSERM, IAME, 75006, Paris, France.,Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France
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18
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Yin L, Li J. <p>Central Venous Catheter Insertion in Colorectal Cancer Patients, PICC or PC?</p>. Cancer Manag Res 2020; 12:5813-5818. [PMID: 32765084 PMCID: PMC7368562 DOI: 10.2147/cmar.s250410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/22/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Methods Results Conclusion
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Affiliation(s)
- Lijuan Yin
- Center of Oncology, Jiangsu Province Hospital, Nanjing, People’s Republic of China
| | - Jinhua Li
- Center of Oncology, Jiangsu Province Hospital, Nanjing, People’s Republic of China
- Correspondence: Jinhua Li Email
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19
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Baier C, Linke L, Eder M, Schwab F, Chaberny IF, Vonberg RP, Ebadi E. Incidence, risk factors and healthcare costs of central line-associated nosocomial bloodstream infections in hematologic and oncologic patients. PLoS One 2020; 15:e0227772. [PMID: 31978169 PMCID: PMC6980604 DOI: 10.1371/journal.pone.0227772] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/27/2019] [Indexed: 12/28/2022] Open
Abstract
Non-implanted central vascular catheters (CVC) are frequently required for therapy in hospitalized patients with hematological malignancies or solid tumors. However, CVCs may represent a source for bloodstream infections (central line-associated bloodstream infections, CLABSI) and, thus, may increase morbidity and mortality of these patients. A retrospective cohort study over 3 years was performed. Risk factors were determined and evaluated by a multivariable logistic regression analysis. Healthcare costs of CLABSI were analyzed in a matched case-control study. In total 610 patients got included with a CLABSI incidence of 10.6 cases per 1,000 CVC days. The use of more than one CVC per case, CVC insertion for conditioning for stem cell transplantation, acute myeloid leukemia, leukocytopenia (≤ 1000/μL), carbapenem therapy and pulmonary diseases were independent risk factors for CLABSI. Hospital costs directly attributed to the onset of CLABSI were 8,810 € per case. CLABSI had a significant impact on the overall healthcare costs. Knowledge about risk factors and infection control measures for CLABSI prevention is crucial for best clinical practice.
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Affiliation(s)
- Claas Baier
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Lena Linke
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Matthias Eder
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Frank Schwab
- Institute of Hygiene and Environmental Medicine, Charité - University Medicine, Berlin, Germany
| | - Iris Freya Chaberny
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Leipzig, Germany
| | - Ralf-Peter Vonberg
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Ella Ebadi
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
- * E-mail:
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20
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Honda Y, Momosaki R, Ogata N. Nasogastric Tube Feeding Versus Total Parenteral Nutrition in Older Dysphagic Patients with Pneumonia: Retrospective Cohort Study. J Nutr Health Aging 2020; 24:883-887. [PMID: 33009540 DOI: 10.1007/s12603-020-1414-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Many older patients with pneumonia cannot intake orally after admission and may need nutritional care such as nasogastric tube feeding or total parenteral nutrition. This study sought to compare in-hospital outcomes between patients receiving nasogastric tube feeding and total parenteral nutrition. DESIGN This is a retrospective cohort study. SETTING A hospital-based database constructed by the Diagnosis Procedure Combination survey data comprising more than 100 acute-care hospitals. PARTICIPANTS The study included consecutive older inpatients aged >65 years admitted to participating hospitals with a diagnosis of pneumonia from 2014 through 2017. MEASUREMENTS We compared patients who received total parenteral nutrition and those who received nasogastric tube feeding in terms of characteristics and outcomes. RESULTS Among the included inpatients, a total of 336 (73.2%) patients received total parenteral nutrition and 123 (26.8%) patients received nasogastric tube feeding. Patients with nasogastric tube feeding had less in-hospital mortality (13.8% vs 27.1%, p = 0.003) and a smaller number of complications (mean; 0.71 vs 1.44, p <0.001), shorter length of hospital stay (mean; 27.6 vs 48.9, p <0.001), more discharges home (72.4% vs 35.1%, p <0.001), and more discharges without oral intake (65.9% vs 45.8%, p <0.001) than patients with total parenteral nutrition. The same results were obtained in propensity score analysis. CONCLUSIONS Older patients with pneumonia treated with total parenteral nutrition were significantly more likely to have higher in-hospital mortality than those receiving nasogastric tube feeding.
