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Bouhrour N, Nibbering PH, Bendali F. Medical Device-Associated Biofilm Infections and Multidrug-Resistant Pathogens. Pathogens 2024; 13:393. [PMID: 38787246 PMCID: PMC11124157 DOI: 10.3390/pathogens13050393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/29/2024] [Accepted: 05/04/2024] [Indexed: 05/25/2024] Open
Abstract
Medical devices such as venous catheters (VCs) and urinary catheters (UCs) are widely used in the hospital setting. However, the implantation of these devices is often accompanied by complications. About 60 to 70% of nosocomial infections (NIs) are linked to biofilms. The main complication is the ability of microorganisms to adhere to surfaces and form biofilms which protect them and help them to persist in the host. Indeed, by crossing the skin barrier, the insertion of VC inevitably allows skin flora or accidental environmental contaminants to access the underlying tissues and cause fatal complications like bloodstream infections (BSIs). In fact, 80,000 central venous catheters-BSIs (CVC-BSIs)-mainly occur in intensive care units (ICUs) with a death rate of 12 to 25%. Similarly, catheter-associated urinary tract infections (CA-UTIs) are the most commonlyhospital-acquired infections (HAIs) worldwide.These infections represent up to 40% of NIs.In this review, we present a summary of biofilm formation steps. We provide an overview of two main and important infections in clinical settings linked to medical devices, namely the catheter-asociated bloodstream infections (CA-BSIs) and catheter-associated urinary tract infections (CA-UTIs), and highlight also the most multidrug resistant bacteria implicated in these infections. Furthermore, we draw attention toseveral useful prevention strategies, and advanced antimicrobial and antifouling approaches developed to reduce bacterial colonization on catheter surfaces and the incidence of the catheter-related infections.
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Affiliation(s)
- Nesrine Bouhrour
- Laboratoire de Microbiologie Appliquée, Faculté des Sciences de la Nature et de la Vie, Université de Bejaia, Bejaia 06000, Algeria;
| | - Peter H. Nibbering
- Department of Infectious Diseases, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
| | - Farida Bendali
- Laboratoire de Microbiologie Appliquée, Faculté des Sciences de la Nature et de la Vie, Université de Bejaia, Bejaia 06000, Algeria;
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Hou Y, Griffin L, Bernatchez SF, Hommes J, Kärpänen T, Palka-Santini M. Comparative Effectiveness of 2 Chlorhexidine Gluconate-Containing Dressings in Reducing Central Line-Associated Bloodstream Infections, Hospital Stay, and Costs. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231214751. [PMID: 38037829 PMCID: PMC10693226 DOI: 10.1177/00469580231214751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/12/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023]
Abstract
Chlorhexidine gluconate (CHG)-containing dressings are recommended to prevent central line associated bloodstream infections (CLABSIs) and other catheter-related infections. This study compared the effect of 2 CHG dressings on CLABSI, cost of care, and contact dermatitis. A retrospective analysis was conducted using the Premier Healthcare Database of hospitalized patients (n = 53 149) with central venous catheters (CVCs) and receiving either a transparent CHG gel dressing (n = 14 488) or an opaque CHG sponge dressing (n = 38 661) between January 2019 and September 2020. Two cohorts (n = 14 488 each), CHG-Gel and CHG-Sponge, were matched 1:1 using a propensity score method on 33 patient and facility characteristics. CLABSI and contact dermatitis rates, hospital length of stay (LOS), and hospitalization costs were compared using mixed-effect multiple regression. This approach effectively controlled for random clustering effects across hospitals and patients' Diagnosis-Related Group (DRG) classifications. CHG gel dressings were associated with a 41% decrease in CLABSI rates (P = .0008) compared to CHG sponge dressings (0.35%vs 0.60%). A 0.4-day shorter LOS (9.53vs 9.90 days, P = .0001) and a cost saving of $3576 per hospital stay ($40 197 vs $43 774, P = .0179) was observed with CHG gel dressing use. There was no statistically significant difference in contact dermatitis rates (P = .7854) between the CHG-Gel and CHG-Sponge cohorts. The findings of this study suggest that the use of CHG gel dressings may be more effective in reducing the risk of CLABSIs and associated clinical costs compared to CHG sponge dressings in hospitalized patients. Moreover, there appears to be no significant discrepancy in contact dermatitis rates between CHG gel and CHG sponge dressings. Healthcare providers may consider using CHG gel dressings as a standard practice for patients with CVCs to reduce the risk of infections and improve patient outcomes.
