Achieving and Maintaining 'Zero' Central Line-Associated Blood Stream Infection for over a Year in a Medical-Surgical Intensive Care Unit

2013 ◽  
Vol 41 (6) ◽  
pp. S17
Author(s):  
Imran Khalid ◽  
Mohammed Qabajah ◽  
Mazen Kadri ◽  
Haia Al Dosary ◽  
Hanadi Al Salmi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
Central Line ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care

scholarly journals Quality Outcomes in the Surgical Intensive Care Unit after Electronic Health Record Implementation

2015 ◽  
Vol 06 (04) ◽  
pp. 611-618 ◽  
Author(s):  
V. H. Flatow ◽  
N. Ibragimova ◽  
C. M. Divino ◽  
D. S. A. Eshak ◽  
B. C. Twohig ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
Central Line ◽  
Surgical Intensive Care Unit ◽  
Readmission Rates ◽  
Surgical Intensive Care ◽  
The Impact

Summary Background: The electronic health record (EHR) is increasingly viewed as a means to provide more coordinated, patient-centered care. Few studies consider the impact of EHRs on quality of care in the intensive care unit (ICU) setting. Objectives: To evaluate key quality measures of a surgical intensive care unit (SICU) following implementation of the Epic EHR system in a tertiary hospital. Methods: A retrospective chart review was undertaken to record quality indicators for all patients admitted to the SICU two years before and two years after EHR implementation. Data from the twelve-month period of transition to EHR was excluded. We collected length of stay, mortality, central line associated blood stream infection (CLABSI) rates, Clostridium difficile (C. diff.) colitis rates, readmission rates, and number of coded diagnoses. To control for variation in the patient population over time, the case mix indexes (CMIs) and APACHE II scores were also analyzed. Results: There was no significant difference in length of stay, C. diff. colitis, readmission rates, or case mix index before and after EHR. After EHR implementation, the rate of central line blood stream infection (CLABSI) per 1 000 catheter days was 85% lower (2.16 vs 0.39; RR, 0.18; 95% CI, 0.05 to 0.61, p < .005), and SICU mortality was 28% lower (12.2 vs 8.8; RR, 1.35; 95% CI, 1.06 to 1.71, p < .01). Moreover, after EHR there was a significant increase in the average number of coded diagnoses from 17.8 to 20.8 (p < .000). Conclusions: EHR implementation was statistically associated with reductions in CLABSI rates and SICU mortality. The EHR had an integral role in ongoing quality improvement endeavors which may explain the changes in CLABSI and mortality, and this invites further study of the impact of EHRs on quality of care in the ICU.

Use of dry dressings for central venous access devices (CVADs) to decrease central line-associated blood stream infections (CLABSI) in a trauma intensive care unit (ICU)

2021 ◽  
Vol 30 (8) ◽  
pp. S37-S42
Author(s):  
France Paquet ◽  
Janette Morlese ◽  
Charles Frenette
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Central Venous Access ◽  
Venous Access ◽  
Blood Stream ◽  
Central Line ◽  
Surgical Intensive Care Unit ◽  
Central Venous ◽  
Surgical Intensive Care ◽  
Venous Access Devices

This article reports the results of a pre-post study conducted in a trauma-medical-surgical intensive care unit (ICU) regarding dressings of central venous access devices (CVADs) for the reduction of central line-associated blood stream infection (CLABSI) and improvement of adherence and integrity of the dressing. Available evidence indicates that dry dressings changed every 48 hours are equivalent to transparent dressings, changed when soiled or loose, or routinely every seven days. In our intensive care unit, where the majority of CVADs are inserted in the internal jugular vein and where there is an important usage of cervical collars, we questioned if dry dressings would be more appropriate than transparent dressings. Results: In the 12 months following the change in practice, we noted a CLABSI reduction from 2.36/1,000 catheter days to zero, improvement in dressing audits from 19.61% to 85.34% of clean dressings (P=0.00001) and 62.75% to 90.58% of adherent dressings. Conclusion: In this pre-post study, a simple change in dressing type was implemented, resulting in a significant reduction in the CLABSI rate.

