Central line associated blood stream infection rate after intervention and comparing outcome with national healthcare safety network and international nosocomial infection control consortium data

Assessment knowledge and practices of central line insertion and maintenance in adult intensive care units at a tertiary care hospital in Saudi Arabia

BACKGROUND

Awareness of central line bundle by healthcare workers (HCWs) is essential for preventing catheter-associated bloodstream infections (CLABSI). The objective was to assess the knowledge and practice of insertion and maintenance central line bundles among HCWs in intensive care units (ICUs).

METHODS

A cross-sectional study was conducted at King Abdul-Aziz medical city in Riyadh between November 2017 and April 2018. The target was nurses and physicians working in three ICUs. The knowledge and practice were assessed using a structured study questionnaire that included also demographic characteristics.

RESULTS

A total 171 nurses and 41 physicians were included in the current analysis. More than 90% of HCWs correctly answered 9 out of 12 knowledge questions, specially questions related hand hygiene, maximal barrier, daily assessment, and dressing change. The overall knowledge score was 82% and was significantly higher among those who received central line bundle training. Self-reported compliance (all or most of the time) with 10 different bundle recommendations ranged between 50% and 97%, being highest with hand hygiene, maximal barrier, and using chlorhexidine (97% each) and lowest with using the subclavian site (50%). The overall self-reported compliance score was 87% and was significantly higher among nurses. There was weak positive correlation between knowledge and practice (correlation coefficient 0.266, p=0.001).

CONCLUSION

Knowledge and compliance of central line bundle were generally high in our HCWs. Training is important in improving knowledge of central line bundle. Future educational activities should focus on specific compliance deficiencies such as using the subclavian site and dressing change.

Chlorhexidine gluconate transparent dressing does not decrease central line‐associated bloodstream infection in critically ill patients: A randomized controlled trial

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.

Impact of nosocomial infections surveillance on nosocomial infection rates: A systematic review

BACKGROUND

According to previously studies, nosocomial infections (NIs) surveillance could effectively reduce infection rates. As NIs surveillance systems have been implemented in some hospitals for several years, their impact on NIs need to be explored. Therefore, the purpose of this review is to evaluate the tendency of NI rates during the surveillance period and the impact of surveillance on NI rates.

METHODS

A systematic literature search of the PubMed database to identify papers that evaluated effect of surveillance on NIs, all kinds of NIs occurred during hospitalization or discharged were included. Exclude articles investigated the surveillance combined with other infection control measures.

RESULTS

Twenty-five articles were included. NI rates had different levels of reduction during surveillance period, the reduction were not limited by state, department, surveillance system, and NI type. Continuous surveillance had a positive impact on NI, OR/RR were ranged from 0.43 to 0.95.

CONCLUSION

Participation in NI surveillance is associated with reducing infection rates, though RCTs need to further prove the effective role of surveillance. Hospitals may consider to perform NIs surveillance systems according to its own conditions.

Killing of Serratia marcescens biofilms with chloramphenicol

Serratia marcescens is a Gram-negative bacterium with proven resistance to multiple antibiotics and causative of catheter-associated infections. Bacterial colonization of catheters mainly involves the formation of biofilm. The objectives of this study were to explore the susceptibility of S. marcescens biofilms to high doses of common antibiotics and non-antimicrobial agents. Biofilms formed by a clinical isolate of S. marcescens were treated with ceftriaxone, kanamycin, gentamicin, and chloramphenicol at doses corresponding to 10, 100 and 1000 times their planktonic minimum inhibitory concentration. In addition, biofilms were also treated with chemical compounds such as polysorbate-80 and ursolic acid. S. marcescens demonstrated susceptibility to ceftriaxone, kanamycin, gentamicin, and chloramphenicol in its planktonic form, however, only chloramphenicol reduced both biofilm biomass and biofilm viability. Polysorbate-80 and ursolic acid had minimal to no effect on either planktonic and biofilm grown S. marcescens. Our results suggest that supratherapeutic doses of chloramphenicol can be used effectively against established S. marcescens biofilms.

Selection of case studies describing PICC tip malposition

This article presents a number of case studies, spanning a 12-month period, associated with peripherally inserted central catheter (PICC) tip location. The aim is to generate debate around the journey PICC tips may take; it is not the purpose of this article to debate technological solutions to the issue of PICC tip location. The discussion of each case illustrates a wide range of potential aberrant PICC tip locations and offers an insight into how the abberant tip location was resolved in each case.

[Essential measures for prehospital treatment of severely injured patients: The trauma care bundle]

BACKGROUND

In order to ensure adequate treatment and to avoid complications, care bundles are increasingly being implemented. These are comprehensive and evidence-based procedures for the treatment of individual diseases or injuries which should be carried out for every patient. The aim of this study was to define a care bundle for the prehospital treatment of severely injured patients.

MATERIAL AND METHODS

The scientific contents of the bundle were gathered from the interdisciplinary evidence-based S3 guidelines for the treatment of severely injured patients by the German Trauma Society. The ABCDE scheme suggested by the prehospital trauma life support (PHTLS®) and the advanced trauma life support (ATLS®) functioned as a matrix for the individual elements in the bundles. The identified elements were finalized by a consensus process.

RESULTS AND DISCUSSION

A bundle of six elements was suggested and a comprehensive summary of key items during prehospital management of severely injured patients was identified. In a next step the effectiveness of the care bundle should be evaluated in a clinical trial.

Calibration of optimal use parameters for an ultraviolet light-emitting diode in eliminating bacterial contamination on needleless connectors

AIMS

Needleless connectors may develop bacterial contamination and cause central-line-associated bloodstream infections (CLABSI) despite rigorous application of best-practice. Ultraviolet (UV) light-emitting diodes (LED) are an emerging, increasingly affordable disinfection technology. We tested the hypothesis that a low-power UV LED could reliably eliminate bacteria on needleless central-line ports in a laboratory model of central-line contamination.

METHODS AND RESULTS

Needleless central-line connectors were inoculated with Staphylococcus aureus. A 285 nm UV LED was used in calibrated fashion to expose contaminated connectors. Ports were directly applied to agar plates and flushed with sterile saline, allowing assessment of bacterial survival on the port surface and in simulated usage flow-through fluid. UV applied to needleless central-line connectors was highly lethal at 0·5 cm distance at all tested exposure times. At distances >1·5 cm both simulated flow-through and port surface cultures demonstrated significant bacterial growth following UV exposure. Logarithmic-phase S. aureus subcultures were highly susceptible to UV induction/maintenance dosing.

CONCLUSIONS

Low-power UV LED doses at fixed time and distance from needleless central-line connector ports reduced cultivable S. aureus from >10(6) CFU to below detectable levels in this laboratory simulation of central-line port contamination.

SIGNIFICANCE AND IMPACT OF THE STUDY

Low-power UV LEDs may represent a feasible alternative to current best-practice in connector decontamination.