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Wassef MA, Ghaith DM, Hussien MM, El-Shazly MA, Yousef RHA. Bundle care approach to reduce device associated infections in post-living-donor-liver transplantation in a tertiary care hospital, Egypt. BMC Infect Dis 2024; 24:674. [PMID: 38969966 PMCID: PMC11225324 DOI: 10.1186/s12879-024-09525-4] [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: 01/21/2024] [Accepted: 06/17/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Device-associated infections (DAIs) are a significant cause of morbidity following living donor liver transplantation (LDLT). We aimed to assess the impact of bundled care on reducing rates of device-associated infections. METHODS We performed a before-and-after comparative study at a liver transplantation facility over a three-year period, spanning from January 2016 to December 2018. The study included a total of 57 patients who underwent LDLT. We investigated the implementation of a care bundle, which consists of multiple evidence-based procedures that are consistently performed as a unified unit. We divided our study into three phases and implemented a bundled care approach in the second phase. Rates of pneumonia related to ventilators [VAP], bloodstream infections associated with central line [CLABSI], and urinary tract infections associated with catheters [CAUTI] were assessed throughout the study period. Bacterial identification and antibiotic susceptibility testing were performed using the automated Vitek-2 system. The comparison between different phases was assessed using the chi-square test or the Fisher exact test for qualitative values and the Kruskal-Wallis H test for quantitative values with non-normal distribution. RESULTS In the baseline phase, the VAP rates were 73.5, the CAUTI rates were 47.2, and the CLABSI rates were 7.4 per one thousand device days (PDD). During the bundle care phase, the rates decreased to 33.3, 18.18, and 4.78. In the follow-up phase, the rates further decreased to 35.7%, 16.8%, and 2.7% PDD. The prevalence of Klebsiella pneumonia (37.5%) and Methicillin resistance Staph aureus (37.5%) in VAP were noted. The primary causative agent of CAUTI was Candida albicans, accounting for 33.3% of cases, whereas Coagulase-negative Staph was the predominant organism responsible for CLABSI, with a prevalence of 40%. CONCLUSION This study demonstrates the effectiveness of utilizing the care bundle approach to reduce DAI in LDLT, especially in low socioeconomic countries with limited resources. By implementing a comprehensive set of evidence-based interventions, healthcare systems can effectively reduce the burden of DAI, enhance infection prevention strategies and improve patient outcomes in resource-constrained settings.
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Affiliation(s)
- Mona A Wassef
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Al-Saray Street, Al-Manial, Cairo, 11559, Egypt
| | - Doaa M Ghaith
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Al-Saray Street, Al-Manial, Cairo, 11559, Egypt.
| | - Marwa M Hussien
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Al-Saray Street, Al-Manial, Cairo, 11559, Egypt
| | - Mostafa A El-Shazly
- General surgery and liver transplantation, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Reham H A Yousef
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Al-Saray Street, Al-Manial, Cairo, 11559, Egypt
- Microbiology, Immunology and Infectious Disease Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
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Knitter S, Noltsch AR, Pesthy S, Beierle AS, Krenzien F, Schöning W, Andreou A, Pratschke J, Schmelzle M. Postoperative infectious complications are associated with diminished overall survival of patients undergoing resection for colorectal liver metastases. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106920. [PMID: 37121813 DOI: 10.1016/j.ejso.2023.04.019] [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: 05/19/2022] [Revised: 03/20/2023] [Accepted: 04/25/2023] [Indexed: 05/02/2023]
Abstract
INTRODUCTION Postoperative infectious complications (PIC) remain one of the most common complications after surgery. The influence of PIC on long-term survival for patients after liver surgery for colorectal liver metastases (CRLM) needs further investigation. METHODS Data of patients who underwent liver resection for CRLM between 2012 and 2017 at the Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin were evaluated. Overall survival (OS) was stratified according to the development of PIC. Independent predictors of PIC and diminished survival were identified using regression models. RESULTS Of 270 patients, eighty-four (31%) patients developed PIC including intraabdominal infections (n = 51, 61%), cholangitis (n = 5, 6%), pneumonia (n = 12, 14%), wound infections (n = 28, 33%), urinary tract infections (n = 5, 6%), or central line-associated bloodstream infections (n = 4, 5%). PIC were associated with a significantly diminished five-year OS (30% vs. 43%, p = 0.008). Age >65 years (p = 0.016, hazard ratio [HR] = 2.2, 95% confidence interval [CI] = 1.2-4.0), comorbidity (p = 0.019, HR [95% CI] = 2.4 [1.2-4.9]), simultaneous resection of primary tumor (p = 0.005, HR [95% CI] = 4.3 [1.6-11.9]), biliary drainage (p < 0.001, HR [95% CI] = 4.1 [2.0-8.5]), and length of procedure ≥272 min (p = 0.012, HR [95% CI] = 2.2 [1.2-4.1]) were independent predictors for the development of PIC. Body-mass index (BMI) > 30 kg/m2 (p = 0.002, HR [95% CI] = 2.4 [1.4-4.0]), postoperative major complications (p = 0.003, HR [95% CI] = 2.2 [1.3-3.8]), and 3- or 4-MRGN bacteria (p = 0.001, HR [95% CI] = 7.7 [2.2-27.3]) were independently associated with diminished OS. CONCLUSIONS PIC are associated with diminished OS after resection for CRLM. Age >65 years, comorbidities, simultaneous resection of the primary tumor, and biliary drainages were identified as independent risk factors for the development of PIC. High BMI, postoperative major morbidity and 3-/4-MRGN bacteria were independently predictive of worse OS. These factors need to be considered in perioperative management for patients with CRLM.