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Affiliation(s)
| | - Leah Griffin
- 3M Health Care, 3M Company, San Antonio, TX, USA
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Duyu M, Karakaya Z, Yazici P, Yavuz S, Yersel NM, Tascilar MO, Firat N, Bozkurt O, Caglar Mocan Y. Comparison of chlorhexidine impregnated dressing and standard dressing for the prevention of central-line associated blood stream infection and colonization in critically ill pediatric patients: A randomized controlled trial. Pediatr Int 2022; 64:e15011. [PMID: 34610185 DOI: 10.1111/ped.15011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/02/2021] [Accepted: 08/17/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND The aim of this study was to compare chlorhexidine gluconate (CHG)-impregnated dressing and standard dressing with respect to the frequency of central-line-associated bloodstream infection (CLABSI), catheter-related bloodstream infection, primary bloodstream infection, and catheter colonization in critically ill pediatric patients with short-term central venous catheters. METHODS Children who were admitted to the pediatric intensive care unit of a tertiary institution between May 2018 and December 2019 and received placement of a short-term central venous catheter were included in this single-center randomized controlled trial. Patients were grouped according to the type of catheter fixation applied. RESULTS A total of 307 patients (151 CHG-impregnated dressing, 156 standard dressing), with 307 catheters (amounting to a collective total of 4,993 catheter days), were included in the study. The CHG-impregnated dressing did not significantly decrease the incidence of CLABSI (6.36 vs 7.59 per 1,000 catheter days; hazard ratio (HR): 0.93, P = 0.76), catheter related bloodstream infection (3.82 vs 4.18 per 1,000 catheter days; HR: 0.98; P = 0.98), and primary bloodstream infection (2.54 vs 3.42 catheter days; HR: 0.79; P = 0.67). The CHG-impregnated dressing significantly decreased the incidence of catheter colonization (3.82 vs 7.59 per 1,000 catheter days; HR: 0.40; P = 0.04). In both groups, the most frequent microorganisms isolated in CLABSI or catheter colonization were Gram-positive bacteria (the majority were coagulase-negative staphylococci). CONCLUSIONS The use of CHG-impregnated dressing does not decrease CLABSI incidence in critically ill pediatric patients but it significantly reduced catheter colonization. Coagulase-negative staphylococci were the most common microorganisms causing CLABSI or catheter colonization.
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Affiliation(s)
- Muhterem Duyu
- Department of Pediatrics, Pediatric Intensive Care Unit, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Zeynep Karakaya
- Department of Pediatrics, Altınova District Hospital, Yalova, Turkey
| | - Pinar Yazici
- Department of Pediatrics, Health Sciences University Ankara Training and Research Hospital, Ankara, Turkey
| | - Senanur Yavuz
- Department of Pediatrics, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Nihal Meryem Yersel
- Department of Pediatrics, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | | | - Nazim Firat
- Department of Pediatrics, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Ozlem Bozkurt
- Department of Pediatrics, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Yasemin Caglar Mocan
- Department of Pediatrics, Health Sciences University Dr. Lutfi Kırdar City Hospital, Istanbul, Turkey
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Olivier RC, Wickman M, Skinner C, Ablir L. The impact of replacing peripheral intravenous catheters when clinically indicated on infection rate, nurse satisfaction, and costs in CCU, Step-Down, and Oncology units. Am J Infect Control 2021; 49:327-332. [PMID: 32763345 DOI: 10.1016/j.ajic.2020.07.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND A practice change of replacing peripheral intravenous (PIV) catheters when clinically indicated was implemented concurrent with a new PIV chlorhexidine securement dressing and existing IV care bundle to prevent the risk of infection. PURPOSE The purpose of this study was to examine the impact of replacing PIV catheters when clinically indicated on infection rates, nurse satisfaction, and costs in 3 high-risk, vulnerable hospital populations (Critical Care, Step Down, and Oncology units). METHODS A retrospective review of 473 medical records, 737 peripheral IV sites, and 2 nursing surveys were completed after the practice change. Data were gathered related to PIV 1) catheter dwell times, 2) phlebitis rates, 3) catheter-related bloodstream infection rates, 4) skin tears related to the new PIV dressing, 5) costs, and 6) a nurse satisfaction survey. RESULTS The average PIV dwell time was 7 days with a 3% phlebitis rate. Findings showed no catheter-related bloodstream infections and 2 (0.27%) skin tears. Cost savings of $17,100.00 in PIV supplies occurred one year after the practice change. Nurse satisfaction with the new dressing was 94.2%, with a 17-month sustainment of satisfaction. CONCLUSIONS The impact of the practice change and new dressing had positive quality outcomes on infection rate, nurse satisfaction, and costs in 3 vulnerable hospital populations.
