scholarly journals Secondary Bacterial Pneumonias and Bloodstream Infections in Patients Hospitalized with COVID-19

2021 ◽  
Vol 1 (S1) ◽  
pp. s46-s46
Author(s):  
Max Adelman ◽  
Divya Bhamidipati ◽  
Alfonso Hernandez ◽  
Ahmed Babiker ◽  
Michael Woodworth ◽  
...  
Keyword(s):  
Bacterial Pneumonia ◽  
Healthcare Delivery ◽  
Specific Effect ◽  
Bloodstream Infections ◽  
Central Line ◽  
Common Source ◽  
Coagulase Negative Staphylococci ◽  
Central Lines ◽  
Secondary Infections ◽  
Control And Prevention

Group Name: The Emory COVID-19 Quality and Clinical Research CollaborativeBackground: Patients hospitalized with COVID-19 are at risk of secondary infections—10%–33% develop bacterial pneumonia and 2%–6% develop bloodstream infection (BSI). We conducted a retrospective cohort study to identify the prevalence, microbiology, and outcomes of secondary pneumonias and BSIs in patients hospitalized with COVID-19. Methods: Patients aged ≥18 years with a positive SARS-CoV-2 real-time polymerase chain reaction assay admitted to 4 academic hospitals in Atlanta, Georgia, between February 15 and May 16, 2020, were included. We extracted electronic medical record data through June 16, 2020. Microbiology tests were performed according to standard protocols. Possible ventilator-associated pneumonia (PVAP) was defined according to Centers for Disease Control and Prevention (CDC) criteria. We assessed in-hospital mortality, comparing patients with and without infections using the χ2 test. SAS University Edition software was used for data analyses. Results: In total, 774 patients were included (median age, 62 years; 49.7% female; 66.6% black). In total, 335 patients (43.3%) required intensive care unit (ICU) admission, 238 (30.7%) required mechanical ventilation, and 120 (15.5%) died. Among 238 intubated patients, 65 (27.3%) had a positive respiratory culture, including 15 with multiple potential pathogens, for a total of 84 potential pathogens. The most common organisms were Staphylococcus aureus (29 of 84; 34.5%), Pseudomonas aeruginosa (16 of 84; 19.0%), and Klebsiella spp (14 of 84; 16.7%). Mortality did not differ between intubated patients with and without a positive respiratory culture (41.5% vs 35.3%; P = .37). Also, 5 patients (2.1%) had a CDC-defined PVAP (1.7 PVAPs per 1,000 ventilator days); none of them died. Among 536 (69.3%) nonintubated patients, 2 (0.4%) had a positive Legionella urine antigen and 1 had a positive respiratory culture (for S. aureus). Of 774 patients, 36 (4.7%) had BSI, including 5 with polymicrobial BSI (42 isolates total). Most BSIs (24 of 36; 66.7%) had ICU onset. The most common organisms were S. aureus (7 of 42; 16.7%), Candida spp (7 of 42; 16.7%), and coagulase-negative staphylococci (5 of 42; 11.9%); 12 (28.6%) were gram-negative. The most common source was central-line–associated BSI (17 of 36; 47.2%), followed by skin (6 of 36; 16.7%), lungs (5 of 36; 13.9%), and urine (4 of 36; 11.1%). Mortality was 50% in patients with BSI versus 13.8% without (p < 0.0001). Conclusions: In a large cohort of patients hospitalized with COVID-19, secondary infections were rare: 2% bacterial pneumonia and 5% BSI. The risk factors for these infections (intubation and central lines, respectively) and causative pathogens reflect healthcare delivery and not a COVID-19–specific effect. Clinicians should adhere to standard best practices for preventing and empirically treating secondary infections in patients hospitalized with COVID-19.Funding: NoDisclosures: None

scholarly journals Targeted Assessment for Prevention Facility Assessments: The Most Common CAUTI and CLABSI Infection Prevention Gaps

