Central Venous Catheter Protective Connector Caps Reduce Intraluminal Catheter-Related Infection

2012 ◽  
Vol 17 (4) ◽  
pp. 210-213 ◽  
Author(s):  
Chuck Ramirez ◽  
Antonina M. Lee ◽  
Ken Welch
Keyword(s):  
Intensive Care ◽  
Central Venous Catheter ◽  
Intensive Care Units ◽  
Blood Stream Infection ◽  
Prospective Trial ◽  
Venous Catheter ◽  
Blood Stream ◽  
Central Line ◽  
Central Venous ◽  
Adult Care

Abstract Background: Central line-associated blood stream infection (CLABSI) rates in adult care intensive care units have been decreasing across the board. However, we continued to see just a few infections in patients whose catheters are in for >4 days. Therefore, we looked at infections associated with intraluminal contamination to help reduce our infection rate. Methods: A protective cap trial was developed and implemented in 2 intensive care units. All of the central venous catheter and intravenous tubing access valves were covered with a protective cap saturated with alcohol. This intervention eliminated the need to wipe off intravenous access points with an alcohol swab. The study was done as a nonrandomized prospective trial occurring March 1, 2011 through February 29, 2012. Results: During 2010, there were 4 CLABSI-related infections. By the end of the trial, we had incurred 1 catheter-associated blood stream infection. CLABSI rate reduced from 1.9 in 2010 to 0.5 during the 1-year trial period. Conclusions: The implementation of the port protector cap system resulted in lower infection rates compared with an alcohol swab technique. Our results indicate that consistent use of the caps in tandem with strict compliance does influence CLABSI rates.

Central Line-Associated Blood Stream Infection in the Critically Ill Trauma Patient

2011 ◽  
Vol 77 (8) ◽  
pp. 1038-1042 ◽  
Author(s):  
Jason W. Smith ◽  
Michael Egger ◽  
Glen Franklin ◽  
Brian Harbrecht ◽  
J. David Richardson
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Central Venous Catheter ◽  
Injury Severity ◽  
Venous Catheter ◽  
Blood Stream ◽  
Central Line ◽  
Central Venous ◽  
Blood Stream Infections ◽  
Sterile Technique

Blood stream infections in the critically ill are a common cause of morbidity. Strict adherence to sterile technique can reduce central line-associated blood stream infections (CLBSIs) and has become a quality improvement measure. We did a retrospective review of 6,014 trauma admissions representing 10,370 catheter days. CLBSI was defined as a positive blood culture with central venous access without evidence of other infectious sources. Thirty-five CLBSIs were identified in the study period (3.26/1,000 line days). The average Injury Severity Score was 32, the average intensive care unit stay was 24 days, and the average overall length of stay was 34 days, which is higher than that of nonCLBSI patients. In 25/35 cases, there was a break in sterile technique during central venous catheter placement (71%). Of the 25 cases, 16 of them were performed in the intensive care unit (64%), five in the operating room (20%), and four in the emergency department (16%). Twenty of the 35 patients with CLBSI (57%) had a total of 24 infections, a 2-fold increase in infectious complications for a given Injury Severity Score. Seventeen (17) of the 25 “dirty” central lines (68%) were changed within 24 hours in an effort to reduce the risk of CLBSI without success. A large percentage of CLBSI can be traced to the initial placement of a central venous line under less than ideal sterile technique. Changing a line within 24 hours may not be sufficient to reduce the risk of CLBSI. Every effort should be made to adhere to proper sterile technique while placing central venous catheter.

