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Harris R, Mehdiratta NL, Rosser MA, Chowdhury AM, Smith BA, Raghunathan K, Krishnamoorthy V. ICU outcomes following a Central Line Associated Blood Stream Infections (CLABSI) reduction quality improvement project. Curr Med Res Opin 2024; 40:1651-1656. [PMID: 39231039 DOI: 10.1080/03007995.2024.2401097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 08/29/2024] [Accepted: 09/02/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND Central Line Associated Blood Stream Infections (CLABSI) are significant complications for hospitalized patients. Several different approaches have been used to reduce CLABSI. OBJECTIVE This study aimed to (1) describe a systematic approach used to analyze and reduce CLABSI rates in a surgical ICU (SICU) at a quaternary care medical facility (CLABSI reduction bundle) and (2) examine the association of the bundle on CLABSI rates in the SICU, compared to six unexposed health system ICUs. METHODS Retrospective analysis of 14,022 adult patients with > 0 central line days within a single health system in the southeastern United States. The CLABSI intervention bundle was created and implemented in July 2021. Single and multiple interrupted time series analyses were performed to assess the impact of the CLABSI bundle on CLABSI rate in SICU (compared to control ICUs) pre- and post-intervention. Secondary analyses examined the association of the bundle with ICU mortality and length of stay. RESULTS The CLABSI bundle was associated with a significant immediate effect in reducing the CLABSI rate in the SICU compared with control ICUs. There was no significant change in the slope of CLABSI rate post-intervention, compared to control ICUs. There was no significant association of the CLABSI reduction bundle on ICU length of stay or mortality in the SICU. CONCLUSION The CLABSI bundle was associated with an immediate reduction in CLABSI incidence in the SICU compared to unexposed ICUs. A simple, bundled intervention can be effective in reducing CLABSI incidence in a surgical ICU population.
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Affiliation(s)
- Ronald Harris
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Nitin L Mehdiratta
- Division of Critical Care Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Morgan A Rosser
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Anand M Chowdhury
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Becky A Smith
- Division of Infections Disease, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Karthik Raghunathan
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Vijay Krishnamoorthy
- Division of Critical Care Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Critical Care and Perioperative Population Health Research Program, Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
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Kharduit PB, Dutta K, Lyngdoh CJ, Bhattacharyya P, Lyngdoh V, Khyriem AB, Devi SK. Monitoring and Outcomes of Central Line-Associated Bloodstream Infections in a Tertiary Care Intensive Care Unit. Cureus 2024; 16:e63428. [PMID: 39077255 PMCID: PMC11284343 DOI: 10.7759/cureus.63428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2024] [Indexed: 07/31/2024] Open
Abstract
Background Central line-associated bloodstream infections (CLABSIs) are significant healthcare-associated infections that increase morbidity, mortality, and healthcare costs. This study aims to analyze the frequency, microbiology, risk factors, and outcomes of CLABSI in an adult intensive care unit. Methods We conducted a hospital-based, prospective surveillance study in the critical care unit of a tertiary care hospital. We included patients with a central line (CL) from admission until discharge or line removal. Data collection focused on patient demographics, comorbidities, CL insertion site, and CLABSI rates. The incidence of CLABSI was calculated per 1,000 CL-days, and statistical analysis was performed using the Chi-square test. Results Of the 169 patients enrolled, 123 episodes of bloodstream infections were recorded, 56 (45.5%) of which were CLABSIs. The organisms most frequently isolated were Klebsiella pneumoniae (n = 14; 24.6%), Enterobacter cloacae complex (n = 11; 19.3%), Klebsiella species (n = 7; 12.28%), and Acinetobacter baumannii (n = 7; 12.28%). The overall CLABSI rate was 24.70 per 1,000 CL-days. No significant association was found between CLABSI and patient age, gender, or the site of CL insertion. However, a significant relationship was observed between CLABSI and the presence of comorbid conditions (p = 0.001). The study also noted a high rate of antibiotic resistance among the isolated pathogens. Conclusions Our results emphasize the need for stringent infection control measures and suggest that comorbid conditions significantly increase the risk of CLABSI. Addressing antibiotic resistance and implementing effective prevention strategies are essential for reducing the burden of CLABSIs.
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Affiliation(s)
- Peter B Kharduit
- Microbiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Kaustuv Dutta
- Anesthesiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Clarissa J Lyngdoh
- Microbiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Prithwis Bhattacharyya
- Anesthesiology and Critical Care, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Valarie Lyngdoh
- Clinical Microbiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Annie B Khyriem
- Microbiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Suriya K Devi
- Microbiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
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3
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Ward A, Chemparathy A, Seneviratne M, Gaskari S, Mathew R, Wood M, Donnelly LF, Lee GM, Scheinker D, Shin AY. The Association Between Central Line-Associated Bloodstream Infection and Central Line Access. Crit Care Med 2023; 51:787-796. [PMID: 36920081 DOI: 10.1097/ccm.0000000000005838] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVES Identifying modifiable risk factors associated with central line-associated bloodstream infections (CLABSIs) may lead to modifications to central line (CL) management. We hypothesize that the number of CL accesses per day is associated with an increased risk for CLABSI and that a significant fraction of CL access may be substituted with non-CL routes. DESIGN We conducted a retrospective cohort study of patients with at least one CL device day from January 1, 2015, to December 31, 2019. A multivariate mixed-effects logistic regression model was used to estimate the association between the number of CL accesses in a given CL device day and prevalence of CLABSI within the following 3 days. SETTING A 395-bed pediatric academic medical center. PATIENTS Patients with at least one CL device day from January 1, 2015, to December 31, 2019. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS There were 138,411 eligible CL device days across 6,543 patients, with 639 device days within 3 days of a CLABSI (a total of 217 CLABSIs). The number of per-day CL accesses was independently associated with risk of CLABSI in the next 3 days (adjusted odds ratio, 1.007; 95% CI, 1.003-1.012; p = 0.002). Of medications administered through CLs, 88% were candidates for delivery through a peripheral line. On average, these accesses contributed a 6.3% increase in daily risk for CLABSI. CONCLUSIONS The number of daily CL accesses is independently associated with risk of CLABSI in the next 3 days. In the pediatric population examined, most medications delivered through CLs could be safely administered peripherally. Efforts to reduce CL access may be an important strategy to include in contemporary CLABSI-prevention bundles.
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Affiliation(s)
- Andrew Ward
- Department of Electrical Engineering, Stanford University, Stanford, CA
| | - Augustine Chemparathy
- Stanford University School of Medicine, Stanford University, Stanford, CA
- Lucile Packard Children's Hospital, Stanford University, Stanford, CA
| | | | - Shabnam Gaskari
- Lucile Packard Children's Hospital, Stanford University, Stanford, CA
| | - Roshni Mathew
- Lucile Packard Children's Hospital, Stanford University, Stanford, CA
| | - Matthew Wood
- Lucile Packard Children's Hospital, Stanford University, Stanford, CA
| | - Lane F Donnelly
- Lucile Packard Children's Hospital, Stanford University, Stanford, CA
| | - Grace M Lee
- Lucile Packard Children's Hospital, Stanford University, Stanford, CA
| | - David Scheinker
- Department of Management Science and Engineering, Stanford University, Stanford, CA
| | - Andrew Y Shin
- Lucile Packard Children's Hospital, Stanford University, Stanford, CA
- Stanford Cardiovascular Institute, Stanford, CA
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van den Berg D, Asker D, Awad TS, Lavielle N, Hatton BD. Mechanical deformation of elastomer medical devices can enable microbial surface colonization. Sci Rep 2023; 13:7691. [PMID: 37169828 PMCID: PMC10175502 DOI: 10.1038/s41598-023-34217-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/26/2023] [Indexed: 05/13/2023] Open
Abstract
Elastomers such as silicone are common in medical devices (catheters, prosthetic implants, endoscopes), but they remain prone to microbial colonization and biofilm infections. For the first time, our work shows that rates of microbial surface attachment to polydimethylsiloxane (PDMS) silicone can be significantly affected by mechanical deformation. For a section of bent commercial catheter tubing, bacteria (P. aeruginosa) show a strong preference for the 'convex' side compared to the 'concave' side, by a factor of 4.2. Further testing of cast PDMS materials in bending only showed a significant difference for samples that were manually wiped (damaged) beforehand (1.75 × 104 and 6.02 × 103 cells/mm2 on the convex and concave sides, respectively). We demonstrate that surface microcracks in elastomers are opened under tensile stress (convex bending) to become 'activated' as sites for microbial colonization. This work demonstrates that the high elastic limit of elastomers enables these microcracks to reversibly open and close, as 'dynamic defects'. Commercial catheters have relatively high surface roughness inherent to manufacturing, but we show that even manual wiping of newly-cast PDMS is sufficient to generate surface microcracks. We consider the implication for medical devices that feature sustained, surgical, or cyclic deformation, in which localized tensile conditions may expose these surface defects to opportunistic microbes. As a result, our work showcases serious potential problems in the widespread usage and development of elastomers in medical devices.
