Laboratory-confirmed, health care-associated bloodstream infections in Jordan: a matched cost and length of stay study

Incidence Rate, Pathogens and Economic Burden of Catheter-Related Bloodstream Infection: A Single-Center, Retrospective Case-Control Study

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.

Knowledge and compliance to prevention of central line-associated blood stream infections among registered nurses in Jordan

Background

Central line-associated bloods tream infections (CLABSIs) are among the most common healthcare-associated infections (HAIs).

Aims

To assess the rates of CLABSIs and to investigate predictors of knowledge and compliance of registered nurses to central venous catheters (CVCs) maintenance care bundle in intensive care units (ICUs).

Methods

A cross-sectional correlational design was used. A convenient sample of 114 registered nurses was selected from three hospitals in Jordan. Nurses' knowledge and compliance were measured by previously established measures and an observational checklist developed according to the Center for Disease Control and Prevention (CDC).

Findings

The rate of CLABSI was the lowest in the hospital that applies the CVC bundle of care. Nurses' knowledge about CLABSI prevention practices was significantly correlated with their compliance to CVCs maintenance care bundle. Nurses' knowledge differed bytheirage, income, experience in ICU, and nurse-to-patient ratio, and in multiple regressions, age was the single predictor of knowledge of CLABSI prevention. Significant differences were also found in nurses' compliance to the CVC care bundle according to the hospital and nurse-to-patient ratio. The nurse-to-patient ratio was the single significant predictor, and it attenuated the effect of age and income on nurse's compliance to the CVC care bundle.

Conclusion

This study indicated the need to expand the application of the CVC maintenance care bundle in hospitals. Programs that target promoting nurses' knowledge about CLABSI prevention and compliance to CVC care need to consider some factors, such as nurses' age and the circumstances of their work (nurse-to-patient ratio).

ICU-acquired central line-associated bloodstream infection and its associated factors in Oman

BACKGROUND

Despite the extensive use of central lines for ICU patients in Oman, no studies have been conducted among adult ICU patients to assess the prevalence, and predictors of CLABSIs.

AIM

To estimate the prevalence of ICU-acquired CLABSIs, identify the most common causative microorganisms, and define possible related risk factors associated with ICU-acquired CLABSIs among adult ICU patients in Oman.

METHOD

A retrospective case-control design was used to screen electronic medical records of for all adult ICU patients admitted over 2 years (2018-2019) in 2 tertiary hospitals in Oman. The CDC definition of CLABSIs was used to allocate a cases group (n = 58), and a randomly selected controls group (n = 174).

RESULTS

The prevalence of ICU-acquired CLABSIs was 8.9 and 8.31 per 1,000 catheter days for the years 2018 and 2019 respectively. The most common isolated microorganisms were gram-positive bacteria (46.6%). The risk factors for ICU-acquired CLABSIs are: heart failure (Odds Ratio [OR] = 11.67, P < .001), female gender (OR = 0.352, P = .035), presence of other infections (OR = 3.4, P = .009), tracheostomy (OR = 5.34, P = .004), and Total Parenteral Nutrition (OR = 3.469, P = .020).

CONCLUSIONS

The prevalence of ICU-acquired CLABSIs in developing countries like Oman is higher than most of developed countries. The current study provides baseline data that can be used as a reference for future national studies and help in building strategies to prevent and control ICU-acquired CLABSIs.

Antimicrobial resistance profiles and associated factors of Acinetobacter and Pseudomonas aeruginosa nosocomial infection among patients admitted at Dessie comprehensive specialized Hospital, North-East Ethiopia. A cross-sectional study

Introduction

Hospital admitted patients are at increased risk of nosocomial infections (NIs) with multi-drug resistant (MDR) pathogens which are prevalent in the hospital environment. Pseudomonas aeruginosa (P. aeruginosa) and Acinetobacter baumannii (A. baumannii) are common causes of NIs worldwide. The objective of this study is to determine antimicrobial resistance profiles and associated factors of Acinetobacter spp and P. aeruginosa NIs among hospitalized patients.

Methods

A cross-sectional study was conducted at Dessie comprehensive specialized hospital, North-East Ethiopia, from February 1 to April 30, 2020. A total of 254 patients who were suspected of the bloodstream, urinary tract, or surgical site nosocomial infections were enrolled consecutively. Socio-demographic and other variables of interest were collected using a structured questionnaire. Specimens were collected and processed following standard microbiological procedures. Antimicrobial susceptibility was determined using the Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute guidelines. Data were analyzed with SPSS version 23 and p-value < 0.05 was considered statistically significant.