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Affiliation(s)
- Y Honda
- Ryo Momosaki, MD, PhD, MPH, Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan, Tel: +81 59 232 1111; Fax: +81 59 231 5661, E-mail:
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21
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Dang FP, Li HJ, Wang RJ, Wu Q, Chen H, Ren JJ, Tian JH. Comparative efficacy of various antimicrobial lock solutions for preventing catheter-related bloodstream infections: A network meta-analysis of 9099 patients from 52 randomized controlled trials. Int J Infect Dis 2019; 87:154-165. [PMID: 31442627 DOI: 10.1016/j.ijid.2019.08.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/11/2019] [Accepted: 08/14/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES It remains uncertain which catheter lock solution (CLS) to prevent catheter-related bloodstream infections (CRBSI) works best and is safest for patients. This study was performed to compare the efficacy of different CLSs for the prevention of CRBSI and ranked these CLSs for practical consideration. METHODS The PubMed, Web of Science, Embase, and MEDLINE databases, earlier relevant meta-analyses, and the reference lists of included studies were searched. The primary outcome was CRBSI; secondary outcomes were catheter-related thrombosis and exit-site infections. A network meta-analysis was performed to estimate odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS A total of 52 randomized controlled trials involving 9099 patients and evaluating 13 CLSs (single and combinations) were included. With regard to the quality of the evidence, the risk of bias was typically low or unclear (45 out of 52 trials, 86.5%). In the network meta-analysis, saline (OR 8.44, 95% CI 2.19-32.46), gentamicin+citrate (OR 2.92, 95% CI 1.32-6.42), ethanol (OR 5.33, 95% CI 1.22-23.32), and cloxacillin+heparin (OR 2.07, 95% CI 1.19-5.49) were associated with a greater effect on CRBSI than heparin. CONCLUSIONS This network meta-analysis showed that minocycline-ethylenediaminetetraacetic acid (EDTA) seemed to be the most effective for the prevention of CRBSI and exit-site infection, and cefotaxime+heparin seemed to be the most effective for catheter-related thrombosis.
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Affiliation(s)
- Fang-Ping Dang
- School of Nursing of Lanzhou University, Yanxi Road 28, Lanzhou 730030, Gansu, China
| | - Hui-Ju Li
- School of Nursing of Lanzhou University, Yanxi Road 28, Lanzhou 730030, Gansu, China.
| | - Rui-Juan Wang
- School of Nursing of Lanzhou University, Yanxi Road 28, Lanzhou 730030, Gansu, China
| | - Qi Wu
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China
| | - Hui Chen
- Second Hospital of Lanzhou University, Cuiying Gate 82, Lanzhou 730030, Gansu, China
| | - Jing-Jie Ren
- School of Nursing of Lanzhou University, Yanxi Road 28, Lanzhou 730030, Gansu, China
| | - Jin-Hui Tian
- Evidence-based Nursing Center, School of Nursing of Lanzhou University, Yanxi Road 28, Lanzhou 730030, Gansu, China; Key Laboratory of Clinical Translational Research and Evidence-based Medicine of Gansu Province, Lanzhou 730030, Gansu, China
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22
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Delle Rose D, Pezzotti P, Fontana C, Altieri A, Minelli S, Mariotti B, Cerretti R, Leoni D, Andreoni M, Sarmati L. An in-depth analysis of nosocomial bloodstream infections due to Gram-negative bacilli: clinical features, microbiological characteristics and predictors of mortality in a 1 year, prospective study in a large tertiary care Italian hospital. Infect Dis (Lond) 2018; 51:12-22. [PMID: 30590969 DOI: 10.1080/23744235.2018.1492149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Bloodstream infections (BSI) due to Gram negative bacilli (GNB) represent a major concern among nosocomial infections, since they are noticeably associated with a high mortality rates, increase of healthcare costs and prolongation of hospital stay. METHODS Over a 12-month period (2014-2015) all the adult patients admitted to a university-based Italian hospital were monitored for development of BSIs due to GNB. Multiple logistics regression models were performed to assess the impact of patients' risk factors on the in-hospital and 14-day mortality. RESULTS During the study period 208 patients were diagnosed with at least a BSI due to a Gram negative species for an incidence rate of 12.8 cases/1,000 admissions (95%CI: 11.2-14.7). Multivariate analyses showed that multiple organ dysfunctions along with immune deficit and inadequate therapy in the first 48hrs were associated with a higher risk of death. CONCLUSIONS A thorough evaluation of both immune status and organ dysfunction at the onset of septic events, along with adequate antimicrobial therapy appear to be the most reliable factors in predicting the outcome in these infections. SOFA score can be efficaciously substituted to the single organ dysfunctions analysis in predicting mortality after these events.
