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Shmoury AH, Hanna W, Zakhour J, Zahreddine NK, Kanj SS. Epidemiology and microbiology of catheter-associated urinary tract infections: A 14-year surveillance study at a tertiary care center in Lebanon. J Infect Public Health 2024; 17:825-832. [PMID: 38537577 DOI: 10.1016/j.jiph.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 03/12/2024] [Accepted: 03/19/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are the most common device-associated healthcare-acquired infections and pose a significant burden on patients and healthcare systems worldwide. However, there is a paucity of data on CAUTI epidemiology and microbiology in the Middle East and North Africa (MENA) region, including Lebanon. METHODS This 14-year retrospective cohort study was conducted at a tertiary care center in Lebanon. It analyzed data on all adult patients diagnosed with CAUTI between January 2009 and December 2022 in intensive care units (ICUs) and between June 2011 and December 2022 in regular units. Incidence rates, urinary catheter utilization ratios, and microbiological profiles were collected and analyzed. RESULTS A total of 620 CAUTI cases were identified during the study period. The overall CAUTI rate was 2.4 per 1000 catheter-days, with higher rates in ICUs (3.2 per 1000 catheter-days) compared to regular units (1.4 per 1000 catheter-days). No significant changes in the rates were noted despite implementing many interventions. The most common pathogens were Gram-negative bacteria, with Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae being predominant. Multidrug-resistant organisms represented 48% of all isolates. Enterobacterales were largely extended-spectrum β-lactamase (ESBL) producing, and most Acinetobacter baumannii isolates showed multidrug resistance. CONCLUSIONS This study provides important insights into CAUTI epidemiology and microbiology in a tertiary care center in Lebanon, addressing the knowledge gap in this area in the MENA region. Despite implementing prevention measures, CAUTI rates remained stable over the 14-year period. The findings highlight the need for continuous improvement in infection prevention practices, diagnostic stewardship, and antimicrobial stewardship, especially given the rising threat of antimicrobial resistance. These results can serve as a guide for the development of targeted preventive strategies to reduce the burden of CAUTIs, particularly in low- and middle-income countries where antimicrobial resistance is a major issue.
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Affiliation(s)
- Abdel Hadi Shmoury
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wael Hanna
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Johnny Zakhour
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nada Kara Zahreddine
- Infection Control and Prevention Program, American University of Beirut Medical Center, Beirut, Lebanon
| | - Souha S Kanj
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon; Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon.
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Mazuel M, Moulier V, Bourrel AS, Guillier C, Tazi A, Jarreau PH, Chollat C. Systematic culture of central catheters and infections related to catheters in a neonatal intensive care unit: an observational study. Sci Rep 2024; 14:8647. [PMID: 38622221 PMCID: PMC11018835 DOI: 10.1038/s41598-024-59371-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/09/2024] [Indexed: 04/17/2024] Open
Abstract
Systematic culture of the tip of central lines is performed in many neonatal intensive care units (NICUs) to guide any subsequent antibiotic therapy. The clinical relevance of this procedure is debated, given the significant bacterial contamination during its removal. We aimed to describe infections related to catheters and assess the usefulness of central catheter systematic cultures for probabilistic antibiotic therapy in cases of suspicion of catheter-related infections in a NICU. A retrospective study in a NICU included all newborn patients hospitalized with a central catheter, between January 2018, and June 2019. The main outcome measures were bacterial catheter colonization, catheter-related infection rate, and simulation-based approach to antibiotic prescription. Three hundred and seventy-five newborns, with 634 central catheters were included. There were 273 (43%) catheters that were colonized by at least one microorganism. There were 183 cases of suspected sepsis, with 31 infections definitively related to the catheter. In our simulation antibiotic prescription approach, there was no significant difference in terms of the efficacy toward the microorganism(s) involved between the probabilistic antibiotic therapies proposed by the experts and those ultimately prescribed. Performing a catheter culture only if catheter-related infection is suspected could be an alternative to routine screening.
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Affiliation(s)
- Marie Mazuel
- Neonatal Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, Paris, France
| | - Virginie Moulier
- University Department of Psychiatry, Centre d'Excellence Thérapeutique, Institut de Psychiatrie, Centre hospitalier du Rouvray, Sotteville-lès-Rouen, France
- Unité de Recherche Clinique, Etablissement Publique de Santé de Ville Evrard, 93332, Neuilly-sur-Marne, France
| | - Anne-Sophie Bourrel
- Department of Bacteriology, University Paris Cité, Assistance Publique-Hôpitaux de Paris, Cochin University Hospital, 75014, Paris, France
| | - Cyril Guillier
- Paediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Armand Trousseau University Hospital, Sorbonne Université, Paris, France
| | - Asmaa Tazi
- Department of Bacteriology, University Paris Cité, Assistance Publique-Hôpitaux de Paris, Cochin University Hospital, 75014, Paris, France
| | - Pierre-Henri Jarreau
- Service de Médecine et Réanimation Néonatales de Port-Royal, Hôpital Cochin, APHP centre - Université Paris Cité, Paris, France
| | - Clément Chollat
- Department of Neonatal Paediatrics, APHP, Service de Néonatologie, Sorbonne Université, Hôpital Armand Trousseau, 26 Av. du Dr Arnold Netter, 75012, Paris, France.
- Université Paris Cité, INSERM, NeuroDiderot, 75019, Paris, France.
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Lau EPM, Ing M, Vekaria S, Tan AL, Charlesworth C, Fysh E, Shrestha R, Yap ELC, Smith NA, Kwan BCH, Saghaie T, Roy B, Goddard J, Muruganandan S, Badiei A, Nguyen P, Hamid MFA, George V, Fitzgerald D, Maskell N, Feller-Kopman D, Murray K, Chakera A, Lee YCG. Australasian Malignant PLeural Effusion (AMPLE)-4 trial: study protocol for a multi-centre randomised trial of topical antibiotics prophylaxis for infections of indwelling pleural catheters. Trials 2024; 25:249. [PMID: 38594766 PMCID: PMC11005276 DOI: 10.1186/s13063-024-08065-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/18/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Malignant pleural effusion (MPE) is a debilitating condition as it commonly causes disabling breathlessness and impairs quality of life (QoL). Indwelling pleural catheter (IPC) offers an effective alternative for the management of MPE. However, IPC-related infections remain a significant concern and there are currently no long-term strategies for their prevention. The Australasian Malignant PLeural Effusion (AMPLE)-4 trial is a multicentre randomised trial that evaluates the use of topical mupirocin prophylaxis (vs no mupirocin) to reduce catheter-related infections in patients with MPE treated with an IPC. METHODS A pragmatic, multi-centre, open-labelled, randomised trial. Eligible patients with MPE and an IPC will be randomised 1:1 to either regular topical mupirocin prophylaxis or no mupirocin (standard care). For the interventional arm, topical mupirocin will be applied around the IPC exit-site after each drainage, at least twice weekly. Weekly follow-up via phone calls or in person will be conducted for up to 6 months. The primary outcome is the percentage of patients who develop an IPC-related (pleural, skin, or tract) infection between the time of catheter insertion and end of follow-up period. Secondary outcomes include analyses of infection (types and episodes), hospitalisation days, health economics, adverse events, and survival. Subject to interim analyses, the trial will recruit up to 418 participants. DISCUSSION Results from this trial will determine the efficacy of mupirocin prophylaxis in patients who require IPC for MPE. It will provide data on infection rates, microbiology, and potentially infection pathways associated with IPC-related infections. ETHICS AND DISSEMINATION Sir Charles Gairdner and Osborne Park Health Care Group Human Research Ethics Committee has approved the study (RGS0000005920). Results will be published in peer-reviewed journals and presented at scientific conferences. TRIAL REGISTRATION Australia New Zealand Clinical Trial Registry ACTRN12623000253606. Registered on 9 March 2023.
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Affiliation(s)
- Estee P M Lau
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Matthew Ing
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- Medical School, Faculty of Health & Medical Sciences, University of Western Australia, Perth, Australia
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Sona Vekaria
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
- Department of Pharmacy, Sir Charles Gairdner Hospital, Perth, Australia
| | - Ai Ling Tan
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
| | - Chloe Charlesworth
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Edward Fysh
- Medical School, Faculty of Health & Medical Sciences, University of Western Australia, Perth, Australia
- Department of Respiratory Medicine, St John of God Hospital Midland, Perth, Australia
- Curtin University Medical School, Perth, Australia
| | - Ranjan Shrestha
- Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, Australia
| | - Elaine L C Yap
- Department of Respiratory Medicine, Middlemore Hospital, Auckland, New Zealand
| | - Nicola A Smith
- Department of Respiratory Medicine, Wellington Regional Hospital, Wellington, New Zealand
| | - Benjamin C H Kwan
- Department of Respiratory and Sleep Medicine, The Sutherland Hospital, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - Tajalli Saghaie
- Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, NSW, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Bapti Roy
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, Australia
| | - John Goddard
- Department of Respiratory Medicine, Sunshine Coast University Hospital, Birtinya, QLD, Australia
- Griffith University, Brisbane, QLD, Australia
| | | | - Arash Badiei
- Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
- Adelaide Medical School, Faculty of Health and Medical Science, University of Adelaide, Adelaide, SA, Australia
| | - Phan Nguyen
- Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
- Adelaide Medical School, Faculty of Health and Medical Science, University of Adelaide, Adelaide, SA, Australia
| | | | - Vineeth George
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
- Hunter Medical Research Institute, Newcastle, Australia
| | - Deirdre Fitzgerald
- Department of Respiratory Medicine, Tallaght University Hospital, Dublin, Ireland
| | - Nick Maskell
- Academic Respiratory Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - David Feller-Kopman
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Kevin Murray
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Aron Chakera
- Medical School, Faculty of Health & Medical Sciences, University of Western Australia, Perth, Australia
- Renal Unit, Sir Charles Gairdner Hospital, Perth, Australia
| | - Y C Gary Lee
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia.
- Medical School, Faculty of Health & Medical Sciences, University of Western Australia, Perth, Australia.
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia.
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Silva AR, Hoffmann NG, Fernandez-Llimos F, Lima EC. Data quality review of the Brazilian nosocomial infections surveillance system. J Infect Public Health 2024; 17:687-695. [PMID: 38471259 DOI: 10.1016/j.jiph.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/29/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Surveillance of healthcare-associated infections (HAIs) is an essential component of hospital infection prevention and control systems. We aimed to assess the quality of the data compiled by the Brazilian HAI Surveillance System from pediatric (PICUs) and neonatal intensive care units (NICUs), between 2012 and 2021. METHODS Data Quality Review, including adherence, completeness, internal consistency, consistency over time, and consistency of population trend, were computed at both national and state levels based on quality metrics from World Health Organization Toolkit. Incidence rates (or incidence density) of ventilator-associated pneumonia (VAP) and central line-associated bloodstream infection (CLABSI) were obtained from the Brazilian National Nosocomial Infections Surveillance (NNIS) system. Data on sepsis-related mortality, spanning the period from 2012 to 2021, were extracted from the Brazilian National Health Service database (DATASUS). Additionally, correlations between sepsis-related mortality and incidence rates of VAP or CLABSI were calculated. RESULTS Throughout the majority of the study period, adherence to VAP reporting remained below 75%, exhibiting a positive trend post-2016. Widespread outliers, as well as inconsistencies over time and in population trends, were evident across all 27 states. Only four states maintained consistent adherence levels above 75% for more than 8 years regarding HAI incidence rates. Notably, CLABSI in NICUs boasted the highest reporting adherence among all HAIs, with 148 periods out of 270 (54.8%) exhibiting reporting adherence surpassing 75%. Three states achieved commendable metrics for CLABSI in PICUs, while five states demonstrated favorable results for CLABSI in NICUs. CONCLUSIONS While adherence to HAI report is improving among Brazilian states, an important room for improvement in the Brazilian NNIS exists. Additional efforts should be made by the Brazilian government to improve the reliability of HAI data, which could serve as valuable guidance for hospital infection prevention and control policies.
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Affiliation(s)
- Alice Ramos Silva
- Pharmacy School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | | | - Fernando Fernandez-Llimos
- Applied Molecular Biosciences Unit (UCIBIO), Laboratory of Pharmacology, Faculty of Pharmacy, University of Porto, Porto, Portugal.
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Kim MH, Choi JS. Effects of organizational and individual factors on nurses' practice of central line-associated bloodstream infection prevention. Am J Infect Control 2024; 52:443-449. [PMID: 38007098 DOI: 10.1016/j.ajic.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND This study explored rarely investigated organizational factors (resource support and organizational culture) in conjunction with well-established individual factors (demographic characteristics, knowledge, and awareness) that impact nurses' practice of central line-associated bloodstream infection (CLABSI) prevention. METHODS Self-reported questionnaire data were collected from 173 nurses recruited from departments that use central venous catheters (ie, intensive care units, emergency rooms, hemodialysis rooms, and oncology wards) in tertiary hospitals in South Korea. Multiple regression analyses were performed to examine the effects of individual and organizational factors. RESULTS Organizational culture (ß = 0.350) had the greatest association with CLABSI prevention practice, followed by awareness (ß = 0.328) and department (ß = -0.217; all ps < 0.01). These variables explained 41.1% of the variance in CLABSI prevention practice (F = 20.996, P < .001). Higher self-reported CLABSI prevention practice was associated with a favorable organizational culture and higher awareness. Emergency room nurses' CLABSI prevention practice was notably inferior as compared to nurses in other departments. DISCUSSION Organizational culture is the most significant factor affecting nurses' practice of CLABSI prevention. CONCLUSIONS An organizational culture with environmental improvements and resource support as well as infection prevention education and awareness-building programs should be fostered.
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Affiliation(s)
- Min Hee Kim
- The Gachon University Gil Hospital, Nursing Department, Incheon, South Korea
| | - Jeong Sil Choi
- Gachon University, College of Nursing, Incheon, South Korea.
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Harrington EM, Trautman K, Davis MB, Varzavand K, Meacham H, Dains A, Marra AR, McDanel J, Kenne L, Hanna B, Murphy JP, Diekema DJ, Wellington M, Brust KB, Kobayashi T, Abosi OJ. Descriptive epidemiology of central line-associated bloodstream infections at an academic medical center in Iowa, 2019-2022. Am J Infect Control 2024; 52:436-442. [PMID: 37827243 DOI: 10.1016/j.ajic.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Central line-associated bloodstream infections (CLABSIs) increased nationally during the COVID-19 pandemic. We described CLABSIs at our institution during 2019 to 2022. METHODS This retrospective observational study examined CLABSIs among adult inpatients at an 866-bed teaching hospital in the Midwest. CLABSI incidence was trended over time and compared to monthly COVID-19 admissions. Manual chart review was performed to obtain patient demographics, catheter-associated variables, pathogens, and clinical outcomes. RESULTS We identified 178 CLABSIs. The CLABSI incidence (cases per 1,000 line days) tripled in October 2020 as COVID-19 admissions increased. CLABSIs in 2020 were more frequently caused by coagulase-negative staphylococci and more frequently occurred in the intensive care units 7+ days after central line insertion. The CLABSI incidence normalized in early 2021 and did not increase during subsequent COVID-19 surges. Throughout 2019 to 2022, about half of the nontunneled central venous catheters involved in CLABSI were placed emergently. One-quarter of CLABSIs involved multiple central lines. Chlorhexidine skin treatment adherence was limited by patient refusal. CONCLUSIONS The increase in CLABSIs in late 2020 during a surge in COVID-19 admissions was likely related to central line maintenance but has resolved. Characterizing CLABSI cases can provide insight into adherence to guideline-recommended prevention practices and identify areas for improvement at individual institutions.