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Roethlisberger M, Moffa G, Fisch U, Wiggli B, Schoen S, Kelly C, Leu S, Croci D, Zumofen DW, Cueni N, Nogarth D, Schulz M, Bucher HC, Weisser-Rohacek M, Wasner MG, Widmer AF, Mariani L. Effectiveness of a Chlorhexidine Dressing on Silver-coated External Ventricular Drain-associated Colonization and Infection: A Prospective Single-blinded Randomized Controlled Clinical Trial. Clin Infect Dis 2019; 67:1868-1877. [PMID: 29733329 DOI: 10.1093/cid/ciy393] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 05/02/2018] [Indexed: 11/14/2022] Open
Abstract
Background Observational studies have shown that dressings containing chlorhexidine gluconate (CHX) lower the incidence external ventricular drain (EVD)-associated infections (EVDAIs). This prospective, randomized controlled trial (RCT) studies the efficacy of CHX-containing dressings in reducing bacterial colonization. Methods In this RCT, patients aged ≥18 years undergoing emergency EVD placement were randomly given either a CHX-containing or an otherwise identical control dressing at the skin exit wound. The primary end-point was bacterial regrowth in cultured skin swab samples of the EVD exit wound. The secondary end-points were catheters processed by sonication, clinically diagnosed EVDAI and surgical treatment of hydrocephalus. Results From October 2013 to January 2016, a total of 57 patients were randomized to receive either a CHX or a control dressing (29 and 28 patients, respectively). Cutaneous bacterial regrowth at the EVD exit wound was significantly reduced over time (geometric mean ratio, 0.18; 95% confidence interval, .08-.42; P < .001). The incidence of colonized catheters was lower in the CHX group (5 of 28; 18%) than in the control group (10 of 27; 33%), with less microbial colonization on the subcutaneous portion. The infection rate was 4 of 28 (14%) in the CHX group, compared with 7 of 27 (26%) in the control group, with a substantially lower hydrocephalus treatment rate (7 of 28 [25%] vs 14 of 27 [52%], respectively). Conclusion Our data support the use of CHX dressings to reduce EVD exit site contamination, potentially reducing EVDAIs and permanent cerebrospinal fluid diversion procedures for hydrocephalus. Clinical Trials Registration NCT02078830.