Results

Overall, 13% of patients had nosocomial Acinetobacter spp and/or P. aeruginosa infections. The culture positivity rate was 16(6.3%) for Acinetobacter spp and 18(7.1%) for P. aeruginosa. Patients admitted in the surgical ward (Adjusted odds ratio (AOR):10.66;95% confidence interval (CI):1.22–93.23), pediatric ward (AOR:14.37;95%CI:1.4–148.5), intensive care unit (AOR:41.93;95%CI:4.7–374.7) and orthopedics (AOR:52.21;95%CI:7.5–365) were significantly at risk to develop NIs compared to patients admitted in the medical ward. Patients who took more than two antimicrobial types at admission were 94% (AOR:0.06; 95% CI:0.004–0.84) times more protected from NIs compared to those who did not take any antimicrobial. About 81% of Acinetobacter spp and 83% of P. aeruginosa isolates were MDR. Amikacin and meropenem showed promising activity against Acinetobacter spp and P. aeruginosa isolates.

Conclusion

The high prevalence of MDR Acinetobacter spp and P. aeruginosa nosocomial isolates enforce treating of patients with NIs based on antimicrobial susceptibility testing results.

Costs of healthcare-associated infections in an Intensive Care Unit

OBJECTIVES

to evaluate hospitalization costs of patients with and without Healthcare-Associated Infections an Intensive Care Unit.

METHODS

a retrospective case-control study. Data collection was retrieved from the medical records of Intensive Care Unit of a medium-sized public hospital in Goiás-Brazil. For each case, two controls were selected. Data on socioeconomic, clinical, and hospital costs were collected. To verify associations between variables, Odds Ratio and linear regression were calculated.

RESULTS

a total of 21 patients diagnosed with Healthcare-Associated Infections and 42 controls were evaluated. The hospitalization cost for patients with infection was four times higher than for non-infection patients (p-value<0.001). There was an association between infection and higher mortality (p-value <0.001), longer hospital-stay (p-value =0.021), and higher hospital costs (p-value =0.007).

CONCLUSIONS

hospitalization costs of diagnosed Healthcare-Associated Infections patients are high compared to those who do not have this diagnosis.

Nurses and physicians knowledge of guidelines for preventing catheter-related blood stream infections

BACKGROUND

Catheter-related blood stream infection (CRBSI) is considered a major challenge for health care providers working in intensive care units.

AIM

This study aimed to evaluate and compare the knowledge of evidence-based guidelines for preventing catheter-related blood Stream infections among physicians and nurses working in critical care units in Jordan.

DESIGN

A cross-sectional survey design was utilized.

METHODS

The study was conducted in five intensive care units; 181 nurses and 68 physicians were recruited from four governmental hospitals and one university-affiliated hospital.

RESULTS

The mean total knowledge score for physicians' knowledge was low at 2.6, SD 1.5 (out of 10). While the mean total score for nurses' knowledge was low at 3.3, SD 1.8 (out of 10). The independent t test shows that nurses had a significantly higher mean total knowledge score than physicians (P < .05).

CONCLUSIONS

The current study demonstrates that Jordanian nurses and physicians working in intensive care units have a low level of knowledge of the guidelines for preventing CRBSI. This problem should be addressed through routine assessment and evaluation and adoption and policies that make nurses and physicians comply with the evidence-based guidelines. Finally, conducting regular educational programmes on CRBSI prevention, and evaluation of compliance with the guidelines in daily clinical practice, are strongly recommended.

RELEVANCE TO CLINICAL PRACTICE

The results of the current study suggest the need for regular assessment of physicians' and nurses' knowledge and skills with regard to central venous catheter insertion and maintenance care. Based on this assessment and using the best available evidence, training programmes on the prevention of CRBSI should be developed. Courses might be online, face to face, or using high fidelity simulation. Finally, regular observation and evaluation of compliance with the CRBSI guidelines in daily clinical practice is needed.

Estimating excess length of stay due to healthcare-associated infections: a systematic review and meta-analysis of statistical methodology

BACKGROUND

Healthcare-associated infection (HCAI) affects millions of patients worldwide. HCAI is associated with increased healthcare costs, owing primarily to increased hospital length of stay (LOS) but calculating these costs is complicated due to time-dependent bias. Accurate estimation of excess LOS due to HCAI is essential to ensure that we invest in cost-effective infection prevention and control (IPC) measures.

AIM

To identify and review the main statistical methods that have been employed to estimate differential LOS between patients with, and without, HCAI; to highlight and discuss potential biases of all statistical approaches.

