Central Line-Associated Bloodstream Infections in Non-ICU Inpatient Wards: A 2-Year Analysis

2015 ◽  
Vol 36 (4) ◽  
pp. 424-430 ◽  
Author(s):  
Yoona Rhee ◽  
Michael Heung ◽  
Benrong Chen ◽  
Carol E. Chenoweth
Keyword(s):  
Hematologic Malignancy ◽  
Significant Proportion ◽  
Total Mortality ◽  
Length Of Hospital Stay ◽  
Bloodstream Infections ◽  
Mortality Rates ◽  
Central Line ◽  
Patient Specific ◽  
Dialysis Patients ◽  
Tertiary Teaching

OBJECTIVELittle is known about patient-specific factors contributing to central line-associated bloodstream infection (CLABSI) outside of the intensive care unit (ICU). We sought to describe these factors and hypothesized that dialysis patients would comprise a significant proportion of this cohort.DESIGNRetrospective observational study from January 2010 to December 2011SETTINGAn 880-bed tertiary teaching hospitalPATIENTSPatients with CLABSI in non–ICU wardsMETHODSCLABSI patients were identified from existing infection-control databases and primary chart review was conducted. National Health and Safety Network (NHSN) definitions were utilized for CLABSI and pathogen classification. CLABSI rates were calculated per patient day. Total mortality rates were inclusive of hospice patients.RESULTSOver a 2-year period, 104 patients incurred 113 CLABSIs for an infection rate of 0.35 per 1,000 patient days. The mean length of hospital stay prior to CLABSI was 16±13.3 days, which was nearly 3 times that of hospital-wide non-ICU length of stay. Only 11 patients (10.6%) received dialysis within 48 hours of CLABSI. However, 67% of patients had a hematologic malignancy, and 91.8% of those admitted with a malignant hematologic diagnosis were neutropenic at the time of CLABSI. Enterococcus spp. was the most common organism recovered, and half of all central venous catheters (CVCs) present were peripherally inserted central catheters (PICC lines). Mortality rates were 18.3% overall and 27.3% among dialysis patients.CONCLUSIONSIn patients with CLABSIs outside of the ICU, only 10.6% received dialysis prior to infection. However, underlying hematologic malignancy, neutropenia, and PICC lines were highly prevalent in this population.Infect Control Hosp Epidemiol 2015;00(0):1–7

scholarly journals Pathogens Associated With Repeat Versus Single Central-Line–Associated Bloodstream Infections, Acute-Care Hospitals, NHSN

2020 ◽  
Vol 41 (S1) ◽  
pp. s343-s344
Author(s):  
Margaret A. Dudeck ◽  
Katherine Allen-Bridson ◽  
Jonathan R. Edwards
Keyword(s):  
Acute Care ◽  
National Level ◽  
Bloodstream Infections ◽  
Acute Care Hospitals ◽  
Central Line ◽  
Patient Specific ◽  
Healthcare Associated Infections ◽  
Healthcare Associated ◽  
Repeat Infection ◽  
Single Versus

