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Drugeon B, Marjanovic N, Boisson M, Buetti N, Mimoz O, Guenezan J. Insertion site and risk of peripheral intravenous catheter colonization and/or local infection: a post hoc analysis of the CLEAN 3 study including more than 800 catheters. Antimicrob Resist Infect Control 2024; 13:57. [PMID: 38840171 DOI: 10.1186/s13756-024-01414-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/25/2024] [Indexed: 06/07/2024] Open
Abstract
AIM Although uncommon, infections associated with peripheral intravenous catheters (PIVCs) may be responsible for severe life-threatening complications and increase healthcare costs. Few data are available on the relationship between PIVC insertion site and risk of infectious complications. METHODS We performed a post hoc analysis of the CLEAN 3 database, a randomized 2 × 2 factorial study comparing two skin disinfection procedures (2% chlorhexidine-alcohol or 5% povidone iodine-alcohol) and two types of medical devices (innovative or standard) in 989 adults patients requiring PIVC insertion before admission to a medical ward. Insertion sites were grouped into five areas: hand, wrist, forearm, cubital fossa and upper arm. We evaluated the risk of risk of PIVC colonization (i.e., tip culture eluate in broth showing at least one microorganism in a concentration of at least 1000 Colony Forming Units per mL) and/or local infection (i.e., organisms growing from purulent discharge at PIVC insertion site with no evidence of associated bloodstream infection), and the risk of positive PIVC tip culture (i.e., PIVC-tip culture eluate in broth showing at least one microorganism regardless of its amount) using multivariate Cox models. RESULTS Eight hundred twenty three PIVCs with known insertion site and sent to the laboratory for quantitative culture were included. After adjustment for confounding factors, PIVC insertion at the cubital fossa or wrist was associated with increased risk of PIVC colonization and/or local infection (HR [95% CI], 1.64 [0.92-2.93] and 2.11 [1.08-4.13]) and of positive PIVC tip culture (HR [95% CI], 1.49 [1.02-2.18] and 1.59 [0.98-2.59]). CONCLUSION PIVC insertion at the wrist or cubital fossa should be avoided whenever possible to reduce the risk of catheter colonization and/or local infection and of positive PIVC tip culture.
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Affiliation(s)
- Bertrand Drugeon
- CHU de Poitiers, Service des Urgences Adultes -SAMU, 86-Centre 15-2, Rue de La Milétrie, Poitiers, Cedex, 86021, France
- INSERM, U1070, Pharmacologie Des Agents Antimicrobiens Et Antibio-Résistances, Poitiers, France
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, QLD, Australia
| | - Nicolas Marjanovic
- CHU de Poitiers, Service des Urgences Adultes -SAMU, 86-Centre 15-2, Rue de La Milétrie, Poitiers, Cedex, 86021, France
- INSERM CIC1402, CHU de Poitiers, Poitiers, France
| | - Matthieu Boisson
- INSERM, U1070, Pharmacologie Des Agents Antimicrobiens Et Antibio-Résistances, Poitiers, France
- Université de Poitiers, UFR de Médecine Pharmacie, Poitiers, France
- Service d'Anesthésie Et Réanimations Et Médecine Péri-Opératoire, CHU de Poitiers, Poitiers, France
| | - Niccolò Buetti
- Infection Control Program and WHO Collaborating Centre, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
- Université Paris-Cité, INSERM, IAME UMR 1137, 75018, Paris, France
| | - Olivier Mimoz
- CHU de Poitiers, Service des Urgences Adultes -SAMU, 86-Centre 15-2, Rue de La Milétrie, Poitiers, Cedex, 86021, France.
- INSERM, U1070, Pharmacologie Des Agents Antimicrobiens Et Antibio-Résistances, Poitiers, France.
- Université de Poitiers, UFR de Médecine Pharmacie, Poitiers, France.