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Affiliation(s)
- Elaine M Harrington
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA.
| | - Kathryn Trautman
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Mary B Davis
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Kristin Varzavand
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Holly Meacham
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Angelique Dains
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Alexandre R Marra
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Jennifer McDanel
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Lynnette Kenne
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Beth Hanna
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Jaime P Murphy
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Daniel J Diekema
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Melanie Wellington
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Karen B Brust
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Takaaki Kobayashi
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Oluchi J Abosi
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
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Duque-Sanchez L, Qu Y, Voelcker NH, Thissen H. Tackling catheter-associated urinary tract infections with next-generation antimicrobial technologies. J Biomed Mater Res A 2024; 112:312-335. [PMID: 37881094 DOI: 10.1002/jbm.a.37630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/21/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023]
Abstract
Urinary catheters and other medical devices associated with the urinary tract such as stents are major contributors to nosocomial urinary tract infections (UTIs) as they provide an access path for pathogens to enter the bladder. Considering that catheter-associated urinary tract infections (CAUTIs) account for approximately 75% of UTIs and that UTIs represent the most common type of healthcare-associated infections, novel anti-infective device technologies are urgently required. The rapid rise of antimicrobial resistance in the context of CAUTIs further highlights the importance of such preventative strategies. In this review, the risk factors for pathogen colonization in the urinary tract are dissected, taking into account the nature and mechanistics of this unique environment. Moreover, the most promising next-generation preventative strategies are critically assessed, focusing in particular on anti-infective surface coatings. Finally, emerging approaches in this field and their likely clinical impact are examined.
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Affiliation(s)
- Lina Duque-Sanchez
- Department of Manufacturing, Commonwealth Scientific and Industrial Research Organization (CSIRO), Clayton, Victoria, Australia
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Yue Qu
- Infection and Immunity Program, Department of Microbiology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Nicolas H Voelcker
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- Melbourne Centre for Nanofabrication, Victorian Node of the Australian National Fabrication Facility, Materials Science and Engineering, Monash University, Clayton, Victoria, Australia
| | - Helmut Thissen
- Department of Manufacturing, Commonwealth Scientific and Industrial Research Organization (CSIRO), Clayton, Victoria, Australia
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Sopirala MM, Estelle CD, Houston L. Central Line-Associated Bloodstream Infection Misclassifications-Rethinking the Centers for Disease Control and Prevention's Central Line-Associated Bloodstream Infection Definition and Its Implications. Crit Care Med 2024; 52:357-361. [PMID: 38180116 DOI: 10.1097/ccm.0000000000006175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Centers for Medicare and Medicaid Services imparts financial penalties for central line-associated bloodstream infections (CLABSIs) and other healthcare-acquired infections. Data for this purpose is obtained from the Centers for Disease Control and Prevention (CDC)'s National Health Safety Network. We present examples of misclassification of bloodstream infections into CLABSI by the CDC's definition and present the financial implications of such misclassification and potential long-term implications.
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Affiliation(s)
- Madhuri M Sopirala
- Infection Prevention, Parkland Health, Dallas, TX
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Carolee D Estelle
- Infection Prevention, Parkland Health, Dallas, TX
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
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Clarke P, Soe A, Nichols A, Harizaj H, Webber MA, Linsell L, Bell JL, Tremlett C, Muthukumar P, Pattnayak S, Partlett C, King A, Juszczak E, Heath PT. 2% chlorhexidine gluconate aqueous versus 2% chlorhexidine gluconate in 70% isopropyl alcohol for skin disinfection prior to percutaneous central venous catheterisation: the ARCTIC randomised controlled feasibility trial. Arch Dis Child Fetal Neonatal Ed 2024; 109:202-210. [PMID: 37907266 PMCID: PMC10894828 DOI: 10.1136/archdischild-2023-325871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/08/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE Catheter-related sepsis (CRS) is a major complication with significant morbidity and mortality. Evidence is lacking regarding the most appropriate antiseptic for skin disinfection before percutaneous central venous catheter (PCVC) insertion in preterm neonates. To inform the feasibility and design of a definitive randomised controlled trial (RCT) of two antiseptic formulations, we conducted the Antiseptic Randomised Controlled Trial for Insertion of Catheters (ARCTIC) feasibility study to assess catheter colonisation, sepsis, and skin morbidity. DESIGN Feasibility RCT. SETTING Two UK tertiary-level neonatal intensive care units. PATIENTS Preterm infants born <34 weeks' gestation scheduled to undergo PCVC insertion. INTERVENTIONS Skin disinfection with either 2% chlorhexidine gluconate (CHG)-aqueous or 2% CHG-70% isopropyl alcohol (IPA) before PCVC insertion and at removal. PRIMARY OUTCOME Proportion in the 2% CHG-70% IPA arm with a colonised catheter at removal. MAIN FEASIBILITY OUTCOMES Rates of: (1) CRS, catheter-associated sepsis (CAS), and CRS/CAS per 1,000 PCVC days; (2) recruitment and retention; (3) data completeness. SAFETY OUTCOMES Daily skin morbidity scores recorded from catheter insertion until 48 hours post-removal. RESULTS 116 babies were randomised. Primary outcome incidence was 4.1% (95% confidence interval: 0.9% to 11.5%). Overall catheter colonisation rate was 5.2% (5/97); CRS 2.3/1000 catheter days; CAS 14.8/1000 catheter days. Recruitment, retention and data completeness were good. No major antiseptic-related skin injury was reported. CONCLUSIONS A definitive comparative efficacy trial is feasible, but the very low catheter colonisation rate would make a large-scale RCT challenging due to the very large sample size required. ARCTIC provides preliminary reassurance supporting potential safe use of 2% CHG-70% IPA and 2% CHG-aqueous in preterm neonates. TRIAL REGISTRATION NUMBER ISRCTN82571474.
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Affiliation(s)
- Paul Clarke
- Neonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Aung Soe
- Neonatal Intensive Care Unit, Medway Maritime Hospital, Gillingham, Kent, UK
| | - Amy Nichols
- Neonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
| | - Helen Harizaj
- Neonatal Intensive Care Unit, Medway Maritime Hospital, Gillingham, Kent, UK
| | - Mark A Webber
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
- Quadram Institute Bioscience, Norwich, Norfolk, UK
| | - Louise Linsell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jennifer L Bell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Catherine Tremlett
- Department of Microbiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
| | - Priyadarsini Muthukumar
- Neonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
| | - Santosh Pattnayak
- Neonatal Intensive Care Unit, Medway Maritime Hospital, Gillingham, Kent, UK
| | - Christopher Partlett
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrew King
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ed Juszczak
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Paul T Heath
- Centre for Neonatal and Paediatric Infection, Infection and Immunity, Saint George's University of London, London, UK
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Blundell H, Morgan JE, Neumann E, Phillips B, Thorbinson C, Bate J. Variation in central venous catheter care and management: a review of UK paediatric oncology principal treatment centre practice. Arch Dis Child 2024; 109:257-258. [PMID: 38199818 DOI: 10.1136/archdischild-2023-326315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Helen Blundell
- Department of Children's Haematology and Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Eloise Neumann
- Paediatric Oncology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, York, UK
- Leeds Children's Hospital, Leeds, UK
| | - Colin Thorbinson
- Paediatric Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Jessica Bate
- Paediatric Oncology, Southampton Children's Hospital, Southampton, UK
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11
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Nelson SE, Tsetsou S, Liang J. Leaving no culture undrawn: Time to revisit the CLABSI and CAUTI metrics. J Crit Care 2024; 79:154442. [PMID: 37797403 DOI: 10.1016/j.jcrc.2023.154442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/18/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023]
Abstract
Central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) are quality metrics for many ICUs, and financial ramifications can be applied to hospitals and providers who perform poorly on these measures. Despite some perceived benefits to tracking these metrics, there are a range of issues associated with this practice: lack of a solid evidence base that documenting them has led to decreased infection rates, moral distress associated with identifying these infections, problems with their definitions, and others. We discuss each of these concerns while also including international perspectives then recommend practical steps to attempt to remediate use of the CLABSI and CAUTI metrics. Specifically, we suggest forming a task force consisting of key stakeholders (e.g., providers, Centers for Medicare & Medicaid Services (CMS), patients/families) to review CLABSI and CAUTI-related issues and then to create a summary statement containing recommendations to improve the use of these metrics.
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Affiliation(s)
- Sarah E Nelson
- Departments of Neurosurgery and Neurology, Mount Sinai West, 1000 10(th) Avenue, Suite 10B-65, New York, NY 10019, USA; Department of Neurology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA; Department of Neurology and Anesthesiology/Critical Care Medicine, Johns Hopkins University, 1800 Orleans Street, Baltimore, MD 21287, USA.
| | - Spyridoula Tsetsou
- Departments of Neurosurgery and Neurology, Mount Sinai West, 1000 10(th) Avenue, Suite 10B-65, New York, NY 10019, USA; Departments of Neurology and Neurosurgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - John Liang
- Departments of Neurosurgery and Neurology, Mount Sinai West, 1000 10(th) Avenue, Suite 10B-65, New York, NY 10019, USA
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12
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Lau EPM, Faber S, Charlesworth C, Morey S, Vekaria S, Filion P, Chakera A, Lee YCG. Topical antibiotics prophylaxis for infections of indwelling pleural/peritoneal catheters (TAP-IPC): A pilot study. Respirology 2024; 29:176-182. [PMID: 37696757 DOI: 10.1111/resp.14595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/28/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Indwelling pleural catheter (IPC) and indwelling peritoneal catheter (IPeC) have established roles in the management of malignant pleural and peritoneal effusions but catheter-related infections remain a major concern. Topical mupirocin prophylaxis has been shown to reduce peritoneal dialysis catheter infections. This study aimed to assess the (i) compatibility of IPC with mupirocin and (ii) feasibility, tolerability and compliance of topical mupirocin prophylaxis in patients with an IPC or IPeC. METHODS (i) Three preparations of mupirocin were applied onto segments of IPC thrice weekly and examined with scanning electron microscope (SEM) at different time intervals. (ii) Consecutive patients fitted with IPC or IPeC were given topical mupirocin prophylaxis to apply to the catheter exit-site following every drainage/dressing change (at least twice weekly) and followed up for 6 months. RESULTS (i) No detectable structural catheter damage was found with mupirocin applied for up to 6 months. (ii) Fifty indwelling catheters were inserted in 48 patients for malignant pleural (n = 41) and peritoneal (n = 9) effusions. Median follow-up was 121 [median, IQR 19-181] days. All patients tolerated mupirocin well; one patient reported short-term local tenderness. Compliance was excellent with 95.8% of the 989 scheduled doses delivered. Six patients developed catheter-related pleural (n = 3), concurrent peritoneal/local (n = 1) and skin/tract (n = 2) infections from Streptococcus mitis (with Bacillus species or anaerobes), Staphylococcus aureus, Klebsiella pneumoniae and Pseudomonas aeruginosa. CONCLUSION This first study of long-term prevention of IPC- or IPeC-related infections found topical mupirocin prophylaxis feasible and well tolerated. Its efficacy warrants future randomized studies.
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Affiliation(s)
- Estee P M Lau
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Sam Faber
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Chloe Charlesworth
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Sue Morey
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Sona Vekaria
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Department of Pharmacy, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Pierre Filion
- PathWest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia, Australia
| | - Aron Chakera
- Renal Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Y C Gary Lee
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Western Australia, Australia
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
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13
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Awoyomi O, Wang Y, Bakare T, Bradbury A, Episcopia B, Castro-Auvet P, Fornek M, Quale J. Reduction in catheter-associated urinary tract infections following a diagnostic stewardship intervention. Am J Infect Control 2024; 52:255-257. [PMID: 37805028 PMCID: PMC10996837 DOI: 10.1016/j.ajic.2023.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/09/2023]
Abstract
Catheter-associated urinary tract infections (CAUTIs) are a frequent hospital-acquired infection and public health concern. In an attempt to reduce the number of CAUTIs, an intervention that emphasized the appropriate laboratory evaluation by ordering providers was implemented. This intervention supplemented ongoing standard bundle protocols. Compared to the 16 months before the intervention, there was a significant decrease in the number of CAUTIs during the 12-month intervention period.
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Affiliation(s)
- Olubosede Awoyomi
- Department of Infection Prevention, NYC Health+Hospitals/Kings County, Brooklyn, NY
| | - Yongsheng Wang
- Department of Infection Prevention, NYC Health+Hospitals/Kings County, Brooklyn, NY
| | - Temilola Bakare
- Department of Infection Prevention, NYC Health+Hospitals/Kings County, Brooklyn, NY
| | - Alison Bradbury
- Department of Infection Prevention, NYC Health+Hospitals/Kings County, Brooklyn, NY
| | - Briana Episcopia
- Department of Infection Prevention, NYC Health+Hospitals/Kings County, Brooklyn, NY.
| | - Patricia Castro-Auvet
- Department of Infection Prevention, NYC Health+Hospitals/Central Office, New York, NY
| | - Mary Fornek
- Department of Medicine, NYC Health+Hospitals/Kings County, Brooklyn, NY
| | - John Quale
- Department of Infection Prevention, NYC Health+Hospitals/Central Office, New York, NY
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14
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Hyte M, Clark C, Pandey R, Redden D, Roderick M, Brock K. How COVID-19 impacted CAUTI and CLABSI rates in Alabama. Am J Infect Control 2024; 52:147-151. [PMID: 37263421 PMCID: PMC10226899 DOI: 10.1016/j.ajic.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND The study objective was to quantify infection rate trends for central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) in 89 Alabama hospitals from 2015 to 2021 to analyze how the COVID-19 pandemic impacted health care delivery. METHODS Retrospective analysis of CLABSI and CAUTI rates, from 89 Alabama hospitals via data from the Alabama Department of Public Health from 2015 to 2021. RESULTS Based on our modeling strategies, there was a statistically significant decrease in rates of CAUTIs from 2015 to 2019 at an estimated rate of 7% per year (P = 0.0167) and CLABSIs from 2015 to 2018 at an estimated rate of 13% per year (P < .001) in these hospitals. In 2020, the CAUTI and CLABSI rates began increasing at a modeled rate of 29% per year (P = .001) and 35% per year (P < .001) respectively. DISCUSSION A review of potential causes for the elevated rate of health care-associated infections illustrated that certain practices may have contributed to increased CAUTI and CLABSI rates. Utilizing staff from noncritical care areas with less experience in health care-associated infection prevention, batching of tasks to conserve personal protective equipment, and a nationwide mental health crisis could have affected infection prevention bundle compliance. CONCLUSIONS An increase in CAUTIs and CLABSIs was observed during the pandemic, likely due to the large volume of patients requiring advanced medical care and subsequent depleted resources.