2020 ◽  
Vol 41 (S1) ◽  
pp. s4-s5
Author(s):  
Rachel Snyder ◽  
Katelyn White ◽  
Janet Glowicz ◽  
Shannon Novosad ◽  
Elizabeth Soda ◽  
...  
Keyword(s):  
Infection Prevention ◽  
Technical Assistance ◽  
Bloodstream Infections ◽  
Central Line ◽  
Postanesthesia Care Unit ◽  
Central Lines ◽  
Control And Prevention ◽  
Acute Care Facilities ◽  
Tract Infections ◽  
Competency Assessments

Background: The Targeted Assessment for Prevention (TAP) strategy is a quality improvement framework created by the Centers for Disease Control and Prevention (CDC) to facilitate the reduction of healthcare-associated infections (HAIs). TAP facility assessments are a component of the TAP strategy and are completed by staff across the facility to help identify perceptions of and target infection prevention gaps. We have described the gaps most commonly reported by facilities completing TAP facility assessments for catheter-associated urinary tract infections (CAUTIs) and central-line–associated bloodstream infections (CLABSIs). Methods: TAP CAUTI and CLABSI assessments were completed by acute-care facilities across the nation, with CDC technical assistance, from December 2014 to August 2019. Similar questions across 2 versions of CAUTI assessments and 3 versions of CLABSI assessments were combined. Analysis was limited to facilities with ≥10 assessments. Infection prevention gaps were defined as ≥33% respondents answering Unknown, ≥33% respondents answering “no,” or ≥50% of respondents answering “no” and “unknown” or “never” and “rarely” “sometimes” “unknown.” The analysis was completed at the facility level, and the gaps most commonly reported across facilities were identified. Results: In total, 1,942 CAUTI assessments from 42 facilities in 12 states and 1,623 CLABSI assessments from 29 facilities in 11 states were included for analysis. The mean numbers of assessments per facility were 46.2 for CAUTIs and 56.0 for CLABSIs. Across both CAUTIs and CLABSIs, commonly reported perceptions about infection prevention gaps included lack of physician and nurse champions for prevention activities, failure to conduct competency assessments, and inconsistency in select device insertion practices (Fig. 1). For CAUTIs, lack of practices to facilitate timely removal of urinary catheters were also commonly reported, with one-third of facilities reporting inconsistency in use of alerts for catheter removal, 78.6% reporting lack of physician response to these alerts, and 90.5% reporting deficiencies in removing unnecessary catheters in the postanesthesia care unit. For CLABSIs, 79.3% of facilities reported failure to replace central lines within 48 hours after emergent insertion, and 62.1% reported that feedback was not provided to staff on central-line device utilization ratios. Conclusion: For both assessments, absence of CAUTI and CLABSI prevention champions, failure to conduct competency assessments, and inconsistency in performing device insertion practices were commonly reported across facilities. These common gaps have and will continue to inform the development of tools and resources to improve infection prevention practices as well as help to better target the implementation of interventions.Funding: NoneDisclosures: None

Diagnosing and Reporting of Central Line–Associated Bloodstream Infections

2012 ◽  
Vol 33 (9) ◽  
pp. 875-882 ◽  
Author(s):  
Susan E. Beekmann ◽  
Daniel J. Diekema ◽  
W. Charles Huskins ◽  
Loreen Herwaldt ◽  
John M. Boyce ◽  
...  
Keyword(s):  
Blood Culture ◽  
Infectious Diseases ◽  
Clinical Judgment ◽  
Bloodstream Infections ◽  
Central Line ◽  
Emerging Infections ◽  
Central Lines ◽  
Time To Positivity ◽  
Control And Prevention ◽  
Question Survey