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Affiliation(s)
| | - Giusi Moffa
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University of Basel, Switzerland
| | - Urs Fisch
- Department of Neurosurgery, University of Basel, Switzerland
| | - Benedikt Wiggli
- Department of Infectious Diseases & Hospital Epidemiology, University of Basel, Switzerland
| | - Stephan Schoen
- Department of Neurosurgery, University of Basel, Switzerland
| | | | - Severina Leu
- Department of Neurosurgery, University of Basel, Switzerland
| | - Davide Croci
- Department of Neurosurgery, University of Basel, Switzerland
| | | | - Nadine Cueni
- Department of Anaesthesiology and Intensive-Care, University of Basel, Switzerland
| | - Danica Nogarth
- Department of Infectious Diseases & Hospital Epidemiology, University of Basel, Switzerland.,Division of Clinical Microbiology, University Hospital Basel, University of Basel, Switzerland
| | - Marianne Schulz
- Department of Neurosurgery, University of Basel, Switzerland
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University of Basel, Switzerland
| | | | | | - Andreas F Widmer
- Department of Infectious Diseases & Hospital Epidemiology, University of Basel, Switzerland
| | - Luigi Mariani
- Department of Neurosurgery, University of Basel, Switzerland
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Yu K, Lu M, Meng Y, Zhao Y, Li Z. Chlorhexidine gluconate transparent dressing does not decrease central line‐associated bloodstream infection in critically ill patients: A randomized controlled trial. Int J Nurs Pract 2019; 25:e12776. [PMID: 31631496 PMCID: PMC9285536 DOI: 10.1111/ijn.12776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 07/14/2019] [Accepted: 07/22/2019] [Indexed: 01/19/2023]
Abstract
Background Central line‐associated blood stream infections are accompanied by increased mortality and health care costs. The application of different types of dressings in infection control has not been fully investigated to date. Aim To assess the effects of two different dressing types on central line‐associated bloodstream infections. Methods A randomized, nonblinded, controlled trial was conducted. Central lines were randomly allocated to intervention (chlorhexidine gluconate transparent dressing, n = 259) and control groups (standard dressing, n = 215). The central line‐associated bloodstream infection rate was assessed. Results A statistically nonsignificant difference was noted in the overall central line‐associated bloodstream infection rates between the two groups. The frequency of dressing changes in the patients with the chlorhexidine gluconate transparent dressing was significantly lower than that in the patients with a standard dressing. The predominant type of infectious microorganisms isolated from the central line‐associated bloodstream infection episodes was Gram‐negative bacteria (57.2%). Gram‐positive bacteria and fungi were noted at lower percentages (28.5% and 14.3%, respectively). Conclusion The use of a chlorhexidine gluconate transparent dressing does not decrease the central line‐associated bloodstream infection rate, although it decreases the frequency of dressing changes so may save nursing time. What is already known about this topic?
The use of a chlorhexidine gluconate transparent dressing has been reported to significantly reduce central line‐associated bloodstream infections or maintain low central line‐associated bloodstream infections in Western countries, but few studies have been carried out in Asian countries. The chlorhexidine dressing does not decrease central line‐associated bloodstream infections due to the presence of Gram‐negative bacteria. It has been reported that nurses prefer the chlorhexidine gluconate transparent dressing over the standard dressing.
What this paper adds?
Compared with the standard dressing, the chlorhexidine gluconate transparent dressing does not significantly decrease the central line‐associated bloodstream infection rate. The predominant infectious microorganisms isolated from central line-associated bloodstream infections episodes were Gram-negative bacteria. The cost of the chlorhexidine gluconate transparent dressing was significantly higher than that of the standard dressing, although the former could save nursing time due to the decreased frequency of dressing changes.
The implications of this paper are as follows:
The use of chlorhexidine gluconate transparent dressing does not offer any additional benefit in controlling infection. Further studies are required to identify ways to control the colonization or infection of Gram‐negative bacteria in patients because Gram‐negative bacteria are the predominant infectious microorganisms that cause central line‐associated bloodstream infection. The use of a chlorhexidine gluconate transparent dressing is proposed as an alternative choice that can reduce ICU nursing time in hospital settings and therefore should be considered by nursing managers for human resource cost control.
