[Results of the implementation of the Bacteremia Zero project in Catalonia, Spain]

Effectiveness of a bundle of measures for reducing central line-associated bloodstream infections

INTRODUCTION

Catheter-associated infections are the main cause of nosocomial bacteremia. The main objective of this study was to demonstrate a possible decrease in CLABSI rates in perioperative environment after the implementation of a bundle of measures. Secondary objective was to determine which factors were associated with an increased risk of CLABSI, after the implementation of the bundle.

METHODS

Insertion bundle consisted of: subclavian vein as access of choice, disinfection with alcoholic 2% chlorhexidine, central-line full body drapes, sterile ultrasound probe-cable covers and insertion check-list. Cumulative Incidence (CI) and Incidence Density Rate (IR) of CLABSIs were compared before and after the intervention. Associations between patient or CVC characteristic and CLABSI were summarized with odds ratios and 95% confidence interval, obtained from multiple logistic regression, adjusting for age, sex, comorbidities and days with CVC.

RESULTS

Before implementing the bundle, from January to November 2016, CI of CLABSI was 5.05% and IR was 5.17 ‰. In the same period of 2018, CI of CLABSI was 2.28% and IR was 2.27 ‰, which means a reduction of 54.8% in CI (P=.072) and of 56% in IR (P=.068) In multivariable analyses, replacement of CVC was associated with a higher risk of CLABSI (OR 11.01, 95%CI 2.03-59.60, P=.005), as well as 2 or more catheterizations (OR 10.05, 95%CI 1.77-57.16, P=.009), and parenteral nutrition (OR 23.37, 95%CI 4.37-124.91, P<.001).

CONCLUSIONS

CLABSI rates decreased after the implementation of the insertion bundle. CVC replacement, 2 or more catheterizations and parenteral nutrition were associated with CLABSI after bundle implementation.

Antisepsis in the handling of vascular access connections

Needleless connectors provide easy access points to the vascular system for the administration of fluids, avoiding the risk of accidental punctures and increasing safety in vascular access manipulation. Non-aseptic manipulation can favor contamination, turning connectors into the penetration route for endoluminal contaminants with the capacity of triggering infectious complications, with serious consequences for the patient. Considering catheter-related bacteremia as a serious and avoidable adverse effect, prevention programs should incorporate measures to combat predisposing factors, such as improved staff training, the safe design of devices, improved disinfection procedures, and optimized antiseptic use. Monitoring adherence to safe practices and reporting results are important to promote understanding of the risks and benefits of decontaminating connections and thus to improve patient safety. safety. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson.

Results of the modification of an acute pancreatitis management protocol in Intensive Care medicine

OBJECTIVE

To determine whether the implementation of a protocol for the management of patients with acute pancreatitis (AP) in an Intensive Care Unit (ICU) improves the clinical outcomes.

DESIGN

A retrospective, before-after observational case series study was carried out.

STUDY PERIOD

1 January 2001 to 31 December 2016, divided in 2 periods (pre-protocol 2001-2007, post-protocol 2008-2016).

SCOPE

An ICU with 48 beds and a recruitment population of 700,000 inhabitants.

PARTICIPANTS

AP patients admitted to the ICU, with no exclusion criteria.

INTERVENTIONS

The recommendations proposed in the 7th Consensus Conference of the SEMICYUC on AP (5 September 2007) were applied in the second period.

MAIN VARIABLES OF INTEREST

Patient age, sex, APACHE II, SOFA, study period, pre-ICU hospital stay, nutrition, surgery, antibiotic prophylaxis, hospital mortality, ICU length of stay, hospital length of stay, determinant-based classification.

RESULTS

The study comprised 286 patients (94 in the pre-protocol period, 192 in the post-protocol period), with a global in-hospital mortality rate of 23.1% (n=66). Application of the protocol decreased the pre-ICU hospital stay and the use of antibiotic prophylaxis, and increased the use of enteral nutrition. Hospital mortality decreased in the second period (35.1 vs. 17.18%; P=.001), with no significant changes in ICU and hospital stays. In the multivariate logistic regression analysis, the variable period of treatment remained as a variable of statistical significance in terms of hospital mortality (OR 0.34 for the period 2008-2016, 95% CI 0.15-0.74).

CONCLUSIONS

The implementation of a protocol could result in decreased mortality among AP patients admitted to the ICU.

Evaluation of the usefulness of a quantitative blood culture in the diagnosis of catheter-related bloodstream infection: Comparative analysis of two periods (2002 and 2012)

INTRODUCTION

A retrospective study was conducted to investigate the usefulness of systematic quantitative blood culture (QBC) in the diagnosis of catheter-related bloodstream infection (CRBSI) during two 1-year periods (2002 and 2012).

METHODS

The study included all QBC requests sent to the microbiology laboratory for suspected CRBSI in adults (≥18 years) with any type of intravascular catheter (IVC). Based on a ratio of ≥4:1CFU/mL of the same microorganism between IVC blood culture from any lumen and peripheral blood culture, 5 diagnostic groups were defined: confirmed or probable CRBSI, primary BSI, other focus of infection, and colonization.

RESULTS

In total, 4521 QBCs were evaluated; 24% positive in 2002 and 16% in 2012 (P<0.0001). There were 243 episodes of suspected CRBSI (101 in 2002 and 142 in 2012). Confirmed CRBSI episodes were higher in 2002 than 2012 (56% vs 34%) (P<0.0001), whereas colonization episodes were lower (18% vs 38%) (P=0.0006). Gram-positive cocci decrease in 2012 relative to 2002 (56% vs 79.7%) (P=0.022). Almost one-third (32%) of confirmed CRBSI would have been missed if blood from all catheter lumens had not been cultured.

CONCLUSIONS

QBC is a useful method for diagnosing CRBSI. Blood samples from all catheter lumens must be cultured to avoid missing around one-third of CRBSI diagnoses.