Background.The diagnosis of central line-associated bloodstream infections (CLABSIs) is often controversial, and existing guidelines differ in important ways.Objective.To determine both the range of practices involved in obtaining blood culture samples and how central line-associated infections are diagnosed and to obtain members' opinions regarding the process of designating bloodstream infections as publicly reportable CLABSIs.Design.Electronic and paper 11-question survey of infectious-diseases physician members of the Infectious Diseases Society of America Emerging Infections Network (IDSA EIN).Participants.All 1,364 IDSA EIN members were invited to participate.Results.692 (51%) members responded; 52% of respondents with adult practices reported that more than half of the blood culture samples for intensive care unit (ICU) patients with central lines were drawn through existing lines. A sizable majority of respondents used time to positivity, differential time to positivity when paired blood cultures are used, and quantitative culture of catheter tips when diagnosing CLABSI or determining the source of that bacteremia. When determining whether a bacteremia met the reportable CLABSI definition, a majority used a decision method that involved clinical judgment.Conclusions.Our survey documents a strong preference for drawing 1 set of blood culture samples from a peripheral line and 1 from the central line when evaluating fever in an ICU patient, as recommended by IDSA guidelines and in contrast to current Centers for Disease Control and Prevention recommendations. Our data show substantial variability when infectious-diseases physicians were asked to determine whether bloodstream infections were primary bacteremias, and therefore subject to public reporting by National Healthcare Safety Network guidelines, or secondary bacteremias, which are not reportable.

scholarly journals Reduction of Central-Line–Associated Bloodstream Infections in a Spinal Cord Injury Unit

2020 ◽  
Vol 41 (S1) ◽  
pp. s370-s370
Author(s):  
Stephanie L. Baer ◽  
Amy Halcyon Larsh ◽  
Annalise Prunier ◽  
Victoria Thurmond ◽  
Donna Goins ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Patient Population ◽  
Bloodstream Infections ◽  
Central Line ◽  
Fiscal Year ◽  
Improvement Project ◽  
Central Lines ◽  
Cord Injury ◽  
Bundle Compliance

Background: Central-line–associated bloodstream infections (CLABSIs) are a complication of indwelling central venous catheters, which increase morbidity, mortality, and cost to patients. Objective: Due to increased rates in a spinal cord injury unit (SCIU), a performance improvement project was started to reduce CLABSI in the patient population. Methods: To reduce the incidence of CLABSI, a prevention bundle was adopted, and a peer-surveillance tool was developed to monitor compliance with the bundle. Staff were trained to monitor their peers and submit weekly surveillance. Audits were conducted by the clinical nurse leader with accuracy feedback. Bundle peer-surveillance was implemented in February of 2018 with data being fed back to leadership, peer monitors, and stakeholders. Gaps in compliance were addressed with peer-to-peer education, changes in documentation requirements, and meetings to improve communication and reduce line days. In addition, the use of an antiseptic-impregnated disc for vascular accesses was implemented for dressing changes. Further quality improvement cycles during the first 2 quarters of fiscal year 2019 included service-wide education reinforcement, identification in variance of practice, and reporting to staff and stakeholders. Results: CLABSI bundle compliance increased from 67% to 98% between February and October 2018. The weekly audit reporting accuracy improved from 33% to 100% during the same period. Bundle compliance was sustained through the fourth quarter of 2019 at 98%, and audit accuracy was 99%. The initial CLABSI rates the quarter prior to the intervention were 6.10 infections per 1,000 line days for 1 of the 3 SCIUs and 2.68 infections per 1,000 line days for the service overall. After the action plan was initiated, no CLABSIs occurred for the next 3 quarters in all SCIUs despite unchanged use of central lines (5,726 line days in 2018). The improvement was sustained, and the line days decreased slightly for 2019, with a fiscal year rate of 0.61 per 1,000 line days (ie, 3 CLABSIs in 4,927 central-line days). Conclusions: The incidence of CLABSI in the SCIU was reduced by an intensive surveillance intervention to perform accurate peer monitoring of bundle compliance with weekly feedback, communication, and education strategies, improvement of the documentation, and the use of antiseptic-impregnated discs for dressings. Despite the complexity of the patient population requiring long-term central lines, the CLABSI rate was greatly impacted by evidence-based interventions coupled with reinforcement of adherence to the bundle.Funding: NoneDisclosures: None

scholarly journals Review of Best Practices for CLABSI Prevention and the Impact of Recent Legislation on CLABSI Reporting

SAGE Open ◽  
2016 ◽  
Vol 6 (4) ◽  
pp. 215824401667774 ◽  
Author(s):  
Benjamin Woodward ◽  
Reba Umberger
Keyword(s):  
Best Practices ◽  
Healthcare Providers ◽  
Bloodstream Infections ◽  
Central Line ◽  
Mandatory Reporting ◽  
Future Research ◽  
Common Source ◽  
Healthcare Associated Infection ◽  
Extrinsic Factors ◽  
The Impact