Background: The NHSN is the nation’s largest surveillance system for healthcare-associated infections. Since 2011, acute-care hospitals (ACHs) have been required to report intensive care unit (ICU) central-line–associated bloodstream infections (CLABSIs) to the NHSN pursuant to CMS requirements. In 2015, this requirement included general medical, surgical, and medical-surgical wards. Also in 2015, the NHSN implemented a repeat infection timeframe (RIT) that required repeat CLABSIs, in the same patient and admission, to be excluded if onset was within 14 days. This analysis is the first at the national level to describe repeat CLABSIs. Methods: Index CLABSIs reported in ACH ICUs and select wards during 2015–2108 were included, in addition to repeat CLABSIs occurring at any location during the same period. CLABSIs were stratified into 2 groups: single and repeat CLABSIs. The repeat CLABSI group included the index CLABSI and subsequent CLABSI(s) reported for the same patient. Up to 5 CLABSIs were included for a single patient. Pathogen analyses were limited to the first pathogen reported for each CLABSI, which is considered to be the most important cause of the event. Likelihood ratio χ2 tests were used to determine differences in proportions. Results: Of the 70,214 CLABSIs reported, 5,983 (8.5%) were repeat CLABSIs. Of 3,264 nonindex CLABSIs, 425 (13%) were identified in non-ICU or non-select ward locations. Staphylococcus aureus was the most common pathogen in both the single and repeat CLABSI groups (14.2% and 12%, respectively) (Fig. 1). Compared to all other pathogens, CLABSIs reported with Candida spp were less likely in a repeat CLABSI event than in a single CLABSI event (P < .0001). Insertion-related organisms were more likely to be associated with single CLABSIs than repeat CLABSIs (P < .0001) (Fig. 2). Alternatively, Enterococcus spp or Klebsiella pneumoniae and K. oxytoca were more likely to be associated with repeat CLABSIs than single CLABSIs (P < .0001). Conclusions: This analysis highlights differences in the aggregate pathogen distributions comparing single versus repeat CLABSIs. Assessing the pathogens associated with repeat CLABSIs may offer another way to assess the success of CLABSI prevention efforts (eg, clean insertion practices). Pathogens such as Enterococcus spp and Klebsiella spp demonstrate a greater association with repeat CLABSIs. Thus, instituting prevention efforts focused on these organisms may warrant greater attention and could impact the likelihood of repeat CLABSIs. Additional analysis of patient-specific pathogens identified in the repeat CLABSI group may yield further clarification.Funding: NoneDisclosures: None

scholarly journals 584. Use of Multi-Disciplinary Prevention Rounds to Reduce Central Line-Associated Bloodstream Infections in a Neonatal Intensive Care Unit

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S275-S276
Author(s):  
Matthew Linam ◽  
Jessica Wright ◽  
Kum Kim ◽  
Cara Van Treek ◽  
Patrick Spafford
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Central Venous Line ◽  
Patient Specific ◽  
Successful Implementation ◽  
Evidence Based ◽  
Clabsi Rate

Abstract Background Despite successful implementation of evidence-based prevention bundles, central line-associated bloodstream infections (CLABSIs) continue to occur in neonatal intensive care units (NICUs). We hypothesized that multi-disciplinary prevention rounds may be able to further reduce CLABSIs. Methods We implemented bedside rounds in a 39-bed tertiary NICU in November 2018 with the focus of reducing CLABSIs. Standardized rounds for all patients with a central venous line (CVL) occurred 2–3 times/week on weekdays during either the day or evening shifts. Rounds included NICU nursing leadership, the Hospital Epidemiologist and the patient’s nurse. Questions focused on the CVL maintenance bundle, reducing line access, and patient-specific CLABSI risk factors. Best practices were reinforced and solutions for identified risk factors were developed. Recommendations were communicated to the physician, as appropriate. Prevention rounds data were collected. Nurses and providers in the NICU were surveyed about their perceptions of the rounds. CLABSIs were identified by Infection Prevention using standard definitions. Results The average daily NICU census was 35.6, with an average of 14 patients with CVLs/day. The average duration of rounds was 45 minutes. Recommendations to physicians, such as changing medications from intravenous to oral or line removal, were accepted 85% of the time. 74.5% of nurses and 87.5% of providers thought that prevention rounds had at least some impact on CLABSI prevention. Nurse and provider responses to the perceived impact of CLABSI prevention rounds are in Tables 1 and 2, respectively. In the 12 months prior to starting prevention rounds, the CLABSI rate was 1.53 /1000 line days and the CLABSI rate for the 6 months after starting rounds was 0.99/1,000 line days, a 65% decrease. Conclusion CLABSI prevention rounds helped reinforce evidence-based prevention practices, identified patient-specific risk factors and improved physician-nurse communication. CLABSIs in NICU were reduced. Disclosures All authors: No reported disclosures.