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Affiliation(s)
- Sebastian Knitter
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany.
| | - Alina Roxana Noltsch
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Sina Pesthy
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Anika Sophie Beierle
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Felix Krenzien
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Wenzel Schöning
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Andreas Andreou
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Johann Pratschke
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Moritz Schmelzle
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
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SARTINI MARINA, PATRONE CARLOTTA, SPAGNOLO ANNAMARIA, SCHINCA ELISA, OTTRIA GIANLUCA, DUPONT CHIARA, ALESSIO-MAZZOLA MATTIA, BRAGAZZI NICOLALUIGI, CRISTINA MARIALUISA. The management of healthcare-related infections through lean methodology: systematic review and meta-analysis of observational studies. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E464-E475. [PMID: 36415303 PMCID: PMC9648549 DOI: 10.15167/2421-4248/jpmh2022.63.3.2661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/13/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Lean is largely applied to the health sector and on the healthcare-associated infections (HAI). However, a few results on the improvement of the outcome have been reported in literature. The purpose of this study is to analyze if the lean application can reduce the HAI rate. METHODS A comprehensive search was performed on PubMed/Medline, Scopus, CINAHL, Cochrane, Embase, and Google Scholar databases using various combinations of the following keywords: "lean" and "infection". Inclusion criteria were: 1) research articles with quantitative data and relevant information on lean methodology and its impact on healthcare infections; 2) prospective studies. The risk of bias and the study quality was independently assessed by two researchers using the "The National Institutes of Health (NIH) quality assessment tool for before-after (Pre-Post) study with no control group". The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines has been used. 22 studies were included in the present meta-analysis. RESULTS Lean application demonstrated a significant protective role on healthcare-associated infections rate (RR 0.50; 95% C.I.: 0.38-0.66) with significant impact on central line-associated bloodstream infections (CLABSIs) (RR 0.47; 95% C.I.: 0.28-0.82). CONCLUSIONS Lean has a positive impact on the decreasing of HAIs and on the improvement of compliance and satisfaction of the staff.
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Affiliation(s)
- MARINA SARTINI
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, Genoa, Italy
| | - CARLOTTA PATRONE
- Department of Directorate, Office Innovation, Development and Lean Application, E.O. Ospedali Galliera, Genoa, Italy
| | - ANNA MARIA SPAGNOLO
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, Genoa, Italy
| | - ELISA SCHINCA
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, Genoa, Italy
| | - GIANLUCA OTTRIA
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, Genoa, Italy
| | - CHIARA DUPONT
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | | | - NICOLA LUIGI BRAGAZZI
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - MARIA LUISA CRISTINA
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, Genoa, Italy
- Correspondence: Maria-Luisa Cristina, Dep. Health Sciences, University of Genoa, Via A. Pastore 1 – 16132 Genova. Phone +39 010 3538883 - E-mail ;
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Wooten R, Kothari D, Pryor R, Bearman G. Preventing Hemodialysis Catheter-Related Bloodstream Infections: Barriers, Controversies, and Best Practices. Curr Infect Dis Rep 2022. [DOI: 10.1007/s11908-022-00773-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Preventing Central Line Blood Stream Infections in Critical Care Patients. Crit Care Nurs Clin North Am 2021; 33:419-429. [PMID: 34742498 DOI: 10.1016/j.cnc.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Currently, the Centers for Disease Control reports close to 40,000 central line-associated bloodstream infections (CLABSI) occur in acute care facilities in the United States each year. Most are considered preventable. Evidence-based practices such as the CLABSI bundle and central line maintenance bundles have demonstrated their effectiveness in reducing CLABSI. This article reviews these best practices and provides a framework for consistent implementation.
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Preventive strategies for the reduction of central line-associated bloodstream infections in adult intensive care units: A systematic review. Collegian 2021. [DOI: 10.1016/j.colegn.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Patel PK, Popovich KJ, Collier S, Lassiter S, Mody L, Ameling JM, Meddings J. Foundational Elements of Infection Prevention in the STRIVE Curriculum. Ann Intern Med 2019; 171:S10-S15. [PMID: 31569229 DOI: 10.7326/m18-3531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Payal K Patel
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., L.M., J.M.)
| | | | - Sue Collier
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (S.C., S.L.)
| | - Shelby Lassiter
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (S.C., S.L.)
| | - Lona Mody
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., L.M., J.M.)
| | | | - Jennifer Meddings
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., L.M., J.M.)
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