Central line-associated bloodstream infections (CLABSI) are a very common source of healthcare-associated infection (HAI). Incidence of CLABSI has been significantly reduced through the efforts of nurses, healthcare providers, and infection preventionists. Extrinsic factors such as recently enacted legislation and mandatory reporting have not been closely examined in relation to changes in rates of HAI. The following review will examine evidence-based practices related to CLABSI and how they are reported, as well as how the Affordable Care Act, mandatory reporting, and pay-for-performance programs have affected these best practices related to CLABSI prevention. There is a disconnect in the methods and guidelines for reporting CLABSI between these programs, specifically among local monitoring agencies and the various federal oversight organizations. Future research will focus on addressing the gap in what defines a CLABSI and whether or not these programs to incentivize hospital to reduce CLABSI rates are effective.

scholarly journals Prevention of central line-associated bloodstream infections: a survey of ICU nurses’ knowledge and practice in China

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Xiuwen Chi ◽  
Juan Guo ◽  
Xiaofeng Niu ◽  
Ru He ◽  
Lijuan Wu ◽  
...  
Keyword(s):  
Insertion Site ◽  
Bloodstream Infections ◽  
Guangdong Province ◽  
Central Line ◽  
Evidence Based ◽  
Department Of Health ◽  
Control And Prevention ◽  
Knowledge And Practice ◽  
Evidence Based Guidelines ◽  
Nurses Knowledge

Abstract Background Central line-associated bloodstream infections (CLABSI) are largely preventable when evidence-based guidelines are followed. However, it is not clear how well these guidelines are followed in intensive care units (ICUs) in China. This study aimed to evaluate Chinese ICU nurses’ knowledge and practice of evidence-based guidelines for prevention of CLABSIs issued by the Centers for Disease Control and Prevention, US and the Department of Health UK. Method Nurses completed online questionnaires regarding their knowledge and practice of evidence-based guidelines for the prevention of CLABSIs from June to July 2019. The questionnaire consisted of 11 questions, and a score of 1 was given for a correct answer (total score = 0–11). Results A total of 835 ICU nurses from at least 104 hospitals completed the questionnaires, and 777 were from hospitals in Guangdong Province. The mean score of 11 questions related to evidence-based guidelines for preventing CLABSIs was 4.02. Individual total scores were significantly associated with sex, length of time as an ICU nurse, educational level, professional title, establishment, hospital grade, and incidence of CLABSIs at the participant’s ICU. Importantly, only 43% of nurses reported always using maximum barrier precautions, 14% of nurses reported never using 2% chlorhexidine gluconate for antisepsis at the insertion site, only 40% reported prompt removal of the catheter when it was no longer necessary, and 33% reported frequently and routinely changing catheters even if there was no suspicion of a CLABSI. Conclusion Chinese ICU nurses in Guangdong Province lack of knowledge and practice of evidence-based guidelines for the prevention of CLABSIs. National health administrations should adopt policies to train ICU nurses to prevent CLABSIs.

Analysis of Central Line–Associated Bloodstream Infections in the Intensive Care Unit after Implementation of Central Line Bundles

2010 ◽  
Vol 31 (05) ◽  
pp. 551-553 ◽  
Author(s):  
Emily K. Shuman ◽  
Laraine L. Washer ◽  
Jennifer L. Arndt ◽  
Christy A. Zalewski ◽  
Robert C. Hyzy ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Bloodstream Infections ◽  
Central Line ◽  
Line Bundles ◽  
Blood Samples ◽  
Central Lines ◽  
Definition Of ◽  
Contaminated Blood

Central line-associated bloodstream infections (CLABSIs) have been reduced in number but not eliminated in our intensive care units with use of central line bundles. We performed an analysis of remaining CLABSIs. Many bloodstream infections that met the definition of CLABSI had sources other than central lines or represented contaminated blood samples.