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Affiliation(s)
- Kunrong Yu
- Department of Pulmonary and Critical Care Medicine Ward, Peking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical Sciences Beijing China
| | - Meishan Lu
- Department of Health Care, Peking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical Sciences Beijing China
| | - Yanling Meng
- Department of Medical ICU, Peking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical Sciences Beijing China
| | - Yanwei Zhao
- Department of Nursing, Peking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical Sciences Beijing China
| | - Zheng Li
- School of NursingPeking Union Medical College Beijing China
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Dang FP, Li HJ, Tian JH. Comparative efficacy of 13 antimicrobial dressings and different securement devices in reducing catheter-related bloodstream infections: A Bayesian network meta-analysis. Medicine (Baltimore) 2019; 98:e14940. [PMID: 30946317 PMCID: PMC6455863 DOI: 10.1097/md.0000000000014940] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/26/2019] [Accepted: 02/28/2019] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The purpose of our study is to carry out a Bayesian network meta-analysis comparing the efficacy of different antimicrobial dressings for prevention of catheter-related blood infections (CRBSI) and rank these antimicrobial dressings for practical consideration. METHODS We searched the PubMed, Cochrane library, Embase, earlier relevant meta-analysis and reference lists of included studies for randomized controlled trials (RCTs) that compared dressings for prevention of CRBSI. Two authors independently extracted data from each included RCT according to a predesigned Excel spreadsheet and assessed the methodological quality of included RCTs using the Cochrane risk of bias tool. Data was analyzed using the WinBUGS (V.1.4.3) and the Stata (V.15.0). RESULTS Finally, 35 RCTs involving 8494 patients and evaluating 13 dressings were included. Network meta-analysis showed that transparent dressing may be the best way to prevent CRBSI. Suture and bordered polyurethane dressing might have the lowest risk of CRBSI rate per 1000 catheter-days, and sutureless securement device might lead to the lowest incidence of catheter failure. CONCLUSIONS This network meta-analysis indicated that transparent dressings may be selected for the prevention of CRBSI in patients with central venous catheters, which is of importance in future research. Although evidence is scant, more attention should be paid to head-to-head comparisons of the most commonly used dressings in this field.
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Affiliation(s)
| | - Hui-Ju Li
- School of Nursing of Lanzhou University
| | - Jin-Hui Tian
- School of Nursing of Lanzhou University
- Key Laboratory of Clinical Translational Research and Evidence-based Medicine of Gansu Province, Lanzhou, Gansu, China
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Patel PK, Gupta A, Vaughn VM, Mann JD, Ameling JM, Meddings J. Review of Strategies to Reduce Central Line-Associated Bloodstream Infection (CLABSI) and Catheter-Associated Urinary Tract Infection (CAUTI) in Adult ICUs. J Hosp Med 2018; 13:105-116. [PMID: 29154382 DOI: 10.12788/jhm.2856] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) are costly and morbid. Despite evidence-based guidelines, Some intensive care units (ICUs) continue to have elevated infection rates. In October 2015, we performed a systematic search of the peer-reviewed literature within the PubMed and Cochrane databases for interventions to reduce CLABSI and/or CAUTI in adult ICUs and synthesized findings using a narrative review process. The interventions were categorized using a conceptual model, with stages applicable to both CAUTI and CLABSI prevention: (stage 0) avoid catheter if possible, (stage 1) ensure aseptic placement, (stage 2) maintain awareness and proper care of catheters in place, and (stage 3) promptly remove unnecessary catheters. We also looked for effective components that the 5 most successful (by reduction in infection rates) studies of each infection shared. Interventions that addressed multiple stages within the conceptual model were common in these successful studies. Assuring compliance with infection prevention efforts via auditing and timely feedback were also common. Hospitalists with patient safety interests may find this review informative for formulating quality improvement interventions to reduce these infections.
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Affiliation(s)
- Payal K Patel
- Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, USA.
- Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Ashwin Gupta
- Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Valerie M Vaughn
- Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jason D Mann
- Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jessica M Ameling
- Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jennifer Meddings
- Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Pediatrics and Communicable Diseases, Division of General Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Veterans Affairs Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
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Velasquez Reyes DC, Bloomer M, Morphet J. Prevention of central venous line associated bloodstream infections in adult intensive care units: A systematic review. Intensive Crit Care Nurs 2017; 43:12-22. [PMID: 28663107 DOI: 10.1016/j.iccn.2017.05.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/03/2017] [Accepted: 05/23/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND In adult Intensive Care Units, the complexity of patient treatment requirements make the use of central venous lines essential. Despite the potential benefits central venous lines can have for patients, there is a high risk of bloodstream infection associated with these catheters. AIM Identify and critique the best available evidence regarding interventions to prevent central venous line associated bloodstream infections in adult intensive care unit patients other than anti-microbial catheters. METHODS A systematic review of studies published from January 2007 to February 2016 was undertaken. A systematic search of seven databases was carried out: MEDLINE; CINAHL Plus; EMBASE; PubMed; Cochrane Library; Scopus and Google Scholar. Studies were critically appraised by three independent reviewers prior to inclusion. RESULTS Nineteen studies were included. A range of interventions were found to be used for the prevention or reduction of central venous line associated bloodstream infections. These interventions included dressings, closed infusion systems, aseptic skin preparation, central venous line bundles, quality improvement initiatives, education, an extra staff in the Intensive Care Unit and the participation in the 'On the CUSP: Stop Blood Stream Infections' national programme. CONCLUSIONS Central venous line associated bloodstream infections can be reduced by a range of interventions including closed infusion systems, aseptic technique during insertion and management of the central venous line, early removal of central venous lines and appropriate site selection.
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Affiliation(s)
| | - Melissa Bloomer
- Deakin University, School of Nursing and Midwifery, PO Box 20000, Geelong, VIC, AUS 3217, Australia
| | - Julia Morphet
- Monash University, School of Nursing and Midwifery Peninsula campus, McMahons Road, Frankston VIC, 3199, Australia
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Prävention von Infektionen, die von Gefäßkathetern ausgehen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:171-206. [DOI: 10.1007/s00103-016-2487-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Perin DC, Erdmann AL, Higashi GDC, Sasso GTMD. Evidence-based measures to prevent central line-associated bloodstream infections: a systematic review. Rev Lat Am Enfermagem 2016; 24:e2787. [PMID: 27598378 PMCID: PMC5016007 DOI: 10.1590/1518-8345.1233.2787] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 02/29/2016] [Indexed: 12/19/2022] Open
Abstract
Objective: to identify evidence-based care to prevent CLABSI among adult patients hospitalized in ICUs. Method: systematic review conducted in the following databases: PubMed, Scopus, Cinahl, Web of Science, Lilacs, Bdenf and Cochrane Studies addressing care and maintenance of central venous catheters, published from January 2011 to July 2014 were searched. The 34 studies identified were organized in an instrument and assessed by using the classification provided by the Joanna Briggs Institute. Results: the studies presented care bundles including elements such as hand hygiene and maximal barrier precautions; multidimensional programs and strategies such as impregnated catheters and bandages and the involvement of facilities in and commitment of staff to preventing infections. Conclusions: care bundles coupled with education and the commitment of both staff and institutions is a strategy that can contribute to decreased rates of central line-associated bloodstream infections among adult patients hospitalized in intensive care units.
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Affiliation(s)
- Daniele Cristina Perin
- MSc. in Nursing Care Management, RN, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Alacoque Lorenzini Erdmann
- PhD, Full Professor, Departamento de Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
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Simon A, Furtwängler R, Graf N, Laws HJ, Voigt S, Piening B, Geffers C, Agyeman P, Ammann RA. Surveillance of bloodstream infections in pediatric cancer centers - what have we learned and how do we move on? GMS HYGIENE AND INFECTION CONTROL 2016; 11:Doc11. [PMID: 27274442 PMCID: PMC4886351 DOI: 10.3205/dgkh000271] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Pediatric patients receiving conventional chemotherapy for malignant disease face an increased risk of bloodstream infection (BSI). Since BSI may represent an acute life-threatening event in patients with profound immunosuppression, and show further negative impact on quality of life and anticancer treatment, the prevention of BSI is of paramount importance to improve and guarantee patients' safety during intensive treatment. The great majority of all pediatric cancer patients (about 85%) have a long-term central venous access catheter in use (type Broviac or Port; CVAD). Referring to the current surveillance definitions a significant proportion of all BSI in pediatric patients with febrile neutropenia is categorized as CVAD-associated BSI. This state of the art review summarizes the epidemiology and the distinct pathogen profile of BSI in pediatric cancer patients from the perspective of infection surveillance. Problems in executing the current surveillance definition in this patient population are discussed and a new concept for the surveillance of BSI in pediatric cancer patients is outlined.