| | - Jérémy Guenezan
- CHU de Poitiers, Service des Urgences Adultes -SAMU, 86-Centre 15-2, Rue de La Milétrie, Poitiers, Cedex, 86021, France
- INSERM, U1070, Pharmacologie Des Agents Antimicrobiens Et Antibio-Résistances, Poitiers, France
- Université de Poitiers, UFR de Médecine Pharmacie, Poitiers, France
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Pérez-Granda MJ, Irigoyen-von-Sierakowski Á, Toledo N, Rodríguez E, Cruz ML, Hernanz G, Serra JA, Kestler M, Muñoz P, Guembe M. Impact of an interventional bundle on complications associated with peripheral venous catheters in elderly patients. Eur J Clin Microbiol Infect Dis 2024; 43:703-712. [PMID: 38326546 DOI: 10.1007/s10096-024-04771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/31/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE Elderly patients admitted to geriatrics departments often require peripheral venous catheters (PVC), which should be inserted and maintained following a series of preventive recommendations. Our objective was to evaluate the impact of a training bundle comprising measures aimed at reducing complications associated with the use of PVC in elderly patients admitted to a tertiary teaching hospital. METHODS We performed a prospective study of patients who received a PVC within 24 h of admission to a geriatrics department. After a 10-month pre-interventional period, we implemented an educational and interventional bundle over a 9-month period. Follow-up was until catheter withdrawal. We analyzed and compared clinical and microbiological data between both study periods. RESULTS A total of 344 patients (475 PVC) were included (pre-intervention period, 204 patients (285 PVC); post-intervention period, 140 patients (190 PVC)). No statistically significant differences in demographic characteristics were observed between the study periods. The colonization and phlebitis rates per 1000 admissions in both periods were, respectively, 36.7 vs. 24.3 (p = 0.198) and 81.5 vs. 65.1 (p = 0.457). The main reason for catheter withdrawal was obstruction/malfunctioning (33.3%). Obstruction rate was higher for those inserted in the hand than for those inserted at other sites (55.7% vs. 44.3%, p = 0.045). CONCLUSIONS We found no statistically significant differences regarding phlebitis and catheter tip colonization rates. It is necessary to carry out randomized studies assessing the most cost-effective measure to reduce complications associated with PVC.
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Affiliation(s)
- María Jesús Pérez-Granda
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo, 46, 28007, Madrid, Spain
- Department of Nursing, School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - Álvaro Irigoyen-von-Sierakowski
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Neera Toledo
- Intermal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Eva Rodríguez
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Luisa Cruz
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Giovanna Hernanz
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José Antonio Serra
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Biomedical Research Networking Centre On Frailty and Healthy Ageing, CIBERFES, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Martha Kestler
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo, 46, 28007, Madrid, Spain.
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
- Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain.
| | - María Guembe
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo, 46, 28007, Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
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Faltoni M, Catho G, Pianca E, Minka-Obama B, Zanella MC, Chraiti MN, Fortchantre L, Harbarth S, Buetti N. Catheter size and risk of short-term peripheral venous catheter-associated bloodstream infections: an observational study. Clin Microbiol Infect 2024; 30:548-551. [PMID: 38142893 DOI: 10.1016/j.cmi.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/12/2023] [Accepted: 12/17/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVES Short-term peripheral venous catheter-associated bloodstream infections (PVC-associated BSI) are disregarded in the literature because of their relatively low incidence. No data are available on the association between PVC diameter size and the risk of PVC-associated BSI. METHODS Using a prospective database, we performed an observational study at the University of Geneva Hospitals from 1 January 2020 to 31 December 2021, including all patients with a PVC. We used univariable and multivariable marginal Cox regression models for clustered data to investigate the association between catheter size and PVC-associated BSI. The main variable of interest 'catheter size' was forced into our multivariable models. Confounders, which are thought to influence the risk of PVC-associated BSI, were used as adjustment factors. RESULTS A total of 206 804 PVCs were included. In all, 10 806 of 201 413 (5.4%), 80 274 of 201 413 (39.9%), 93 047 of 201 413 (46.2%) and 17 286 of 201 413 (8.6%) PVCs measured ≤16G, 18G, 20G and ≥22G, respectively. The univariable analysis showed that diameters of ≤16G were significantly associated with a higher risk of PVC-associated BSI (hazard ratio [HR] 4.52, 95% CI, 1.14-18.00). Multivariable models confirmed these results (HR 4.65, 95% CI, 1.19-18.20). Sensitivity analyses including PVC inserted only in 2021 (HR 4.80, 95% CI, 1.21-19.10), for dwell time >2 days (HR 3.67, 95% CI, 0.92-14.65) and only in adults (HR 3.97, 95% CI, 0.97-15.39) showed similar results. DISCUSSION Larger PVC size may increase the risk of PVC-associated BSI. Diameter size should be considered when selecting PVCs to reduce the burden of PVC-associated BSI.
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Affiliation(s)
- Matteo Faltoni
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy
| | - Gaud Catho
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; Division of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
| | - Eva Pianca
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Basilice Minka-Obama
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marie-Céline Zanella
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marie-Nöelle Chraiti
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Loïc Fortchantre
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Niccolὸ Buetti
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; IAME U 1137, INSERM, Université Paris-Cité, Paris, France.
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Zanella MC, Pianca E, Catho G, Obama B, De Kraker MEA, Nguyen A, Chraiti MN, Sobel J, Fortchantre L, Harbarth S, Abbas M, Buetti N. Increased Peripheral Venous Catheter Bloodstream Infections during COVID-19 Pandemic, Switzerland. Emerg Infect Dis 2024; 30:159-162. [PMID: 38063084 PMCID: PMC10756358 DOI: 10.3201/eid3001.230183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
Studies suggest that central venous catheter bloodstream infections (BSIs) increased during the COVID-19 pandemic. We investigated catheter-related BSIs in Switzerland and found peripheral venous catheter (PVC) BSI incidence increased during 2021-2022 compared with 2020. These findings should raise awareness of PVC-associated BSIs and prompt inclusion of PVC BSIs in surveillance systems.
