Impact of a bundle on prevention and control of healthcare associated infections in intensive care unit

Cellulosimicrobium Infections in Humans-A Narrative Review

Cellulosimicrobium species (formerly known as Oerskovia) are Gram-positive filamentous bacteria in the family Promicromonosporaceae and are more commonly found in sewage and soil. The present study aimed to identify all the published cases of Cellulosimicrobium species infections in the literature, describe the epidemiological, clinical, and microbiological characteristics, and provide data regarding its antimicrobial resistance, treatment, and outcomes. A narrative review was performed based on a PubMed and Scopus database search. In total, 38 studies provided data on 40 patients with infections by these species. The median age of patients was 52.5 years, and 55% were male. The most common infection types were bacteremia, infective endocarditis (IE), osteoarticular infections, peritoneal dialysis-associated peritonitis, and endophthalmitis. Antimicrobial resistance to vancomycin and the combination of trimethoprim and sulfamethoxazole was minimal, and vancomycin was the most commonly used antimicrobial for treating these infections. Overall mortality was minimal for all infections, except for bacteremia and IE, which carried high mortality rates.

Impact of a comprehensive care bundle educational program on device-associated infections in an emergency intensive care unit

Introduction

Implementation of care bundles was shown to reduce the incidence of device-associated infections (DAIs). Substantial improvements in the rate of infection have been achieved by applying educational programs for infection control. Objectives: To demonstrate the impact of a comprehensive care bundle educational program (CCBEP) on DAIs, mortality rates in an emergency Intensive Care Unit (ICU), and improving healthcare workers (HCWs') knowledge, compliance to care bundle, and infection control practice.

Methods

A quasi-experimental study was carried out in an 15-beds emergency ICU, from May 2017 to October 2018. A comprehensive care bundle educational program was implemented. It covers items regarding device care bundle and infection control.

Results

Device care bundle compliance was variable between different bundle items. There was a significant improvement in HCWs' knowledge after the educational program intervention especially in hand hygiene, catheter-associated urinary tract infection (CAUTI) bundle, and total knowledge. There was a higher risk of ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLABSI), and CAUTI in the pre-intervention phase compared to post-intervention (RR: 1.4, 1.4, and 1.9 respectively). The total mortality rate decreased from 24.2/100 to 16.7/100 patients after intervention.

Conclusions

There was a statistically significant improvement in compliance with device care bundles with a decrease in the incidence of DAIs.

Sustained Low Incidence Rates of Central Line-Associated Blood Stream Infections in the Intensive Care Unit

Background

Central line-associated bloodstream infection (CLABSI) is an important cause of increased morbidity and mortality in ICUs. The occurrence of CLABSI in significantly higher in developing countries and contributes to the burden of healthcare-associated infections.

Methods

This prospective study was carried out from January 2016 to December 2019 in the intensive care unit at King Faisal Medical Complex in Taif, Saudi Arabia. The Society for Healthcare Epidemiology of America/Infectious Diseases Society of America (SHEA/IDSA) recommendations were introduced and implemented during 2017–2019. In the post-intervention period, observation of hand hygiene, CLABSI bundle compliance, and benchmarking of CLABSI rates were carried out.

Results

The CLABSI incidence rate was 1.12/1,000 central-line days, with a 0.51 utilization ratio in the pre-intervention period. This dropped to 0.46/1,000 central line days with a 0.44 utilization ratio in the post-intervention period. This reduction was also confirmed in benchmarking with National Healthcare Safety Network (NHSN) (50th–75th) percentile pre-intervention vs (25th–50th) percentile post-intervention. Institutional risk assessment revealed a formal educational program as a potential need for improvement. The CLABSIs were caused predominantly by multidrug-resistant Klebsiella pneumoniae.

Conclusion

We observed a reduction and sustained low incidence rate of CLABSI benchmarking to NHSN for 3 years after implementation of the basic SHEA/IDSA recommendations.

Stewardship actions for device associated infections: An intervention study in the emergency intensive care unit

Improving the practices of antimicrobial use in hospitals, especially in developing countries, is a challenging duty.

OBJECTIVES

The aim of the study was to determine the effect of certain stewardship actions on the use of antibiotics for device-associated infections in the emergency intensive care unit in Egypt.

MEHODS

The intervention included establishment of AS team, design an antibiogram and preparation of antibiotic use guidelines, education, and infection prevention and control measures. Pre- and postinterventions surveys tookplace including: antibiotic prescription compliance, antibiotic cost, bacterial profile and antibiotic resistance rates.