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Affiliation(s)
- Diego Delle Rose
- a Clinical Infectious Diseases, Fondazione Policlinico Tor Vergata University Hospital , Rome , Italy
| | | | - Carla Fontana
- c Clinical Microbiology Laboratories, Fondazione Policlinico Tor Vergata University Hospital , Rome , Italy
| | - Anna Altieri
- c Clinical Microbiology Laboratories, Fondazione Policlinico Tor Vergata University Hospital , Rome , Italy
| | - Silvia Minelli
- c Clinical Microbiology Laboratories, Fondazione Policlinico Tor Vergata University Hospital , Rome , Italy
| | - Benedetta Mariotti
- d Haematology Department , Fondazione Policlinico Tor Vergata University Hospital , Rome , Italy
| | - Raffaella Cerretti
- d Haematology Department , Fondazione Policlinico Tor Vergata University Hospital , Rome , Italy
| | - Davide Leoni
- a Clinical Infectious Diseases, Fondazione Policlinico Tor Vergata University Hospital , Rome , Italy
| | - Massimo Andreoni
- a Clinical Infectious Diseases, Fondazione Policlinico Tor Vergata University Hospital , Rome , Italy
| | - Loredana Sarmati
- a Clinical Infectious Diseases, Fondazione Policlinico Tor Vergata University Hospital , Rome , Italy
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23
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Cai Y, Zhu M, Sun W, Cao X, Wu H. Study on the cost attributable to central venous catheter-related bloodstream infection and its influencing factors in a tertiary hospital in China. Health Qual Life Outcomes 2018; 16:198. [PMID: 30305105 PMCID: PMC6180575 DOI: 10.1186/s12955-018-1027-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 09/26/2018] [Indexed: 11/14/2022] Open
Abstract
Background Central venous catheters (CVC) have been widely used for patients with severe conditions. However, they increase the risk of catheter-related bloodstream infection (CRBSI), which is associated with high economic burden. Until now, no study has focused on the cost attributable to CRBSI in China, and data on its economic burden are unavailable. The aim of this study was to assess the cost attributable to CRBSI and its influencing factors. Methods A retrospective matched case-control study and multivariate analysis were conducted in a tertiary hospital, with 94 patients (age ≥ 18 years old) from January 2011 to November 2015. Patients with CRBSI were matched to those without CRBSI by age, principal diagnosis, and history of surgery. The difference in cost between the case group and control group during the hospitalization was calculated as the cost attributable to CRBSI, which included the total cost and five specific cost categories: drug, diagnostic imaging, laboratory testing, health care technical services, and medical material. The relation between the total cost attributable to CRBSI and its influencing factors such as demographic characteristics, diagnosis and treatment, and pathogenic microorganism, was analysed with a general linear model (GLM). Results The total cost attributable to CRBSI was $3528.6, and the costs of specific categories including drugs, diagnostic imaging, laboratory testing, health care technical services, and medical material, were $2556.4, $112.1, $321.7, $268.7, $276.5, respectively. GLM analysis indicated that the total cost was associated with the intensive care unit (ICU), pathogenic microorganism, age, and catheter number, according to the sequence of standardized estimate (β). ICU contributed the most to the model R-square. Conclusion Central venous catheter–related bloodstream infection represents a great economic burden for patients. More attentions should be paid to further prevent and control this infection in China.
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Affiliation(s)
- Yuanyi Cai
- Department of Health Service Management, School of Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, 110122, People's Republic of China
| | - Min Zhu
- Department of Health Service Management, School of Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, 110122, People's Republic of China
| | - Wei Sun
- Department of Social Medicine, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, 110122, People's Republic of China
| | - Xiaohong Cao
- Department of Health Service Management, School of Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, 110122, People's Republic of China
| | - Huazhang Wu
- Department of Health Service Management, School of Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, 110122, People's Republic of China.