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Affiliation(s)
| | - Dalal Asker
- Department of Materials Science and Engineering, University of Toronto, Toronto, Canada
- Food Science & Technology Department, Alexandria University, Alexandria, Egypt
| | - Tarek S Awad
- Department of Materials Science and Engineering, University of Toronto, Toronto, Canada
| | - Nicolas Lavielle
- Physique et Mécanique des Milieux Hétérogènes, CNRS, ESPCI, PSL Research University, Sorbonne Université, Sorbonne Paris Cité, 75005, Paris, France
| | - Benjamin D Hatton
- Department of Materials Science and Engineering, University of Toronto, Toronto, Canada.
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada.
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Na YS, Baek AR, Baek MS, Kim WY, Kim JH, Lee BY, Seong GM, Lee SI. Clinical outcomes of and risk factors for secondary infection in patients with severe COVID-19: a multicenter cohort study in South Korea. Korean J Intern Med 2023; 38:68-79. [PMID: 36420564 PMCID: PMC9816674 DOI: 10.3904/kjim.2022.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/03/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND/AIMS Secondary infection with influenza virus occurs in critically ill patients and is associated with substantial morbidity and mortality; however, there is limited information about it in patients with severe coronavirus disease 2019 (COVID-19). Thus, we investigated the clinical outcomes of and risk factors for secondary infections in patients with severe COVID-19. METHODS This study included patients with severe COVID-19 who were admitted to seven hospitals in South Korea between February 2020 to February 2021. Multivariate logistic regression analyses were performed to assess factors associated with the risk of secondary infections. RESULTS Of the 348 included patients, 104 (29.9%) had at least one infection. There was no statistically significant difference in the 28-day mortality (17.3% vs. 12.3%, p = 0.214), but in-hospital mortality was higher (29.8% vs. 15.2%, p = 0.002) in the infected group than in the non-infected group. The risk factors for secondary infection were a high frailty scale (odds ratio [OR], 1.314; 95% confidence interval [CI], 1.123 to 1.538; p = 0.001), steroid use (OR, 3.110; 95% CI, 1.164 to 8.309; p = 0.024), and the application of mechanical ventilation (OR, 4.653; 95% CI, 2.533 to 8.547; p < 0.001). CONCLUSION In-hospital mortality was more than doubled in patients with severe COVID-19 and secondary infections. A high frailty scale, the use of steroids and application of mechanical ventilation were risk factors for secondary infection.
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Affiliation(s)
- Yong Sub Na
- Department of Pulmonology and Critical Care Medicine, Chosun University Hospital, Gwangju,
Korea
| | - Ae-Rin Baek
- Division of Allergy and Pulmonology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon,
Korea
| | - Moon Seong Baek
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul,
Korea
| | - Won-Young Kim
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul,
Korea
| | - Jin Hyoung Kim
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan,
Korea
| | - Bo young Lee
- Division of Allergy and Respiratory Diseases, Soonchunhyang University Hospital, Seoul,
Korea
| | - Gil Myeong Seong
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju,
Korea
| | - Song-I Lee
- Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon,
Korea
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Quadros AID, Stocco JGD, Cristoff C, Alcantara CBD, Pimenta AM, Machado BGS. Adherence to central venous catheter maintenance bundle in an intensive care unit. Rev Esc Enferm USP 2022; 56:e20220077. [PMID: 36150027 PMCID: PMC10081618 DOI: 10.1590/1980-220x-reeusp-2022-0077en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/19/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To check adherence to the Central Venous Catheter maintenance bundle in an Intensive Care Unit, after an educational intervention to the professionals who provide care to patients using this catheter. METHOD Descriptive-exploratory study, carried out in two stages: stage 1 - educational intervention and stage 2 - verification/observation of adherence. Data were organized in the Microsoft Excel® and analyzed through the Stata®. RESULTS Sixty three workers participated in stage 1 and 44 in stage 2. The sample consisted of 64 observation opportunities. Among the domains observed, the recording of indication of permanence had an 8% compliance rate; aseptic technique in catheter handling, 3%; maintenance of the infusion system, 15%; and care with the central venous catheter dressing, 17%. The domains represent unwanted care according to the Positivity Index for assessing the quality of care. CONCLUSION The findings show the need for discussions, training, and investments in constant strategies for the prevention of primary bloodstream infections related to the central venous catheter.
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Affiliation(s)
| | | | - Cristiane Cristoff
- Universidade Federal do Paraná, Complexo do Hospital de Clínicas, Curitiba, PR, Brazil
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7
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Al-Sofyani KA, Uddin MS. Can inverse probability treatment weighting (IPTW) be used to assess differences of CRBSI rates between non-tunneled femoral and jugular CVCs in PICU patients? BMC Infect Dis 2022; 22:598. [PMID: 35799133 PMCID: PMC9264698 DOI: 10.1186/s12879-022-07571-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/28/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND In children in the ICU, catheter-related bloodstream infections (CRBSI) have also been linked to mortality, morbidity, and healthcare costs. Although CRBSI poses many potential risks, including the need to avoid femoral access, there is debate regarding whether jugular access is preferable to femoral access in adults. Study reports support both perspectives. There is no consensus in meta-analyses. Children have yet to be examined in depth. Based on compliance with the central line bundle check lists, we aim to determine CRBSI risk in pediatric intensive care units for patients with non-tunneled femoral and internal jugular venous access. METHODS A retrospective cohort study was conducted on patients with central venous catheters in the pediatric ICU of King Abdulaziz University Hospital between January 1st, 2017 and January 30th, 2018. For the post-match balance, we use a standardized mean difference of less than 0.1 after inverse probability treatment weighting for all baseline covariates, and then we draw causal conclusions. As a final step, the Rosenbaum sensitivity test was applied to see if any bias influenced the results. RESULTS We recorded 145 central lines and 1463 central line days with 49 femoral accesses (33.79%) and 96 internal jugular accesses (66.21%). CRBSI per 1000 central line days are 4.10, along with standardized infections of 3.16. CRBSI risk differed between non-tunneled femoral vein access and internal jugular vein access by 0.074 (- 0.021, 0.167), P-value 0.06, and relative risk was 4.67 (0.87-25.05). Using our model, the actual probability was 4.14% (0.01-0.074) and the counterfactual probability was 2.79% (- 0.006, 0.062). An unobserved confounding factor was not identified in the sensitivity analysis. CONCLUSIONS So long as the central line bundle is maintained, a femoral line does not increase the risk of CRBSI. Causation can be determined through propensity score weighting, as this is a trustworthy method of estimating causality. There is no better way to gain further insight in this regard than through the use of randomized, double-blinded, multicenter studies.
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Affiliation(s)
- Khouloud Abdulrhman Al-Sofyani
- Department of Pediatric, Pediatric Intensive Care Unit, King Abdulaziz University Hospital, Faculty of Medicine and Clinical Skills and Simulation Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed Shahab Uddin
- Pediatric Department, Ministry of National Guard Health Affairs, Dammam, Saudi Arabia.
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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: 106] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Quadros AID, Stocco JGD, Cristoff C, Alcantara CBD, Pimenta AM, Machado BGS. Adesão ao bundle de manutenção de Cateter Venoso Central em uma Unidade de Terapia Intensiva. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2022-0077pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: Verificar a adesão ao bundle de manutenção do Cateter Venoso Central em uma Unidade de Terapia Intensiva, após intervenção educativa aos profissionais que realizam o cuidado aos pacientes em uso desse cateter. Method: Estudo descritivo-exploratório, realizado em duas fases, fase 1 – intervenção educativa, e fase 2 – verificação/observação da adesão. Os dados foram organizados no Microsoft Excel ® e analisados por meio do Stata®. Resultados: Participaram da fase 1 63 profissionais e da fase 2, 44. A amostra foi constituída de 64 oportunidades de observações. Entre os domínios observados, o registro de indicação de permanência apresentou 8% de taxa de conformidade; a técnica asséptica no manuseio do cateter, 3%; a manutenção do sistema de infusão, 15%; e os cuidados com o curativo do cateter venoso central, 17%. Os domínios representam uma assistência indesejada, conforme o Índice de Positividade de avaliação da qualidade da assistência. Conclusion: Os achados mostram a necessidade de discussões, treinamentos e investimentos em estratégias constantes para a prevenção de infecções primárias de corrente sanguínea relacionadas ao cateter venoso central.