Quality Improvement to Reduce Neonatal CLABSI: The Journey to Zero

2020 ◽  
Vol 37 (S 02) ◽  
pp. S14-S17
Author(s):  
Stephen A. Pearlman
Keyword(s):  
Quality Improvement ◽  
Central Venous Access ◽  
Bloodstream Infections ◽  
Venous Access ◽  
Central Line ◽  
Central Lines ◽  
The Past ◽  
Healthcare Improvement ◽  
Key Points ◽  
Innovative Techniques

Neonatal infections, including those associated with central lines, continue to be a major cause of morbidity and mortality despite many other improvements in neonatal outcomes. Over the past decades, significant advances have been made to reduce central line-associated bloodstream infections (CLABSIs) using quality improvement methodology. This article will review pertinent studies that used both the Institute for Healthcare Improvement Model for Improvement and other innovative techniques such as orchestrated testing and health care failure mode and effects analysis. These studies, by applying best practices, have demonstrated substantial and sustainable reductions in CLABSI. Some initiatives have been able to achieve rates of zero CLABSI for prolonged periods of time. While neonates often require prolonged central venous access and suffer from impaired immunity which increases the risk of CLABSI, this review demonstrates the journey to zero is feasible. Key Points

scholarly journals 81. Reducing Unnecessary Blood Cultures Through Diagnostic Stewardship

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S157-S157
Author(s):  
Sujeet Govindan ◽  
Luke Strnad
Keyword(s):  
Blood Culture ◽  
Positive Blood Culture ◽  
Cost Savings ◽  
Bloodstream Infections ◽  
Central Line ◽  
Blood Cultures ◽  
Coagulase Negative Staphylococci ◽  
Candida Sp ◽  
Daily Frequency ◽  
Oregon Health

Abstract Background At our institution, we learned the frequency of blood cultures was sometimes being changed from “Once” to “Daily” without a defined number of days. We hypothesized this led to unnecessary blood cultures being performed. Methods Over a 3 month period from 12/6/2019-3/6/2020, we retrospectively evaluated the charts of patients who had a blood culture frequency changed to “Daily”. We evaluated if there was an initial positive blood culture within 48 hours of the “Daily” order being placed and the number of positive, negative, or “contaminant” sets of cultures drawn with the order. Contaminant blood cultures were defined as a contaminant species, present only once in the repeat cultures, and not present in initial positive cultures. Results 95 unique orders were placed with 406 sets of cultures drawn from 89 adults. ~20% of the time (17 orders) the order was placed without an initial positive blood culture. This led to 62 sets of cultures being drawn, only 1 of which came back positive. 78/95 orders had an initial positive blood culture. The most common initial organisms were Staphylococcus aureus (SA) (38), Candida sp (10), Enterobacterales sp (10), and coagulase negative staphylococci (7). 43/78 (55%) orders with an initial positive set had positive repeat cultures. SA (26) and Candida sp (8) were most common to have positive repeats. Central line associated bloodstream infections (CLABSI) were found in 5 of the orders and contaminant species were found in 4 of the orders. 54% of the patients who had a “Daily” order placed did not have positive repeat cultures. The majority of the cultures were drawn from Surgical (40 orders) and Medical (35 orders) services. Assuming that SA and Candida sp require 48 hours of negative blood cultures to document clearance and other species require 24 hours, it was estimated that 51% of the cultures drawn using the "Daily" frequency were unnecessary. Cost savings over a year of removing the "Daily" frequency would be ~&14,000. Data from "Daily" blood culture orders drawn at Oregon Health & Science University from 12/6/2019-3/6/2020 Conclusion Unnecessary blood cultures are drawn when the frequency of blood cultures is changed to "Daily". Repeat blood cultures had the greatest utility in bloodstream infections due to SA or Candida sp, and with CLABSI where the line is still in place. These results led to a stewardship intervention to change blood culture ordering at our institution. Disclosures All Authors: No reported disclosures

scholarly journals Bloodstream Infections With a Novel Nontuberculous Mycobacterium Involving 52 Outpatient Oncology Clinic Patients―Arkansas, 2018

