scholarly journals Central Line–Associated Bloodstream Infections in Neonates with Gastrointestinal Conditions: Developing a Candidate Definition for Mucosal Barrier Injury Bloodstream Infections

2014 ◽  
Vol 35 (11) ◽  
pp. 1391-1399 ◽  
Author(s):  
Susan E. Coffin ◽  
Sarah B. Klieger ◽  
Christopher Duggan ◽  
W. Charles Huskins ◽  
Aaron M. Milstone ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Neonatal Intensive Care ◽  
Chart Review ◽  
Bloodstream Infections ◽  
Central Line ◽  
Mucosal Barrier ◽  
Neonatal Intensive Care Units ◽  
Gastrointestinal Conditions ◽  
Mucosal Barrier Injury ◽  
Definition Of

Objective.To develop a candidate definition for central line–associated bloodstream infection (CLABSI) in neonates with presumed mucosal barrier injury due to gastrointestinal (MBI-GI) conditions and to evaluate epidemiology and microbiology of MBI-GI CLABSI in infantsDesign.Multicenter retrospective cohort study.Setting.Neonatal intensive care units from 14 US children’s hospitals and pediatric facilities.Methods.A multidisciplinary focus group developed a candidate MBI-GI CLABSI definition based on presence of an MBI-GI condition, parenteral nutrition (PN) exposure, and an eligible enteric organism. CLABSI surveillance data from participating hospitals were supplemented by chart review to identify MBI-GI conditions and PN exposure.Results.During 2009–2012, 410 CLABSIs occurred in 376 infants. MBI-GI conditions and PN exposure occurred in 149 (40%) and 324 (86%) of these 376 neonates, respectively. The distribution of pathogens was similar among neonates with versus without MBI-GI conditions and PN exposure. Fifty-nine (16%) of the 376 initial CLABSI episodes met the candidate MBI-GI CLABSI definition. Subsequent versus initial CLABSIs were more likely to be caused by an enteric organism (22 of 34 [65%] vs 151 of 376 [40%]; P = .009) and to meet the candidate MBI-GI CLABSI definition (19 of 34 [56%] vs 59 of 376 [16%]; P < .01).Conclusions.While MBI-GI conditions and PN exposure were common, only 16% of initial CLABSIs met the candidate definition of MBI-GI CLABSI. The high proportion of MBI-GI CLABSIs among subsequent infections suggests that infants with MBI-GI CLABSI should be a population targeted for further surveillance and interventional research.Infect Control Hosp Epidemiol 2014;35(11):1391–1399

scholarly journals 582. Impact of Central Line Bundle for Prevention of Umbilical Vein Catheter-Related Bloodstream Infections in a Neonatal Intensive Care Unit

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S275-S275
Author(s):  
İlker devrim ◽  
Ferit Kulalı ◽  
İlknur Çağlar ◽  
Yeliz Oruc ◽  
Nevbahar Demiray ◽  
...  
Keyword(s):  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Umbilical Vein ◽  
Bloodstream Infections ◽  
Central Line ◽  
Neonatal Intensive Care Units ◽  
Vein Catheter ◽  
Single Use ◽  
Umbilical Vein Catheter ◽  
Central Line Bundle

Abstract Background Umbilical vein catheters (UVC) are one of the most common types of vascular access device in the neonatal intensive care units. Central line-associated bloodstream infections were reported to be in the first place of healthcare-associated infections in preterm infants. In this study, we aimed to evaluate the effectiveness of the bundle applications in the prevention of umbilical vein catheter-associated bloodstream infections in neonates including premature infants. Methods This 40 months cross-sectional study included two periods, including pre-bundle period (from August 1, 2015 to March 31, 2017) and bundle period (April 1, 2017 to November 30, 2018). The umbilical vein catheter-related bloodstream infections, catheter line days, number of the patients were recorded and compared between the prebundle and bundle periods. Bundle steps were defined as education-training-assignment, evaluation of daily catheter indications, hand hygiene and aseptic technique while insertion, maximal sterile barrier precautions, closure of the catheter area with transparent semi-permeable membrane, using needless connectors in stead of 3-way stop-cocks, and single-use prefilled saline syringes for flushing. Results During the whole study period total umbilical vein catheter days were 2,228 days. During the prebundle period there was 10 and in the bundle period there was 2 umbilical vein catheter-related bloodstream infections (Table 1). While umbilical vein-associated bloodstream infection rate was 8.9 per 1,000 catheter days in the pre-bundle period, and significantly decreased to 1.79 in the bundle period (P < 0.05). After the introduction of bundle applications, it was observed that the rate of infection decreased by 68% (P < 0.05) Conclusion Our study showed that implementation of central line bundle including needless connectors and single-use prefilled syringes for umbilical vein-related bloodstream infections was effective for the prevention of catheter-related bloodstream infections in neonatal intensive care units. Disclosures All authors: No reported disclosures.