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Central line-associated bloodstream infections in Australian ICUs: evaluating modifiable and non-modifiable risks in Victorian healthcare facilities. Epidemiol Infect 2017; 145:3047-3055. [PMID: 28868995 DOI: 10.1017/s095026881700187x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Central line-associated bloodstream infections (CLABSIs) in intensive care units (ICUs) result in poor clinical outcomes and increased costs. Although frequently regarded as preventable, infection risk may be influenced by non-modifiable factors. The objectives of this study were to evaluate organisational factors associated with CLABSI in Victorian ICUs to determine the nature and relative contribution of modifiable and non-modifiable risk factors. Data captured by the Australian and New Zealand Intensive Care Society regarding ICU-admitted patients and resources were linked to CLABSI surveillance data collated by the Victorian Healthcare Associated Infection Surveillance System between 1 January 2010 and 31 December 2013. Accepted CLABSI surveillance methods were applied and hospital/patient characteristics were classified as 'modifiable' and 'non-modifiable', enabling longitudinal Poisson regression modelling of CLABSI risk. In total, 26 ICUs were studied. Annual CLABSI rates were 1·72, 1·37, 1·00 and 0·93/1000 CVC days for 2010-2013. Of non-modifiable factors, the number of non-invasively ventilated patients standardised to total ICU bed days was found to be independently associated with infection (RR 1·07; 95% CI 1·01-1·13; P = 0·030). Modelling of modifiable risk factors demonstrated the existence of a policy for mandatory ultrasound guidance for central venous catheter (CVC) localisation (RR 0·51; 95% CI 0·37-0·70; P < 0·001) and increased number of sessional specialist full-time equivalents (RR 0·52; 95% CI 0·29-0·93; P = 0·027) to be independently associated with protection against infection. Modifiable factors associated with reduced CLABSI risk include ultrasound guidance for CVC localisation and increased availability of sessional medical specialists.
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Kumpf O, Braun JP, Brinkmann A, Bause H, Bellgardt M, Bloos F, Dubb R, Greim C, Kaltwasser A, Marx G, Riessen R, Spies C, Weimann J, Wöbker G, Muhl E, Waydhas C. Quality indicators in intensive care medicine for Germany - third edition 2017. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2017; 15:Doc10. [PMID: 28794694 PMCID: PMC5541336 DOI: 10.3205/000251] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Indexed: 12/29/2022]
Abstract
Quality improvement in medicine is depending on measurement of relevant quality indicators. The quality indicators for intensive care medicine of the German Interdisciplinary Society of Intensive Care Medicine (DIVI) from the year 2013 underwent a scheduled evaluation after three years. There were major changes in several indicators but also some indicators were changed only minimally. The focus on treatment processes like ward rounds, management of analgesia and sedation, mechanical ventilation and weaning, as well as the number of 10 indicators were not changed. Most topics remained except for early mobilization which was introduced instead of hypothermia following resuscitation. Infection prevention was added as an outcome indicator. These quality indicators are used in the peer review in intensive care, a method endorsed by the DIVI. A validity period of three years is planned for the quality indicators.
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Affiliation(s)
- Oliver Kumpf
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jan-Peter Braun
- Department of Anesthesiology and Intensive Care Medicine, Martin-Luther Krankenhaus, Berlin, Germany
| | - Alexander Brinkmann
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Heidenheim, Germany
| | - Hanswerner Bause
- Department of Anaesthesiology and Intensive Care Medicine, Asklepiosklinikum Altona, Hamburg, Germany
| | - Martin Bellgardt
- Department of Anaesthesiology and Intensive Care Medicine, St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum, Germany
| | - Frank Bloos
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Rolf Dubb
- Kreiskliniken Reutlingen, Deutsche Gesellschaft für Fachkrankenpflege und Funktionsdienste (DGF), Germany
| | - Clemens Greim
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Fulda, Germany
| | - Arnold Kaltwasser
- Kreiskliniken Reutlingen, Deutsche Gesellschaft für Fachkrankenpflege und Funktionsdienste (DGF), Germany
| | - Gernot Marx
- Department of Intensive Care Medicine, Universitätsklinikum RTWH Aachen, Germany
| | - Reimer Riessen
- Zentralbereich des Departments für Innere Medizin, Internistische Intensivmedizin, Universitätsklinikum Tübingen, Germany
| | - Claudia Spies
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jörg Weimann
- Department of Anesthesiology and Interdisciplinary Intensive Care Medicine, Sankt Gertrauden-Krankenhaus, Berlin, Germany
| | - Gabriele Wöbker
- Department of Intensive Care Medicine, Helios-Klinikum Wuppertal, Germany
| | - Elke Muhl
- Department of Surgery, Medical University of Schleswig Holstein, Kiel, Germany
| | - Christian Waydhas