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10
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Hamza WS, Hamed EATM, Alfadhli MA, Ramadan MAM. A multidisciplinary intervention to reduce central line-associated bloodstream infection in pediatrics and neonatal intensive care units. Pediatr Neonatol 2022; 63:71-77. [PMID: 34620576 DOI: 10.1016/j.pedneo.2021.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/05/2021] [Accepted: 08/27/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND To date, central line-associated bloodstream infections (CLABSIs) are the most common healthcare-associated infections in high-risk neonates and children. These infections are associated with significantly longer hospital stays, increased health care cost, and mortality in the health care systems. Application of evidence-based preventive interventions has proven to decrease CLABSI rate. The purpose of this study is to reduce the undesired relative high CLABSI rate through the adoption of standardized quality improvement interventions. METHODS and Methods: The study employed a pre-post-intervention design. Phase one is a retrospective calculation of 12 months of surveillance period as a baseline. Phase 2 establishes a multidisciplinary quality improvement intervention, which includes the formation of a dedicated central line insertion team, provision of central line kit at the bedside, training and educating the team, and selecting bundle checklist. In the third phase, we performed auditing and calculating the checklist compliance and monthly feedback for 12 consecutive post-intervention months. During phase 1 and 3, we calculated the following measures; CLABSI per 1000 catheter-days, duration of central line use, and device utilization ratio. RESULTS During the post-intervention phase the CLABSI rate significantly reduced by 59.5% from 7.5 to 3.0 per 1000 central line day, and the duration of use of the central line decreased from 21.3 ± 9.9 to 11.0 ± 3.2 days (P < 0.05). CONCLUSION Implementation of quality improvement multidisciplinary intervention; central line insertion and maintenance care bundle, dedicated IV team, education and feedback effectively reduced the rate of CLABSI within our pediatrics and neonatal ICUs.
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Affiliation(s)
- Wafaa Seddik Hamza
- Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Egypt.
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11
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Adherence to the central line bundle in intensive care: An integrative review. Am J Infect Control 2021; 49:937-956. [PMID: 33221472 DOI: 10.1016/j.ajic.2020.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Central line-associated bloodstream infections (CLABSI) occurring in intensive care units are associated with increased morbidity and mortality, increased length of hospitalization, and cost of care associated with treating CLABSIs. The Centers for Disease Control and Prevention guidelines and checklist bundle are intended to provide evidence-based recommendations for the prevention of CLABSIs. Despite the promotion of central line bundle policies, wide variability exists in compliance and infection rates in intensive care units. OBJECTIVE To evaluate and synthesize the existing literature on adherence to the central line bundle recommendations for the prevention of CLABSI. DESIGN Integrative literature review. DATA SOURCES CINHAL, PubMed, and SCOPUS databases were searched. REVIEW METHODS Whittmore and Knafl's integrative review method. RESULTS A total of 608 articles were identified, 407 articles were screened for topic of interest and adherence to the inclusion criteria, and 19 articles were included in this review. None of the 19 studies addressed adherence to all 14 recommendations of the central line bundle checklist. CONCLUSION This integrative review identified gaps in adherence to the central line bundle. Research is needed to determine the actual adherence to each item in the bundle, and to investigate factors that contribute to nonadherence. To achieve complete compliance with all the bundle items creative and innovative technology is needed.
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12
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Sun Y, Bao Z, Guo Y, Yuan X. Positive effect of care bundles on patients with central venous catheter insertions at a tertiary hospital in Beijing, China. J Int Med Res 2021; 48:300060520942113. [PMID: 32720831 PMCID: PMC7388130 DOI: 10.1177/0300060520942113] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective This study was performed to evaluate the effect of care bundles on the
prevention of central venous catheter-related bloodstream infection (CRBSI)
and improvement of patients’ experience. Methods In total, 212 patients with central venous catheter insertions were enrolled
in this study. All patients were matched by sex, age, Acute Physiology and
Chronic Health Evaluation II score, body mass index, department, and
catheter insertion site and were randomly divided into case and control
groups (n = 106 each). The control group was given conventional care, and
the case group was given care bundles including nurse education, hand
hygiene, maximal sterile barrier precautions, bedside observation, and
evaluation. The anxiety scores, hospitalization days, CRBSI rate, and degree
of satisfaction with hospitalization were compared between the two
groups. Results The patients’ mean self-rating anxiety scale score and self-rating depression
scale score after nursing intervention were significantly lower in the case
group than in the control group. The mean number of hospitalization days and
CRBSI rate were significantly lower and the satisfaction rate was
significantly higher in the case group. Conclusion Care bundles are essential for preventing CRBSI. They can improve patients’
psychological state and hospitalization satisfaction and reduce the
hospitalization days.
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Affiliation(s)
- Yuling Sun
- Department of Infectious Diseases, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zhongying Bao
- Department of Infectious Diseases, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yang Guo
- Department of Infectious Diseases, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xiaodong Yuan
- Department of Infectious Diseases, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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13
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Timsit JF, Baleine J, Bernard L, Calvino-Gunther S, Darmon M, Dellamonica J, Desruennes E, Leone M, Lepape A, Leroy O, Lucet JC, Merchaoui Z, Mimoz O, Misset B, Parienti JJ, Quenot JP, Roch A, Schmidt M, Slama M, Souweine B, Zahar JR, Zingg W, Bodet-Contentin L, Maxime V. Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit. Ann Intensive Care 2020; 10:118. [PMID: 32894389 PMCID: PMC7477021 DOI: 10.1186/s13613-020-00713-4] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 07/06/2020] [Indexed: 12/15/2022] Open
Abstract
The French Society of Intensive Care Medicine (SRLF), jointly with the French-Speaking Group of Paediatric Emergency Rooms and Intensive Care Units (GFRUP) and the French-Speaking Association of Paediatric Surgical Intensivists (ADARPEF), worked out guidelines for the management of central venous catheters (CVC), arterial catheters and dialysis catheters in intensive care unit. For adult patients: Using GRADE methodology, 36 recommendations for an improved catheter management were produced by the 22 experts. Recommendations regarding catheter-related infections’ prevention included the preferential use of subclavian central vein (GRADE 1), a one-step skin disinfection(GRADE 1) using 2% chlorhexidine (CHG)-alcohol (GRADE 1), and the implementation of a quality of care improvement program. Antiseptic- or antibiotic-impregnated CVC should likely not be used (GRADE 2, for children and adults). Catheter dressings should likely not be changed before the 7th day, except when the dressing gets detached, soiled or impregnated with blood (GRADE 2− adults). CHG dressings should likely be used (GRADE 2+). For adults and children, ultrasound guidance should be used to reduce mechanical complications in case of internal jugular access (GRADE 1), subclavian access (Grade 2) and femoral venous, arterial radial and femoral access (Expert opinion). For children, an ultrasound-guided supraclavicular approach of the brachiocephalic vein was recommended to reduce the number of attempts for cannulation and mechanical complications. Based on scarce publications on diagnostic and therapeutic strategies and on their experience (expert opinion), the panel proposed definitions, and therapeutic strategies.