The use of 3.15% chlorhexidine gluconate/70% alcohol hub disinfection to prevent central line-associated bloodstream infections in dialysis patients

2020 ◽  
Vol 29 (2) ◽  
pp. S24-S26 ◽  
Author(s):  
R. Marty Cooney ◽  
Nisha Manickam ◽  
Paul Becherer ◽  
Laura S. Harmon ◽  
Liza Gregg ◽  
...  
Keyword(s):  
Vascular Grafts ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Chlorhexidine Gluconate ◽  
P Value ◽  
Dialysis Patients ◽  
Skin Disinfection ◽  
Confounding Variables ◽  
Inpatient Population

Purpose: Preventing CLABSI events in the dialysis inpatient population represents significant challenges. Bacteremia associated with lines or grafts are common health-associated infections that lead to adverse patient outcomes. Dialysis patients represent a much higher infection risk due to health frequency needs, more frequent hospitalizations, multiple comorbidity issues, fistula functionality, and multiple attempts for line access leading to additional complications, costs, morbidity, and mortality. Methods: An observational study was conducted including central line device days, CLABSI events, and possible confounding variables in admitted dialysis patients. All CLABSI data were identified according to the Centers for Disease Control and Prevention's National Healthcare Safety Network's definitions for CLABSIs. The intervention involved the removal of 70% alcohol swabs and alcohol hub disinfecting caps, then replacing with swabs containing 3.15% chlorhexidine gluconate/70% alcohol for central line hub disinfection and vascular graft access skin disinfection. Results: The 5-year preintervention period (2008–2012) involved 7568 central line days, 11 CLABSI events, and a 1.45 per 1000 device day rate. The 6-month trial period involved 1559 central line days and no CLABSI events. The 5-year postimplementation period (2013–2017) involved 9787 central line days, 5 CLABSI events, and a 0.51 per 1000 device day rate. The postimplementation period represented a statistically significant (P value=0.0493) reduction with 65% fewer CLABSI events compared with the preimplementation period. Limitations: A limitation was variations in scrub time and dry time during central venous catheter hub access. While we were comparing 2 products, behavioral practices using these 2 products were possible influencers and represent a possible confounding variable. Conclusions: This study found that using alcohol with chlorhexidine gluconate prior to accessing central line hubs and vascular grafts allows for reduction in CLABSI events and sustains statistically significant lower CLABSI rates in the inpatient dialysis population. HIGHLIGHTS Using alcohol with chlorhexidine gluconate (CHG) before accessing central line hubs helps reduce central line-associated bloodstream infection (CLABSI) events Using alcohol with CHG before accessing vascular grafts helps reduce CLABSI events A statistically significant reduction (65%) in CLABSI events occurred after use. Statistically significant lower CLABSI rates are sustainable with use of alcohol with CHG

Device-Associated Infections (Outside of the Neonatal Intensive Care Unit)

2019 ◽  
pp. 31-58
Author(s):  
Manjiree V. Karandikar ◽  
Grace M. Lee ◽  
Galit Holzmann-Pazgal ◽  
Susan Coffin
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Pediatric Care ◽  
Patient Specific ◽  
Prevention Strategies ◽  
Tract Infections

Device-associated infections cause substantial morbidity in children. These healthcare-associated infections (HAI) can increase length of stay and healthcare costs. The strategies used to prevent device-associated infections in children can vary, depending on many patient-specific factors, including the child’s age and physical location when receiving inpatient pediatric care. In addition, infection prevention strategies in children are not always the same as adult prevention strategies. This chapter reviews practical, evidence-based strategies to prevent pediatric ventilator-associated events (VAE), central line–associated bloodstream infections (CLABSI), and catheter-associated urinary tract infections (CAUTI). The recommendations focus on patients outside the neonatal intensive care unit (NICU) setting.

Surveillance for Healthcare-Associated Infections: Hospital-Onset Adult Sepsis Events versus Current Reportable Conditions

2021 ◽  
Author(s):  
Brady Page ◽  
Michael Klompas ◽  
Christina Chan ◽  
Michael R Filbin ◽  
Sayon Dutta ◽  
...  
Keyword(s):  
Medical Record ◽  
Pay For Performance ◽  
Bloodstream Infections ◽  
Mortality Rates ◽  
Central Line ◽  
Healthcare Associated Infections ◽  
Urinary Infections ◽  
Abdominal Infections ◽  
Healthcare Associated ◽  
Record Review