- Department of Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany.,Medical Faculty of the University Duisburg-Essen, Germany
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A quality improvement initiative to reduce central line infection in neonates using checklists. Eur J Pediatr 2017; 176:639-646. [PMID: 28283785 DOI: 10.1007/s00431-017-2888-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 02/21/2017] [Accepted: 02/26/2017] [Indexed: 10/20/2022]
Abstract
UNLABELLED Central line associated blood stream infections (CLABSI) are the most common complication of central catheters in neonates. These infections increase length of hospital stay, hospital costs and impact on mortality and morbidities. We performed a quasi-experimental study, over 24 months, utilising a pre-post design to determine the impact checklists had on central line infections. We introduced checklists for insertion, daily maintenance and procedural access based on the existing clinical guideline. Infections and compliance were monitored and reported back to the unit each month. We utilised the interrupted time series analysis to evaluate the impact of introduction of the checklists. Over the 24 months, 318 infants were included with a total of 509 central lines inserted. In the post intervention phase, definite CLABSI rates declined by 41%, from 13.8 definite CLABSIs per 1000 central-line days to 7.8 definite CLABSIs per 1000 central-line days. There was significant change in the mean levels in the post intervention phase (coefficient crude -0.01015; 95% CI -0.01980-0.00051, p value 0.039). Checklist compliance for insertion was 70%, and daily maintenance compliance overall mean was 66%. CONCLUSION Our quality improvement initiative using checklists, supported with education and feedback, significantly reduced CLABSI in our neonatal unit. What is Known: • Central line associated blood stream infection (CLABSI) continue to cause mortality and morbidity in the neonatal population. • Bundles of intervention use quality improvement methodology to reduce CLABSI and checklists can assist with the introduction of these. What is New: • Checklists assist with reducing central line infection. • To ensure the success of checklists, robust education, leadership and continuous feedback are vital.
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27
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Prävention von Infektionen, die von Gefäßkathetern ausgehen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:171-206. [DOI: 10.1007/s00103-016-2487-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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28
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Prävention von Infektionen, die von Gefäßkathetern ausgehen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:216-230. [DOI: 10.1007/s00103-016-2485-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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29
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Vafa Homann M, Johansson D, Wallen H, Sanchez J. Improved ex vivo blood compatibility of central venous catheter with noble metal alloy coating. J Biomed Mater Res B Appl Biomater 2016; 104:1359-65. [PMID: 26698606 PMCID: PMC5054833 DOI: 10.1002/jbm.b.33403] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 12/22/2014] [Accepted: 02/16/2015] [Indexed: 01/09/2023]
Abstract
Central line associated bloodstream infections (CLABSIs) are a serious cause of morbidity and mortality induced by the use of central venous catheters (CVCs). Nobel metal alloy (NMA) coating is an advanced surface modification that prevents microbial adhesion and growth on catheters and thereby reduces the risk of infection. In vitro microbiological analyses have shown up to 90% reduction in microbial adhesion on coated CVC compared to uncoated ones. This study aimed to assess the blood compatibility of NMA-coated CVC according to ISO 10993-4. Hemolysis, thrombin-antithrombin (TAT) complex, platelet counts, fibrin deposition, and C3a and SC5b-9 complement activation were analyzed in human blood exposed to the NMA-coated and control CVCs using a Chandler-loop model. NMA-coated CVC did not induce hemolysis and fell in the "nonhemolytic" category according to ASTM F756-00. Significantly lower amounts of TAT were generated and less fibrin was deposited on NMA-coated CVC than on uncoated ones. Slightly higher platelet counts and lower complement markers were observed for NMA-coated CVC compared to uncoated ones. These data suggest that the NMA-coated CVC has better ex vivo blood compatibility compared to uncoated CVC. © 2015 The Authors Journal of Biomedical Materials Research Part B: Applied Biomaterials Published by Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 1359-1365, 2016.
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Affiliation(s)
| | - Dorota Johansson
- Research and Development Department, Bactiguard AB, Stockholm, Sweden
| | - Håkan Wallen
- Division of internal and Cardiovascular Medicine, Department of Clinical Science Danderyd Hospital, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Javier Sanchez
- Research and Development Department, Bactiguard AB, Stockholm, Sweden.