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Affiliation(s)
- Jean-François Timsit
- APHP/Hopital Bichat-Medical and Infectious Diseases ICU (MI2), 46 rue Henri Huchard, 75018, Paris, France.,UMR 1137-IAME Team 5-DeSCID: Decision SCiences in Infectious Diseases, Control and Care Inserm/Université de Paris, Sorbonne Paris Cité, 75018, Paris, France
| | - Julien Baleine
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve University Hospital, 371 Avenue Doyen G Giraud, 34295, Montpellier Cedex 5, France
| | - Louis Bernard
- Infectious Diseases Unit, University Hospital Tours, Nîmes 2 Boulevard, 37000, Tours, France
| | - Silvia Calvino-Gunther
- CHU Grenoble Alpes, Réanimation Médicale Pôle Urgences Médecine Aiguë, 38000, Grenoble, France
| | - Michael Darmon
- Medical ICU, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Jean Dellamonica
- Centre Hospitalier Universitaire de Nice, Médecine Intensive Réanimation, Archet 1, UR2CA Unité de Recherche Clinique Côte d'Azur, Université Cote d'Azur, Nice, France
| | - Eric Desruennes
- Clinique d'anesthésie pédiatrique, Hôpital Jeanne-de-Flandre, avenue Eugène-Avinée, CHU Lille, 59000, Lille, France.,Unité accès vasculaire, Centre Oscar Lambret, 3 rue Frédéric Combemale, 59000, Lille, France
| | - Marc Leone
- Anesthésie Réanimation, Hôpital Nord, 13015, Marseille, France
| | - Alain Lepape
- Service d'Anesthésie et de Réanimation, Hospices Civils de Lyon, Groupement Hospitalier Sud, Lyon, France.,UMR CNRS 5308, Inserm U1111, Laboratoire des Pathogènes Émergents, Centre International de Recherche en Infectiologie, Lyon, France
| | - Olivier Leroy
- Medical ICU, Chatilliez Hospital, Tourcoing, France.,U934/UMR3215, Institut Curie, PSL Research University, 75005, Paris, France
| | - Jean-Christophe Lucet
- AP-HP, Infection Control Unit, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France.,INSERM IAME, U1137, Team DesCID, University of Paris, Paris, France
| | - Zied Merchaoui
- Pediatric Intensive Care, Paris South University Hospitals AP-HP, Le Kremlin Bicêtre, 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
| | - Benoit Misset
- Department of Intensive Care, Sart-Tilman University Hospital, and University of Liège, Liège, Belgium
| | - Jean-Jacques Parienti
- Department of Biostatistics and Clinical Research and Department of Infectious Diseases, Caen University Hospital, 14000, Caen, France.,EA2656 Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0) UNICAEN, CHU Caen Medical School Université Caen Normandie, Caen, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France.,Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France.,INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - Antoine Roch
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Service des Urgences, 13015, Marseille, France.,Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, Faculté de médecine, Aix-Marseille Université, 13005, Marseille, France
| | - Matthieu Schmidt
- Assistance Publique-Hôpitaux de Paris (APHP), Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, 75651, Paris, France.,INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, Sorbonne Universités, 75651, Paris Cedex 13, France
| | - Michel Slama
- Medical Intensive Care Unit, CHU Sud Amiens, Amiens, France
| | - Bertrand Souweine
- Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France
| | - Jean-Ralph Zahar
- IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, Paris, France.,Service de Microbiologie Clinique et Unité de Contrôle et de Prévention Du Risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 Rue de Stalingrad, 93000, Bobigny, France
| | - Walter Zingg
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Laetitia Bodet-Contentin
- Medical Intensive Care Unit, INSERM CIC 1415, CRICS-TriGGERSep Network, CHRU de Tours and Université de Tours, Tours, France
| | - Virginie Maxime
- Surgical and Medical Intensive Care Unit Hôpital, Raymond Poincaré, 9230, Garches, France.
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14
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Haddad FC, Rao R, Kaur S, Redkey J, Karcz A, Ladd AP. The implication of intestinal bacterial translocation in central line associated blood stream infections in the pediatric population. J Pediatr Surg 2020; 55:1651-1654. [PMID: 32307100 DOI: 10.1016/j.jpedsurg.2020.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Bacterial intestinal translocation plays an important role in neonatal sepsis. We aimed to elucidate the importance of such translocation in causing central line associated blood stream infection (CLABSI) in patients undergoing gastrointestinal surgery (GIS). METHODS Using a database of pediatric patients with CLABSI, patients were divided into those who had a GI-surgery (where intestines were opened), those who had a non-GI-surgery (NGIS; all other types of surgery) and those who had no surgery (NS). Data regarding type of organisms isolated on culture, their resistance patterns, clearance of CLABSI, type of antibiotic therapy and patient demographics were collected. RESULTS 117 CLABSIs were identified between 2011 and 2018. 26 patients had GIS, 22 had NGIS and 69 had NS. NS patients were younger. 80% of GIS and NGIS patients had a central line at the time of surgery. Coagulase-negative staphylococcus (CoNS) was the most common organism isolated (32%). CoNS was more common in GIS compared to NGIS and NS (58% vs. 9% vs. 29% respectively, p=0.04). There were no differences in the time to resolution of bacteremia, mortality rates or need to remove the central line. CONCLUSIONS This information should help inform efforts for prevention of CLABSIs in patients undergoing GI surgery with central lines present. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Fuad C Haddad
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Raghavendra Rao
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Sandeep Kaur
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Jaime Redkey
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Adam Karcz
- Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, Indiana
| | - Alan P Ladd
- Division of Pediatric General Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Indiana University School of Medicine, Indianapolis, Indiana.
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15
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Central Venous Catheters Complications in the Pediatric Cardiac ICU-The Devil Is in the Details. Pediatr Crit Care Med 2020; 21:769-770. [PMID: 32769942 DOI: 10.1097/pcc.0000000000002362] [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: 11/26/2022]
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16
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Abstract
These practice guidelines update the Practice Guidelines for Central Venous Access: A Report by the American Society of Anesthesiologists Task Force on Central Venous Access, adopted by the American Society of Anesthesiologists in 2011 and published in 2012. These updated guidelines are intended for use by anesthesiologists and individuals under the supervision of an anesthesiologist and may also serve as a resource for other physicians, nurses, or healthcare providers who manage patients with central venous catheters.
Supplemental Digital Content is available in the text.
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17
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An Intervention Based Prevention of Catheter Associated Blood Stream Infection in Adult Critical Care Unit. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2019. [DOI: 10.22207/jpam.13.4.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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18
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Kulali F, Çalkavur Ş, Oruç Y, Demiray N, Devrim İ. Impact of central line bundle for prevention of umbilical catheter-related bloodstream infections in a neonatal intensive care unit: A pre-post intervention study. Am J Infect Control 2019; 47:387-390. [PMID: 30502109 DOI: 10.1016/j.ajic.2018.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Central line-associated bloodstream infection is the most common infection associated with healthcare in preterm infants. The purpose of this 18-month cross-sectional study was to evaluate the effectiveness of bundle applications in the prevention of umbilical venous catheter (UVC)-associated bloodstream infections. METHODS This study included patients in whom UVCs were inserted and who were diagnosed with central line-associated bloodstream infection between July 1, 2016, and December 31, 2017, according to the Centers for Disease Control and Prevention criteria. During the second 9-month period of the study (April 1, 2017, to December 31, 2017), bundles were implemented. RESULTS In the prebundle period, 589 patients were admitted to the neonatal intensive care unit, and 6,769 hospitalization days and 485 UVC days were recorded. Similarly, during the bundle period, 508 patients were admitted to the neonatal intensive care unit, and 7,789 hospitalization days and 508 UVC days were recorded. The UVC-associated bloodstream infection rate was 12.4 per 1,000 catheter days in the prebundle period and decreased to 3.9 per 1,000 catheter days in the bundle period. Thus, after introducing bundle applications, the rate of infection decreased by 68% (P < .01). CONCLUSIONS This study showed that bundle application effectively reduced UVC-associated bloodstream infection.
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19
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Chung HC, Wang LS, Wu JL, Hsieh TC. Utilization of a central venous catheter insertion care bundle in Taiwan: A cross-sectional analysis of the National Health Insurance Research Database. Tzu Chi Med J 2019; 31:182-187. [PMID: 31258295 PMCID: PMC6559030 DOI: 10.4103/tcmj.tcmj_63_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objectives The objectives of this study are to explore medical care utilization associated with promoting the central venous catheter (CVC) care bundle plan using Taiwan's National Health Insurance Research Database (NHIRD). Materials and Methods We performed a cross-sectional, secondary analysis of the data from patients who were admitted to a medical center for the first time between July 1, 2010, and June 30, 2012, in the NHIRD. The control group was patients who were admitted at nine medical center hospitals that participated in the pilot plan, and the study group was patients who were admitted at other ten medical center hospitals that did not participate in the pilot plan, and the differences between groups were analyzed. Results After implementing the CVC care bundle, the average hospital stay decreased significantly (18.43 ± 12.96 vs. 15.49 ± 10.16, P < 0.05). In addition, the study group patients were clinically less likely to require antibiotics than the control group (odds ratio = 0.33, 95% confidence interval [CI] = [0.07, 1.71] vs. 0.62, 95% CI = [0.40, 0.96], P = 3768), and their medical expenses were lower (220, 618 ± 226, 419 vs. 208, 079 ± 193, 610, P > 05). Furthermore, the incidence rate of CVC-associated sepsis decreased from 12.59% to 5.66%. Conclusions By implementing the CVC care bundle in clinical practice in accordance with national policies, medical utilization decreased, thereby considerably improving medical resource usage. These results confirmed that implementing the CVC care bundle possibly decreased medical utilization in clinical practice.