scholarly journals 585. Shifting Focus Toward Healthcare-Associated Bloodstream Infections: Need for More NICU-Specific NHSN Definitions

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S276-S277
Author(s):  
Sonali D Advani ◽  
Thomas Murray ◽  
Matthew Bizzarro
Keyword(s):  
Neonatal Intensive Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Mucosal Barrier ◽  
Source Attribution ◽  
Chi Square ◽  
Mortality And Morbidity ◽  
Source Of Infection ◽  
Chi Square Test ◽  
Healthcare Associated

Abstract Background Healthcare-associated bloodstream infections (HABSIs) are a significant cause of mortality and morbidity in the neonatal intensive care unit (NICU) population. Our objectives were to review the epidemiology of HABSIs in our NICU and to examine the applicability of National Healthcare Safety Network (NHSN) definitions to the NICU population. Methods We performed a retrospective review of all neonates admitted to the 54-bed level IV NICU at Yale-New Haven Children’s Hospital with a HABSI between January 1, 2013 and December 31, 2018. HABSI was defined as a positive blood culture at >72 hours of life growing an organism not considered a contaminant. Clinical definitions per treating NICU team and NHSN site-specific definitions were compared for source attribution using McNemar’s Chi-square test. Results We identified 88 HABSIs with an incidence rate of 0.81 per 1,000 patient-days. Only 13% of these were central line-associated bloodstream infections (CLABSIs). Infants with a HABSI had median birth weight and gestational age of 830 grams and 26 weeks, respectively, with a high percentage requiring mechanical ventilation parenteral nutrition and vascular access (Table 1). Sepsis-related mortality was 24%. The majority of HABSIs were caused by gram-positive and gram-negative bacteria (Figure 1). Most were secondary to necrotizing enterocolitis, pneumonia or a source that was not identified (Table 2). NHSN definitions were less likely to identify a source compared with clinical definitions per NICU treating team (P < 0.001, Table 2). Fifty percent of patients without an identified source of infection by NHSN criteria were identified with a Mucosal Barrier Injury (MBI) organism, likely causing bacteremia from gut translocation. Conclusion HABSIs occur in premature babies with comorbidities, and are more prevalent than CLABSIs. Gut translocation with MBI organisms may be an important unidentified source of HABSIs in neonates. With the increasing focus on HABSI prevention, there is a need for better NHSN definitions for source attribution of bloodstream infections in neonates. Disclosures All authors: No reported disclosures.

scholarly journals Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infections (MBI-LCBI): Descriptive Analysis of Data Reported to National Healthcare Safety Network (NHSN), 2013

2015 ◽  
Vol 37 (1) ◽  
pp. 2-7 ◽  
Author(s):  
Lauren Epstein ◽  
Isaac See ◽  
Jonathan R. Edwards ◽  
Shelley S. Magill ◽  
Nicola D. Thompson
Keyword(s):  
Acute Care ◽  
Descriptive Analysis ◽  
Bloodstream Infections ◽  
Central Line ◽  
Mucosal Barrier ◽  
National Healthcare ◽  
National Healthcare Safety Network ◽  
Mucosal Barrier Injury ◽  
The Impact ◽  
Clabsi Rate

OBJECTIVESTo determine the impact of mucosal barrier injury laboratory-confirmed bloodstream infections (MBI-LCBIs) on central-line–associated bloodstream infection (CLABSI) rates during the first year of MBI-LCBI reporting to the National Healthcare Safety Network (NHSN)DESIGNDescriptive analysis of 2013 NHSN dataSETTINGSelected inpatient locations in acute care hospitalsMETHODSA descriptive analysis of MBI-LCBI cases was performed. CLABSI rates per 1,000 central-line days were calculated with and without the inclusion of MBI-LCBIs in the subset of locations reporting ≥1 MBI-LCBI, and in all locations (regardless of MBI-LCBI reporting) to determine rate differences overall and by location type.RESULTSFrom 418 locations in 252 acute care hospitals reporting ≥1 MBI-LCBIs, 3,162 CLABSIs were reported; 1,415 (44.7%) met the MBI-LCBI definition. Among these locations, removing MBI-LCBI from the CLABSI rate determination produced the greatest CLABSI rate decreases in oncology (49%) and ward locations (45%). Among all locations reporting CLABSI data, including those reporting no MBI-LCBIs, removing MBI-LCBI reduced rates by 8%. Here, the greatest decrease was in oncology locations (38% decrease); decreases in other locations ranged from 1.2% to 4.2%.CONCLUSIONSAn understanding of the potential impact of removing MBI-LCBIs from CLABSI data is needed to accurately interpret CLABSI trends over time and to inform changes to state and federal reporting programs. Whereas the MBI-LCBI definition may have a large impact on CLABSI rates in locations where patients with certain clinical conditions are cared for, the impact of MBI-LCBIs on overall CLABSI rates across inpatient locations appears to be more modest.Infect. Control Hosp. Epidemiol. 2015;37(1):2–7