- Division of internal and Cardiovascular Medicine, Department of Clinical Science Danderyd Hospital, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
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30
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Lutze B, Chaberny IF, Graf K, Krauth C, Lange K, Schwadtke L, Stahmeyer J, von Lengerke T. Intensive care physicians' and nurses' perception that hand hygiene prevents pathogen transmission: Belief strength and associations with other cognitive factors. J Health Psychol 2016; 22:89-100. [PMID: 26253651 DOI: 10.1177/1359105315595123] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Besides habituation, conscious decision-making remains important for healthcare workers' hand hygiene compliance. This study compared 307 physicians and 348 nurses in intensive care at a German university medical centre regarding their belief that hand disinfection prevents pathogen transmission. Physicians perceived less risk reduction ( p < 0.001; variance explained: 4%), a comparison outscored only by lower self-rated guideline knowledge (8%). In both groups, the transmission-preventive belief was associated with high response efficacy, behavioural intention and self-efficacy, but not with self-rated knowledge. Consistent with the Health Action Process Approach, hand hygiene interventions targeting risk reduction beliefs may promote high motivation, but not action control.
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Affiliation(s)
- Bettina Lutze
- 1 Hannover Medical School, Medical Psychology Unit, Germany
| | - Iris F Chaberny
- 2 Hannover Medical School, Institute for Medical Microbiology and Hospital Epidemiology, Germany
| | - Karolin Graf
- 2 Hannover Medical School, Institute for Medical Microbiology and Hospital Epidemiology, Germany
| | - Christian Krauth
- 3 Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Germany
| | - Karin Lange
- 1 Hannover Medical School, Medical Psychology Unit, Germany
| | - Laura Schwadtke
- 2 Hannover Medical School, Institute for Medical Microbiology and Hospital Epidemiology, Germany
| | - Jona Stahmeyer
- 3 Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Germany
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Clinical and economic burden of bloodstream infections in critical care patients with central venous catheters. J Crit Care 2016; 35:69-74. [PMID: 27481738 DOI: 10.1016/j.jcrc.2016.04.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 04/14/2016] [Accepted: 04/17/2016] [Indexed: 11/21/2022]
Abstract
PURPOSE Bloodstream infections (BSIs) complicate the management of intensive care unit (ICU) patients. We assessed the clinical and economic impact of BSI among patients of a managed care provider group who had a central venous catheter (CVC) placed in the ICU. METHODS We considered hospitalizations occurring between January 1, 2011, and September 30, 2014, that involved an ICU stay during which a CVC was placed. Comparisons were made between episodes where the patient did vs did not develop BSI after CVC insertion. Length of stay, costs of index hospitalization, and total costs over the 180 days after discharge were compared using linear mixed models. Inhospital mortality and 30-day readmission rates were compared using negative binomial regression models. RESULTS Development of BSI was associated with longer hospital stay (+7 days), more than 3-fold increase in risk of inhospital death, and an additional $129 000 in costs for the index hospitalization. No statistically significant differences in 30-day readmission rates or costs of care over the 180-day period after discharge from the index admission were observed. CONCLUSION Bloodstream infections after CVC placement in ICU patients are associated with significant increases in costs of care and risk of death during the index hospitalization but no differences in readmissions or costs after discharge.
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Wong SW, Gantner D, McGloughlin S, Leong T, Worth LJ, Klintworth G, Scheinkestel C, Pilcher D, Cheng AC, Udy AA. The influence of intensive care unit-acquired central line-associated bloodstream infection on in-hospital mortality: A single-center risk-adjusted analysis. Am J Infect Control 2016; 44:587-92. [PMID: 26874406 DOI: 10.1016/j.ajic.2015.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/07/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To explore the risk-adjusted association between intensive care unit (ICU)-acquired central line-associated bloodstream infection (CLABSI) and in-hospital mortality. DESIGN Retrospective observational study. SETTING Forty-five-bed adult ICU. PATIENTS All non-extracorporeal membrane oxygenation ICU admissions between July 1, 2008, and April 30, 2014, requiring a central venous catheter (CVC), with a length of stay > 48 hours, were included. METHODS Data were extracted from our infection prevention and ICU databases. A multivariable logistic regression model was constructed to identify independent risk factors for ICU-acquired CLABSI. The propensity toward developing CLABSI was then included in a logistic regression of in-hospital mortality. RESULTS Six thousand three hundred fifty-three admissions were included. Forty-six cases of ICU-acquired CLABSI were identified. The overall CLABSI rate was 1.12 per 1,000 ICU CVC-days. Significant independent risk factors for ICU-acquired CLABSI included: double lumen catheter insertion (odds ratio [OR], 2.59; 95% confidence interval [CI], 1.16-5.77), CVC exposure > 7 days (OR, 2.07; 95% CI, 1.06-4.04), and CVC insertion before 2011 (OR, 2.20; 95% CI, 1.22-3.97). ICU-acquired CLABSI was crudely associated with greater in-hospital mortality, although this was attenuated once the propensity to develop CLABSI was adjusted for (OR, 1.20; 95% CI, 0.54-2.68). CONCLUSIONS A greater propensity toward ICU-acquired CLABSI was independently associated with higher in-hospital mortality, although line infection itself was not. The requirement for prolonged specialized central venous access appears to be a key risk factor for ICU-acquired CLABSI, and likely informs mortality as a marker of persistent organ dysfunction.