Inpatient Peripherally Inserted Central Venous Catheter Complications: Should Peripherally Inserted Central Catheter Lines be Placed in the Intensive Care Unit Setting?

2017 ◽  
Vol 83 (8) ◽  
pp. 925-927 ◽  
Author(s):  
Michael Martyak ◽  
Ishraq Kabir ◽  
Rebecca Britt
Keyword(s):  
Intensive Care Unit ◽  
Interventional Radiology ◽  
Intensive Care ◽  
Infection Rate ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
Central Line ◽  
Complication Rates ◽  
Central Venous ◽  
Icu Patients

Peripherally inserted central venous catheters (PICCs) are now commonly used for central access in the intensive care unit (ICU) setting; however, there is a paucity of data evaluating the complication rates associated with these lines. We performed a retrospective review of all PICCs placed in the inpatient setting at our institution during a 1-year period from January 2013 to December 2013. These were divided into two groups: those placed at the bedside in the ICU and those placed by interventional radiology in non-ICU patients. Data regarding infectious and thrombotic complications were collected and evaluated. During the study period, 1209 PICC line placements met inclusion criteria and were evaluated; 1038 were placed by interventional radiology in non-ICU patients, and 171 were placed at the bedside in ICU patients. The combined thrombotic and central line associated blood stream infection rate was 6.17 per cent in the non-ICU group and 10.53 per cent in the ICU group (P = 0.035). The thrombotic complication rate was 5.88 per cent in the non-ICU group and 7.60 per cent in the ICU group (P = 0.38), whereas the central line associated blood stream infection rate was 0.29 per cent in the non-ICU group and 2.92 per cent in the ICU group (P = 0.002). This study seems to suggest that PICC lines placed at the bedside in the ICU setting are associated with higher complication rates, in particular infectious complications, than those placed by interventional radiology in non-ICU patients. The routine placement of PICC lines in the ICU settings needs to be reevaluated given these findings.

Probabilistic Measurement of Central Line–Associated Bloodstream Infections

2015 ◽  
Vol 37 (2) ◽  
pp. 149-155 ◽  
Author(s):  
Bala Hota ◽  
Paul Malpiedi ◽  
Scott K. Fridkin ◽  
John Martin ◽  
William Trick
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Probabilistic Method ◽  
Bloodstream Infections ◽  
Central Line ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Equal Distribution ◽  
Final Model ◽  
C Statistic

OBJECTIVETo develop a probabilistic method for measuring central line–associated bloodstream infection (CLABSI) rates that reduces the variability associated with traditional, manual methods of applying CLABSI surveillance definitions.DESIGNMulticenter retrospective cohort study of bacteremia episodes among patients hospitalized in adult patient-care units; the study evaluated presence of CLABSI.SETTINGHospitals that used SafetySurveillor software system (Premier) and who also reported to the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN).PATIENTSPatients were identified from a stratified sample from all eligible blood culture isolates from all eligible hospital units to generate a final set with an equal distribution (ie, 20%) from each unit type. Units were divided a priori into 5 major groups: medical intensive care unit, surgical intensive care unit, medical-surgical intensive care unit, hematology unit, or general medical wards.INTERVENTIONSEpisodes were reviewed by 2 experts, and a selection of discordant reviews were re-reviewed. Data were joined with NHSN data for hospitals for in-plan months. A predictive model was created; model performance was assessed using the c statistic in a validation set and comparison with NHSN reported rates for in-plan months.RESULTSA final model was created with predictors of CLABSI. The c statistic for the final model was 0.75 (0.68–0.80). Rates from regression modeling correlated better with expert review than NHSN-reported rates.CONCLUSIONSThe use of a regression model based on the clinical characteristics of the bacteremia outperformed traditional infection preventionist surveillance compared with an expert-derived reference standard.Infect. Control Hosp. Epidemiol. 2016;37(2):149–155

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