METHODS

A systematic review from 1997 to April 2017 was conducted in PubMed, CINAHL, ProQuest and EconLit databases. Studies were quality-assessed using an adapted Newcastle-Ottawa Scale (NOS). Methods were categorized as time-fixed or time-varying, with the former exhibiting time-dependent bias. Two examples of meta-analysis were used to illustrate how estimates of excess LOS differ between different studies.

FINDINGS

Ninety-two studies with estimates on excess LOS were identified. The majority of articles employed time-fixed methods (75%). Studies using time-varying methods are of higher quality according to NOS. Studies using time-fixed methods overestimate additional LOS attributable to HCAI. Undertaking meta-analysis is challenging due to a variety of study designs and reporting styles. Study differences are further magnified by heterogeneous populations, case definitions, causative organisms, and susceptibilities.

CONCLUSION

Methodologies have evolved over the last 20 years but there is still a significant body of evidence reliant upon time-fixed methods. Robust estimates are required to inform investment in cost-effective IPC interventions.

Nurses' compliance with central line associated blood stream infection prevention guidelines

Objectives:

To assess nurses’ compliance with central line associated bloodstream infection (CLABSI) prevention guidelines related to maintenance of the central line and the predictors of compliance.

Method:

This was an observational study that used a descriptive cross-sectional design. A sample of 171 intensive care unit (ICU) nurses were observed and their compliance was recorded on a structured observational sheet. The study was conducted in the ICUs of 15 hospitals located in 5 cities in Jordan. Data were collected over a 5-month period from March to July 2017. Central lines were all inserted by physicians inside the ICUs.

Results:

One hundred and twenty participants (70%) showed sufficient compliance. The mean compliance scores were 14.2±4.7 (min=8, max=20); however, the rate of CLABSI was variable across the participating ICUs. Logistic regression with 4 independent variables (years of experience, previous education with CLABSI, nurse-patient ratio and the ICU’s bed capacity) was conducted to investigate predictors of sufficient compliance. The model was significant (χ²(4)=133.773, p=0.00). The nurse-patient ratio was the only significant predictor. Nurses with a 1:1 nurse:patient ratio demonstrated superior compliance over their counterparts with a 1:2 ratio.

Conclusion:

Further improvement in compliance and patients’ outcomes could be achieved by lowering the nurse-patient ratio.

Compliance of Middle Eastern hospitals with the central line associated bloodstream infection prevention guidelines

AIMS

The purposes of this study were to (1) assess compliance with the CLABSI prevention guidelines, (2) assess the predictors of compliance, and (3) investigate the effect of compliance on the rate of CLABSI and related mortality.

BACKGROUND

Implementation of the Central Line Associated Bloodstream Infection (CLABSI) prevention guidelines from the Centers for Disease Control and Prevention (CDC) helps to reduce the rate of CLABSI and related mortality, although the extent to which hospitals implement these guidelines is questionable.

METHODS

A prospective design was used in this study. Observations were conducted over three months in the intensive care units of 58 hospitals in three Middle Eastern countries. An observational checklist, based on the CDC guidelines, was used to assess compliance. The rate of CLABSI and related mortality were obtained from patients' records.

RESULTS

The degree of compliance, rate of CLABSI and mortality were highly variable. The multiple regression model showed that the hospitals' characteristics explained 82.0% of the variance of compliance (R2Adj= 0.820, F=29.82, p<0.05). The number of beds in the intensive care unit and patient-nurse ratio were significant predictors of compliance. A lower number of beds and a lower patient-to-nurse ratio were related to higher compliance. Moreover, higher compliance with CLABSI prevention guidelines was associated with lower rate of CLABSI and related mortality.

CONCLUSIONS

Improvement in the patients' outcome can be achieved through compliance with the CLABSI prevention guidelines. lowering patient-nurse ratio and the number of beds in the ICUs would help to improve compliance.

Educating intensive care unit nurses to use central venous catheter infection prevention guidelines: effectiveness of an educational course

Background

Nurses' knowledge of central venous catheter-related infection (CVC-RI) prevention guidelines is poor, indicating that nurses do not receive proper education about these guidelines.

Aim

The aim of this study was to evaluate the effectiveness of an educational course that aimed to improve nurses' knowledge about CVC-RI prevention guidelines.

Method

A sample of 131 nurses were randomly assigned to the experimental group (received an educational course) or control group (received no education). Pre-Post data were collected using a structured questionnaire that included a 23-item knowledge assessment.

Results

In the pre-test, all participants demonstrated poor knowledge, with mean scores of 8.2 (standard deviation = 3.6). After completion of the course, knowledge was significantly improved in the experimental group, whereas the control group showed no change (t(106,3) = 25.1, p = 0.00).