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Affiliation(s)
- S W Wong
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia
| | - D Gantner
- Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia; Perioperative and Critical Care Services, Intensive Care Unit, Footscray Hospital, Footscray, Victoria, Australia
| | - S McGloughlin
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia; Infectious Diseases Unit, The Alfred, Prahran, Melbourne, Victoria, Australia
| | - T Leong
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia
| | - L J Worth
- Infectious Diseases Unit, The Alfred, Prahran, Melbourne, Victoria, Australia; Infection Prevention and Healthcare Epidemiology, Alfred Health, Prahran, Melbourne, Victoria, Australia
| | - G Klintworth
- Infection Prevention and Healthcare Epidemiology, Alfred Health, Prahran, Melbourne, Victoria, Australia
| | - C Scheinkestel
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia
| | - D Pilcher
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia
| | - A C Cheng
- Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia; Infectious Diseases Unit, The Alfred, Prahran, Melbourne, Victoria, Australia; Infection Prevention and Healthcare Epidemiology, Alfred Health, Prahran, Melbourne, Victoria, Australia
| | - A A Udy
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia.
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Expanding the statistical toolbox: analytic approaches for cohort studies with healthcare-associated infectious outcomes. Curr Opin Infect Dis 2016; 28:384-91. [PMID: 26098502 DOI: 10.1097/qco.0000000000000179] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW Healthcare-associated infections (HAIs) are a leading cause of adverse patient outcomes. Further elucidation of the etiology of these infections and the pathogens that cause them has been a primary goal of research in infection control and healthcare epidemiology. Longitudinal studies, in particular, afford a range of statistical methods to better understand the process of pathogen acquisition or HAI development. This review intends to convey the scope of available statistical methodology. RECENT FINDINGS Despite the range of methods available, logistic regression remains the dominant statistical approach in use. Poisson regression, survival methods, and mechanistic (mathematical) models remain underutilized. Recent studies that use these approaches are looking beyond associations to answer questions about the timing, duration, and mechanism of infectious risk. SUMMARY Logistic regression remains an important approach to the study of HAIs, but in the context of cohort studies, it is most appropriate for short observation periods, during which mechanism is not of primary interest. Additional statistical methodologies are available to build upon risk factor analysis to better inform the process of risk and infection in the hospital setting.
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Cesaro S, Cavaliere M, Pegoraro A, Gamba P, Zadra N, Tridello G. A comprehensive approach to the prevention of central venous catheter complications: results of 10-year prospective surveillance in pediatric hematology-oncology patients. Ann Hematol 2016; 95:817-25. [DOI: 10.1007/s00277-016-2634-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 02/29/2016] [Indexed: 11/24/2022]
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International multidisciplinary consensus conference on multimodality monitoring: ICU processes of care. Neurocrit Care 2015; 21 Suppl 2:S215-28. [PMID: 25208666 DOI: 10.1007/s12028-014-0020-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
There is an increased focus on evaluating processes of care, particularly in the high acuity and cost environment of intensive care. Evaluation of neurocritical-specific care and evidence-based protocol implementation are needed to effectively determine optimal processes of care and effect on patient outcomes. General quality measures to evaluate intensive care unit (ICU) processes of care have been proposed; however, applicability of these measures in neurocritical care populations has not been established. A comprehensive literature search was conducted for English language articles from 1990 to August 2013. A total of 1,061 articles were reviewed, with 145 meeting criteria for inclusion in this review. Care in specialized neurocritical care units or by neurocritical teams can have a positive impact on mortality, length of stay, and in some cases, functional outcome. Similarly, implementation of evidence-based protocol-directed care can enhance outcome in the neurocritical care population. There is significant evidence to support suggested quality indicators for the general ICU population, but limited research regarding specific use in neurocritical care. Quality indices for neurocritical care have been proposed; however, additional research is needed to further validate measures.