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Affiliation(s)
- Arne Simon
- Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Rhoikos Furtwängler
- Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Norbert Graf
- Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Hans Jürgen Laws
- Klinik für Pädiatrische Onkologie, Hämatologie und Immunologie, Universitätskinderklinik, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Sebastian Voigt
- Klinik für Pädiatrie m. S. Onkologie / Hämatologie / Stammzelltransplantation, Charité – Universitätsmedizin Berlin, Germany
| | - Brar Piening
- Institut für Hygiene und Umweltmedizin, Charité – Universitätsmedizin Berlin, Germany
| | - Christine Geffers
- Institut für Hygiene und Umweltmedizin, Charité – Universitätsmedizin Berlin, Germany
| | - Philipp Agyeman
- Pädiatrische Infektiologie und Pädiatrische Hämatologie-Onkologie, Universitätsklinik für Kinderheilkunde, Inselspital, Bern, Switzerland
| | - Roland A. Ammann
- Pädiatrische Infektiologie und Pädiatrische Hämatologie-Onkologie, Universitätsklinik für Kinderheilkunde, Inselspital, Bern, Switzerland
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Grigonis AM, Dawson AM, Burkett M, Dylag A, Sears M, Helber B, Snyder LK. Use of a Central Catheter Maintenance Bundle in Long-Term Acute Care Hospitals. Am J Crit Care 2016; 25:165-72. [PMID: 26932919 DOI: 10.4037/ajcc2016894] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Evidence-based guidelines have resulted in decreases in bloodstream infections associated with central catheters (CLABSIs) in hospital intensive care units. However, relatively little is known about CLABSI incidence and prevention in long-term acute care hospitals (LTACHs). METHODS A central catheter maintenance bundle was implemented in 30 LTACHs, and compliance with the bundle was tracked for 6 months. CLABSI rates were monitored for 14 months before and 14 months after the bundle was implemented. RESULTS The pooled mean CLABSI rate (No. of infections per 1000 days with a central catheter) was 1.28 before the bundle and 0.96 after the bundle (repeated measures general linear model; F1,58 = 6.973; P = .01; partial η(2) = .11). From 14 months before to 14 months after the bundle was implemented, the mean number of CLABSIs per LTACH decreased by 4.5 (95% CI, 1.85-7.15). Time series modeling showed a significant decrease in the mean hospital CLABSI rate after the bundle was implemented (-0.511 CLABSI/1000 catheter days, SE = 0.050), indicating an immediate effect of the bundle. The mean hospital CLABSI rate was decreasing slightly before the bundle was implemented and continued to decrease at a reduced rate after the bundle was implemented. CONCLUSION The bundle resulted in a significant and sustained reduction in CLABSI rates in 30 LTACHs for 14 months. These results encourage the development and implementation of similar bundles as effective strategies for infection reduction in LTACHs.
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Affiliation(s)
- Antony M. Grigonis
- Antony M. Grigonis is vice president of quality improvement, Amanda M. Dawson is director of research, Betty Helber is director of inpatient education, and Lisa K. Snyder is chief quality officer at Select Medical, Mechanicsburg, Pennsylvania. Mary Burkett is assistant professor of nursing, Capital University, Columbus, Ohio. Arthur Dylag is conduct coordinator at University of California, Davis. Matthew Sears is patient experience data analyst at The George Washington University Hospital, Washington, DC
| | - Amanda M. Dawson
- Antony M. Grigonis is vice president of quality improvement, Amanda M. Dawson is director of research, Betty Helber is director of inpatient education, and Lisa K. Snyder is chief quality officer at Select Medical, Mechanicsburg, Pennsylvania. Mary Burkett is assistant professor of nursing, Capital University, Columbus, Ohio. Arthur Dylag is conduct coordinator at University of California, Davis. Matthew Sears is patient experience data analyst at The George Washington University Hospital, Washington, DC
| | - Mary Burkett
- Antony M. Grigonis is vice president of quality improvement, Amanda M. Dawson is director of research, Betty Helber is director of inpatient education, and Lisa K. Snyder is chief quality officer at Select Medical, Mechanicsburg, Pennsylvania. Mary Burkett is assistant professor of nursing, Capital University, Columbus, Ohio. Arthur Dylag is conduct coordinator at University of California, Davis. Matthew Sears is patient experience data analyst at The George Washington University Hospital, Washington, DC