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Affiliation(s)
- Hui-Chun Chung
- Department of Nursing, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Lih-Shinn Wang
- Division of Infectious Disease, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Jung-Lun Wu
- Institute of Medical Sciences, College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Tsung-Cheng Hsieh
- Institute of Medical Sciences, College of Medicine, Tzu Chi University, Hualien, Taiwan
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20
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Lin WP, Chang YC, Wu UI, Hung MC, Chuang PY, Wang JT, Sheng WH, Chen YC, Chang SC. Multimodal interventions for bundle implementation to decrease central line-associated bloodstream infections in adult intensive care units in a teaching hospital in Taiwan, 2009–2013. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018; 51:644-651. [DOI: 10.1016/j.jmii.2017.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/19/2017] [Accepted: 08/02/2017] [Indexed: 10/19/2022]
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21
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Chen Z, Hong Y, Dai J, Xing L. Incorporation of point-of-care ultrasound into morning round is associated with improvement in clinical outcomes in critically ill patients with sepsis. J Clin Anesth 2018; 48:62-66. [PMID: 29763777 DOI: 10.1016/j.jclinane.2018.05.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/02/2018] [Accepted: 05/03/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Point-of-care ultrasound (POCUS) has been widely used in the intensive care unit (ICU). However, it is largely unknown whether the use of POCUS is associated with improved patient-important outcomes. The study aimed to investigate whether incorporation of POCUS during morning round on a routine basis was able to improve clinical outcomes in critically ill patients with sepsis. DESIGN It was a prospective observational study. SETTING A tertiary care emergency intensive care unit. PATIENTS All patients admitted to the emergency ICU from January 2016 to December 2017 were screened for potential eligibility. Sepsis was defined as infection plus signs of organ dysfunction. INTERVENTION The intervention group incorporated POCUS during morning round on a routine basis, and a checklist was developed to improve the compliance. The control group did not have the mandates to perform POCUS during morning round, but could use POCUS when necessary. MEASUREMENTS Clinical outcomes of mortality, length of stay in ICU, durations of vasopressors and mechanical ventilation were compared between the intervention and control groups. Multivariable regression model was employed to adjust for confounding factors. MAIN RESULTS A total of 129 subjects, including 88 in the control group and 41 in the intervention group, were included for analysis. Univariate analysis showed that the intervention group had shorter durations of mechanical ventilation (MV) (4.5 ± 1.2 vs. 5.7 ± 1.0 days; p = 0.034) and more negative fluid balance (-143 vs. 48 ml/24 h; p = 0.003) on day 3. In multivariable model, routine incorporation of POCUS was associated with lower risk of prolonged (>7 days) ICU stay (OR: 0.39, 95% CI: 0.29-0.88; p = 0.029). CONCLUSIONS The study showed that incorporation of POCUS during morning round on a routine basis was associated with shortened duration of MV and length of stay in ICU. The possible mechanism underlying the relationship may be via reduced fluid administration. Future randomized controlled trials are needed to validate current findings.
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Affiliation(s)
- Zhonghua Chen
- Department of emergency medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
| | - Yucai Hong
- Department of emergency medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Junru Dai
- Department of emergency medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Lifeng Xing
- Department of emergency medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
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Lee KH, Cho NH, Jeong SJ, Kim MN, Han SH, Song YG. Effect of Central Line Bundle Compliance on Central Line-Associated Bloodstream Infections. Yonsei Med J 2018; 59:376-382. [PMID: 29611399 PMCID: PMC5889989 DOI: 10.3349/ymj.2018.59.3.376] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 02/06/2018] [Accepted: 02/06/2018] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The present study aimed to evaluate the effect of central line (CL) bundle compliance on central line-associated bloodstream infections (CLABSIs) in different departments of the same hospital, including the intensive care unit (ICU) and other departments. MATERIALS AND METHODS The four components of the CL bundle were hand hygiene, use of maximal sterile barrier precautions, chlorhexidine use, and selection of an appropriate site for venous access. Compliance of the CL bundle and CLABSIs were measured for every department [emergency room (ER), ICU, general ward (GW), and operating room (OR)]. A total of 1672 patients were included over 3 years (August 2013 through July 2016). RESULTS A total of 29 CLABSI episodes (1.73%) were identified, and only 53.7% of the patients completed CL bundles. The performance rates of all components of the CL bundle were 22.3%, 28.5%, 36.5%, and 84.6% for the ER, ICU, GW, and OR, respectively. The highest CLABSI rate was observed in patients of the ICU, for whom all components were not performed perfectly. Conversely, the lowest CLABSI rate was observed for patients of GWs, for whom all components were performed. Among individual components, femoral insertion site [relative risk (RR), 2.26; 95% confidence interval (CI), 1.09-4.68], not using a full body drape (RR, 3.55; 95% CI, 1.44-8.71), and not performing all CL bundle components (RR, 2.79; 95% CI, 1.19-6.54) were significant variables associated with CLABSIs. CONCLUSION This study provides direct evidence that completing all CL bundle components perfectly is essential for preventing CLABSIs. Customized education should be provided, according to specific weaknesses of bundle performance.
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Affiliation(s)
- Kyoung Hwa Lee
- Division of Infectious Diseases, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Infection Control, Gangnam Severance Hospital, Seoul, Korea
| | - Nan Hyoung Cho
- Department of Infection Control, Gangnam Severance Hospital, Seoul, Korea
| | - Su Jin Jeong
- Division of Infectious Diseases, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Infection Control, Gangnam Severance Hospital, Seoul, Korea
| | - Mi Na Kim
- Department of Infection Control, Gangnam Severance Hospital, Seoul, Korea
| | - Sang Hoon Han
- Division of Infectious Diseases, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Infection Control, Gangnam Severance Hospital, Seoul, Korea
| | - Young Goo Song
- Division of Infectious Diseases, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Infection Control, Gangnam Severance Hospital, Seoul, Korea.
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Holt S, Thompson-Brazill KA, Sparks ER, Lipetzky J. Treating Central Catheter-Associated Bacteremia Due to Methicillin-Resistant Staphylococcus aureus: Beyond Vancomycin. Crit Care Nurse 2018; 36:46-57. [PMID: 27481801 DOI: 10.4037/ccn2016475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Methicillin-resistant Staphylococcus aureus is a frequent cause of hospital-associated infections, including central catheter-associated bacteremia. Vancomycin has been the drug of choice for treating this type of bacteremia for decades in patients who have no contraindications to the antibiotic. However, resistance to vancomycin is an emerging problem. Newer antibiotics approved by the Food and Drug Administration have activity against methicillin-resistant S aureus Some of the antibiotics also have activity against strains of S aureus that are intermediately susceptible or resistant to vancomycin. This article uses a case study to highlight the clinical signs of vancomycin failure and describes the indications for and appropriate use of alternative antimicrobials such as ceftaroline, daptomycin, linezolid, tigecycline, and telavancin. (Critical Care Nurse 2016;36[4]:46-57).
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Affiliation(s)
- Shannon Holt
- Shannon Holt is an assistant professor of clinical education, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, and a clinical pharmacist specialist in infectious diseases, Wake Med Health and Hospitals, Raleigh, North Carolina.Kelly Thompson-Brazill is a nurse practitioner in cardiothoracic surgery, Wake Med Health and Hospitals, a consulting associate instructor, Duke University School of Nursing, Durham, North Carolina, and a contributing editor to Critical Care Nurse.E. Ryan Sparks is a postgraduate year 1 pharmacy practice resident at Wake Med Health and Hospitals.Juliana Lipetzky is a postgraduate year 1 pharmacy practice resident at Durham VA Medical Center, Durham, North Carolina
| | - Kelly A Thompson-Brazill
- Shannon Holt is an assistant professor of clinical education, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, and a clinical pharmacist specialist in infectious diseases, Wake Med Health and Hospitals, Raleigh, North Carolina.Kelly Thompson-Brazill is a nurse practitioner in cardiothoracic surgery, Wake Med Health and Hospitals, a consulting associate instructor, Duke University School of Nursing, Durham, North Carolina, and a contributing editor to Critical Care Nurse.E. Ryan Sparks is a postgraduate year 1 pharmacy practice resident at Wake Med Health and Hospitals.Juliana Lipetzky is a postgraduate year 1 pharmacy practice resident at Durham VA Medical Center, Durham, North Carolina.