Electronic Documentation of Central Venous Catheter—Days: Validation Is Essential

2013 ◽  
Vol 34 (09) ◽  
pp. 899-907 ◽  
Author(s):  
Sheri Chernetsky Tejedor ◽  
Gina Garrett ◽  
Jesse T. Jacob ◽  
Ellen Meyer ◽  
Mary Dent Reyes ◽  
...  
Keyword(s):  
Intensive Care ◽  
Central Venous Catheter ◽  
Intensive Care Units ◽  
Error Rate ◽  
Total Error ◽  
Venous Catheter ◽  
Central Line ◽  
Electronic Documentation ◽  
Central Venous ◽  
Electronic Data

Background.Measurement of central line-associated bloodstream infection (CLABSI) rates outside of intensive care units is challenged by the difficulty in reliably determining central venous catheter (CVC) use. The National Healthcare Safety Network (NHSN) allows for use of electronic data for determination of CVC-days, but validation of electronic data has not been studied systematically.Objective.To design and validate a process to reliably measure CVC-days outside of the intensive care units that leverages electronic documentation.Methods.Thirty-four inpatient wards at 2 academic hospitals using a common electronic platform for nursing documentation were studied. Electronic queries were created to capture patient and CVC information, and tools and processes for tracking and reporting errors in documentation were developed. Strategies to validate electronic data included comparisons with manual CVC-day determinations and automated data validation using customized tools. Interventions included redesign of documentation interface, real-time audit with feedback of errors, and education. The primary outcome was patient-level total error rate in electronic CVC-day measurement compared with manually counted CVC-days.Results.At baseline, there were a mean (± standard deviation) of 0.32 ± 0.25 electronic CVC-day errors (omission and commission errors summed and counted equally) per manually counted CVC-day. After several process improvement cycles over 7 months, the error rate decreased to <0.05 errors per CVC-day and remained at or below this level for 2 years.Conclusions.Baseline electronic CVC-day counts had a high error rate. Stepwise interventions reduced errors to consistently low levels. Validation of electronic calculation of CVC-days is essential to ensure accuracy, particularly if these data will be used for interinstitutional comparison.

Central-Line–Associated Bloodstream Infections in Québec Intensive Care Units: Results from the Provincial Healthcare-Associated Infections Surveillance Program (SPIN)

2016 ◽  
Vol 37 (10) ◽  
pp. 1186-1194 ◽  
Author(s):  
Lynne Li ◽  
Elise Fortin ◽  
Claude Tremblay ◽  
Muleka Ngenda-Muadi ◽  
Caroline Quach ◽  
...  
Keyword(s):  
Intensive Care ◽  
Central Venous Catheter ◽  
Intensive Care Units ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Incidence Rates ◽  
Surveillance Program ◽  
Central Venous ◽  
Healthcare Associated

BACKGROUNDFollowing implementation of bundled practices in 2009 in Quebec and Canadian intensive care units (ICUs), we describe CLABSI epidemiology during the last 8 years in the province of Québec (Canada) and compare rates with Canadian and American benchmarks.METHODSCLABSI incidence rates (IRs) and central venous catheter utilization ratios (CVCURs) by year and ICU type were calculated using 2007–2014 data from the Surveillance Provinciale des Infections Nosocomiales (SPIN) program. Using American and Canadian surveillance data, we compared SPIN IRs to rates in other jurisdictions using standardized incidence ratios (SIRs).RESULTSIn total, 1,355 lab-confirmed CLABSIs over 911,205 central venous catheter days (CVC days) were recorded. The overall pooled incidence rate (IR) was 1.49 cases per 1,000 CVC days. IRs for adult teaching ICUs, nonteaching ICUs, neonatal ICUs (NICUs), and pediatric ICUs (PICUs) were 1.04, 0.91, 4.20, and 2.15 cases per 1,000 CVC days, respectively. Using fixed SPIN 2007–2009 benchmarks, CLABSI rates had decreased significantly in all ICUs except for PICUs by 2014. Rates declined by 55% in adult teaching ICUs, 52% in adult nonteaching ICUs, and 38% in NICUs. Using dynamic American and Canadian CLABSI rates as benchmarks, SPIN adult teaching ICU rates were significantly lower and adult nonteaching ICUs had lower or comparable rates, whereas NICU and PICU rates were higher.CONCLUSIONQuébec ICU CLABSI surveillance shows declining CLABSI rates in adult ICUs. The absence of a decrease in CLABSI rate in NICUs and PICUs highlights the need for continued surveillance and analysis of factors contributing to higher rates in these populations.Infect Control Hosp Epidemiol 2016;1–9

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