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Affiliation(s)
- Melanie Hyte
- Edward Via College of Osteopathic Medicine-Auburn Campus, Auburn, AL.
| | - Cassidy Clark
- Edward Via College of Osteopathic Medicine-Auburn Campus, Auburn, AL
| | - Rishika Pandey
- Edward Via College of Osteopathic Medicine-Auburn Campus, Auburn, AL
| | - David Redden
- Edward Via College of Osteopathic Medicine-Auburn Campus, Auburn, AL
| | | | - Kenny Brock
- Edward Via College of Osteopathic Medicine-Auburn Campus, Auburn, AL
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15
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Kurata Y, Ohira G, Hayano K, Imanishi S, Tochigi T, Takahashi Y, Mamiya H, Iwata M, Uesato M, Murakami K, Toyozumi T, Matsumoto Y, Nakano A, Otsuka R, Hayashi H, Matsubara H. Peripherally inserted central catheter securement with cyanoacrylate glue and bloodstream infection: A retrospective cohort study. JPEN J Parenter Enteral Nutr 2024; 48:215-223. [PMID: 38047542 DOI: 10.1002/jpen.2583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 11/06/2023] [Accepted: 11/28/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Treatment via a peripherally inserted central venous catheter is important for anticancer treatment, perioperative management, and nutrition management. In this study, we aimed to investigate the usefulness of cyanoacrylate glue (CG) in managing peripherally inserted central venous catheters in adults. METHODS This retrospective cohort study enrolled 411 adults requiring a central venous catheter for treatment in the Chiba University Esophageal-Gastro-Intestinal Surgery department between January 2021 and October 2022. The preventive effect of CG in reducing adverse events, including infection, tip migration, and thrombus formation, was evaluated by reviewing electronic medical records, chest radiographs, and contrast-enhanced computed tomography scans. RESULTS CG and other dressings were used in 158 (CG group) and 253 (control group) patients, respectively. The incidence of catheter infection based on the clinical course was lower in the CG group (3.2%) than in the control group (9.1%; P = 0.03). However, cases of infection confirmed by blood or catheter cultures did not differ between the CG (1.3%) and control (1.9%) groups (P = 1.0). Chest radiographs revealed that catheter tip migration (mean ± SD) was lesser in the CG group (8.2 ± 6.7 mm) than in the control group (15.0 ± 15.8 mm; P < 0.01). There were two cases of venous thrombus formation in the control group. CONCLUSION In a population dominated by esophago-gastroenterological malignancy, peripherally inserted central catheter securement via CG was associated with decreased catheter removal because of suspected catheter infection. Further research on larger cohorts is needed to determine if other adverse events decrease following peripherally inserted central catheter securement via CG.
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Affiliation(s)
- Yoshihiro Kurata
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Gaku Ohira
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Koichi Hayano
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shunsuke Imanishi
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Toru Tochigi
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yumiko Takahashi
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hisashi Mamiya
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Moe Iwata
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masaya Uesato
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kentaro Murakami
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takeshi Toyozumi
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasunori Matsumoto
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Akira Nakano
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ryota Otsuka
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | | | - Hisahiro Matsubara
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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16
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Jansen SJ, Broer SDL, Hemels MAC, Visser DH, Antonius TAJ, Heijting IE, Bergman KA, Termote JUM, Hütten MC, van der Sluijs JPF, d'Haens EJ, Kornelisse RF, Lopriore E, Bekker V. Central-line-associated bloodstream infection burden among Dutch neonatal intensive care units. J Hosp Infect 2024; 144:20-27. [PMID: 38103692 DOI: 10.1016/j.jhin.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/18/2023] [Accepted: 11/25/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The establishment of an epidemiological overview provides valuable insights needed for the (future) dissemination of infection-prevention initiatives. AIM To describe the nationwide epidemiology of central-line-associated bloodstream infections (CLABSI) among Dutch Neonatal Intensive Care Units (NICUs). METHODS Data from 2935 neonates born at <32 weeks' gestation and/or with a birth weight <1500 g admitted to all nine Dutch NICUs over a two-year surveillance period (2019-2020) were analysed. Variations in baseline characteristics, CLABSI incidence per 1000 central-line days, pathogen distribution and CLABSI care bundles were evaluated. Multi-variable logistic mixed-modelling was used to identify significant predictors for CLABSI. RESULTS A total of 1699 (58%) neonates received a central line, in which 160 CLABSI episodes were recorded. Coagulase-negative staphylococci were the most common infecting organisms of all CLABSI episodes (N=100, 63%). An almost six-fold difference in the CLABSI incidence between participating units was found (2.91-16.14 per 1000 line-days). Logistic mixed-modelling revealed longer central line dwell-time (adjusted odds ratio (aOR):1.08, P<0.001), umbilical lines (aOR:1.85, P=0.03) and single rooms (aOR:3.63, P=0.02) to be significant predictors of CLABSI. Variations in bundle elements included intravenous tubing care and antibiotic prophylaxis. CONCLUSIONS CLABSI remains a common problem in preterm infants in The Netherlands, with substantial variation in incidence between centres. Being the largest collection of data on the burden of neonatal CLABSI in The Netherlands, this epidemiological overview provides a solid foundation for the development of a collaborative platform for continuous surveillance, ideally leading to refinement of national evidence-based guidelines. Future efforts should focus on ensuring availability and extraction of routine patient data in aggregated formats.
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Affiliation(s)
- S J Jansen
- Willem-Alexander Children's Hospital, Department of Paediatrics, Division of Neonatology, Leiden University Medical Centre, The Netherlands.
| | - S D L Broer
- Willem-Alexander Children's Hospital, Department of Paediatrics, Division of Neonatology, Leiden University Medical Centre, The Netherlands
| | - M A C Hemels
- Department of Neonatology, Isala, Zwolle, The Netherlands
| | - D H Visser
- Emma Children's Hospital, Department of Paediatrics, Division of Neonatology, Amsterdam University Medical Centre (AUMC), Location AMC, Amsterdam, The Netherlands
| | - T A J Antonius
- Amalia Children's Hospital, Department of Paediatrics, Division of Neonatology, Radboud University Medical Centre (Radboud UMC), Nijmegen, The Netherlands
| | - I E Heijting
- Amalia Children's Hospital, Department of Paediatrics, Division of Neonatology, Radboud University Medical Centre (Radboud UMC), Nijmegen, The Netherlands
| | - K A Bergman
- Beatrix Children's Hospital, Department of Paediatrics, Division of Neonatology, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - J U M Termote
- Wilhelmina Children's Hospital, Department of Neonatology, Division of Mother and Child, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands
| | - M C Hütten
- Department of Paediatrics, Division of Neonatology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - J P F van der Sluijs
- Department Paediatrics, Division of Neonatology, Máxima Medical Centre (MMC), Veldhoven, The Netherlands
| | - E J d'Haens
- Department of Neonatology, Isala, Zwolle, The Netherlands
| | - R F Kornelisse
- Erasmus MC - Sophia Children's Hospital, Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - E Lopriore
- Willem-Alexander Children's Hospital, Department of Paediatrics, Division of Neonatology, Leiden University Medical Centre, The Netherlands
| | - V Bekker
- Willem-Alexander Children's Hospital, Department of Paediatrics, Division of Neonatology, Leiden University Medical Centre, The Netherlands
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17
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Williams TJ, Moy N, Kaazan P, Callaghan G, Holtmann G, Martin N. Cost-effectiveness of taurolidine-citrate in a cohort of patients with intestinal failure receiving home parenteral nutrition. JPEN J Parenter Enteral Nutr 2024; 48:165-173. [PMID: 38062902 DOI: 10.1002/jpen.2589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 10/05/2023] [Accepted: 12/05/2023] [Indexed: 01/02/2024]
Abstract
BACKGROUND Catheter-related bloodstream infections (CRBSIs) in patients receiving home parenteral nutrition (HPN) for chronic intestinal failure (CIF) are associated with significant morbidity and financial costs. Taurolidine is associated with a reduction in bloodstream infections, with limited information on the cost-effectiveness as the primary prevention. This study aimed to determine the cost-effectiveness of using taurolidine-citrate for the primary prevention of CRBSIs within a quaternary hospital. METHODS All patients with CIF receiving HPN were identified between January 2015 and November 2022. Data were retrospectively collected regarding patient demographics, HPN use, CRBSI diagnosis, and use of taurolidine-citrate. The direct costs associated with CRBSI-associated admissions and taurolidine-citrate use were obtained from the coding department using a bottom-up approach. An incremental cost-effective analysis was performed, with a time horizon of 4 years, to compare the costs associated with primary and secondary prevention against the outcome of cost per infection avoided. RESULTS Forty-four patients received HPN within this period. The CRBSI rates were 3.25 infections per 1000 catheter days before the use of taurolidine-citrate and 0.35 infections per 1000 catheter days after taurolidine-citrate use. The incremental cost-effectiveness ratio indicates primary prevention is the weakly dominant intervention, with the base case value of $27.04 per CRBSI avoided. This held with one-way sensitivity analysis. CONCLUSION Taurolidine-citrate in the primary prevention of CRBSIs in patients with CIF receiving HPN is associated with reduced hospital costs and infection rates.
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Affiliation(s)
- Thomas J Williams
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Naomi Moy
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
| | - Patricia Kaazan
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Gavin Callaghan
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
| | - Gerald Holtmann
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Neal Martin
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Herston, Queensland, Australia
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18
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Castellà L, Casas I, Giménez M, Reina D, Sopena N, García-Quesada MJ. Hygiene with wet wipes in bedridden patients to prevent catheter-associated urinary tract infection in cardiac surgery: A randomized controlled trial. Infect Control Hosp Epidemiol 2024; 45:227-230. [PMID: 37615098 DOI: 10.1017/ice.2023.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
We assessed hygiene with wet wipes in bedridden patients with urinary catheters for catheter-associated urinary tract infection (CAUTI) prevention. CAUTIs occurred in 16.5% of the control group compared to 5.9% of the intervention group (P = .035). Hygiene with wet wipes can substitute for conventional hygiene for preventing CAUTI.
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Affiliation(s)
- Laia Castellà
- Infection Control Nursing, Infection Control Team, Germans Trias i Pujol University Hospital, Badalona, Spain
- Germans Trias i Pujol Research Institute (IGTP), Germans Trias i Pujol University Hospital, Badalona, Spain
- NURECARE-IGTP Nursing Research Group, Germans Trias i Pujol Research Institute, Badalona, Spain
| | - Irma Casas
- Germans Trias i Pujol Research Institute (IGTP), Germans Trias i Pujol University Hospital, Badalona, Spain
- Preventive Medicine Department, Infection Control Team, Germans Trias i Pujol University Hospital, Badalona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, Spain
| | - Montse Giménez
- Microbiology Department, Infection Control Team, North Metropolitan Clinical Laboratory, Germans Trias i Pujol University Hospital, Badalona, Spain
- Infectious Diseases Department, Infection Control Team, Germans Trias i Pujol University Hospital, Badalona, Spain
- CIBERES Instituto de Salud Carlos III, Madrid, Spain
| | - Dina Reina
- Infection Control Nursing, Infection Control Team, Germans Trias i Pujol University Hospital, Badalona, Spain
- NURECARE-IGTP Nursing Research Group, Germans Trias i Pujol Research Institute, Badalona, Spain
| | - Nieves Sopena
- Germans Trias i Pujol Research Institute (IGTP), Germans Trias i Pujol University Hospital, Badalona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, Spain
- Microbiology Department, Infection Control Team, North Metropolitan Clinical Laboratory, Germans Trias i Pujol University Hospital, Badalona, Spain
- Infectious Diseases Department, Infection Control Team, Germans Trias i Pujol University Hospital, Badalona, Spain
- CIBERES Instituto de Salud Carlos III, Madrid, Spain
| | - Maria-José García-Quesada
- Infection Control Nursing, Infection Control Team, Germans Trias i Pujol University Hospital, Badalona, Spain
- Germans Trias i Pujol Research Institute (IGTP), Germans Trias i Pujol University Hospital, Badalona, Spain
- NURECARE-IGTP Nursing Research Group, Germans Trias i Pujol Research Institute, Badalona, Spain
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19
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Reynolds H, Gowardman J, Woods C. Care bundles and peripheral arterial catheters. Br J Nurs 2024; 33:S34-S41. [PMID: 38271041 DOI: 10.12968/bjon.2024.33.2.s34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
HIGHLIGHTS What we know about the topic: Recommendations for the use of vascular access care bundles to reduce infection are followed for different devices. The risk of arterial catheter-related infection is comparable with short-term, non-cuffed central venous catheters. There are practice concerns for clinicians inserting and caring for peripheral arterial catheters. What this paper adds: The selected studies had a theme of decreased infection after using bundled strategies for all devices. Few studies addressed use of bundles for care of peripheral arterial catheters. High-quality research should be performed about using care bundles for insertion and care of arterial catheters. INTRODUCTION A scoping review of the literature was performed. AIMS/OBJECTIVES To find information on the use of care bundles for care of arterial, central, and peripherally inserted venous catheters. METHODS Data was extracted by 2 independent researchers using standardized methodology. RESULTS Results of 84 studies included 2 (2.4%) randomized controlled trials, 38 (45.2%) observational studies, 29 (34.5%) quality projects, and 15 (17.9%) reviews. Populations had more adults than pediatric patients. All studies had the most prominent theme of decreased infection in all devices after using bundle strategies. DISCUSSION AND CONCLUSIONS The mapping of available evidence strongly supports the use of care bundles to reduce infection in the care of all intravascular devices. However, deficiencies regarding practice concerns about insertion and care of arterial catheters highlight areas for future research with the aim to eliminate the gap in the evidence of studies of care bundles for peripheral arterial catheters.
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Affiliation(s)
- Heather Reynolds
- Department of Anaesthesia & Perioperative Medicine, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia, The University of Queensland, St Lucia, Queensland, Australia, Alliance for Vascular Access Teaching & Research, Griffith University, Nathan, Queensland, Australia
| | - John Gowardman
- Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia, The University of Queensland, St Lucia, Queensland, Australia
| | - Christine Woods
- Department of Anaesthesia & Perioperative Medicine, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia, The University of Queensland, St Lucia, Queensland, Australia
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Barton A. KiteLock 4%: the next generation of CVAD locking solutions. Br J Nurs 2024; 33:S20-S26. [PMID: 38271043 DOI: 10.12968/bjon.2024.33.2.s20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Central venous access devices (CVADs), including peripherally inserted central catheters (PICCs) and cuffed tunnelled catheters, play a crucial role in modern medicine by providing reliable access for medication and treatments directly into the bloodstream. However, these vital medical devices also pose a significant risk of catheter-related bloodstream infections (CRBSIs) alongside associated complications such as thrombosis or catheter occlusion. To mitigate these risks, healthcare providers employ various strategies, including the use of locking solutions in combination with meticulous care and maintenance protocols. KiteLock 4% catheter lock is a solution designed to combat the triple threat of infection, occlusion and biofilm. This locking solution is described as the only locking solution to provide cover for all three complications.
