National action plan to eliminate central line-associated bloodstream infections in Taiwan

Reduction in hemodialysis catheter-related bloodstream infections after implementation of a novel care program

BACKGROUND

Catheter-related bloodstream infection (CRBSI) due to dialysis is the major factor causing morbidity and mortality factor for patients undergoing hemodialysis and is associated with additional costs for these patients. This study investigated the effect of a novel care program in terms of reducing CRBSIs for hemodialysis patients with nontunneled (temporary) catheters inserted in their femoral veins.

METHODS

This study included dialysis patients (inpatients and outpatients) from July 2018 to September 2019, covering two periods, pre-intervention (baseline period) and intervention with a novel care program (novel care period). The novel care program was initiated on December 1, 2018. The CRBSI rates (/1000 catheter-days) for the baseline and novel care periods were compared, and the characteristics of the pathogens were determined.

FINDINGS

Of a total of 72 patients, 33 were from the baseline period and 39 were from the novel care period. Patients in the baseline and novel care periods had the catheter inserted in their femoral veins for a median of 20 and 29 days, respectively. The CRBSI rate decreased by 82.63%, from 8.52/1000 catheter-days in the baseline period to 1.48/1000 catheter-days in the novel care period (p = 0.036). The most common organisms involved in CRBSIs were coagulase-negative staphylococcus and Burkholderia cepacia (26% for both).

DISCUSSION

The novel care program reduced the incidence of CRBSIs in patients with temporary catheters inserted in their femoral veins.

Implementation of a national bundle care program to reduce central line-associated bloodstream infections in intensive care units in Taiwan

BACKGROUND/PURPOSE

This study assessed the effect of the central line bundle on the rate of central line-associated bloodstream infections (CLABSI) in intensive care units (ICUs) in Taiwan.

METHODS

This national study was conducted in 27 ICUs with 404 beds total, including 15 medical ICUs, 11 surgical ICUs, and one mixed ICU. The study period was divided into two phases: a pre-intervention (between June 1, 2011 and October 31, 2011) and intervention phase (between December 1, 2011 and October 31, 2012). Outcome variables, including CLABSI rates (per 1000 catheter-days) and catheter utilization rates, were measured.

RESULTS

The overall rate of CLABSI significantly decreased by 12.2% (p < 0.001) from 5.74 per 1000 catheter-days in the pre-intervention phase to 5.04 per 1000 catheter-days in the intervention phase. The catheter utilization rate decreased by 1.1% from 55.3% in the pre-intervention phase to 54.2% in the intervention phase. The decline in CLABSI varied significantly among hospital and ICU levels, except surgical ICUs (p = 0.59).

CONCLUSIONS

Implementing a multidimensional central-line bundle significantly reduced the rates of CLABSI by 12.2% in nearly all participating ICUs, except surgical ICUs.

Bio-Kil, a nano-based disinfectant, reduces environmental bacterial burden and multidrug-resistant organisms in intensive care units

BACKGROUND/PURPOSE

This prospective before-after study was intended to investigate the effect of Bio-Kil on reducing environmental bacterial burden and healthcare-associated infections (HAIs) in intensive care units (ICUs) at the Municipal Wan-Fang Hospital, Taipei, Taiwan in 2014.

METHODS

Four rooms in the medical and surgical ICUs were investigated and designated as study rooms (n = 2) or control rooms (n = 2). Routine disinfection was performed during the pre-intervention period in both room types. Bio-Kil was applied to the fomites and surroundings of the study rooms during the intervention period. Total bacterial burden and proportion of colonization of fomites and surroundings by multidrug-resistance organisms (MDROs) were determined before and after the intervention. The demographic characteristics, underlying conditions, and clinical outcomes of patients were analyzed.

RESULTS

After application of Bio-Kil, the bacterial burden declined in both groups, although the reduction was greater in the study rooms as compared with the control rooms (p = 0.001). During the pre-intervention period, 16 patients were admitted to control rooms and 18 patients to study rooms. After the intervention, 22 patients were admitted to control rooms and 21 patients to study rooms. The number of cases of new-onset sepsis declined in the intervention group (from 33% to 23.8%), but increased in the control group (from 25% to 40.9%); however, there was no significant difference in incidence of new-onset sepsis between the study and control rooms after intervention.

CONCLUSION

Application of Bio-Kil reduced the environmental bacterial burden and MDROs in ICUs. Further studies are needed to evaluate the efficacy of this nanotechnology-based disinfectant in reducing HAIs.

Effects of various antimicrobial stewardship programs on antimicrobial usage and resistance among common gram-negative bacilli causing health care-associated infections: A multicenter comparison

BACKGROUND

The effects of various antimicrobial stewardship programs (ASPs) on both antibiotic consumption and resistance among different hospitals within the same insurance system have rarely been investigated.

METHODS

This 6-year retrospective study included three medical centers with similar facilities and infection control measures in Taiwan. These hospitals used different types of ASPs: one had a hospital-wide preauthorization requirement by infectious diseases physicians for all broad-spectrum antibiotics, covering all intensive care units; the second used the same program, but excluded all intensive care units; and the third used postprescription review only. The nonsusceptibility of unduplicated isolates of gram-negative bacilli causing health care-associated infections and consumption of broad-spectrum antibiotics were analyzed.

RESULTS

Overall, the usage of broad-spectrum antibiotics of all classes escalated significantly over time in all three hospitals, but consumption was lowest under the hospital-wide preauthorization program. Under this ASP, despite a 2-fold increase in the total broad-spectrum antibiotic consumption during study period, some declining trends of resistance were found, including ciprofloxacin-resistant Pseudomonas aeruginosa and Acinetobacter baumannii, and carbapenem-resistant P. aeruginosa. By contrast, the other two hospitals with preauthorization program excluding all intensive care units and postprescription review had similar high broad-spectrum antibiotic consumption, comparable growing trends of resistant strains in general, and the correlations of antibiotic consumption and resistance were basically positive. Carbapenem-resistant A. baumannii increased significantly over time in all three hospitals.

CONCLUSION

This interhospital comparison suggested that hospital-wide preauthorization program is the most effective to reduce key gram-negative bacilli resistance, with the exception of carbapenem-resistant A. baumannii.