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Benenson S, Ben-Yosef Y, Schwartz C, Cohen MJ, Oster Y. Sources of primary bloodstream infections in internal medicine patients - a cohort study. Eur J Intern Med 2023; 113:69-74. [PMID: 37117089 DOI: 10.1016/j.ejim.2023.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/20/2023] [Accepted: 04/22/2023] [Indexed: 04/30/2023]
Abstract
PURPOSE To describe the sources of bloodstream infections (BSIs) in internal-medicine patients, on admission and during hospitalization, and to determine the proportion of BSIs in which no secondary cause could be defined (i.e., primary-BSI). METHODS We analyzed all BSIs at the internal-medicine wards of the two campuses of the Hadassah Hebrew-University Medical Center, during 2017-2018. We defined the BSI source of each event (secondary, Central-line associated BSI (CLABSI) or primary non-CLABSI) and compared BSIs present on admission (POA) to hospital acquired (HA). RESULTS There were 595 patient-unique BSI events, 316 (53.1%) POA-BSI and 279 (46.9%) HA-BSI. Overall, 309 (51.9%) were secondary, 194 (32.6%) primary non-CLABSI and 92 (15.5%) CLABSI. Primary non-CLABSI in the POA-BSI group was 20.6% vs. 46.2% in the HA-BSI group (p = 0.001). The length of hospital stay (LOS) of the HA-BSI group was longer than in the POA-BSI group (mean LOS, 19 days vs. 13.6 days, p = 0.01) and mortality rate was higher (48.7% vs. 19%, p = 0.001). Staphylococcus aureus was more common in primary non-CLABSI than in CLABSI and secondary BSI (29.5%, 12.8% and 16.2%, respectively). CONCLUSIONS The proportion of primary non-CLABSI among HA-BSI events is very high (46.2%). The absence of any plausible source for these BSIs, and the fact that in our hospital more than 90% of patients in medicine wards have peripheral lines, suggests that these may be a possible source for primary non-CLABSIs. Measures to prevent peripheral-line associated BSI (PLABSI), like those implemented successfully for the prevention of CLABSI, should be considered.
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Affiliation(s)
- Shmuel Benenson
- Faculty of Medicine, Hebrew University of Jerusalem, Israel; Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
| | | | - Carmela Schwartz
- Faculty of Medicine, Hebrew University of Jerusalem, Israel; Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Matan J Cohen
- Faculty of Medicine, Hebrew University of Jerusalem, Israel; Clalit Health Services, Jerusalem District, Affiliated With The Hebrew University, 1 Ygal Alon St, Bet Shemesh, Jerusalem, Israel.
| | - Yonatan Oster
- Faculty of Medicine, Hebrew University of Jerusalem, Israel; Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Rowley S, Clare S. ANTT ® standardisation facilitates new efficiencies with a novel partially-sterile Standard-ANTT PIVC Pack. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S4-S10. [PMID: 37027407 DOI: 10.12968/bjon.2023.32.7.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Introduction: The widespread adoption of the ANTT®Clinical Practice Framework as a single standard for aseptic technique, has highlighted that many clinical procedures do not require a sterile procedure pack to be performed safely and aseptically. This study explores the utilisation of a partially-sterile procedure pack that is specifically tailored to Standard-ANTT. Methods: A prospective project improvement evaluation, using a non-paired sample (pre: n=41; post: n =33) of emergency department staff in an NHS hospital. Staff were evaluated performing peripheral intravenous cannulations (PIVC) using Standard-ANTT and the B. Braun Standard-ANTT peripheral cannulation pack. Findings: Significant improvements were observed in practice following the implementation of the pack and training in Standard-ANTT, including: Key-Part protection significantly improved (pre: n=28, 68.2%; post: n=33, 100%), and reduction in the Key-Site being touched after disinfection (pre: n=17; 41.4%; post n=5; 15.1%). Conclusions: In conjunction with appropriate education and training, this study provides proof of concept that due to the widespread use of the ANTT Clinical Practice Framework as a single standard aseptic technique, procedure packs that are specifically tailored to Standard-ANTT, can help to promote best practice and improve efficiencies. DEFINITIONS Partially-sterile procedure pack - all items required to be sterile remain in their individual blister wrapper. The final assembled pack itself is not then subjected to a further round of sterilisation as it is not needed. Sterile procedure pack - often contains a mixture of non-sterile and sterile items that have been stripped from their individual blister wrapper requiring the sterilisation of the final assembled pack.
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Affiliation(s)
- Stephen Rowley
- Clinical Director, The Association for Safe Aseptic Practice (ASAP)
| | - Simon Clare
- Research and Development Director, The Association for Safe Aseptic Practice (ASAP)
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