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Affiliation(s)
- Andrew Barton
- Nurse Consultant, IV Therapy and Vascular Access and Lead Nurse, IVAS, Frimley Park Hospital, Frimley Health NHS Foundation Trust and Chair, NIVAS
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21
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Picaud JC, Faton S, Pradat P, Pastor-Diez B, Martelin A, Armoiry X, Hays S. A new perfusion system to reduce the burden of central-venous-line-associated bloodstream infections in neonates. J Hosp Infect 2024; 143:203-212. [PMID: 37858805 DOI: 10.1016/j.jhin.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/22/2023] [Accepted: 10/08/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Central-venous-line-associated bloodstream infection (CLABSI) is a significant cause of morbidity and mortality in preterm infants. As there is large variation in the reported effect of multi-modal preventive strategies, it could be relevant to propose new additional strategies. AIM To assess the impact of a new perfusion system on CLABSI rate. METHODS A before-and-after study was performed in infants born at <32 weeks of gestation or with birth weight <1500 g who required a multi-perfusion system connected to a central venous line. In the first 12-month period ('before'), the pre-existing perfusion system (multiple stopcocks) was used. An intervention period then occurred with implementation of a new perfusion closed system, without change in 'bundles' related to various aspects of central line care. During the second 12-month period ('after'), the CLABSI rate was assessed and compared with the pre-intervention period. FINDINGS In total, 313 infants were included in this study (before: N=163; after: N=150), and 46% had birth weight <1000 g. The change in perfusion system resulted in a significant decrease in CLABSI rate from 11.3 to 2.2 per 1000 catheter-days (P<0.001). The period was independently associated with an 88% reduction in the risk of CLABSI after implementation of the new perfusion system [odds ratio (OR) 0.12, 95% confidence interval (CI) 0.03-0.39; P<0.001]. The duration of central line use was also associated with CLABSIs (for each additional day: OR 1.05, 95% CI 1.02-1.07; P<0.001). CONCLUSIONS Implementation of the new perfusion system was feasible in a large neonatal unit, and reduced the CLABSI rate soon after implementation.
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Affiliation(s)
- J C Picaud
- Service de néonatologie, Hopital universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Laboratoire CarMen, INSERM, INRA, Claude Bernard University Lyon 1, Pierre-Bénite, France.
| | - S Faton
- Service de néonatologie, Hopital universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - P Pradat
- Centre de recherche clinique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - B Pastor-Diez
- Service de néonatologie, Hopital universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - A Martelin
- Pharmacie, Hôpital de la Croix-Rousse, Lyon, France
| | - X Armoiry
- University of Lyon, School of Pharmacy/UMR CNRS 5510 MATEIS/Edouard Herriot Hospital, Pharmacy Department, Lyon, France; University of Warwick, Warwick Medical School, Coventry, UK
| | - S Hays
- Service de néonatologie, Hopital universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
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Savarese I, Yazami S, De Rose DU, Carkeek K, Campi F, Auriti C, Danhaive O, Piersigilli F. Use of 2% taurolidine lock solution for treatment and prevention of catheter-related bloodstream infections in neonates: a feasibility study. J Hosp Infect 2024; 143:76-81. [PMID: 37972710 DOI: 10.1016/j.jhin.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/26/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Taurolidine lock, a technique used to prevent or treat catheter-related bloodstream infection (CRBSI), is effective in adult and paediatric patients but has been described rarely in neonates. The aim of this descriptive retrospective study, was to determine the feasibility and direct outcomes of prophylactic and therapeutic taurolidine locks in term and preterm neonates. METHODS We implemented the use of therapeutic taurolidine lock in addition to antibiotic treatment with the aim of catheter salvage in critical neonates with difficult vascular access (group 1). In addition, we introduced taurolidine lock as a preventive measure in neonates with a central venous catheter (CVC) at high risk of developing CRBSI (group 2). Every 24 h (in the treatment group) a 2% taurolidine solution was injected and the catheter locked for at least 120 min, until infection clearance (group 1). In the preventive group, the catheter was locked for 30 min every 48 h until CVC removal (group 2). FINDINGS Thirty-seven neonates who received taurolidine were included in this study. We did not observe any major adverse events. In group 1 (21 cases), clinical symptom disappearance and bacteraemia clearance were achieved without catheter removal in 18 cases (85.7%); in the other three neonates the catheter was removed shortly after the start of the locks as it was possible to replace the CVC. In group 2 (16 neonates), no CRBSI was observed during the duration of the catheter placement. CONCLUSIONS In this retrospective study, taurolidine was successfully used in neonates both for prevention and treatment of CRBSI, without major undesired effects. A larger cohort and a randomized clinical trial is warranted in order to establish its efficacy and safety in neonates.
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Affiliation(s)
- I Savarese
- Neonatal Intensive Care Unit, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - S Yazami
- Neonatal Intensive Care Unit, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Bruxelles, Belgium
| | - D U De Rose
- Neonatal Intensive Care Unit, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - K Carkeek
- Neonatal Intensive Care Unit, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Bruxelles, Belgium
| | - F Campi
- Neonatal Intensive Care Unit, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - C Auriti
- Neonatal Intensive Care Unit, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - O Danhaive
- Neonatal Intensive Care Unit, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Bruxelles, Belgium
| | - F Piersigilli
- Neonatal Intensive Care Unit, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Bruxelles, Belgium.
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Rosenthal VD, Yin R, Abbo LM, Lee BH, Rodrigues C, Myatra SN, Divatia JV, Kharbanda M, Nag B, Rajhans P, Shingte V, Mehta Y, Sarma S, Todi SK, Bhattacharyya M, Basu S, Sahu S, Mishra SB, Samal S, Chawla R, Jain AC, Nair PK, Kalapala D, Arjun R, Singla D, Sandhu K, Badyal B, Palaniswamy V, Bhakta A, Gan CS, Mohd-Basri MN, Lai YH, Tai CW, Lee PC, Bat-Erdene I, Begzjav T, Acharya SP, Dongol R, Ikram A, Tumu N, Tao L, Jin Z. An international prospective study of INICC analyzing the incidence and risk factors for catheter-associated urinary tract infections in 235 ICUs across 8 Asian Countries. Am J Infect Control 2024; 52:54-60. [PMID: 37499758 DOI: 10.1016/j.ajic.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Identify urinary catheter (UC)-associated urinary tract infections (CAUTI) incidence and risk factors (RF) in 235 ICUs in 8 Asian countries: India, Malaysia, Mongolia, Nepal, Pakistan, the Philippines, Thailand, and Vietnam. METHODS From January 1, 2014, to February 12, 2022, we conducted a prospective cohort study. To estimate CAUTI incidence, the number of UC days was the denominator, and CAUTI was the numerator. To estimate CAUTI RFs, we analyzed 11 variables using multiple logistic regression. RESULTS 84,920 patients hospitalized for 499,272 patient days acquired 869 CAUTIs. The pooled CAUTI rate per 1,000 UC-days was 3.08; for those using suprapubic-catheters (4.11); indwelling-catheters (2.65); trauma-ICU (10.55), neurologic-ICU (7.17), neurosurgical-ICU (5.28); in lower-middle-income countries (3.05); in upper-middle-income countries (1.71); at public-hospitals (5.98), at private-hospitals (3.09), at teaching-hospitals (2.04). The following variables were identified as CAUTI RFs: Age (adjusted odds ratio [aOR] = 1.01; 95% CI = 1.01-1.02; P < .0001); female sex (aOR = 1.39; 95% CI = 1.21-1.59; P < .0001); using suprapubic-catheter (aOR = 4.72; 95% CI = 1.69-13.21; P < .0001); length of stay before CAUTI acquisition (aOR = 1.04; 95% CI = 1.04-1.05; P < .0001); UC and device utilization-ratio (aOR = 1.07; 95% CI = 1.01-1.13; P = .02); hospitalized at trauma-ICU (aOR = 14.12; 95% CI = 4.68-42.67; P < .0001), neurologic-ICU (aOR = 14.13; 95% CI = 6.63-30.11; P < .0001), neurosurgical-ICU (aOR = 13.79; 95% CI = 6.88-27.64; P < .0001); public-facilities (aOR = 3.23; 95% CI = 2.34-4.46; P < .0001). DISCUSSION CAUTI rate and risk are higher for older patients, women, hospitalized at trauma-ICU, neurologic-ICU, neurosurgical-ICU, and public facilities. All of them are unlikely to change. CONCLUSIONS It is suggested to focus on reducing the length of stay and the Urinary catheter device utilization ratio, avoiding suprapubic catheters, and implementing evidence-based CAUTI prevention recommendations.
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Affiliation(s)
- Victor D Rosenthal
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, USA; Infeciton Control Department, International Nosocomial Infection Control Consortium, INICC Foundation, Miami, USA.
| | - Ruijie Yin
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, USA
| | - Lilian M Abbo
- Division of Infectious Disease, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Camilla Rodrigues
- Pd Hinduja National Hospital and Medical Research Centre, Department of Microbiology, Mumbai, India
| | - Sheila N Myatra
- Tata Memorial Hospital, Homi Bhabha National Institute, Department of Anesthesiology, Critical Care and Pain, Mumbai, India
| | | | - Mohit Kharbanda
- Deenanath Mangeshkar Hospital And Research Center Erandwane Pune, Pune, India
| | - Bikas Nag
- Deenanath Mangeshkar Hospital And Research Center Erandwane Pune, Pune, India
| | - Prasad Rajhans
- Deenanath Mangeshkar Hospital And Research Center Erandwane Pune, Pune, India
| | - Vasudha Shingte
- Deenanath Mangeshkar Hospital And Research Center Erandwane Pune, Pune, India
| | - Yatin Mehta
- Medanta The Medicity, Department of Critical Care and Anesthesiology, Haryana, India
| | - Smita Sarma
- Medanta The Medicity, Department of Critical Care and Anesthesiology, Haryana, India
| | - Subhash K Todi
- Advanced Medicare Research Institute AMRI Hospitals, Department of Critical Care, Kolkata, India
| | - Mahuya Bhattacharyya
- Advanced Medicare Research Institute AMRI Hospitals, Department of Critical Care, Kolkata, India
| | - Sushmita Basu
- Advanced Medicare Research Institute Mukundapur Unit, Kolkata, India
| | | | - Shakti B Mishra
- Critical Care Department, IMS and SUM Hospital, Bhubaneswar, India
| | - Samir Samal
- Critical Care Department, IMS and SUM Hospital, Bhubaneswar, India
| | - Rajesh Chawla
- Indraprastha Apollo Hospitals, Department of Critical Care, New Delhi, India
| | - Aakanksha C Jain
- Indraprastha Apollo Hospitals, Department of Critical Care, New Delhi, India
| | - Pravin K Nair
- Critical Care Department, Holy Spirit Hospital, Mumbai, India
| | - Durga Kalapala
- Critical Care Department, Holy Spirit Hospital, Mumbai, India
| | - Rajalakshmi Arjun
- Kerala Institute Of Med Sciences Health, Department of Critical Care, Trivandrum, India
| | - Deepak Singla
- Critical Care Department, Maharaja Agrasen Hospital, New Delhi, India
| | - Kavita Sandhu
- Max Super Speciality Hospital Saket Delhi, Department of Critical Care, New Delhi, India
| | - Binesh Badyal
- Max Super Speciality Hospital Saket Delhi, Department of Critical Care, New Delhi, India
| | | | - Arpita Bhakta
- University Malaya Medical Centre, Department of Pediatric Intensive Care, Kuala Lumpur, Malaysia
| | - Chin S Gan
- University Malaya Medical Centre, Department of Pediatric Intensive Care, Kuala Lumpur, Malaysia
| | - Mat N Mohd-Basri
- International Islamic University Malaysia, Department of Anesthesia and Critical Care, Kuantan, Pahang, Malaysia
| | - Yin H Lai
- International Islamic University Malaysia, Department of Anesthesia and Critical Care, Kuantan, Pahang, Malaysia
| | - Chian-Wern Tai
- Universiti Kebangsaan Malaysia Specialist Children's Hospital, Department of Critical Care, Kuala Lumpur, Malaysia
| | - Pei-Chuen Lee
- Universiti Kebangsaan Malaysia Specialist Children's Hospital, Department of Critical Care, Kuala Lumpur, Malaysia
| | - Ider Bat-Erdene
- Critical Care Department, Intermed Hospital, Ulaanbaatar, Mongolia
| | - Tsolmon Begzjav
- Critical Care Department, Intermed Hospital, Ulaanbaatar, Mongolia
| | - Subhash P Acharya
- Critical Care Department, Grande International Hospital, Kathmandu, Nepal
| | - Reshma Dongol
- Critical Care Department, Grande International Hospital, Kathmandu, Nepal
| | - Aamer Ikram
- Critical Care Department, Armed Forces Institute of Urology, Rawalpindi, Pakistan
| | - Nellie Tumu
- Department of Public Health Sciences, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Lili Tao
- Zhongshan Hospital, Fudan University, Department of Pneumonology, Shanghai, China
| | - Zhilin Jin
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, USA
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24
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Sharma R, Gandhi KA, Biswal M, Kaur K, Sahni N, Yaddanapudi L. Effect of intensive training and education of health care workers on the maintenance bundle of venous access devices in critically ill patients at a tertiary care academic hospital. Am J Infect Control 2024; 52:41-45. [PMID: 37474007 DOI: 10.1016/j.ajic.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/07/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND The maintenance bundle of care for all venous access devices (peripheral intravenous catheters, PIVC; central venous catheters, CVCs; hemodialysis ports) is important to prevent secondary sepsis in critically ill patients. This quality improvement project analyzed the effect of intensive training and education of health care workers (HCWs) on maintenance bundles for venous access devices. METHODS The study period comprising of preintervention phase (3-months) included 25 random visits to the intensive care unit for point observations regarding maintenance of all venous access devices in-situ in all intensive care unit patients on the day of the visit. The observations were categorized as appropriate or inappropriate practices based on American Society of Anesthesiologists (ASA) guidelines for CVC 2020, INICC guidelines for PIVC 2017, and Australian Commission on Safety and Quality in Health Care (ACQHCS) for PIVC and hemodialysis ports, December 2019. While the intervention phase (1-month) comprised intensive training and education of HCWs, postintervention phase 3 (3-months) included similar visits and point observations as during the preintervention phase. RESULTS The maintenance of PIVC improved significantly in terms of the condition of site (from 82.7% appropriate observations to 97.8%, P < .05); condition of connectors (45.7%-56.8%, P < .05), and any attached unused IV sets (90.5%-98.56%, P < .05). For CVC, there was significant improvement in condition of insertion site (66%-94%, P < .01); condition of connectors (0%-44.37%, P < .01); fixation (91%-99.3%, P < .05); any attached unused IV sets (38.9%-97.3%, P < .01) and knowledge of HCW (96.52%-100%, P = .05). For hemodialysis ports, no significant improvement was observed. CONCLUSIONS Intensive training and education of HCWs led to significant improvement in the maintenance bundle of care for PIVC and CVC.
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Affiliation(s)
- Rubina Sharma
- Department of Anesthesia & Intensive Care, PGIMER, Chandigarh, India
| | - Komal A Gandhi
- Department of Anesthesia & Intensive Care, PGIMER, Chandigarh, India
| | - Manisha Biswal
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Kulbeer Kaur
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Neeru Sahni
- Department of Anesthesia & Intensive Care, PGIMER, Chandigarh, India.
