1
|
Patel AB, Schroeder S, Hadzic A, Schulz NA, Bichl JA, Smith CM, Hahn GR, DeRose E, Collins C, Clark J, Wainer C, Hugo M, Rae ML, Evans MA, Vu EL, Sohn L, Pedersen J, Lund AM, Greenwood A, Davies JA, Newburn A, Rajeswaran S, Jhaveri R. 777. Implementation of Antimicrobial Impregnated Catheters to Reduce Central Line Associated Bloodstream Infections (CLABSI) in a Pediatric Setting. Open Forum Infect Dis 2021. [PMCID: PMC8644698 DOI: 10.1093/ofid/ofab466.974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Antimicrobial impregnated catheters (AIC) are one strategy to prevent CLABSI with existing data for central lines required for short duration, however, the strength of evidence, particularly for children, is lacking. Recent 3-year CLABSI data at our institution show 60 (51%) infections occurred in central lines within 8 weeks of insertion, suggesting an opportunity for evaluation of an intervention targeting this time frame. We implemented AIC to evaluate their effectiveness in reducing CLABSI standardized infection ratio (SIR) in patients requiring central venous access for less than 8 weeks. We also monitored for complications (malfunction, line exchange, fungal infection). Methods A stepped wedge observational design was used to implement Minocycline + Rifampin impregnated catheters in a rolling fashion across the institution. Children > 3kg were eligible if admitted to a participating unit and required central venous access through a peripherally inserted central catheter (PICC), non-tunneled catheter, or tunneled non-cuffed femoral catheter for < 8 weeks. Units, prioritized based on CLABSI SIR, were added to the intervention monthly until AIC were used throughout the institution. A multidisciplinary team (infectious diseases and infection control experts, CLABSI leaders, unit-based physicians and nurses, proceduralists, supply chain) met weekly to facilitate implementation, assess for CLABSI and monitor for complications. Figure 1. Study design. ![]()
This figure describes the stepped wedge study design where units were phased into the invention on a rolling monthly basis allowing for comparison between and within units. The shaded boxes represent time periods when units were using antimicrobial impregnated catheters and the white boxes represent time periods when units were using standard non-impregnated catheters. Results AIC were systematically implemented over a 7-month period. The institution’s CLABSI SIR decreased from 0.80 to 0.59 during this timeframe. There were no NHSH defined CLABSI in patients with an AIC during the intervention. Obstacles included shortage of catheters due to supply chain disruption, adjustment of technique for line insertion and cracked/broken lines. Infections and complications were reviewed by the multidisciplinary team and compared to historical rates with non-impregnated lines. ![]()
This figure shows the institution’s rolling 12-month SIR during the intervention period. Conclusion CLABSI SIR decreased at our institution during the intervention period. While many efforts likely led to this reduction (optimizing maintenance bundle, unit based CLABSI initiatives), we believe the use of AIC contributed to this improvement. There were no pediatric-specific safety events identified during implementation. Disclosures Ravi Jhaveri, MD, AstraZeneca (Consultant)Dynavax (Consultant)Elsevier (Other Financial or Material Support, Editorial stipend as Co-EiC, Clinical Therapeutics)Hologic (Consultant)Seqirus (Consultant)
Collapse
Affiliation(s)
- Ami B Patel
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Armela Hadzic
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Nadine A Schulz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Jannell A Bichl
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Craig M Smith
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Erin DeRose
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Catherine Collins
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Jade Clark
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Carolyn Wainer
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Maria Hugo
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Mary Lynn Rae
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Michael A Evans
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Eric L Vu
- Lurie Children's Hospital, Chicago, Illinois
| | - Lisa Sohn
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Jerusha Pedersen
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Anna M Lund
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | | | | | | | - Ravi Jhaveri
- Northwestern University/Lurie Children's Hospital of Chicago, Chicago, Illinois
| |
Collapse
|
2
|
Dandoy CE, Kelley T, Gaur AH, Nagarajan R, Demmel K, Alonso PB, Guinipero T, Savelli S, Hakim H, Owings A, Myers K, Aquino V, Oldridge C, Rae ML, Schjodt K, Kilcrease T, Scurlock M, Marshburn AM, Hill M, Langevin M, Lee J, Cooksey R, Mian A, Eckles S, Ferrell J, El-Bietar J, Nelson A, Turpin B, Huang FS, Lawlor J, Esporas M, Lane A, Hord J, Billett AL. Outcomes after bloodstream infection in hospitalized pediatric hematology/oncology and stem cell transplant patients. Pediatr Blood Cancer 2019; 66:e27978. [PMID: 31486593 DOI: 10.1002/pbc.27978] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 08/06/2019] [Accepted: 08/08/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Pediatric hematology/oncology (PHO) patients receiving therapy or undergoing hematopoietic stem cell transplantation (HSCT) often require a central line and are at risk for bloodstream infections (BSI). There are limited data describing outcomes of BSI in PHO and HSCT patients. METHODS This is a multicenter (n = 17) retrospective analysis of outcomes of patients who developed a BSI. Centers involved participated in a quality improvement collaborative referred to as the Childhood Cancer and Blood Disorder Network within the Children's Hospital Association. The main outcome measures were all-cause mortality at 3, 10, and 30 days after positive culture date; transfer to the intensive care unit (ICU) within 48 hours of positive culture; and central line removal within seven days of the positive blood culture. RESULTS Nine hundred fifty-seven BSI were included in the analysis. Three hundred fifty-four BSI (37%) were associated with at least one adverse outcome. All-cause mortality was 1% (n = 9), 3% (n = 26), and 6% (n = 57) at 3, 10, and 30 days after BSI, respectively. In the 165 BSI (17%) associated with admission to the ICU, the median ICU stay was four days (IQR 2-10). Twenty-one percent of all infections (n = 203) were associated with central line removal within seven days of positive blood culture. CONCLUSIONS BSI in PHO and HSCT patients are associated with adverse outcomes. These data will assist in defining the impact of BSI in this population and demonstrate the need for quality improvement and research efforts to decrease them.
Collapse
Affiliation(s)
- Christopher E Dandoy
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Tammy Kelley
- Children's Hospital of Atlanta, Atlanta, Georgia
| | - Aditya H Gaur
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Rajaram Nagarajan
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kathy Demmel
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Priscila Badia Alonso
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | | | - Hana Hakim
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Angie Owings
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kasiani Myers
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | | | - Mary Lynn Rae
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | | | | | | | | | | | | | | | - Amir Mian
- Arkansas Children's Hospital, Little Rock, Arkansas
| | | | - Justin Ferrell
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Javier El-Bietar
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Adam Nelson
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Brian Turpin
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - John Lawlor
- Children's Hospital Association, Washington, District of Columbia
| | - Megan Esporas
- Children's Hospital Association, Washington, District of Columbia
| | - Adam Lane
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Amy L Billett
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| |
Collapse
|