| | - Arthur Dylag
- Antony M. Grigonis is vice president of quality improvement, Amanda M. Dawson is director of research, Betty Helber is director of inpatient education, and Lisa K. Snyder is chief quality officer at Select Medical, Mechanicsburg, Pennsylvania. Mary Burkett is assistant professor of nursing, Capital University, Columbus, Ohio. Arthur Dylag is conduct coordinator at University of California, Davis. Matthew Sears is patient experience data analyst at The George Washington University Hospital, Washington, DC
| | - Matthew Sears
- Antony M. Grigonis is vice president of quality improvement, Amanda M. Dawson is director of research, Betty Helber is director of inpatient education, and Lisa K. Snyder is chief quality officer at Select Medical, Mechanicsburg, Pennsylvania. Mary Burkett is assistant professor of nursing, Capital University, Columbus, Ohio. Arthur Dylag is conduct coordinator at University of California, Davis. Matthew Sears is patient experience data analyst at The George Washington University Hospital, Washington, DC
| | - Betty Helber
- Antony M. Grigonis is vice president of quality improvement, Amanda M. Dawson is director of research, Betty Helber is director of inpatient education, and Lisa K. Snyder is chief quality officer at Select Medical, Mechanicsburg, Pennsylvania. Mary Burkett is assistant professor of nursing, Capital University, Columbus, Ohio. Arthur Dylag is conduct coordinator at University of California, Davis. Matthew Sears is patient experience data analyst at The George Washington University Hospital, Washington, DC
| | - Lisa K. Snyder
- Antony M. Grigonis is vice president of quality improvement, Amanda M. Dawson is director of research, Betty Helber is director of inpatient education, and Lisa K. Snyder is chief quality officer at Select Medical, Mechanicsburg, Pennsylvania. Mary Burkett is assistant professor of nursing, Capital University, Columbus, Ohio. Arthur Dylag is conduct coordinator at University of California, Davis. Matthew Sears is patient experience data analyst at The George Washington University Hospital, Washington, DC
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Infektionsschutz und spezielle Hygienemaßnahmen in klinischen Disziplinen. KRANKENHAUS- UND PRAXISHYGIENE 2016. [PMCID: PMC7152143 DOI: 10.1016/b978-3-437-22312-9.00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Scheithauer S, Schulze-Steinen H, Höllig A, Lopez-Gonzalez L, Hilgers RD, Reinges MHT, Marx G, Lemmen S. Significant Reduction of External Ventricular Drainage–Associated Meningoventriculitis by Chlorhexidine-Containing Dressings: A Before-After Trial: Table 1. Clin Infect Dis 2015; 62:404-5. [DOI: 10.1093/cid/civ887] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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When antibiotics can be avoided in skin inflammation and bacterial colonization: a review of topical treatments. Curr Opin Infect Dis 2014; 27:125-9. [PMID: 24514163 DOI: 10.1097/qco.0000000000000044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review looks at the recent evidence on the safety, toxicity, microbiology and the prevention and management of acute and chronic wound infections with regard to antiseptics and antiseptic wound dressings. It is timely and relevant because of the global concerns of antimicrobial resistance and the need to address the inappropriate use of antimicrobials in the healthcare setting. RECENT FINDINGS There have been a number of recent Cochrane reviews that have concluded that there is little evidence to delineate clinical outcomes between antiseptics and antiseptic dressings. Published in-vitro evidence offers some new techniques and evaluates some new dressings and antiseptics. There are no economic evaluations of antiseptics and antiseptic dressings. SUMMARY Better clinical trials on the effectiveness and cost-effectiveness of wound dressings are needed to ensure evidence-based guidance is developed for optimizing the treatment of patients. It is surprising that with the paucity of evidence of clinical effectiveness, healthcare organizations continue to spend considerable resources on poorly evaluated topical wound products.
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