Catheter-Related Polymicrobial Bloodstream Infections among Pediatric Bone Marrow Transplant Outpatients—Atlanta, Georgia, 2007

2010 ◽  
Vol 31 (05) ◽  
pp. 522-527 ◽  
Author(s):  
Petra Wiersma ◽  
Sarah Schillie ◽  
Harry Keyserling ◽  
J. Renee Watson ◽  
Anindya De ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplant ◽  
Infection Prevention ◽  
Patient Flow ◽  
Conditional Logistic Regression ◽  
Bloodstream Infections ◽  
Marrow Transplant ◽  
Single Use ◽  
Gram Negative Organisms ◽  
Preservative Free

Objective.To identify risk factors for polymicrobial bloodstream infections (BSIs) in pediatric bone marrow transplant (BMT) outpatients attending a newly constructed clinic affiliated with a children's hospital.Methods.All 30 outpatients treated at a new BMT clinic during September 10-21, 2007, were enrolled in a cohort study. The investigation included interviews, medical records review, observations, and bacterial culture and molecular typing of patient and environmental isolates. Data were analyzed using exact conditional logistic regression.Results.Thirteen patients experienced BSIs caused by 16 different, predominantly gram-negative organisms. Presence of a tunneled catheter (odds ratio [OR], 19.9 [95% confidence interval {CI}, 2.4-∞), catheter access (OR, 13.7 [95% CI, 1.8-∞]), and flushing of a catheter with predrawn saline (OR, 12.9 [95% CI, 1.0-766.0]) were independently associated with BSI. The odds of experiencing a BSI increased by a factor of 16.8 with each additional injection of predrawn saline (95% CI, 1.8-827.0). Although no environmental source of pathogens was identified, interviews revealed breaches in recommended infection prevention practice and medication handling. Saline flush solutions were predrawn, and multiple doses were obtained from single-dose preservative-free vials to avoid delays in patient care.Conclusion.We speculate that infection prevention challenges in the new clinic, combined with successive needle punctures of vials, facilitated extrinsic contamination and transmission of healthcare-associated pathogens. We recommend that preservative-free single-use vials not be punctured more than once. Use of single-use prefilled saline syringes might prevent multiuse of single-use saline vials. Storage of saline outside a medication supply system might be advisable. Before opening new clinic facilities, hospitals should consider conducting a mock patient flow exercise to identify infection control challenges.

scholarly journals Admission Screening for Clostridium difficile Infection (CDI) in Bone Marrow Transplant Populations

2020 ◽  
Vol 41 (S1) ◽  
pp. s113-s113
Author(s):  
Jessica Tarabay ◽  
Marie Ayers ◽  
Tanushree Soni ◽  
Amelia Langston ◽  
Emily Bracewell ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Clostridium Difficile ◽  
Bone Marrow Transplant ◽  
Early Identification ◽  
Infection Prevention ◽  
Marrow Transplant ◽  
Cell Transplant ◽  
Admission Screening ◽  
Screening Protocol ◽  
Toxin Assay

Background:Clostridium difficile infection (CDI) is the most common healthcare-associated infection (HAI) and is often associated with increased medical costs and longer lengths of hospital stay. Previous studies have highlighted that hematopoietic stem cell transplant (HSCT) recipients are at an increased risk for CDI of up to 33% from other hospitalized patients. Studies have also supported the prevalence of asymptomatic colonization with C. difficile among HSCT patients. Asymptomatic colonization with C. difficile is a significant risk factor for transmission of infection to other patients developing hospital onset (HO-CDI). Therefore, targeted infection prevention efforts, such as early identification of patients with community-onset (CO-CDI) and patients with asymptomatic colonization with CDI in HSCT patients, may be effective in reducing the occurrence of HO-CDI. We discuss the CDI admission screening protocol in Emory University Hospital’s (EUH) bone marrow transplant (BMT) unit. Methods: As part of an infection prevention initiative, a CDI screening protocol was implemented in December 2018 for all patients that admitted to the EUH inpatient BMT unit. Upon admission, patients were screened for CO-CDI symptoms, specifically loose or unformed stools. A C. difficile toxin assay PCR would be collected within the first 3 calendar days of admission for all patients screened. Patients with symptoms were placed on isolation precautions pending results of the C. difficile toxin assay. If a patient had a positive C. difficile toxin assay result, isolation precautions would be maintained for the duration of hospitalization regardless of symptoms. Patients who are were unable to produce a stool specimen on the first 3 days of admission were excluded from the screening protocol. Patients with positive C. difficile toxin assay PCRs were classified as CO-CDI and were treated. Results: Since implementation of the CDI screening protocol, 109 CDI events were identified from January 2019 to October 2019. Moreover, 79% of positive C. difficile toxin assays were collected within the first 3 calendar days of admission. HO-CDI has decreased from 78% in 2018 to 21% during the designated time frame. Conclusions: CDI screening upon admission of BMT populations has shown a decrease among HO-CDI by early identification of CO-CDI and CO asymptomatic colonization with C. difficile. This early identification has allowed rapid implementation of infection preventions precautions, thus reducing risk of unit-based transmission.Funding: NoneDisclosures: None