Abstract Background U.S. hospitals are required by CMS to publicly report CLABSI, CAUTI, C.diffficile, MRSA bacteremia, and selected SSIs for benchmarking and pay-for-performance programs. It is unclear, however, to what extent these conditions capture the full breadth of serious healthcare-associated infections (HAIs). CDC’s hospital-onset Adult Sepsis Event (HO-ASE) definition could facilitate more comprehensive and efficient surveillance for serious HAIs, but the overlap between HO-ASE and currently reportable HAIs is unknown. Methods We retrospectively assessed the overlap between HO-ASEs and reportable HAIs among adults hospitalized between June 2015-June 2018 in 3 hospitals. Medical record reviews were conducted for 110 randomly selected HO-ASE cases to determine clinical correlates. Results Amongst 282,441 hospitalized patients, 2,301 (0.8%) met HO-ASE criteria and 1,260 (0.4%) had reportable HAIs. In-hospital mortality rates were higher with HO-ASEs than reportable HAIs (28.6% vs 12.9%). Mortality rates for HO-ASE missed by reportable HAIs were substantially higher than mortality rates for reportable HAIs missed by HO-ASE (28.1% vs 6.3%). Reportable HAIs were only present in 334/2,301 (14.5%) HO-ASEs, most commonly CLABSIs (6.0% of HO-ASEs), C.difficile (5.0%), and CAUTI (3.0%). On medical record review, most HO-ASEs were caused by pneumonia (39.1%, of which only 34.9% were ventilator-associated), bloodstream infections (17.4%, of which only 10.5% were central line-associated), non-C.difficile intra-abdominal infections (14.5%), urinary infections (7.3%, of which 87.5% were catheter-associated), and skin/soft tissue infections (6.4%). Conclusions CDC’s HO-ASE definition detects many serious nosocomial infections missed by currently reportable HAIs. HO-ASE surveillance could increase the efficiency and clinical significance of surveillance while identifying new targets for prevention.

scholarly journals CHG Skin Application in Non-ICU Patients with Central Venous Catheters: Impact on CLABSI, MRSA Bacteremia, and LabID Rates

2020 ◽  
Vol 41 (S1) ◽  
pp. s164-s165
Author(s):  
Carey Dombecki ◽  
Jennifer Sweeney ◽  
Jackie White ◽  
Amanda Valyko ◽  
Terri Stillwell ◽  
...  
Keyword(s):  
Hematologic Malignancy ◽  
Bacterial Colonization ◽  
Bloodstream Infections ◽  
Central Line ◽  
Central Venous Catheters ◽  
Cell Transplant ◽  
Central Venous ◽  
Icu Patients ◽  
Contact Precautions ◽  
Quasi Experimental

Background: Prevention of central-line–associated bloodstream infections (CLABSIs) and methicillin-resistant Staphylococcus aureus (MRSA) infections requires a multifaceted approach including strategies to decrease cutaneous bacterial colonization. Prior studies have shown benefit from chlorhexidine-gluconate (CHG) skin application on CLABSI and MRSA infection rates in intensive care units (ICUs); however, the use of CHG in the non-ICU population has not been well studied. Methods: We performed a quasi-experimental before-and-after study to evaluate the use of daily 2% CHG wipes in non-ICU patients at a 1,000 bed acute-care teaching hospital beginning in November 2017. The study population included adult and pediatric patients with central venous catheters on non-ICU units, excluding patients on the following units: stem cell transplant and hematologic malignancy (these units had already established use of CHG skin application as a standard prior to the intervention), labor and delivery, and psychiatry. CHG was applied according to the manufacturer’s instruction by nurses or nurse aides and random monthly auditing of compliance was performed. NHSN CLABSI, hospital-onset MRSA bacteremia, and hospital-onset MRSA LabID rates were compared for the period 24 months before the intervention (November 1, 2015, through October 31, 2017) to the 24-month period after the intervention (November 1, 2017, through October 31, 2019) using a paired t test. Notably, the health system also discontinued the use of contact precautions for patients with MRSA (excluding MRSA from open, draining wounds) 11 months prior to onset of this intervention. Results: The CLABSI rate decreased by 26% from 0.594 events per 1,000 central-line days (n = 50) before the intervention to 0.438 events per 1,000 central-line days (n = 38) after the intervention (P = 0.19). The number of CLABSIs with gram-positive organisms also decreased by 29%. MRSA LabID rates decreased by 37% from 0.301 events per 1,000 patient days (n = 119) to 0.189 events per 1,000 patient days (n = 75) (P = 0.01). MRSA bacteremia rates decreased by 79% from 0.058 events per 1,000 patient days (n = 23) to 0.012 events per 1,000 patient days (n = 5) (P < 0.01). Compliance with the intervention was 83% (n = 225). Conclusions: Daily CHG skin application in non-ICU patients with central venous catheters is an effective strategy to prevent CLABSIs and MRSA infections. We observed a decrease in MRSA LabID and bacteremia rates despite discontinuation of contact precautions. These findings suggest that a horizontal prevention approach of daily CHG skin application may be an effective alternative to contact isolation to interrupt transmission of MRSA in hospitalized patients outside the ICU setting.Funding: NoneDisclosures: None