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Yildirim S, Yilmaz B, Yilmaz E, Derici UB. Metastatic spondylodiscitis in central venous catheter related bloodstream infections in hemodialysis patients: Risk factors and prognosis. J Vasc Access 2024; 25:232-238. [PMID: 35470746 DOI: 10.1177/11297298221085460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Infection is one of the most common causes of death in hemodialysis patients. Catheter infections are among the most common infections in this patient group. Spondylodiscitis which has a high incidence in ESRD is more commonly encountered in patients with CVCs compared to AVF. In this study, we aimed to evaluate the frequency and risk factors of spondylodiscitis in catheter-related bloodstream infections in hemodialysis patients. METHODS In total, 1620 patients were screened and 42 male and 35 female patients with central catheter infection with a mean age of 65.8 ± 14.9 years were included in this study. Patients with metastatic infections secondary to CVC related bloodstream infections were determined. The diagnosis of spondylodiscitis was based on clinical information, computed tomography (CT) and magnetic resonance imaging (MRI), and vertebral cultures. RESULTS Metastatic infection due to catheter infection was observed in 15 patients (19.5%). In the regression analysis, CRP level and RRT time were found to be significantly correlated with the development of metastatic infection. Spondylodiscitis was the most common subtype of metastatic infections (8/15). The presence of lumbar hernia was associated with increased risk of metastatic spondylodiscitis in case of catheter infection in hemodialysis patients. The only factor associated with resistance to medical treatment was the time from admission to diagnosis. CONCLUSION Patients with long RRT time and high blood CRP levels on admission should be closely monitored for metastatic infection in patients with CVC related bloodstream infections. Screening for spondylodiscitis with CT or MRI should be performed in patients with symptoms, since early diagnosis may prevent the development of possible neurological deficits and treatment resistance.
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Affiliation(s)
- Saliha Yildirim
- Nephrology Department, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Beyza Yilmaz
- Internal Medicine Department, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Eren Yilmaz
- Internal Medicine Department, Gazi University Faculty of Medicine, Ankara, Turkey
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26
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Takashima M, Ezure Y, Furuya-Kanamori L, Wolf J, Dufficy M, Gibson V, Clark J, Ullman A. Pediatric Central Venous Access Device Lock Solutions: A Network Meta-analysis. Pediatrics 2024; 153:e2023063264. [PMID: 38287882 DOI: 10.1542/peds.2023-063264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 01/31/2024] Open
Abstract
CONTEXT Central venous access device (CVAD) locks are routine interventions used to prevent and treat complications, such as infection, thrombosis, and catheter occlusion. OBJECTIVE To compare and rank lock-solutions for prevention or treatment of complications in pediatrics. Design Systematic review and network meta-analysis. DATA SOURCES Five databases and 2 clinical trial registries were searched. STUDY SELECTION Published and unpublished randomized controlled trials that enrolled pediatric patients with a CVAD and compared the effectiveness of lock-solutions. DATA EXTRACTION Data extraction was conducted by 2 reviewers. Odds ratio (OR) for prevention or treatment of CVAD-associated bloodstream infection (BSI), thrombosis, occlusion, CVAD-failure, and mortality were calculated, with point estimates ranking lock-solutions. RESULTS Twenty-nine studies were included. Chelating agents and antibiotic locks given as prevention were associated with lower odds (OR: 0.11; 95% confidence interval [CI]: 0.02-0.67; moderate-quality; OR: 0.19; 95% CI: 0.05-0.79, high-quality, respectively) of CVAD-associated BSI compared with heparinized saline (reference). Preventative thrombolytic agents had lower odds (OR: 0.64, 95% CI: 0.44-0.93; low-quality) of CVAD occlusion, whereas ethanol had higher odds (OR: 2.84, 95% CI: 1.31-6.16; high-quality) compared with heparinized saline (reference). No lock solution had effects on thrombosis prevention or treatment, CVAD-failure, CVAD-associated BSI treatment failure, or mortality. LIMITATIONS There was substantial uncertainty around the point estimates because of the limited number of studies for outcomes and study heterogeneity. More high-quality studies are needed to confirm the efficacy of lock solutions. CONCLUSIONS Chelating agents and antibiotic locks may be effective for CVAD-associated BSI prevention in pediatrics. Thrombolytic agents can be an option for CVAD occlusion prevention, whereas ethanol may not be recommended.
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Affiliation(s)
- Mari Takashima
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
- Children's Health Research Centre, The University of Queensland, St Lucia, Queensland, Australia
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Yukiko Ezure
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Luis Furuya-Kanamori
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Joshua Wolf
- Department of Infectious Diseases, St Jude Children's Research Hospital, Tennessee
- Department of Pediatrics, University of Tennessee Health Science Center, Tennessee
| | - Mitchell Dufficy
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
| | - Victoria Gibson
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
| | | | - Amanda Ullman
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
- Children's Health Research Centre, The University of Queensland, St Lucia, Queensland, Australia
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
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27
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Luva A, Mijares A, Richards B, Ashburn A. Deployment of nursing students to assist in CLABSI and CAUTI prevention bundle audits and interventions during the COVID-19 pandemic. Am J Infect Control 2024; 52:129-132. [PMID: 37567364 DOI: 10.1016/j.ajic.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023]
Abstract
The COVID-19 pandemic exacerbated previously existing health care challenges related to hospital-acquired infections. Nursing students were deployed to augment staffing shortages and mitigate incidences of catheter-associated urinary tract infections and catheter-associated bloodstream infections. Nursing students' use as an adjunct to infection prevention measures facilitated success in sustaining low rates of catheter-associated bloodstream infections and catheter-associated urinary tract infections.
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Affiliation(s)
- Allyson Luva
- Department of Clinical Epidemiology and Infection Prevention, Department of Quality, Loma Linda University Medical Center, Loma Linda, CA; Loma Linda University School of Nursing, Loma Linda, CA.
| | - Ann Mijares
- Department of Clinical Epidemiology and Infection Prevention, Department of Quality, Loma Linda University Medical Center, Loma Linda, CA; Loma Linda University School of Nursing, Loma Linda, CA
| | - Brandie Richards
- Department of Clinical Epidemiology and Infection Prevention, Department of Quality, Loma Linda University Medical Center, Loma Linda, CA; Loma Linda University School of Nursing, Loma Linda, CA
| | - Angelika Ashburn
- Department of Clinical Epidemiology and Infection Prevention, Department of Quality, Loma Linda University Medical Center, Loma Linda, CA; Loma Linda University School of Nursing, Loma Linda, CA
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Rosati P, Crocoli A, Saulle R, Amato L, Brancaccio M, Mitrova Z, Ciliento G, Ciofi degli Atti M, Raponi M. Does letting adolescent and young adult inpatients share decisions in choosing the central-line insertion site reduce central-line-associated bloodstream infections? An empty systematic review. J Vasc Access 2024; 25:51-59. [PMID: 35114837 PMCID: PMC10845812 DOI: 10.1177/11297298221074448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/24/2021] [Indexed: 11/15/2022] Open
Abstract
To study whether allowing adolescents and young adults (AYA) with chronic or oncologic diseases admitted to tertiary or intensive care units to share decisions in choosing the insertion site for central-venous catheters (CVC) implanted for intravenous therapies or parenteral nutrition reduces central-line-associated and catheter-related bloodstream infections (CLABSI and CRBSI). Following the PRISMA guidelines, we systematically reviewed the literature by searching MEDLINE, Embase, CINAHL, CENTRAL, SCOPUS, Cochrane Library, and Web of Science up to December 2019. According to our aims, the review identified no study that could be included. This empty systematic review on healthcare teams allowing AYA with chronic or oncologic diseases admitted in tertiary or intensive care units to share decisions in choosing the site for implanting CVC prompts further research on clinical pathways on this hot-topic. By considering purportedly risk-taking behaviors in youngsters thus reducing CLABSI and CRBSI, healthcare teams should test specific strategies by engaging AYA empathetically in sharing decisions on the site for implanting CVC to improve quality in health care bundles.
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Affiliation(s)
- Paola Rosati
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Alessandro Crocoli
- Department of Surgery and Surgical Oncology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Rosella Saulle
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Laura Amato
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Matilde Brancaccio
- Health Management Department, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Critical Care Department, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Zuzana Mitrova
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Gaetano Ciliento
- Health Management Department, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Marta Ciofi degli Atti
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Azzopardi A, Trapani J. Chlorhexidine-based versus non-chlorhexidine dressings to prevent catheter-related bloodstream infections: An evidence-based review. Nurs Crit Care 2024; 29:191-195. [PMID: 36579384 DOI: 10.1111/nicc.12879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 12/30/2022]
Abstract
In patients with central venous catheters (CVCs) in situ, the development of catheter-related bloodstream infections (CRBSIs) is often linked with increased morbidity and mortality. Sterile gauze or transparent polyurethane dressings are conventionally used as extraluminal barriers; however, antimicrobial chlorhexidine CVC dressings could potentially reduce infection risk. This short evidence-based review examined the literature comparing the effectiveness of chlorhexidine-based CVC dressings against non-chlorhexidine dressings in reducing CRBSI occurrence. Four systematic reviews with meta-analysis were reviewed, all of which reported a statistically significant reduction in CRBSI occurrence on using chlorhexidine-based dressings. Further research is needed to determine the cost-effectiveness of chlorhexidine-based CVC dressings and their effectiveness in reducing CRBSIs in different catheter types and entry sites because infection risk is not uniform.
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Affiliation(s)
| | - Josef Trapani
- Department of Nursing, University of Malta, L-Imsida, Malta
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Fillman KM, Ryder JH, Brailita DM, Rupp ME, Cavalieri RJ, Fey PD, Lyden ER, Hankins RJ. Disinfection of vascular catheter connectors that are protected by antiseptic caps is unnecessary. Infect Control Hosp Epidemiol 2024; 45:35-39. [PMID: 37466074 DOI: 10.1017/ice.2023.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVE Determination of whether vascular catheter disinfecting antiseptic-containing caps alone are effective at decreasing microbial colonization of connectors compared to antiseptic-containing caps plus a 5-second alcohol manual disinfection. SETTING The study was conducted in a 718-bed, tertiary-care, academic hospital. PATIENTS A convenience sample of adult patients across intensive care units and acute care wards with peripheral and central venous catheters covered with antiseptic-containing caps. METHODS Quality improvement study completed over 5 days. The standard-of-care group consisted of catheter connectors with antiseptic-containing caps cleaned with a 5-second alcohol wipe scrub prior to culture. The comparison group consisted of catheter connectors with antiseptic-containing caps without a 5-second alcohol wipe scrub prior to culture. The connectors were pressed directly onto blood agar plates and incubated. Plates were assessed for growth after 48-72 hours. RESULTS In total, 356 catheter connectors were cultured: 165 in the standard-of-care group, 165 in the comparison group, and 26 catheters connectors without an antiseptic-containing cap, which were designated as controls. Overall, 18 catheter connectors (5.06%) yielded microbial growth. Of the 18 connectors with microbial growth, 2 (1.21%) were from the comparison group, 1 (0.61%) was from the standard-of-care group, and 15 were controls without an antiseptic-containing cap. CONCLUSIONS Bacterial colonization rates were similar between the catheter connectors cultured with antiseptic-containing caps alone and catheter connectors with antiseptic-containing caps cultured after a 5-second scrub with alcohol. This finding suggests that the use of antiseptic-containing caps precludes the need for additional disinfection.
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Affiliation(s)
| | - Jonathan H Ryder
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Daniel M Brailita
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Mark E Rupp
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - R Jennifer Cavalieri
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Paul D Fey
- Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Elizabeth R Lyden
- Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Richard J Hankins
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
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Jones KM, Krein SL, Mantey J, Harrod M, Mody L. Characterizing infection prevention programs and urinary tract infection prevention practices in nursing homes: A mixed-methods study. Infect Control Hosp Epidemiol 2024; 45:40-47. [PMID: 37589094 PMCID: PMC10782201 DOI: 10.1017/ice.2023.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE US policies require robust nursing home (NH) infection prevention and control (IPC) programs to ensure safe care. We assessed IPC resources and practices related to catheter and non-catheter-associated urinary tract infection (CAUTI and UTI) prevention among NHs. METHODS We conducted a mixed-methods study from April 2018 through November 2019. Quantitative surveys assessed NH IPC program resources, practices, and communication during resident transfer. Semistructured qualitative interviews focused on IPC programs, CAUTI and UTI prevention practices, and resident transfer processes. Using a matrix as an analytic tool, findings from the quantitative survey data were combined with the qualitative data in the form of a joint display. RESULTS Representatives from 51 NHs completed surveys; interviews were conducted with 13 participants from 7 NHs. Infection preventionists (IPs) had limited experience and/or additional roles, and in 36.7% of NHs, IPs had no specific IPC training. IP turnover was often mentioned during interviews. Most facilities were aware of their CAUTI and UTI rates and reported using prevention practices, such as hydration (85.7%) or nurse-initiated catheter discontinuation (65.3%). Qualitative interviewees confirmed use of these practices and expressed additional concerns about overuse of urine testing and antibiotics. Although transfer sheets were used by 84% to communicate about infections, the information received was described as suboptimal. CONCLUSIONS NHs identified IP challenges related to turnover, limited education, and serving multiple roles. However, most NHs reported awareness of their CAUTI and UTI rates as well as their use of prevention practices. Importantly, we identified opportunities to enhance communication between NHs and hospitals to improve resident care and safety.
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Affiliation(s)
- Karen M. Jones
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Sarah L. Krein
- Center for Clinical Management Research, Veterans’ Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Julia Mantey
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Molly Harrod
- Center for Clinical Management Research, Veterans’ Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Lona Mody
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Geriatrics Research Education and Clinical Center (GRECC), Veterans’ Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
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Oliveira RMC, de Sousa AHF, de Salvo MA, Petenate AJ, Gushken AKF, Ribas E, Torelly EMS, Silva KCCD, Bass LM, Tuma P, Borem P, Ue LY, de Barros CG, Vernal S. Estimating the savings of a national project to prevent healthcare-associated infections in intensive care units. J Hosp Infect 2024; 143:8-17. [PMID: 37806451 DOI: 10.1016/j.jhin.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/14/2023] [Accepted: 10/03/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) have a significant impact on patients' morbidity and mortality, and have a detrimental financial impact on the healthcare system. Various strategies exist to prevent HAIs, but economic evaluations are needed to determine which are most appropriate. AIM To present the financial impact of a nationwide project on HAI prevention in intensive care units (ICUs) using a quality improvement (QI) approach. METHODS A health economic evaluation assessed the financial results of the QI initiative 'Saúde em Nossas Mãos' (SNM), implemented in Brazil between January 2018 and December 2020. Among 116 participating institutions, 13 (11.2%) fully reported the aggregate cost and stratified patients (with vs without HAIs) in the pre-intervention and post-intervention periods. Average cost (AC) was calculated for each analysed HAI: central-line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (CAUTIs). The absorption model and time-driven activity-based costing were used for cost estimations. The numbers of infections that the project could have prevented during its implementation were estimated to demonstrate the financial impact of the SNM initiative. RESULTS The aggregated ACs calculated for each HAI from these 13 ICUs - US$8480 for CLABSIs, US$10,039 for VAP, and US$7464 for CAUTIs - were extrapolated to the total number of HAIs prevented by the project (1727 CLABSIs, 3797 VAP and 2150 CAUTIs). The overall savings of the SNM as of December 2020 were estimated at US$68.8 million, with an estimated return on investment (ROI) of 765%. CONCLUSION Reporting accurate financial data on HAI prevention strategies is still challenging in Brazil. These results suggest that a national QI initiative to prevent HAIs in critical care settings is a feasible and value-based approach, reducing financial waste and yielding a significant ROI for the healthcare system.