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36
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Bischoff P, Geffers C, Gastmeier P. [Hygiene measures in the intensive care station]. Med Klin Intensivmed Notfmed 2015; 109:627-39. [PMID: 25388301 DOI: 10.1007/s00063-014-0438-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Medical personnel in intensive care units (ICU) deal with critically ill patients and a high work load. Patients face a higher risk of acquiring a nosocomial infection during their ICU stay. Especially, invasively ventilated patients are threatened. A catheter-related bloodstream infection might even lead to more severe complications. The number of multiresistant pathogens continues to rise; thus, comprehensive infection control measures are crucial to avoid pathogen transmission and infection. The most important measure is hand disinfection. With a proper personnel-patient ratio, educational programs, and infection control bundles, it is possible to reduce infection rates and enhance compliance among health care workers.
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Affiliation(s)
- P Bischoff
- Institut für Hygiene und Umweltmedizin, Charité - Universitätsmedizin Berlin, Hindenburgdamm 27, 12203, Berlin, Deutschland,
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Worth LJ, Spelman T, Bull AL, Brett JA, Richards MJ. Central line-associated bloodstream infections in Australian intensive care units: Time-trends in infection rates, etiology, and antimicrobial resistance using a comprehensive Victorian surveillance program, 2009-2013. Am J Infect Control 2015; 43:848-52. [PMID: 26026826 DOI: 10.1016/j.ajic.2015.03.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 03/25/2015] [Accepted: 03/26/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND The epidemiology of central line-associated bloodstream infections (CLABSI) in Australian intensive care units (ICUs) has not previously been reported. We sought to describe time-trends in CLABSI rates, infections by ICU peer-groups, etiology, and antimicrobial susceptibility of pathogens in a large cohort of Australian ICUs for the period January 1, 2009-December 31, 2013. METHODS Using National Healthcare Safety Network methods, CLABSI surveillance in adult patients was performed by hospitals participating in the Victorian Healthcare Associated Infection Surveillance System (n = 29). Hospitals were grouped by location, sector, and teaching status. RESULTS Overall, 384 CLABSI events were reported over 303,968 central venous catheter (CVC)-days, corresponding to a rate of 1.26/1,000 CVC-days (95% confidence interval, 1.14-1.40). Every 1-year increase was associated with a 26% reduction in CLABSI risk (risk ratio, 0.74, 95% confidence interval, 0.69-0.80; P < .001). The most frequently identified pathogens were Enterococcus spp (26.3%), followed by Candida spp (15.4%) and Staphylococcus aureus (13.3%). CLABSI due to Enterococcus spp, S aureus, and coagulase-negative Staphylococcus spp displayed significant reductions over time. CONCLUSIONS Internationally accepted surveillance methods have been employed in Australia, demonstrating CLABSI rates comparable to medical/surgical ICUs in the United States and a reduction in pathogen-specific infections over a 5-year period.
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Affiliation(s)
- Leon J Worth
- Victorian Healthcare Associated Infection Surveillance System Coordinating Centre, Victoria, Australia; Department of Medicine, University of Melbourne, Victoria, Australia.
| | - Tim Spelman
- Victorian Healthcare Associated Infection Surveillance System Coordinating Centre, Victoria, Australia
| | - Ann L Bull
- Victorian Healthcare Associated Infection Surveillance System Coordinating Centre, Victoria, Australia
| | - Judith A Brett
- Victorian Healthcare Associated Infection Surveillance System Coordinating Centre, Victoria, Australia
| | - Michael J Richards
- Victorian Healthcare Associated Infection Surveillance System Coordinating Centre, Victoria, Australia; Department of Medicine, University of Melbourne, Victoria, Australia
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Attributable mortality of central line associated bloodstream infection: systematic review and meta-analysis. Infection 2014; 43:29-36. [DOI: 10.1007/s15010-014-0689-y] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/06/2014] [Indexed: 01/01/2023]
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