2019 ◽  
Vol 71 (7) ◽  
pp. e178-e185
Author(s):  
Sarah M Labuda ◽  
Kelley Garner ◽  
Michael Cima ◽  
Heather Moulton-Meissner ◽  
Alison Laufer Halpin ◽  
...  
Keyword(s):  
Laboratory Data ◽  
Bloodstream Infections ◽  
Nontuberculous Mycobacterium ◽  
Common Source ◽  
Whole Genome ◽  
Species Identity ◽  
Oncology Patients ◽  
Department Of Health ◽  
Risk Period ◽  
Control And Prevention

Abstract Background In July 2018, the Arkansas Department of Health (ADH) was notified by hospital A of 3 patients with bloodstream infections (BSIs) with a rapidly growing nontuberculous Mycobacterium (NTM) species; on 5 September 2018, 6 additional BSIs were reported. All were among oncology patients at clinic A. We investigated to identify sources and to prevent further infections. Methods ADH performed an onsite investigation at clinic A on 7 September 2018 and reviewed patient charts, obtained environmental samples, and cultured isolates. The isolates were sequenced (whole genome, 16S, rpoB) by the Centers for Disease Control and Prevention to determine species identity and relatedness. Results By 31 December 2018, 52 of 151 (34%) oncology patients with chemotherapy ports accessed at clinic A during 22 March–12 September 2018 had NTM BSIs. Infected patients received significantly more saline flushes than uninfected patients (P &lt; .001) during the risk period. NTM grew from 6 unused saline flushes compounded by clinic A. The identified species was novel and designated Mycobacterium FVL 201832. Isolates from patients and saline flushes were highly related by whole-genome sequencing, indicating a common source. Clinic A changed to prefilled saline flushes on 12 September as recommended. Conclusions Mycobacterium FVL 201832 caused BSIs in oncology clinic patients. Laboratory data allowed investigators to rapidly link infections to contaminated saline flushes; cooperation between multiple institutions resulted in timely outbreak resolution. New state policies being considered because of this outbreak include adding extrapulmonary NTM to ADH’s reportable disease list and providing more oversight to outpatient oncology clinics.

Burden of bloodstream infections among ambulatory pediatric hematology/oncology patients with a central line.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 262-262
Author(s):  
Constance Barysauskas ◽  
David G. Bundy ◽  
Aditya H. Gaur ◽  
Jeffrey D. Hord ◽  
Marlene R. Miller ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Bloodstream Infections ◽  
Central Line ◽  
Ambulatory Setting ◽  
Blood Disorders ◽  
Central Lines ◽  
Pediatric Hematology ◽  
Reduction Strategies ◽  
Single Positive ◽  
One Year

262 Background: Pediatric hematology/oncology (PHO) patients are at high risk of bloodstream infections (BSI). The burden of BSI in PHO patients in the ambulatory setting has not been well documented. Methods: The Children’s Hospital Association leads the Childhood Cancer and Blood Disorders Network, a multicenter United States quality improvement collaborative, working to reduce the incidence of inpatient and ambulatory Central Line-Associated BSI (CLABSI) among PHO patients. Positive blood culture events (+BCE) were adjudicated as CLABSI, single positive blood cultures (SPBC) with potential commensals, or secondary BSI (attributed to source other than the central line) following standardized National Healthcare Safety Network definitions. Our study investigated the prevalence of +BCE among all centers with 90% complete monthly reporting of both +BCE and central line days (CLD) for at least one year (n=25) between January 2012 and September 2014. Ambulatory and inpatient BSI rates and 95% confidence intervals (CI) were calculated as the number of +BCE per 1,000 CLD per month. Results: A total of 1,747 +BCE and 4,883,413 CLD were reported among our target ambulatory population, whereas 1,095 +BCE and 353,259 CLD were reported among our corresponding inpatient population [Table]. While the CLABSI and SPBC rates were significantly lower in the ambulatory setting compared to inpatient (p<0.001), the total number of ambulatory CLABSI and SPBC events was 2.0 and 1.6 times higher than inpatient events, respectively. Conclusions: Our findings from a large multicenter collaborative demonstrate the burden of BSI among ambulatory PHO patients and identify benchmarks for future quality improvement work.Further investigation is necessary to develop effective infection reduction strategies for ambulatory PHO patients with central lines. [Table: see text]

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