Infection Prevention and Control Planning for Development of a new Bone Marrow Transplant Unit is NOT a Lone Star Production

2012 ◽  
Vol 40 (5) ◽  
pp. e69-e70
Author(s):  
Elizabeth (Libby) Singhoffer ◽  
Catherine Tierney ◽  
Gregory Braswell ◽  
Bradley Beckham ◽  
Mark Slye ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplant ◽  
Prevention And Control ◽  
Infection Prevention ◽  
Marrow Transplant ◽  
Infection Prevention And Control ◽  
Star Production ◽  
And Control

scholarly journals POLYCLONAL OUTBREAK OF BLOODSTREAM INFECTIONS CAUSED BY Burkholderia cepacia COMPLEX IN HEMATOLOGY AND BONE MARROW TRANSPLANT OUTPATIENT UNITS

2014 ◽  
Vol 56 (1) ◽  
pp. 71-76 ◽  
Author(s):  
Icaro Boszczowski ◽  
Gladys Villas Boas do Prado ◽  
Mirian F. Dalben ◽  
Roberto C. P. Telles ◽  
Maristela Pinheiro Freire ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Laminar Flow ◽  
Hand Hygiene ◽  
Bone Marrow Transplant ◽  
Burkholderia Cepacia ◽  
Bloodstream Infections ◽  
Marrow Transplant ◽  
Burkholderia Cepacia Complex ◽  
Hand Hygiene Improvement ◽  
Laminar Flow Cabinet

Aim: The objective was to describe an outbreak of bloodstream infections by Burkholderia cepacia complex (Bcc) in bone marrow transplant and hematology outpatients. Methods: On February 15, 2008 a Bcc outbreak was suspected. 24 cases were identified. Demographic and clinical data were evaluated. Environment and healthcare workers' (HCW) hands were cultured. Species were determined and typed. Reinforcement of hand hygiene, central venous catheter (CVC) care, infusion therapy, and maintenance of laminar flow cabinet were undertaken. 16 different HCWs had cared for the CVCs. Multi-dose heparin and saline were prepared on counter common to both units. Findings: 14 patients had B. multivorans (one patient had also B. cenopacia), six non-multivorans Bcc and one did not belong to Bcc. Clone A B. multivorans occurred in 12 patients (from Hematology); in 10 their CVC had been used on February 11/12. Environmental and HCW cultures were negative. All patients were treated with meropenem, and ceftazidime lock-therapy. Eight patients (30%) were hospitalized. No deaths occurred. After control measures (multidose vial for single patient; CVC lock with ceftazidime; cleaning of laminar flow cabinet; hand hygiene improvement; use of cabinet to store prepared medication), no new cases occurred. Conclusions: This polyclonal outbreak may be explained by a common source containing multiple species of Bcc, maybe the laminar flow cabinet common to both units. There may have been contamination by B. multivorans (clone A) of multi-dose vials.

Risk Factors for Anaerobic Bloodstream Infections in Bone Marrow Transplant Recipients

2001 ◽  
Vol 33 (3) ◽  
pp. 338-343 ◽  
Author(s):  
Rebecca L. Lark ◽  
Shelly A. McNeil ◽  
Kristi VanderHyde ◽  
Zehra Noorani ◽  
Joseph Uberti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Marrow ◽  
Bone Marrow Transplant ◽  
Bloodstream Infections ◽  
Marrow Transplant ◽  
Transplant Recipients
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