| | - E Ryan Sparks
- Shannon Holt is an assistant professor of clinical education, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, and a clinical pharmacist specialist in infectious diseases, Wake Med Health and Hospitals, Raleigh, North Carolina.Kelly Thompson-Brazill is a nurse practitioner in cardiothoracic surgery, Wake Med Health and Hospitals, a consulting associate instructor, Duke University School of Nursing, Durham, North Carolina, and a contributing editor to Critical Care Nurse.E. Ryan Sparks is a postgraduate year 1 pharmacy practice resident at Wake Med Health and Hospitals.Juliana Lipetzky is a postgraduate year 1 pharmacy practice resident at Durham VA Medical Center, Durham, North Carolina
| | - Juliana Lipetzky
- Shannon Holt is an assistant professor of clinical education, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, and a clinical pharmacist specialist in infectious diseases, Wake Med Health and Hospitals, Raleigh, North Carolina.Kelly Thompson-Brazill is a nurse practitioner in cardiothoracic surgery, Wake Med Health and Hospitals, a consulting associate instructor, Duke University School of Nursing, Durham, North Carolina, and a contributing editor to Critical Care Nurse.E. Ryan Sparks is a postgraduate year 1 pharmacy practice resident at Wake Med Health and Hospitals.Juliana Lipetzky is a postgraduate year 1 pharmacy practice resident at Durham VA Medical Center, Durham, North Carolina
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Abstract
Over half of the nearly two million healthcare-associated infections can be attributed to indwelling medical devices. In this review, we highlight the difficulty in diagnosing implantable device-related infection and how this leads to a likely underestimate of the prevalence. We then provide a length-scale conceptualization of device-related infection pathogenesis. Within this conceptualization we focus specifically on biofilm formation and the role of host immune and coagulation systems. Using this framework, we describe how current and developing preventative strategies target specific processes along the entire length-scale. In light of the significant time horizon for the development and translation of new preventative technologies, we also emphasize the need for parallel development of in situ treatment strategies. Specific examples of both preventative and treatment strategies and how they align with the length-scale conceptualization are described.
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Prevention of hospital infections by intervention and training (PROHIBIT): results of a pan-European cluster-randomized multicentre study to reduce central venous catheter-related bloodstream infections. Intensive Care Med 2017; 44:48-60. [PMID: 29248964 DOI: 10.1007/s00134-017-5007-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/24/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To test the effectiveness of a central venous catheter (CVC) insertion strategy and a hand hygiene (HH) improvement strategy to prevent central venous catheter-related bloodstream infections (CRBSI) in European intensive care units (ICUs), measuring both process and outcome indicators. METHODS Adult ICUs from 14 hospitals in 11 European countries participated in this stepped-wedge cluster randomised controlled multicentre intervention study. After a 6 month baseline, three hospitals were randomised to one of three interventions every quarter: (1) CVC insertion strategy (CVCi); (2) HH promotion strategy (HHi); and (3) both interventions combined (COMBi). Primary outcome was prospective CRBSI incidence density. Secondary outcomes were a CVC insertion score and HH compliance. RESULTS Overall 25,348 patients with 35,831 CVCs were included. CRBSI incidence density decreased from 2.4/1000 CVC-days at baseline to 0.9/1000 (p < 0.0001). When adjusted for patient and CVC characteristics all three interventions significantly reduced CRBSI incidence density. When additionally adjusted for the baseline decreasing trend, the HHi and COMBi arms were still effective. CVC insertion scores and HH compliance increased significantly with all three interventions. CONCLUSIONS This study demonstrates that multimodal prevention strategies aiming at improving CVC insertion practice and HH reduce CRBSI in diverse European ICUs. Compliance explained CRBSI reduction and future quality improvement studies should encourage measuring process indicators.
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Padilla Fortunatti CF. Impact of two bundles on central catheter-related bloodstream infection in critically ill patients. Rev Lat Am Enfermagem 2017; 25:e2951. [PMID: 29211195 PMCID: PMC5738873 DOI: 10.1590/1518-8345.2190.2951] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 08/27/2017] [Indexed: 11/30/2022] Open
Abstract
Objective: To evaluate the impact of the implementation of insertion and maintenance bundles
on the rates of catheter-related bloodstream infection in an intensive care unit.
Method: This is a quasi-experimental, before-and-after study with a non-equivalent control
group. During a six-month period, insertion and maintenance bundles for the
central venous catheters were implemented. Supervision guidelines were developed
to assess compliance with the bundle and catheter characteristics. Results: A total of 444 central catheters corresponding to 390 patients were observed, of
which 68.7% were inserted in the unit. The maintenance and insertion bundles
reached 62.9% and 94.7% compliance, respectively, and 50.7% of the insertions were
supervised. It was possible to observe a 54.5% decrease in the rate of central
catheter infection (3.48 vs 1.52 x 1000 days/catheter, p<0.05) when compared
with the control group. Conclusion: The simultaneous implementation of insertion and maintenance bundles has a
positive impact on the reduction of catheter-related bloodstream infection;
therefore it is an efficient alternative to improve the quality and safety of care
in high complexity units.
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Affiliation(s)
- Cristobal Felipe Padilla Fortunatti
- Student in Master's degree, Escuela de Enfermería, Pontificia Universidad Católica de Chile, Santiago, Chile. RN, Unidad de Paciente Crítico, Hospital Clinico Red de Salud UC - CHRISTUS, Santiago, Chile
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Kung SC, Lin WT, Tsai TC, Lin MH, Chang CH, Lai CC, Chao CM. Epidemiologic characteristics and outcomes of major trauma patients requiring prolonged mechanical ventilation. Medicine (Baltimore) 2017; 96:e9487. [PMID: 29384944 PMCID: PMC6393113 DOI: 10.1097/md.0000000000009487] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The epidemiologic characteristics and outcomes of severe trauma patients requiring prolonged mechanical ventilation (PMV) remain unclear. This retrospective study aims to investigate the outcomes of PMV in this specific group. All patients with major trauma admitted to the respiratory care center (RCC) requiring PMV (duration ≥21 days between January 2014 and December 2016) were enrolled. A total of 36343 trauma patients visited our emergency department for management, and 1388 (3.82%) were admitted to the intensive care unit (ICU) after initial resuscitation. After ICU management, 93 major trauma patients required PMV, and were then transferred to the RCC. Their mean age of these 93 patients was 68.6 ± 18.3 years and 65 patients (70.0%) were older than 65 years. Head/neck trauma (n = 78, 83.9%) were the most common injury, followed by thoracic trauma (n = 30, 32.2%), and extremity trauma (n = 29, 31.2%). Their median injury severity score was 25 (interquartile range [IQR] 16-27). The median length of hospital stay was 50 days (IQR, 39-62). Six patients died of ventilator-associated pneumonia for an in-hospital morality rate of 6.5%. In addition, 11 PMV patients became mechanical ventilator-dependent and were transferred to the respiratory care ward for further long-term care. In conclusion, <0.3% of trauma patients required PMV, and their in-hospital mortality rate was only 6.5%. Ventilator-associated pneumonia was the main cause of death and nosocomial infections were common in patients with long-term mechanical ventilator dependence.
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Affiliation(s)
| | - Wei-Ting Lin
- Departments of Orthopedics and Trauma, Chi Mei Medical Center
| | | | | | | | - Chih-Cheng Lai
- Departments of Intensive Care Medicine, Chi Mei Medical Center, Liouying
| | - Chien-Ming Chao
- Departments of Intensive Care Medicine, Chi Mei Medical Center, Liouying
- Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan
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Lai CC, Cia CT, Chiang HT, Kung YC, Shi ZY, Chuang YC, Lee CM, Ko WC, Hsueh PR. Implementation of a national bundle care program to reduce central line-associated bloodstream infections in intensive care units in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 51:666-671. [PMID: 29108783 DOI: 10.1016/j.jmii.2017.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 10/10/2017] [Accepted: 10/10/2017] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Cong-Tat Cia
- Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Hsiu-Tzy Chiang
- Infection Control Center, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yung-Chung Kung
- Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Zhi-Yuan Shi
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yin-Ching Chuang
- Department of Internal Medicine, Chi Mei Hospital, Liouying, Taiwan
| | - Chun-Ming Lee
- Infection Control Center, MacKay Memorial Hospital, Taipei, Taiwan; Department of Internal Medicine, St. Joseph's Hospital, Yunlin County, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.