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Affiliation(s)
| | | | - M A de Salvo
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - A J Petenate
- Institute for Healthcare Improvement, Cambridge, MA, USA
| | | | - E Ribas
- Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | | | - L M Bass
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - P Tuma
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil; Institute for Healthcare Improvement, Cambridge, MA, USA
| | - P Borem
- Institute for Healthcare Improvement, Cambridge, MA, USA
| | - L Y Ue
- Ministério da Saúde, Brasilia, Brazil
| | - C G de Barros
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - S Vernal
- Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil; Hcor, Sao Paulo, Brazil; Hospital Israelita Albert Einstein, Sao Paulo, Brazil; Hospital Moinhos de Vento, Porto Alegre, Brazil; Hospital Sírio-Libanês, Sao Paulo, Brazil.
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Şanlı D, Sarıkaya A, Pronovost PJ. Effects of the care given to intensive care patients using an evidence model on the prevention of central line-associated bloodstream infections. Int J Qual Health Care 2023; 35:mzad104. [PMID: 38157270 DOI: 10.1093/intqhc/mzad104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/16/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024] Open
Abstract
It is important to put evidence-based guidelines into practice in the prevention of central line-associated bloodstream infections in intensive care patients. In contrast to expensive and complex interventions, a care bundle that includes easy-to-implement and low-cost interventions improves clinical outcomes. The compliance of intensive care nurses with guidelines is of great importance in achieving these results. The Translating Evidence into Practice Model provides guidance in how to implement the necessary guidelines. This quasi-experimental study used a post-test control group design in nonequivalent groups and was conducted in the anesthesia intensive care unit of a tertiary-level training and research hospital. All patients who were hospitalized in the intensive care unit, who had a central line during the study, and who met the inclusion criteria were included in the sample. The care bundle comprised education, and protocols for hand hygiene and the aseptic technique, maximum sterile barrier precautions, central line insertion trolley, and management of nursing care. To analyze the data, the independent samples t-test, the Mann-Whitney U test, chi-square test, dependent samples t-test, rate ratio, and relative risk were used with 95% confidence intervals. The rate of central line-associated bloodstream infections was significantly lower in the intervention group (2.85/1000 central line days) than in the control group (3.35/1000 central line days) (P = 0.042). The number of accesses to the central line by the nurses decreased significantly in the intervention group compared to the control group (P < 0.001). The mean score for the nurses' evidence-based guideline post-education knowledge (70.80 ± 12.26) was significantly higher than that pre-education (48.20 ± 14.66) (P < 0.001). Compliance with the guideline recommendations in central line-related nursing interventions and in the central line insertion process was significantly better in the intervention group than in the control group in many interventions (P < 0.05). The mean score for the nurses' attitude towards evidence-based nursing increased significantly over time (59.87 ± 7.23 at the 0th month; 63.79 ± 7.24 at the 6th month) (P < 0.001). Nursing care given by implementing the central line care bundle with the Translating Evidence into Practice Model affected the measures. Thanks to the implementation of the care bundle, the rate of infections and the number of accesses to the central line decreased, while the critical care nurses' knowledge of evidence-based guidelines, compliance with the guideline recommendations in central line-related nursing interventions, and attitudes towards evidence-based nursing improved.
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Saavedra Bravo MA, Santos GCSD, Petenate AJ, Westphal PJ, Souza LGDA, Marques RG, Morosov EDM, Gushken AKF, Franco FF, Silva WG, de Moura RM, de Lima AL, Dos Santos RG, Andrade KDC, Hamada APS, Cristalda CMR, Ue LY, de Barros CG, Vernal S. Adapting lean management to prevent healthcare-associated infections: a low-cost strategy involving Kamishibai cards to sustain bundles' compliance. Int J Qual Health Care 2023; 35:mzad100. [PMID: 38157269 DOI: 10.1093/intqhc/mzad100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/31/2023] [Accepted: 12/07/2023] [Indexed: 01/03/2024] Open
Abstract
Lean healthcare visual management has been successfully integrated into infection control programs, leading to lower healthcare-associated infection (HAI) rates and greater provider compliance with evidence-based prevention practices; however, its implementation during quality improvement (QI) initiatives in limited-resource settings has not yet been well exploited. We aimed to describe a low-cost strategy involving Kamishibai cards to sustain bundles' adherence to prevent HAIs in a middle-income country. This descriptive case study evaluated the implementation of a lean healthcare visual management tool-Kamishibai board (K-board)-during a nationwide QI collaborative preventing three critical HAIs in 189 adult and pediatric/neonatal intensive care units (ICUs) from September 2021 to January 2023. Considering a limited-resource setting, our team adapted a K-board using simple, cheap, and easy-to-handle materials for routine monitoring of QI procedures, including safety bundles' compliance. After test prototypes, the final K-board version was implemented. The chart materials and assembly cost BRL 80.00 (USD 15.48). Before launching, expert working group meetings were held to shape the contents, refine technical issues, and prepare the ICU teams for implementation. After starting, plan-do-study-act cycles were conducted according to the Breakthrough Series model. Participating ICU teams, including leaders and front-line health workers, performed bedside audits following a weekly chronogram. Two indicators were calculated: the percentage of ICUs in which K-boards were being implemented and whether bundles' compliance was addressed in the K-board. Audit data were recorded in 'SimpleQI'. After 17 months of this initiative, 177 (93.7%) participating ICUs had included this visual management tool in their daily care routines. When more than 94 (>50%) ICUs posted K-board data, the mean compliance for the bundles for each HAI was sustained above 85%. A lean healthcare visual management tool can be adapted to local settings, including healthcare facilities with limited resources. K-board seems to be a feasible method for auditing evidence-based practices in medical care, including safety bundles to simultaneously prevent three types of HAIs.
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Affiliation(s)
| | | | - Ademir Jose Petenate
- Universidade Estadual de Campinas - UNICAMP, Cidade Universitária Zeferino Vaz - Barão Geraldo, Campinas, SP, 13083-970, Brazil
| | - Patrick Jacobsen Westphal
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 910 - Moinhos de Vento, Porto Alegre, RS 90035-000, Brazil
| | | | - Roberta Gonçalves Marques
- Hospital Israelita Albert Einstein, Avenida Paulista, 2300 - Bela Vista, Sao Paulo, SP 01310-300, Brazil
| | | | | | - Flavia Fernanda Franco
- Hospital Israelita Albert Einstein, Avenida Paulista, 2300 - Bela Vista, Sao Paulo, SP 01310-300, Brazil
| | - Wladimir Garcia Silva
- Hospital Alemão Oswaldo Cruz, Rua Treze de Maio, 1815 - Bela Vista, Sao Paulo, SP 01323-020, Brazil
| | - Rafaela Moraes de Moura
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 910 - Moinhos de Vento, Porto Alegre, RS 90035-000, Brazil
| | - Andreia Lopes de Lima
- BP - A Beneficência Portuguesa de São Paulo, Rua Maestro Cardim, 769 - Bela Vista, Sao Paulo, SP 01323-001, Brazil
| | | | | | - Andreza Pivato Susin Hamada
- Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91 - Bela Vista, Sao Paulo, SP 01308-050, Brazil
- BP - A Beneficência Portuguesa de São Paulo, Rua Maestro Cardim, 769 - Bela Vista, Sao Paulo, SP 01323-001, Brazil
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 910 - Moinhos de Vento, Porto Alegre, RS 90035-000, Brazil
- Hospital Alemão Oswaldo Cruz, Rua Treze de Maio, 1815 - Bela Vista, Sao Paulo, SP 01323-020, Brazil
- Hospital Israelita Albert Einstein, Avenida Paulista, 2300 - Bela Vista, Sao Paulo, SP 01310-300, Brazil
- Hcor, Rua Desembargador Eliseu Guilherme, 147 - Paraíso, Sao Paulo, SP 04004-030, Brazil
| | | | - Luciana Yumi Ue
- Ministério da Saúde, Esplanada dos Ministérios - Bloco G, Brasília, DF 70058-900, Brazil
| | - Claudia Garcia de Barros
- Hospital Israelita Albert Einstein, Avenida Paulista, 2300 - Bela Vista, Sao Paulo, SP 01310-300, Brazil
| | - Sebastian Vernal
- Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91 - Bela Vista, Sao Paulo, SP 01308-050, Brazil
- BP - A Beneficência Portuguesa de São Paulo, Rua Maestro Cardim, 769 - Bela Vista, Sao Paulo, SP 01323-001, Brazil
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 910 - Moinhos de Vento, Porto Alegre, RS 90035-000, Brazil
- Hospital Alemão Oswaldo Cruz, Rua Treze de Maio, 1815 - Bela Vista, Sao Paulo, SP 01323-020, Brazil
- Hospital Israelita Albert Einstein, Avenida Paulista, 2300 - Bela Vista, Sao Paulo, SP 01310-300, Brazil
- Hcor, Rua Desembargador Eliseu Guilherme, 147 - Paraíso, Sao Paulo, SP 04004-030, Brazil
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Choo YH, Shim Y, Kim H, Goh HY, Kim SJ, Kim EJ, Kang CK, Ha EJ. Significant Reduction in External Ventricular Drain-Related Infections After Introducing a Novel Bundle Protocol: A Before and After Trial. J Korean Med Sci 2023; 38:e386. [PMID: 38147836 PMCID: PMC10752748 DOI: 10.3346/jkms.2023.38.e386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 10/12/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND External ventricular drain (EVD)-related infection (ERI) is a serious complication in neurosurgical patients. The estimated ERI rates range from 5 to 20 cases per 1,000 EVD catheter days. The pathophysiology of ERI is similar to central line-associated bloodstream infections (CLABSIs) stemming from skin-derived bacterial colonization. The use of bundle management can reduce CLABSI rates. Due to the pathogenic similarities between infections related to the two devices, we developed and evaluated the effectiveness of an ERI-bundle protocol based on CLABSI bundles. METHODS From November 2016 to November 2021, we conducted a study to evaluate the effectiveness of an ERI-bundle protocol. This study adopted a before-and-after trial, comparing the ERI rates for the 2 years before and 3 years after the introduction of the newly developed ERI-bundle protocol. We also analyzed the contributing factors to ERI using logistic regression analysis. RESULTS A total of 183 patients with 2,381 days of catheter use were analyzed. The ERI rate decreased significantly after the ERI-bundle protocol from 16.7% (14 of 84; 14.35 per 1,000 catheter days) to 4.0% (4 of 99; 3.21 per 1,000 catheter days) (P = 0.004). CONCLUSION Introduction of the ERI-bundle protocol was very effective in reducing ERI.
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Affiliation(s)
- Yoon-Hee Choo
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youngbo Shim
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Hyeseon Kim
- Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Hye Yeon Goh
- Center for Infection Control and Prevention, Seoul National University Hospital, Seoul, Korea
| | - Su Jung Kim
- Department of Nursing, Seoul National University Hospital, Seoul, Korea
| | - Eun Jin Kim
- Department of Nursing, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Jin Ha
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
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Reppucci M, Prendergast C, Flynn K, Scarbro S, Derderian SC, Diaz-Miron J. Trainee educational curriculum to standardize central venous catheter repair. BMC Med Educ 2023; 23:978. [PMID: 38115058 PMCID: PMC10731855 DOI: 10.1186/s12909-023-04977-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 12/14/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Children may require durable central venous catheters (CVCs) for various reasons. CVC-related integrity complications are common and can often be repaired at the bedside to increase lifetime. Variability in repair techniques can lead to complications, including the need for repeat repair and Central Line Associated Blood Stream Infection (CLABSI). METHODS The impact of an educational curriculum to standardize tunneled CVC repairs for trainees on a pediatric surgery service was studied, focusing on comfort level with tunneled CVC repair and to determine the impact on complication rates. Rotating trainees studied a dedicated audiovisual educational curriculum comprised of a video, educational slides, and a practical component from November 2020 through January 2022. Experience and comfort level with tunneled CVC repairs were assessed before and after the rotation. CVCs repaired during the duration of the study were evaluated and compared to the period prior. RESULTS Forty-nine individuals completed the pre- and post-training survey. Respondents (34.7%, n = 17) most commonly reported one year of surgical experience, and (79.6%, n = 39) had never observed or assisted in a repair previously. Following training, respondents felt more comfortable with all aspects of the CVC repair process (p < 0.001). There were no statistically significant differences in re-repair rates or CLABSI rates following the implementation of the curriculum. CONCLUSIONS Tunneled CVC procedural repair variability can be standardized with a dedicated educational curriculum for rotating trainees, which improves knowledge and comfort with such procedures.
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Affiliation(s)
- Marina Reppucci
- Department of General Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Connor Prendergast
- Pediatric Surgery, Children's Hospital Colorado, 13213 E 16th Ave, Box 323, 80045, Aurora, CO, USA
| | - Katherine Flynn
- Pediatric Surgery, Children's Hospital Colorado, 13213 E 16th Ave, Box 323, 80045, Aurora, CO, USA
| | - Sharon Scarbro
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - S Christopher Derderian
- Pediatric Surgery, Children's Hospital Colorado, 13213 E 16th Ave, Box 323, 80045, Aurora, CO, USA
| | - Jose Diaz-Miron
- Pediatric Surgery, Children's Hospital Colorado, 13213 E 16th Ave, Box 323, 80045, Aurora, CO, USA.
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Ruan C, Shi S, Shen Z, Guo L, Gong L. Effect of precision management scheme based on the best evidence summary on reducing catheter-associated urinary tract infection. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2023; 48:1333-1342. [PMID: 38044644 PMCID: PMC10929873 DOI: 10.11817/j.issn.1672-7347.2023.230173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES Catheter-associated urinary tract infection (CAUTI) is an important cause of prolonged hospital stay, which increases economic and medical burden for patients and hospitals, and it is a key focus of hospital infection prevention and control. However, there are currently few studies that convert evidence-based scientific evidence on CAUTI prevention and control into clinical applications and evaluation on its practical effects in combination with standardized infection ratio (SIR), the critical indicator of infection prevention and control. This study aims to establish a precision management plan for reducing the incidence of CAUTI, driven by the findings of a comprehensive evidence summary, to apply this plan across all the nursing units within the entire hospital, followed by a comparative analysis of CAUTI incidence, SIR, the average duration of indwelling urinary catheter for each patient, and the compliance rate on hand hygiene protocols for medical staff before and after the implementation of the precision management plan. METHODS Based on a comprehensive review of the best evidence for preventing CAUTI, a precision management plan was meticulously developed through panel discussions and 2 rounds of expert consultations using Delphi technique. Subsequently, a historical control study was conducted to evaluate the plan's effectiveness. A total of 17 658 patients with indwelling urinary catheter in inpatient departments from January to December 2021 comprised the control group. These patients received standard nursing measures for CAUTI. Another 18 753 patients with indwelling urinary catheters in the inpatient departments from January to December 2022 comprised the intervention group, underwent the precision management scheme based on the best available evidence, to enhance CAUTI prevention. The incidence and SIR of CAUTI, the average duration of indwelling urinary catheter for each patient, and the compliance rate on hand hygiene protocols for medical staff were compared between the 2 groups. RESULTS Compared with the control group, the incidence of CAUTI in the intervention group was significantly decreased (0.48‰ vs 1.12‰, χ2=20.814, P<0.001), SIR was decreased in the intervention group (0.55 vs 1.37); the average duration of indwelling urinary catheter for each patient was significantly decreased [(4.33±1.55) d vs (4.43±1.79) d, t=11.941, P<0.001]. The ratio of compliance rate of medical staff with strict hand hygiene protocols higher than 95% in the intervention group was significantly higher than that in the control group (93.3% vs 83.3%, χ2=5.822, P=0.016). CONCLUSIONS The implementation of the precision management plan for reducing CAUTI based on a summary of the best available evidence on CAUTI prevention and control in patients with indwelling urinary catheters has found to be effective. This approach significantly reduces the incidence of CAUTI, reduces the average duration of indwelling urinary catheter, and enhances hand hygiene compliance among medical staff. It provides a scientific and efficient strategy for preventing and controlling CAUTI in the hospital, ultimately saving patients from unnecessary medical expense.