RESULTS

Antibiotic prescription compliance improved, especially for prophylactic antibiotics prescription; in preintervention phase, 27.4% of cases received unindicated antibiotic prophylaxis vs 5.8% after intervention. A statistically significant decrease in cost after the intervention was reported (p = 0.04). Acinetobacter baumannii and Klebsiella pneumonia were the most frequently isolated pathogens (25.6%) and (21.8%) in pre and post-intervention phases respectively. A statistically significant decrease in the prevalence of MDR (X² = 11.9, p = 0.009) was observed. The most prevalent XDR is K-pneumonia (45% vs 17%) in phase 1&3. No pan drug-resistant isolates were detected.

CONCLUSION

Sound antibiotic guidelines coupled with effective infection control precautions and education would be a good intervention, particularly with a leadership commitment. The use of microbiology tests to direct prescribing decisions should be a underscored. Sustained research initiatives may support the proper implementation of AS programmes in limited resource settings.

Pathogenesis-Targeted Preventive Strategies for Multidrug Resistant Ventilator-Associated Pneumonia: A Narrative Review

Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection in the intensive care unit (ICU), accounting for relevant morbidity and mortality among critically ill patients, especially when caused by multidrug resistant (MDR) organisms. The rising problem of MDR etiologies, which has led to a reduction in treatment options, have increased clinician’s attention to the employment of effective prevention strategies. In this narrative review we summarized the evidence resulting from 27 original articles that were identified through a systematic database search of the last 15 years, focusing on several pathogenesis-targeted strategies which could help preventing MDR-VAP. Oral hygiene with Chlorhexidine (CHX), CHX body washing, selective oral decontamination (SOD) and/or digestive decontamination (SDD), multiple decontamination regimens, probiotics, subglottic secretions drainage (SSD), special cuff material and shape, silver-coated endotracheal tubes (ETTs), universal use of gloves and contact isolation, alcohol-based hand gel, vaporized hydrogen peroxide, and bundles of care have been addressed. The most convincing evidence came from interventions directly addressed against the key factors of MDR-VAP pathogenesis, especially when they are jointly implemented into bundles. Further research, however, is warranted to identify the most effective combination.

Summary of the Prevention of Catheter-Associated Urinary Tract Infection in An Intensive Care Unit

Background: Catheter-associated urinary tract infection is the most common type of nosocomial infection in an intensive care unit. The aim of this study was to examine the existing evidence of preventative measures against catheter-associated urinary tract infection being implemented to reduce urinary tract infection in intensive care units.Method: Databases were used to identify potential articles, namely Scopus, Pubmed, EBSCO and Proquest, limited to those published within the last 5 years from 2013 to 2018. The literature review used the keyword prevention, CAUTI and ICU. In the article search using “AND”, only 14 studies met the inclusion criteria. Across the 14 studies, 42486 participants and a mean 3540 per trial were included.Discussion: Nursing round, CAUTI bundle, bacitracin and cranberry, Nurse-driven protocol, protocol by team/ developmental protocol, surveillance of CAUTI, education, performance feedback, and general cultural practices alongside the American College of Critical Care Medicine and the Infectious Disease Society of America present guidelines that recommend CAUTI preventive practices that can be implemented to reduce the incidence of CAUTI in ICUs.Conclusion: From the several strategies used to prevent CAUTI, the most effective is the multidimensional approach because this approach combines several interventions and it also involves other practitioners. A multidimensional approach is more effective than a single dimensional approach in ICU.

Implementation of a Nurse-Driven Protocol for Catheter Removal to Decrease Catheter-Associated Urinary Tract Infection Rate in a Surgical Trauma ICU

INTRODUCTION

Early removal of urinary catheters is an effective strategy for catheter-associated urinary tract infection (CAUTI) prevention. We hypothesized that a nurse-directed catheter removal protocol would result in decreased catheter utilization and CAUTI rates in a surgical trauma intensive care unit (STICU).

METHODS

We performed a retrospective, cohort study following implementation of a multimodal CAUTI prevention bundle in the STICU of a large tertiary care center. Data from a 19-month historical control were compared to data from a 15-month intervention period. Pre- and postintervention indwelling catheter utilization and CAUTI rates were compared.

RESULTS

Catheter utilization decreased significantly with implementation of the nurse-driven protocol from 0.78 in the preintervention period to 0.70 in the postintervention period (P < .05). As a result of the bundle, the CAUTI rate declined significantly, from 5.1 to 2.0 infections per 1000 catheter-days in the pre- vs postimplementation period (Incident Rate Ratio [IRR]: 0.38, 95% confidence interval: 0.21-0.65).

CONCLUSIONS

Implementation of a nurse-driven protocol for early urinary catheter removal as part of a multimodal CAUTI intervention strategy can result in measurable decreases in both catheter utilization and CAUTI rates.