| | - Wen-Chien Ko
- Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
| | - Po-Ren Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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Mishra SB, Misra R, Azim A, Baronia AK, Prasad KN, Dhole TN, Gurjar M, Singh RK, Poddar B. Incidence, risk factors and associated mortality of central line-associated bloodstream infections at an intensive care unit in northern India. Int J Qual Health Care 2017; 29:63-67. [PMID: 27940521 DOI: 10.1093/intqhc/mzw144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 11/17/2016] [Indexed: 12/14/2022] Open
Abstract
Objective To evaluate the incidence, risk factors and associated mortality of central line-associated bloodstream infection (CLABSI) in an adult intensive care unit (ICU) in India. Design This prospective observational study was conducted over a period of 16 months at a tertiary care referral medical center. Setting We conducted this study over a period of 16 months at a tertiary care referral medical center. Participants All patients with a central venous catheter (CVC) for >48 h admitted to the ICU were enrolled. Intervention and main outcome measures Patient characteristics included were underlying disease, sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation (APACHE II) scores and outcome. Statistical analysis of risk factors for their association with mortality was also done. Results There were 3235 inpatient-days and 2698 catheter-days. About 46 cases of CLABSI were diagnosed during the study period. The overall rate of CLABSI was 17.04 per 1000 catheter-days and 14.21 per 1000 inpatient-days. The median duration of hospitalization was 23.5 days while the median number of days that a CVC was in place was 17.5. The median APACHE II and SOFA scores were 17 and 10, respectively. Klebsiella pneumoniae was the most common organism (n = 22/55, 40%). Immunosuppressed state and duration of central line more than 10 days were significant factors for developing CLABSI. SOFA and APACHE II scores showed a tendency towards significance for mortality. Conclusions Our results underscore the need for strict institutional infection control measures. Regular training module for doctors and nurses for catheter insertion and maintenance with a checklist on nurses' chart for site inspection and alerts in all shifts are some measures planned at our center.
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Affiliation(s)
- S B Mishra
- Department of Critical Care Medicine, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow 226014, India
| | - R Misra
- Department of Microbiology, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow 226014, India
| | - A Azim
- Department of Critical Care Medicine, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow 226014, India
| | - A K Baronia
- Department of Critical Care Medicine, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow 226014, India
| | - K N Prasad
- Department of Microbiology, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow 226014, India
| | - T N Dhole
- Department of Microbiology, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow 226014, India
| | - M Gurjar
- Department of Critical Care Medicine, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow 226014, India
| | - R K Singh
- Department of Critical Care Medicine, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow 226014, India
| | - B Poddar
- Department of Critical Care Medicine, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow 226014, India
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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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Branch-Elliman W. A Roadmap for Reducing Cardiac Device Infections: a Review of Epidemiology, Pathogenesis, and Actionable Risk Factors to Guide the Development of an Infection Prevention Program for the Electrophysiology Laboratory. Curr Infect Dis Rep 2017; 19:34. [PMID: 28815459 DOI: 10.1007/s11908-017-0591-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Cardiovascular implantable electronic device (CIED) infections are highly morbid, common, and costly, and rates are increasing (Sohail et al. Arch Intern Med 171(20):1821-8 2011; Voigt et al. J Am Coll Cardiol 48(3):590-1 2006). Factors that contribute to the development of CIED infections include patient factors (comorbid conditions, self-care, microbiome), procedural details (repeat procedure, contamination during procedure, appropriate pre-procedural prep, and antimicrobial use), environmental and organizational factors (patient safety culture, facility barriers, such as lack of space to store essential supplies, quality of environmental cleaning), and microbial factors (type of organism, virulence of organism). Each of these can be specifically targeted with infection prevention interventions. RECENT FINDINGS Basic prevention practices, such as administration of systemic antimicrobials prior to incision and delaying the procedure in the setting of fever or elevated INR, are helpful for day-to-day prevention of cardiac device infections. Small single-center studies provide proof-of-concept that bundled prevention interventions can reduce infections, particularly in outbreak settings. However, data regarding which prevention strategies are the most important is limited as are data regarding the optimal prevention program for day-to-day prevention (Borer et al. Infect Control Hosp Epidemiol 25(6):492-7 2004; Ahsan et al. Europace 16(10):1482-9 2014). Evolution of infection prevention programs to include ambulatory and procedural areas is crucial as healthcare delivery is increasingly provided outside of hospitals and operating rooms. The focus on traditional operating rooms and inpatient care leaves the vast majority of healthcare delivery-including cardiac device implantations in the electrophysiology laboratory-uncovered.
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Affiliation(s)
- Westyn Branch-Elliman
- VA Boston Healthcare System, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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Velasquez Reyes DC, Bloomer M, Morphet J. Prevention of central venous line associated bloodstream infections in adult intensive care units: A systematic review. Intensive Crit Care Nurs 2017; 43:12-22. [PMID: 28663107 DOI: 10.1016/j.iccn.2017.05.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/03/2017] [Accepted: 05/23/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND In adult Intensive Care Units, the complexity of patient treatment requirements make the use of central venous lines essential. Despite the potential benefits central venous lines can have for patients, there is a high risk of bloodstream infection associated with these catheters. AIM Identify and critique the best available evidence regarding interventions to prevent central venous line associated bloodstream infections in adult intensive care unit patients other than anti-microbial catheters. METHODS A systematic review of studies published from January 2007 to February 2016 was undertaken. A systematic search of seven databases was carried out: MEDLINE; CINAHL Plus; EMBASE; PubMed; Cochrane Library; Scopus and Google Scholar. Studies were critically appraised by three independent reviewers prior to inclusion. RESULTS Nineteen studies were included. A range of interventions were found to be used for the prevention or reduction of central venous line associated bloodstream infections. These interventions included dressings, closed infusion systems, aseptic skin preparation, central venous line bundles, quality improvement initiatives, education, an extra staff in the Intensive Care Unit and the participation in the 'On the CUSP: Stop Blood Stream Infections' national programme. CONCLUSIONS Central venous line associated bloodstream infections can be reduced by a range of interventions including closed infusion systems, aseptic technique during insertion and management of the central venous line, early removal of central venous lines and appropriate site selection.
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Affiliation(s)
| | - Melissa Bloomer
- Deakin University, School of Nursing and Midwifery, PO Box 20000, Geelong, VIC, AUS 3217, Australia
| | - Julia Morphet
- Monash University, School of Nursing and Midwifery Peninsula campus, McMahons Road, Frankston VIC, 3199, Australia
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Aleman-Ortega H, Lee R, Shambo L, Czinn E. Neuraxial Anesthesia and the Use of Sterile Gowning. AORN J 2017; 105:184-192. [DOI: 10.1016/j.aorn.2016.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/11/2016] [Accepted: 12/07/2016] [Indexed: 11/25/2022]
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Bhorkar N, Dhansura T, Tarawade U, Mahajan S. Alternative use of the ophthalmic drape for anaesthesia procedures. Indian J Anaesth 2017; 61:271-272. [PMID: 28405045 PMCID: PMC5372412 DOI: 10.4103/ija.ija_711_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Matthes G, Trentzsch H, Wölfl CG, Paffrath T, Flohe S, Schweigkofler U, Ekkernkamp A, Schulz-Drost S. [Essential measures for prehospital treatment of severely injured patients: The trauma care bundle]. Unfallchirurg 2016; 118:652-6. [PMID: 26160129 DOI: 10.1007/s00113-015-0042-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND In order to ensure adequate treatment and to avoid complications, care bundles are increasingly being implemented. These are comprehensive and evidence-based procedures for the treatment of individual diseases or injuries which should be carried out for every patient. The aim of this study was to define a care bundle for the prehospital treatment of severely injured patients. MATERIAL AND METHODS The scientific contents of the bundle were gathered from the interdisciplinary evidence-based S3 guidelines for the treatment of severely injured patients by the German Trauma Society. The ABCDE scheme suggested by the prehospital trauma life support (PHTLS®) and the advanced trauma life support (ATLS®) functioned as a matrix for the individual elements in the bundles. The identified elements were finalized by a consensus process. RESULTS AND DISCUSSION A bundle of six elements was suggested and a comprehensive summary of key items during prehospital management of severely injured patients was identified. In a next step the effectiveness of the care bundle should be evaluated in a clinical trial.