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Affiliation(s)
- Chunhong Ruan
- Department of Hematology, Third Xiangya Hospital, Central South University, Changsha 410013.
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha 410013.
| | - Shuangjiao Shi
- Department of Hematology, Third Xiangya Hospital, Central South University, Changsha 410013
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha 410013
| | - Zhiying Shen
- Department of Hematology, Third Xiangya Hospital, Central South University, Changsha 410013
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha 410013
| | - Lanping Guo
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha 410013
- Neurology Intensive Critical Unit, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Lina Gong
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha 410013.
- Neurology Intensive Critical Unit, Third Xiangya Hospital, Central South University, Changsha 410013, China.
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Summerlin-Long S, DiBiase LM, Padgett M, Mack J, Clark C, Teal L, Sickbert-Bennett E. A helping hand: The impact of a central line insertion support team. Am J Infect Control 2023; 51:1438-1440. [PMID: 37865892 DOI: 10.1016/j.ajic.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/01/2023] [Accepted: 09/02/2023] [Indexed: 10/23/2023]
Abstract
As part of a central line-associated bloodstream infections prevention initiative, our academic medical center formed a dedicated nursing team to assist with central line insertions and provide support with caring for difficult lines and dressings. During the program's first 3 years, the proportion of insertion-related central line-associated bloodstream infections occurring in areas within the team's scope declined overall by 47%.
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Affiliation(s)
- Shelley Summerlin-Long
- Department of Infection Prevention, UNC Health, Chapel Hill, NC, USA; Public Health Leadership, UNC Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Lauren M DiBiase
- Department of Infection Prevention, UNC Health, Chapel Hill, NC, USA; Department of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Melody Padgett
- Adult Specialty Care Team, UNC Health, Chapel Hill, NC, USA
| | - Jennifer Mack
- Adult Specialty Care Team, UNC Health, Chapel Hill, NC, USA
| | - Christa Clark
- Department of Infection Prevention, UNC Health, Chapel Hill, NC, USA
| | - Lisa Teal
- Department of Infection Prevention, UNC Health, Chapel Hill, NC, USA
| | - Emily Sickbert-Bennett
- Department of Infection Prevention, UNC Health, Chapel Hill, NC, USA; Department of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Dept of Epidemiology, UNC Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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39
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Wu Y, Liu Y, Wang B, Feng B. Efficacy of antimicrobial peripherally inserted central catheters in line-associated bloodstream infections: A systematic review and meta-analysis. Am J Infect Control 2023; 51:1425-1429. [PMID: 37088441 DOI: 10.1016/j.ajic.2023.04.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Several studies have investigated the safety and efficacy of antimicrobial peripherally inserted central catheters (PICCs), and the results are conflicting. Therefore, in this systematic review and meta-analysis, we aimed to summarize and identify the effect of antimicrobial PICCs on central line-associated bloodstream infection (CLABSI) risk. METHODS A systematic search of PubMed, Ovid MEDLINE, Ovid Embase, and Web of Science was performed to identify relevant studies up to December 2022. RESULTS A total of 9 studies were included for analysis. There were 7 retrospective/prospective cohort studies and 2 randomized controlled trials. The 9 studies involved 51,373 patients with PICCs. Among these patients, 6,563 (12.8%) antimicrobial-coated/impregnated PICCs and 44,810 (87.2%) nonantimicrobial-impregnated PICCs were inserted. The meta-analysis showed that antimicrobial PICCs had a nonsignificant association with lower CLABSI risk compared with noncoated PICCs (relative risk [RR] = 0.67; 95% CI, 0.43-1.05). In the subgroup analysis, minocycline-rifampin-(RR = 0.30; 95% CI, 0.19-0.49) or chlorhexidine-coated (RR = 0.61; 95% CI, 0.04-8.55) PICCs showed an association with reduced risk of CLABSI. In the adult population, antimicrobial PICCs had a nonsignificant association with lower CLABSI risk (RR = 0.50; 95% CI, 0.20-1.22). CONCLUSIONS This systematic review and meta-analysis suggested that antimicrobial PICCs had a nonsignificant association with lower CLABSI risk compared with noncoated PICCs. Minocycline-rifampin-or chlorhexidine-coated PICCs showed an association with reduced risk of CLABSI.
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Affiliation(s)
- Yanyan Wu
- Department of Radiotherapy and Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yaqiong Liu
- Department of Radiotherapy and Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bei Wang
- Department of Radiotherapy and Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bilong Feng
- Department of Radiotherapy and Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China.
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40
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Piersigilli F, Iacona G, Yazami S, Carkeek K, Hocq C, Auriti C, Danhaive O. Cyanoacrylate glue as part of a new bundle to decrease neonatal PICC-related complications. Eur J Pediatr 2023; 182:5607-5613. [PMID: 37816981 DOI: 10.1007/s00431-023-05253-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/12/2023]
Abstract
A "bundle" is defined as a combination of evidence-based interventions that, if followed collectively and reliably, improve patient outcomes. The aim of this quasi-experimental study, conducted in a level-III NICU in Belgium, was to assess the impact of central line dressing and maintenance bundle implementation on the rate of catheter-related mechanical complications. We performed a quality improvement (QI) project. Prior to bundle implementation, neonatal PICC lines were secured by Steri-Strip® and occlusive dressing. We implemented a new PICC bundle consisting of the use of glue, sutureless device (Griplock®), and a transparent dressing to secure the catheter to the skin. We compared the rate of infections, mechanical complications, and dislocations before and after bundle implementation (periods 1 and 2, respectively). The use of glue resulted in a significantly decreased rate of central line-associated bloodstream infection (CLABSI) (p < 0.001), dislocations, and mechanical complications (p < 0.0001). During period 2, there was a significant increase for the average number of days the catheter stayed in place (p < 0.05). We did not observe catheter breakage or patient skin irritations attributable to the use of glue (not even in ELBW infants). CONCLUSION The implementation of the new bundle to secure neonatal PICCs in our NICU was associated with a significant reduction in CLABSI and dislodgment rates, without glue-related complications. Active surveillance of CVC placement procedure, positioning, and management, as well as analysis of related complications is crucial for improving patient safety. Continuous implementation of up-to-date central line bundles based on best practice recommendations is a key for quality improvement in NICUs. WHAT IS KNOWN • Stable vascular access is crucial in the NICU. Neonatal PICC securement issues can have serious consequences and are associated with device failure. WHAT IS NEW • Catheter securement with tissue adhesive is safe and effective in reducing failure and complication rates in the neonatal population.
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Affiliation(s)
- Fiammetta Piersigilli
- Division of Neonatology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Brussels, Belgium.
| | - Giulia Iacona
- Faculty of Medicine, Imperial College London, London, UK
| | - Sarah Yazami
- Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Katherine Carkeek
- Division of Neonatology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Brussels, Belgium
| | - Catheline Hocq
- Division of Neonatology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Brussels, Belgium
| | - Cinzia Auriti
- Saint Camillus International, University of Health Sciences, Rome, Italy
| | - Olivier Danhaive
- Division of Neonatology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Brussels, Belgium
- Division of Neonatology, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
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Smith RW, Pettini M, Gulden R, Wendel D. Central venous catheter safety in pediatric patients with intestinal failure. Nutr Clin Pract 2023; 38:1273-1281. [PMID: 37537891 DOI: 10.1002/ncp.11047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/20/2023] [Accepted: 07/08/2023] [Indexed: 08/05/2023] Open
Abstract
Children with intestinal failure (IF) require long-term central venous access to provide life-sustaining parenteral nutrition. Mechanical, thrombotic, and infectious complications are potentially life-threatening and may necessitate central venous catheter (CVC) replacement. Repeated central line replacements may lead to a loss of vascular access sites and increases risk for intestinal transplantation. Children with IF face unique challenges for CVC safety given their young age, altered anatomy, and increased risk of thrombosis and infection. The following review addresses preventative, diagnostic, and treatment strategies for central line safety concerns specific to children with IF as well as recommendations for promoting catheter safety during activities, travel, and emergencies.
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Affiliation(s)
- Rachel Warsco Smith
- Division of Gastroenterology and Hepatology, Seattle Children's Hospital, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Melissa Pettini
- Division of Gastroenterology and Hepatology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Rachel Gulden
- Division of Gastroenterology and Hepatology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Danielle Wendel
- Division of Gastroenterology and Hepatology, Seattle Children's Hospital, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
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Suzuki T, Michimoto K, Hasumi J, Kisaki S, Hasegawa Y, Fujimori A, Yoshimatsu L, Ashida H, Ojiri H. Silver-Mixed Port Reduces Venous Access Port Related Infection Rate Compared to Non-Silver-mixed Port: A Single-center Retrospective Analysis. Cardiovasc Intervent Radiol 2023; 46:1696-1702. [PMID: 37902854 PMCID: PMC10695883 DOI: 10.1007/s00270-023-03583-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 09/30/2023] [Indexed: 11/01/2023]
Abstract
PURPOSE Totally implantable venous access ports (TIVAPs) are increasingly used as safe and convenient central venous access devices. However, several TIVAP-related complications occur, with port/catheter infection being most common. Silver-mixed ports have recently been introduced in anticipation of reducing TIVAP infection. This study aimed to investigate the efficacy of this device in reducing port infection by examining groups with and without silver-mixed devices. MATERIALS AND METHODS From April 2017 to July 2022, silver-mixed ports (S group) and non-silver-mixed port group (NS group) were reviewed at our institution. The incidence of TIVAP-related infections, patient characteristics, and bacteriological data were evaluated. Univariate and multivariate analyses were used to evaluate risk factors for TIVAP-related infection. RESULTS A total of 607 patients (S group, n = 203; NS group, n = 404) were enrolled. The rates of TIVAP-related infection were 3.0% (n = 6) and 7.7% (n = 31) in the S and NS groups, respectively. The incidence of total infection per 1000 catheter-days were 0.114 and 0.214 the S and NS groups, respectively. In the entire group, the rates of infection were 6.1% (n = 37) and the incidence of total infection per 1000 catheter-days was 0.187. Univariate and multivariate analyses revealed a significantly lower TIVAP-related infection rate in S group than NS group (p = 0.0216, odds ratio = 2.88 confidence interval: 1.17-7.08). No gram-negative rods were detected in the S group as port infection. CONCLUSION Silver-mixed port may be feasible in preventing port infection. LEVEL OF EVIDENCE Level 3, Local non-random sample.
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Affiliation(s)
- Takayuki Suzuki
- Department of Radiology, The Jikei University School of Medicine, The Jikei University of Second Building 14F, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan.
| | - Kenkichi Michimoto
- Department of Radiology, The Jikei University School of Medicine, The Jikei University of Second Building 14F, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan
| | - Jun Hasumi
- Department of Radiology, The Jikei University School of Medicine, The Jikei University of Second Building 14F, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan
| | - Shunsuke Kisaki
- Department of Radiology, The Jikei University School of Medicine, The Jikei University of Second Building 14F, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan
| | - Yasuaki Hasegawa
- Department of Radiology, The Jikei University School of Medicine, The Jikei University of Second Building 14F, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan
| | - Ayako Fujimori
- Department of Radiology, The Jikei University Katsushika Medical Center, 6-41-2, Aoto, Katsushika-ku, Tokyo, 125-8506, Japan
| | - Lynn Yoshimatsu
- Department of Radiology, The Jikei University Daisan Hospital, 4-11-1, Izumihonchou, Komae-shi, Tokyo, 201-8601, Japan
| | - Hirokazu Ashida
- Department of Radiology, The Jikei University School of Medicine, The Jikei University of Second Building 14F, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine, The Jikei University of Second Building 14F, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan
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Ray-Barruel G, Chopra V, Fulbrook P, Lovegrove J, Mihala G, Wishart M, Cooke M, Mitchell M, Rickard CM. The impact of a structured assessment and decision tool (I-DECIDED®) on improving care of peripheral intravenous catheters: A multicenter, interrupted time-series study. Int J Nurs Stud 2023; 148:104604. [PMID: 37801935 DOI: 10.1016/j.ijnurstu.2023.104604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Peripheral intravenous catheters are the most widely used invasive device in hospitals but have serious risks. OBJECTIVE To determine if a structured assessment and decision tool (I-DECIDED®) improves daily peripheral intravenous catheter assessment and care decisions. DESIGN Prospective, interrupted time-series study. SETTINGS Seven adult inpatient wards in three Australian hospitals. PARTICIPANTS 825 adults with 867 peripheral intravenous catheters. METHODS Between August 2017 and December 2018, peripheral intravenous catheter assessments and chart audits were undertaken with informed patient consent. Following a 4-month pre-intervention period (with 2-weekly measures), the I-DECIDED® tool was implemented over 3 months (no data collection) using multiple strategies (stakeholder meetings, vascular access device form, education sessions, ward champions, lanyard cards, and posters), followed by a 4-month post-intervention period (with 2-weekly measures). Primary outcomes were device utilization (number of peripheral intravenous catheters per total number of patients screened); idle/unused catheters; insertion site complications, substandard dressing quality; and primary bloodstream infections. RESULTS Of 2055 patients screened, 1175 (57.2%) had a peripheral intravenous catheter, and 825 patients (867 catheters) consented and were included in the final analysis. Device utilization increased from 42.0% of catheters at baseline to 49.6% post-intervention (absolute risk difference [ARD] 7.5%, 95% confidence interval [CI] 4.8, 10.3; relative risk [RR] 1.18, 95% CI 1.11, 1.25; p < 0.001). The proportion of idle catheters reduced from 12.7% to 8.3% (ARD -4.4%, 95% CI -8.5, -0.3; RR 0.66, 95% CI 0.44, 0.97; p = 0.035). Peripheral intravenous catheter complications reduced from 16.1% to 10.9% (ARD -5.2%, 95% CI -9.7, -0.6; RR 0.68, 95% CI 0.48, 0.96; p = 0.026). Substandard dressings reduced from 24.6% to 19.5% (ARD -5.2%, 95% CI -10.7, 0.4; RR 0.79, 95% CI 0.61, 1.02; p = 0.067). Only one primary bloodstream infection occurred (post-intervention). CONCLUSIONS Implementation of a comprehensive device assessment and decision tool (I-DECIDED®) reduced idle catheters and catheter complications, despite higher device utilization. Dressing quality improved but was not statistically significant. Further implementation of the tool could improve hospital safety for patients with an intravenous catheter. ANZCTR TRIAL REGISTRATION ACTRN12617000067370. Date of registration 13 January 2017. Date of first data collection 3rd August 2017. TWEETABLE ABSTRACT #IDECIDEDassessment reduces prevalence of idle peripheral catheters and device complications.