scholarly journals The Use of 3.15% Chlorhexidine Gluconate/70% Alcohol Hub Disinfection to Prevent Central Line-Associated Bloodstream Infections in Dialysis Patients

2019 ◽  
Vol 24 (4) ◽  
pp. 33-36
Author(s):  
R. Marty Cooney ◽  
Nisha Manickam ◽  
Paul Becherer ◽  
Laura S. Harmon ◽  
Liza Gregg ◽  
...  
Keyword(s):  
Vascular Grafts ◽  
Bloodstream Infections ◽  
Central Line ◽  
Chlorhexidine Gluconate ◽  
Dialysis Patients

Highlights Using alcohol with CHG before accessing central line hubs helps reduce CLABSI events. Using alcohol with CHG before accessing vascular grafts helps reduce CLABSI events. A statistically significant reduction (65%) in CLABSI events occurred after use. Statistically significant lower CLABSI rates are sustainable with use of alcohol with CHG.

Healthcare-associated infections in the postoperative period after cardiac surgery

2018 ◽  
Vol 14 (1) ◽  
Author(s):  
Edivete Regina Andrioli ◽  
Rubens Andrioli Cavalheiro ◽  
Guilherme Campos Furtado ◽  
Walter José Gomes ◽  
Eduardo Alexandrino Medeiros
Keyword(s):  
Cardiac Surgery ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
Central Line ◽  
Healthcare Associated Infections ◽  
Independent Variables ◽  
Tract Infections ◽  
Healthcare Associated

Background: This study aimed to determine the incidence of healthcare-associated infections (HAIs) in patients undergoing cardiac surgery, analyzing data and clinical outcomes in patients with and without HAIs. Methods: This was a prospective cohort study involving 293 consecutive adult patients undergoing cardiac surgery between April 2011 and October 2012. Results: Of the 293 patients, 60 (24.9%) developed 73 HAIs: 24 surgical site infections, 24 pneumonias, 14 urinary tract infections (UTIs), and 11 bloodstream infections (BSIs). The incidence of ventilator-associated pneumonia was 14.6 cases/1,000 ventilator-days, whereas that of catheter-associated UTI was 7.15 cases/1,000 catheter-days and that of central line-associated BSI was 4.52 cases/1,000 central line-days. Of the 60 patients with HAIs, 20 (33%) died before postoperative day 90, compared with 18 (7.7%) of the 233 patients without HAIs (P < .001). Independent variables associated with infection were length of hospital stay (OR, 1.04; 95% CI, 1.01-1.06; P = .002), duration of urinary catheter use (OR, 1.19; 95% CI, 1.07-1.13; P = .001), and duration of central line use (OR, 1.07; 95% CI, 1.01-1.13; P = .032). Independent variables associated with mortality were Acute Physiology and Chronic Health Evaluation II score (OR, 1.27; 95% CI 1.14-1.42; P < .001), pneumonia (OR, 11.94; 95% CI, 3.83-37.17; P < .001), UTI (OR, 8.59; 95% CI, 1.91-38.7; P = .005), and BSI (OR, 6.16; 95% CI, 1.08-34.98; P = .040). Conclusion: Among the most important complications after cardiac surgery are HAIs. Patients who experience postoperative infections have increased length of hospital stay and mortality.

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