Conclusions

An educational course on CVC-RI prevention guidelines had an encouraging effect. Decision makers are recommended to implement such courses in their settings to improve nurses' competency.

A concealed observational study of infection control and safe injection practices in Jordanian governmental hospitals

BACKGROUND

The recognized international organizations on infection prevention recommend using an observational method as the gold standard procedure for assessing health care professional's compliance with standard infection control practices. However, observational studies are rarely used in Jordanian infection control studies. This study aimed to evaluate injection practices among nurses working in Jordanian governmental hospitals.

METHODS

A cross-sectional concealed observational design is used for this study. A convenience sampling technique was used to recruit a sample of nurses working in governmental hospitals in Jordan. Participants were unaware of the time and observer during the observation episode.

RESULTS

A total of 384 nurses from 9 different hospitals participated in the study. A total of 835 injections events were observed, of which 73.9% were performed without handwashing, 64.5% without gloving, and 27.5% were followed by needle recapping. Handwashing rate was the lowest (18.9%) when injections were performed by beginner nurses. Subcutaneous injections were associated with the lowest rate (26.7%) of postinjection handwashing compared with other routes.

CONCLUSIONS

This study demonstrates the need for focused and effective infection control educational programs in Jordanian hospitals. Future studies should consider exploring the whole infection control practices related to waste disposal and the roles of the infection control nurse in this process in Jordanian hospitals.

Risk factors for hospital-acquired infections in teaching hospitals of Amhara regional state, Ethiopia: A matched-case control study

Background

Hospital-acquired infection affects hundreds of millions of people worldwide. It is a major global issue for patient safety. Understanding the potential risk factors is important to appreciate the local context. A matched case control study design, which is the first of its kind in the study region, was undertaken to identify risk factors in teaching hospitals of Amhara regional state, Ethiopia.

Method

A matched case control study design matched with age and hospital type was used. The study was conducted in University of Gondar and Felege-Hiwot medical teaching hospital. Cases were patients who fulfilled the criteria based on CDC definition of hospital-acquired infection and controls were patients admitted to the hospital that stayed for more than 48 hours in the ward in the study period, but who did not develop infection. For one case, four controls were selected. Of 545 patients, 109 were cases and 436 were controls. Conditional logistic regression using STATA 13 was used for data analysis.

Result

The median length of stay for cases and controls was 7 and 8 days, respectively. Patients admitted in wards with the presence of medical waste container in the room had 82% less chance of developing hospital-acquired infection (AOR 0.18; 95% CI, 0.03–0.98). The odds of developing hospital-acquired infection among immune deficient patients were 2.34 times higher than their counterparts (95% CI; 1.17–4.69). Patients received antimicrobials, central vascular catheter and surgery since admission had 8.63, 6.91 and 2.35 higher odds of developing hospital-acquired infection, respectively.

Conclusion

Health providers and mangers should consider the provision and availability of healthcare materials and facilities in all of the ward rooms, follow appropriate safe medical procedures for use of external devices on patients, and give attention to the immunocompromised patients for the prevention and control of hospital-acquired infections.

Infection control practices among intensive care unit registered nurses: a Jordanian national study

AIMS

This study aimed to evaluate infection control (IC) practices among Jordanian registered nurses (RNs) working in intensive care unit (ICU) settings.

BACKGROUND

The Centers for Disease Control and Prevention (CDC) recommends periodic assessment of IC practices for health care workers as an effective strategy to control infections.

DESIGN

Cross-sectional descriptive design.

METHODS

A stratified, cluster random sampling technique was used. The sample consisted of ICU RNs from all major health care service providers and from all geographical areas in Jordan. The IC-Practices Tool (Cronbach α = 0·88) a self-report instrument was used.

RESULTS

A total of 21 hospitals participated in the study, of which, 8 were governmental, 7 military, 4 private and 2 university-affiliated. The final sample consisted of 247 RNs from 56 critical care units. Of the total sample, 36% of RNs were from governmental hospitals. Of the total sample, 51% were female with a mean age of 28·5 years (SD = 5·2), and 54·7% worked in general ICUs. The mean overall IC practice score was 122·6 (SD = 13·2). Nurses who reported that they had been trained about IC procedures in their hospital scored higher on the IC practice scale (M = 124·3, SD = 12·3) than nurses who never received any IC training in the hospital (M = 117·3, SD = 14·6, p < 0·001).

CONCLUSION

This study demonstrated the importance of conducting IC educational programmes as an effective strategy to increase staff compliance with standard IC practices.

RELEVANCE TO CLINICAL PRACTICE

Educational role of IC nurse is important to enhance RNs compliance with standard IC practices.