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Affiliation(s)
- Gillian Ray-Barruel
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia; UQ Centre for Clinical Research, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia; Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia.
| | - Vineet Chopra
- Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Brisbane, Queensland, Australia; The Michigan Hospital Medicine Safety Consortium, Ann Arbor, MI, United States of America; Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America.
| | - Paul Fulbrook
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Josephine Lovegrove
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia; UQ Centre for Clinical Research, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; National Health & Medical Research Council Centre for Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia
| | - Gabor Mihala
- Centre for Health Services Research, The University of Queensland, Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Michael Wishart
- Infection Prevention and Control, St Vincent's Private Hospital Northside, Brisbane, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Marion Mitchell
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Claire M Rickard
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia; UQ Centre for Clinical Research, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; National Health & Medical Research Council Centre for Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia.
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Saint S, Greene MT, Krein SL, Fowler KE, Linder KA, Ratz D, Meddings J. What US hospitals are doing to prevent common device-associated infections during the coronavirus disease 2019 (COVID-19) pandemic: Results from a national survey in the United States. Infect Control Hosp Epidemiol 2023; 44:1913-1919. [PMID: 37259703 PMCID: PMC10755151 DOI: 10.1017/ice.2023.65] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The ways that device-associated infection prevention practices changed during the coronavirus disease 2019 (COVID-19) pandemic remain unknown. We collected data mid-pandemic to assess the use of several infection prevention practices and for comparison with historical data. DESIGN Repeated cross-sectional survey. SETTING US acute-care hospitals. PARTICIPANTS Infection preventionists. METHODS We surveyed infection preventionists from a national random sample of 881 US acute-care hospitals in 2021 to estimate the current use of practices to prevent catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated events (VAE). We compared the 2021 results with those from surveys occurring every 4 years since 2005. RESULTS The 2021 survey response rate was 47%; previous survey response rates ranged from 59% to 72%. Regular use of most practices to prevent CLABSI (chlorhexidine gluconate for site antisepsis, 99.0%, and maximum sterile barrier precautions, 98.7%) and VAE (semirecumbent positioning, 93.4%, and sedation vacation, 85.8%) continued to increase or plateaued in 2021. Conversely, use of several CAUTI prevention practices (portable bladder ultrasound scanner, 65.6%; catheter reminders or nurse-initiated discontinuation, 66.3%; and intermittent catheterization, 37.3%) was lower in 2021, with a significant decrease for some practices compared to 2017 (P ≤ .02 for all comparisons). In 2021, 42.1% of hospitals reported regular use of the newer external urinary collection devices for women. CONCLUSIONS Although regular use of CLABSI and VAE preventive practices continued to increase (or plateaued), use of several CAUTI preventive practices decreased during the COVID-19 pandemic. Structural issues relating to care during the pandemic may have contributed to a decrease in device-associated infection prevention practices.
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Affiliation(s)
- Sanjay Saint
- Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- VA/UM Patient Safety Enhancement Program, Ann Arbor, Michigan
| | - M. Todd Greene
- Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- VA/UM Patient Safety Enhancement Program, Ann Arbor, Michigan
| | - Sarah L. Krein
- Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- VA/UM Patient Safety Enhancement Program, Ann Arbor, Michigan
| | - Karen E. Fowler
- Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan
- VA/UM Patient Safety Enhancement Program, Ann Arbor, Michigan
| | - Kathleen A. Linder
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- VA/UM Patient Safety Enhancement Program, Ann Arbor, Michigan
- Infectious Disease Section, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - David Ratz
- Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan
- VA/UM Patient Safety Enhancement Program, Ann Arbor, Michigan
| | - Jennifer Meddings
- Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- VA/UM Patient Safety Enhancement Program, Ann Arbor, Michigan
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
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Fritz A, Kalu IC, Candito TL, Krishnan AM, Reynolds SS. Strength in numbers: Utilization of an innovative electronic audit to enhance the completion of central line maintenance audits. Am J Infect Control 2023; 51:1366-1369. [PMID: 37268018 DOI: 10.1016/j.ajic.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/18/2023] [Accepted: 05/20/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Health care systems use auditing processes to monitor compliance with evidence-based practices. The auditing process for a bundle targeting central line-associated bloodstream infection prevention at a large children's hospital was suboptimal. The purpose of this project was to implement a revised audit and feedback data collection process. The specific aims of the project were to evaluate (1) the number of completed audits and, (2) central line maintenance bundle compliance rates before and after implementing a new process. METHODS An innovative, electronic audit process was developed to allow data entry in real-time as central line-associated bloodstream infection prevention champions conducted audits. Data were fed into a robust electronic dashboard, allowing units to readily visualize their performance. Data was analyzed over a 52-month period (26 months pre- and post-implementation). RESULTS The number of central line maintenance bundle audits significantly increased post-implementation from an average of 36 to 64 per month, P = .001. Central line maintenance bundle compliance scores also increased from an average compliance score of 76.3% to 89.3%, P = .001. Special cause variation was also noted in the statistical process control charts. DISCUSSION This project demonstrated the effectiveness of using an electronic process to capture audit data to assist with quality improvement efforts. CONCLUSIONS Other institutions may consider implementing a similar electronic audit process to capture infection prevention compliance data.
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Affiliation(s)
- Anna Fritz
- Duke Children's Hospital and Health Center, Pediatric Intensive Care Unit, Durham, NC.
| | - Ibukunoluwa C Kalu
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Duke University School of Medicine, Durham, NC
| | - Tammy L Candito
- Duke Children's Hospital and Health Center, Pediatric Intensive Care Unit, Durham, NC
| | | | - Staci S Reynolds
- Duke University Hospital, Department of Infection Prevention and Hospital Epidemiology, Durham, NC; Duke University School of Nursing, Adult Health Division, Durham, NC
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Shen L, Fu T, Huang L, Sun H, Wang Y, Sun L, Lu X, Zhang J, Yang Z, Ni C. 7295 elderly hospitalized patients with catheter-associated urinary tract infection: a case-control study. BMC Infect Dis 2023; 23:825. [PMID: 38001413 PMCID: PMC10668367 DOI: 10.1186/s12879-023-08711-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/14/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Catheter-associated urinary tract infection (CAUTI) ranks second among nosocomial infections in elderly patients after lung infections. Improper treatment can lead to death. This study analysed the risk factors, pathogen distribution, clinical characteristics and outcomes of CAUTI in elderly inpatients with a large sample size to provide evidence for clinical prevention and control. METHODS Based on the HIS and LIS, a case‒control study was conducted on all hospitalized patients with indwelling urinary catheters ≥ 60 years old from January 1, 2019, to December 31, 2022, and the patients were divided into the CAUTI group and the non-CAUTI group. RESULTS CAUTI occurred in 182 of 7295 patients, and the infection rate was 3.4/per 1000 catheter days. Urine pH ≥ 6.5, moderate dependence or severe dependence in the classification of self-care ability, age ≥ 74 years, male sex, hospitalization ≥ 14 days, indwelling urinary catheter ≥ 10 days, diabetes and malnutrition were independent risk factors for CAUTI (P < 0.05). A total of 276 strains of pathogenic bacteria were detected in urine samples of 182 CAUTI patients at different times during hospitalization. The main pathogens were gram-negative bacteria (n = 132, 47.83%), followed by gram-positive bacteria (n = 91, 32.97%) and fungi (n = 53, 19.20%). Fever, abnormal procalcitonin, positive urinary nitrite and abnormal urination function were the clinical characteristics of elderly CAUTI patients (P < 0.001). Once CAUTI occurred in elderly patients, the hospitalization days were increased by 18 days, the total hospitalization cost increased by ¥18,000, and discharge all-cause mortality increased by 2.314 times (P<0.001). CONCLUSION The situation of CAUTI in the elderly is not optimistic, it is easy to have a one-person multi-pathogen infection, and the proportion of fungi infection is not low. Urine pH ≥ 6.5, moderate or severe dependence on others and malnutrition were rare risk factors for elderly CAUTI in previous studies. Our study analysed the clinical characteristics of CAUTI in the elderly through a large sample size, which provided a reliable basis for its diagnosis and identified the adverse outcome of CAUTI.
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Affiliation(s)
- Li Shen
- Department of Disease Prevention and Control, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
- Department of Nursing, Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Ting Fu
- Department of Military Prevention Medicine, Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Luguang Huang
- Department of information, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Huiying Sun
- Department of Disease Prevention and Control, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Yu Wang
- Neurosurgical ICU, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Lili Sun
- Neurological ICU, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Xiaoyun Lu
- Department of Disease Prevention and Control, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Jing Zhang
- Department of Disease Prevention and Control, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Zhaoxu Yang
- Department of Disease Prevention and Control, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China.
| | - Chunping Ni
- Department of Nursing, Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China.
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Bauder N, Brant JM. When the Catheter-Associated Urinary Tract Infection Bundle Is Not Enough. Clin J Oncol Nurs 2023; 27:669-675. [PMID: 38009887 DOI: 10.1188/23.cjon.669-675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Patients with cancer who are immunocompromised are at risk for catheter-associated urinary tract infections (CAUTIs). Many recommendations are available for healthcare organizations to use to reduce CAUTIs. Implementing vario.
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Baburova PI, Kladko DV, Lokteva A, Pozhitkova A, Rumyantceva V, Rumyantceva V, Pankov IV, Taskaev S, Vinogradov VV. Magnetic Soft Robot for Minimally Invasive Urethral Catheter Biofilm Eradication. ACS Nano 2023; 17:20925-20938. [PMID: 37871301 DOI: 10.1021/acsnano.2c10127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Catheter-related biofilm infection remains the main problem for millions of people annually, affecting morbidity, mortality, and quality of life. Despite the recent advances in the prevention of biofilm formation, alternative methods for biofilm prevention or eradication still should be found to avoid traumatic and expensive removal or catheter replacement. Soft magnetic robots have drawn significant interest in favor of remote control, fast response, and wide space for design. In this work, we demonstrated magnetic soft robots as a minimally invasive, safe, and effective approach to eliminate biofilm from urethral catheters (20 Fr or 5.1 mm in diameter). Seven designs of the robot were fabricated (size 4.5 × 15 mm), characterized, and tested in the presence of a rotating magnetic field. As a proof-of-concept, we demonstrated the superior efficiency of biofilm removal on the model of a urethral catheter using a magnetic robot, reaching full eradication for the octagram-shaped robot (velocity 2.88 ± 0.6 mm/s) at a 15 Hz frequency and a 10 mT amplitude. These findings are helpful for the treatment of biofilm-associated catheter contamination, which allows an increase in the catheter wearing time without frequent replacement and treatment of catheter-associated infections.
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Affiliation(s)
- Polina I Baburova
- International Institute "Solution Chemistry of Advanced Materials and Technologies", ITMO University, 191002 Saint Petersburg, Russia
| | - Daniil V Kladko
- International Institute "Solution Chemistry of Advanced Materials and Technologies", ITMO University, 191002 Saint Petersburg, Russia
| | - Alina Lokteva
- International Institute "Solution Chemistry of Advanced Materials and Technologies", ITMO University, 191002 Saint Petersburg, Russia
| | - Anna Pozhitkova
- International Institute "Solution Chemistry of Advanced Materials and Technologies", ITMO University, 191002 Saint Petersburg, Russia
| | - Viktoriya Rumyantceva
- International Institute "Solution Chemistry of Advanced Materials and Technologies", ITMO University, 191002 Saint Petersburg, Russia
| | - Valeriya Rumyantceva
- International Institute "Solution Chemistry of Advanced Materials and Technologies", ITMO University, 191002 Saint Petersburg, Russia
| | - Ilya V Pankov
- Institute of Physical and Organic Chemistry, Southern Federal University, 344090 Rostov-on-Don, Russia
| | - Sergey Taskaev
- National Research South Ural State University, Chelyabinsk 454080, Russia
- Chelyabinsk State University, Chelyabinsk 454001, Russia
| | - Vladimir V Vinogradov
- International Institute "Solution Chemistry of Advanced Materials and Technologies", ITMO University, 191002 Saint Petersburg, Russia
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Pontes L, Tibério BA, Pereira JDFG, da Luz RR. Digital technology for the prevention of healthcare-related infections in critical care. Rev Bras Enferm 2023; 76Suppl 4:e20220528. [PMID: 37971053 PMCID: PMC10642013 DOI: 10.1590/0034-7167-2022-0528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 03/20/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE To develop digital technology for patient and family integration into the Intensive Care Unit care team, aiming to subsidize decision-making for the prevention of infections related to healthcare. METHOD Methodological research of technological production in three phases: pre-production, production, and post-production in a teaching hospital in southern Brazil. Sixteen intensive care unit nurses participated. RESULTS The research produced six videos: general guidelines on the Intensive Care Unit, Preventing infections: hand hygiene; Pneumonia associated with mechanical ventilation; Catheter-associated primary bloodstream infection; Catheter-related urinary tract infection. FINAL CONSIDERATIONS The proposed technology was developed and aims to assist nurses in bringing patients and families closer to the routines of the intensive care environment to provide safety in the contact of the patient of intensive care units with family members and in the active participation for the prevention of infections related to healthcare.
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Affiliation(s)
- Letícia Pontes
- Universidade Federal do Paraná. Curitiba, Paraná, Brazil
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50
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Harward N, Sumner S, Merrill K. Nephrology Nurses and Infection Preventionists: Working Together to Improve Quality Outcomes. Nephrol Nurs J 2023; 50:479-482. [PMID: 38112675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Tunneled central venous hemodialysis catheters have higher infection rates compared to other access devices. Recommendations for dressing changes of these catheters are to apply povidone iodine (PI) or a triple antibiotic ointment during catheter dressing changes. Growing evidence supports using chlorhexidine gluconate (CHG) dressings to prevent catheter-related bloodstream infections in patients with short-term central venous catheters. This quality improvement project studied whether dressing changes with PI ointment in tunneled dialysis catheters was equivalent to CHG-impregnated dressings in preventing vascular access infections (VAIs). Standardized education was required for all nurses and dialysis technicians working at four dialysis centers. VAIs were measured before and after the change. Results showed that CHG is equivalent to PI ointment in preventing VAI in tunneled dialysis catheters.
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Affiliation(s)
- Nichole Harward
- Infection Preventionist, Sevier Valley Hospital, Richfield, UT
| | - Sharon Sumner
- Infection Preventionist, Intermountain Healthcare, Salt Lake City, UT
| | - Katreena Merrill
- Professor and Research Consultant, Brigham Young University College of Nursing, Provo, UT
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