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Affiliation(s)
- G Matthes
- Klinik für Unfallchirurgie und Orthopädie, Unfallkrankenhaus Berlin, Warener Str.7, 12683, Berlin, Deutschland,
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Perin DC, Erdmann AL, Higashi GDC, Sasso GTMD. Evidence-based measures to prevent central line-associated bloodstream infections: a systematic review. Rev Lat Am Enfermagem 2016; 24:e2787. [PMID: 27598378 PMCID: PMC5016007 DOI: 10.1590/1518-8345.1233.2787] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 02/29/2016] [Indexed: 12/19/2022] Open
Abstract
Objective: to identify evidence-based care to prevent CLABSI among adult patients hospitalized in ICUs. Method: systematic review conducted in the following databases: PubMed, Scopus, Cinahl, Web of Science, Lilacs, Bdenf and Cochrane Studies addressing care and maintenance of central venous catheters, published from January 2011 to July 2014 were searched. The 34 studies identified were organized in an instrument and assessed by using the classification provided by the Joanna Briggs Institute. Results: the studies presented care bundles including elements such as hand hygiene and maximal barrier precautions; multidimensional programs and strategies such as impregnated catheters and bandages and the involvement of facilities in and commitment of staff to preventing infections. Conclusions: care bundles coupled with education and the commitment of both staff and institutions is a strategy that can contribute to decreased rates of central line-associated bloodstream infections among adult patients hospitalized in intensive care units.
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Affiliation(s)
- Daniele Cristina Perin
- MSc. in Nursing Care Management, RN, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Alacoque Lorenzini Erdmann
- PhD, Full Professor, Departamento de Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
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Hsin HT, Hsu MS, Shieh JS. The long-term effect of bundle care for catheter-related blood stream infection: 5-year follow-up. Postgrad Med J 2016; 93:133-137. [PMID: 27474228 DOI: 10.1136/postgradmedj-2016-134261] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 07/02/2016] [Accepted: 07/04/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To address the importance of bundle care for catheter-related infection (CRBSI) on the basis of long-term observation in a catheter-abundant cardiovascular intensive care unit (CVICU). DESIGN Prospective longitudinal cohort study. SETTING CVICU of a tertiary referring medical centre in northern Taiwan. PARTICIPANTS Around 1400 critically ill patients annually for 5 years in the CVICU (from January 2010 to June 2015). CRBSI bundle care has been applied ever since by a multidisciplinary team. MAIN OUTCOME MEASURES CRBSI per 1000 catheter days, bloodstream infection (BSI) per 1000 inpatient days, and catheter utilisation rates. RESULTS From January 2010 to June 2015 (22 quarters), there were in total 45 140 inpatient days and 24 163 catheter days, with an overall central venous catheter utilisation rate of 53.5%. The duration of the indwelled catheter was 6.3±1.2 days. The beginning CRBSI rate was 7.0 per 1000 catheter days and was significantly decreased to 0.7 per 1000 catheter days (p<0.001). Regarding the time series, cubic polynomial function depicted the CRBSI decrement most vividly (R2=0.501, p=0.005). In addition, the improvement in overall BSIs (2010 Q1, 4.4 per 1000 inpatient days to 2015 Q2, 0.5 per 1000 inpatient days, p<0.001) significantly correlated with the decrease in CRBSI (r=0.86, p<0.001). CONCLUSIONS Through the bundle care, we successfully reduced CRBSIs. After 5 years of follow-up, we observed that the effect of bundle care was stepwise and persistent, as long as we kept working on this integrated project.
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Affiliation(s)
- Ho-Tsung Hsin
- Cardiovascular Intensive Care Unit, Far-Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Mechanical Engineering, Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Tauyuan City, Taiwan
| | - Meng-Shiuan Hsu
- Division of Infectious Disease, Department of Internal Medicine, Far-Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jiann-Shing Shieh
- Department of Mechanical Engineering, Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Tauyuan City, Taiwan
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Kim HY, Lee WK, Na S, Roh YH, Shin CS, Kim J. The effects of chlorhexidine gluconate bathing on health care–associated infection in intensive care units: A meta-analysis. J Crit Care 2016; 32:126-37. [DOI: 10.1016/j.jcrc.2015.11.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/29/2015] [Accepted: 11/14/2015] [Indexed: 12/11/2022]
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Ista E, van der Hoven B, Kornelisse RF, van der Starre C, Vos MC, Boersma E, Helder OK. Effectiveness of insertion and maintenance bundles to prevent central-line-associated bloodstream infections in critically ill patients of all ages: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2016; 16:724-734. [PMID: 26907734 DOI: 10.1016/s1473-3099(15)00409-0] [Citation(s) in RCA: 149] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 10/14/2015] [Accepted: 10/15/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Central-line-associated bloodstream infections (CLABSIs) are a major problem in intensive care units (ICUs) worldwide. We aimed to quantify the effectiveness of central-line bundles (insertion or maintenance or both) to prevent these infections. METHODS We searched Embase, MEDLINE OvidSP, Web-of-Science, and Cochrane Library to identify studies reporting the implementation of central-line bundles in adult ICU, paediatric ICU (PICU), or neonatal ICU (NICU) patients. We searched for studies published between Jan 1, 1990, and June 30, 2015. For the meta-analysis, crude estimates of infections were pooled by use of a DerSimonian and Laird random effect model. The primary outcome was the number of CLABSIs per 1000 catheter-days before and after implementation. Incidence risk ratios (IRRs) were obtained by use of random-effects models. FINDINGS We initially identified 4337 records, and after excluding duplicates and those ineligible, 96 studies met the eligibility criteria, 79 of which contained sufficient information for a meta-analysis. Median CLABSIs incidence were 5·7 per 1000 catheter-days (range 1·2-46·3; IQR 3·1-9·5) on adult ICUs; 5·9 per 1000 catheter-days (range 2·6-31·1; 4·8-9·4) on PICUs; and 8·4 per 1000 catheter-days (range 2·6-24·1; 3·7-16·0) on NICUs. After implementation of central-line bundles the CLABSI incidence ranged from 0 to 19·5 per 1000 catheter-days (median 2·6, IQR 1·2-4·4) in all types of ICUs. In our meta-analysis the incidence of infections decreased significantly from median 6·4 per 1000 catheter-days (IQR 3·8-10·9) to 2·5 per 1000 catheter-days (1·4-4·8) after implementation of bundles (IRR 0·44, 95% CI 0·39-0·50, p<0·0001; I(2)=89%). INTERPRETATION Implementation of central-line bundles has the potential to reduce the incidence of CLABSIs. FUNDING None.
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Affiliation(s)
- Erwin Ista
- Intensive Care Unit, Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.
| | | | - René F Kornelisse
- Department of Paediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Cynthia van der Starre
- Intensive Care Unit, Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; Department of Paediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, Netherlands
| | - Eric Boersma
- Department of Cardiology, Cardiovascular Research School COEUR, Erasmus MC, Rotterdam, Netherlands
| | - Onno K Helder
- Department of Paediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
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Gassiep I, Armstrong M, Van Havre Z, Schlebusch S, McCormack J, Griffin P. Acute vancomycin-resistant enterococcal bacteraemia outbreak analysis in haematology patients: a case-control study. ACTA ACUST UNITED AC 2015. [DOI: 10.1071/hi15013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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41
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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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Marang-van de Mheen PJ, van Bodegom-Vos L. Meta-analysis of the central line bundle for preventing catheter-related infections: a case study in appraising the evidence in quality improvement. BMJ Qual Saf 2015; 25:118-29. [DOI: 10.1136/bmjqs-2014-003787] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 07/01/2015] [Indexed: 11/04/2022]
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Abstract
Central line-associated bloodstream infections (CLABSI) are one of the leading causes of death in the USA and around the world. As a preventable healthcare-associated infection, they are associated with significant morbidity and excess costs to the healthcare system. Effective and long-term CLABSI prevention requires a multifaceted approach, involving evidence-based best practices coupled with effective implementation strategies. Currently recommended practices are supported by evidence and are simple, such as appropriate hand hygiene, use of full barrier precautions, avoidance of femoral lines, skin antisepsis, and removal of unnecessary lines. The most successful and sustained improvements in CLABSI rates further utilize an adaptive component to align provider behaviors with consistent and reliable use of evidence-based practices. Great success has been achieved in reducing CLABSI rates in the USA and elsewhere over the past decade, but more is needed. This article aims to review the initiatives undertaken to reduce CLABSI and summarizes the sentinel and recent literature regarding CLABSI and its prevention.
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Affiliation(s)
- Asad Latif
- Department of Anesthesiology and Critical Care Medicine, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, 600 North Wolfe Street, Meyer 297-A, Baltimore, MD, 21287, USA,
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