scholarly journals Incidence Trends of Central-Line–Associated Bloodstream Infections in Neonatal Intensive Care Units, NHSN, 2009–2018

2020 ◽  
Vol 41 (S1) ◽  
pp. s68-s68
Author(s):  
Allan Nkwata ◽  
Minn Soe ◽  
Qunna Li ◽  
Dominque Godfrey-Johnson ◽  
Jonathan Edwards ◽  
...  
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Negative Binomial ◽  
Bloodstream Infections ◽  
Central Line ◽  
Mucosal Barrier ◽  
Weight Category ◽  
Incidence Trends

Background: Central-line–associated bloodstream infections (CLABSIs) are a major source of healthcare-associated infections (HAIs) in neonatal intensive care unit (NICU) patients, and they are associated with increased morbidity, mortality, and costs. CLABSI surveillance has been a critical component for hospitals participating in the Center for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) for many years. CLABSI reporting grew substantially as a result of state reporting mandates first introduced in 2005 and federal reporting requirements for all intensive care units that began in 2011. However, no recent assessment of NHSN CLABSI incidence rate changes have been performed. The objective of this analysis was to estimate the overall trends in annual CLABSI incidence rates in NICUs from 2009 to 2018. Methods: We analyzed NHSN CLABSI data reported from NICUs during 2009–2018. CLABSIs further classified as mucosal barrier injury were included in this analysis. To evaluate the trends of CLABSI incidence (per 1,000 central-line days), and to account for the potential impact of definition changes introduced in 2015, we conducted an interrupted time-series analysis using mixed-effects negative binomial regression modeling. Birth weight category, patient care location type and hospital-level characteristics such as hospital type, medical affiliation, teaching status, bed size, and average length of inpatient stay) were assessed as potential covariates in regression analysis. Random intercept and slope models were evaluated with covariance tests and used to account for differential baseline incidence and trends among reporting NICUs. Results: The number of NICUs reporting to NHSN increased significantly following the federal mandate and has remained slightly >1,000 NICUs since 2013. The crude incidence of CLABSI dropped from 2.24 in 2009 to 0.98 infections per 1,000 central-line days in 2018, except for an increase in 2015 (Table 1). The CLABSI incidence, adjusted for birth weight category, decreased by an average of 11.6% per year from 2009 to 2018 except for a 35.8% increase in 2015 (Table 2). Conclusion: These findings suggest that hospitals have made significant strides in reducing the occurrence of CLABSIs in NICUs over the last 10 years. The increase in 2015 could be explained in part by the implementation and application of new definitional changes. Continued practices and policies that target, assess and prevent CLABSI in this setting may have been effective and remain vital to sustaining this decline nationally in subsequent years.Funding: NoneDisclosures: None

scholarly journals Central Line-Associated Bloodstream Infections in Neonatal Intensive Care Units

2012 ◽  
Vol 17 (suppl_A) ◽  
pp. 15A-15A
Author(s):  
AC Blanchard ◽  
E Fortin ◽  
I Rocher ◽  
D Moore ◽  
C Frenette ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Neonatal Intensive Care Units

scholarly journals Mucosal Barrier Injury Central Line-Associated Bloodstream Infections: What Is the Impact of Standard Prevention Bundles?

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Julia Shaklee Sammons ◽  
Rachael Ross ◽  
Susan Ditaranto ◽  
Margaret Gilman ◽  
Anne Reilly ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Central Line ◽  
Mucosal Barrier ◽  
Mucosal Barrier Injury ◽  
The Impact

scholarly journals Mucosal Barrier Injury Central-Line–Associated Bloodstream Infections: What is the Impact of Standard Prevention Bundles?

2017 ◽  
Vol 38 (11) ◽  
pp. 1385-1387 ◽  
Author(s):  
Ana M. Vaughan ◽  
Rachael Ross ◽  
Margaret M. Gilman ◽  
Lauren Satchell ◽  
Susan Ditaranto ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Central Line ◽  
Mucosal Barrier ◽  
Mucosal Barrier Injury ◽  
The Impact
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