Central-Line–Associated Bloodstream Infections in Québec Intensive Care Units: Results from the Provincial Healthcare-Associated Infections Surveillance Program (SPIN)

2016 ◽  
Vol 37 (10) ◽  
pp. 1186-1194 ◽  
Author(s):  
Lynne Li ◽  
Elise Fortin ◽  
Claude Tremblay ◽  
Muleka Ngenda-Muadi ◽  
Caroline Quach ◽  
...  
Keyword(s):  
Intensive Care ◽  
Central Venous Catheter ◽  
Intensive Care Units ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Incidence Rates ◽  
Surveillance Program ◽  
Central Venous ◽  
Healthcare Associated

BACKGROUNDFollowing implementation of bundled practices in 2009 in Quebec and Canadian intensive care units (ICUs), we describe CLABSI epidemiology during the last 8 years in the province of Québec (Canada) and compare rates with Canadian and American benchmarks.METHODSCLABSI incidence rates (IRs) and central venous catheter utilization ratios (CVCURs) by year and ICU type were calculated using 2007–2014 data from the Surveillance Provinciale des Infections Nosocomiales (SPIN) program. Using American and Canadian surveillance data, we compared SPIN IRs to rates in other jurisdictions using standardized incidence ratios (SIRs).RESULTSIn total, 1,355 lab-confirmed CLABSIs over 911,205 central venous catheter days (CVC days) were recorded. The overall pooled incidence rate (IR) was 1.49 cases per 1,000 CVC days. IRs for adult teaching ICUs, nonteaching ICUs, neonatal ICUs (NICUs), and pediatric ICUs (PICUs) were 1.04, 0.91, 4.20, and 2.15 cases per 1,000 CVC days, respectively. Using fixed SPIN 2007–2009 benchmarks, CLABSI rates had decreased significantly in all ICUs except for PICUs by 2014. Rates declined by 55% in adult teaching ICUs, 52% in adult nonteaching ICUs, and 38% in NICUs. Using dynamic American and Canadian CLABSI rates as benchmarks, SPIN adult teaching ICU rates were significantly lower and adult nonteaching ICUs had lower or comparable rates, whereas NICU and PICU rates were higher.CONCLUSIONQuébec ICU CLABSI surveillance shows declining CLABSI rates in adult ICUs. The absence of a decrease in CLABSI rate in NICUs and PICUs highlights the need for continued surveillance and analysis of factors contributing to higher rates in these populations.Infect Control Hosp Epidemiol 2016;1–9

A Simple Educational Intervention to Decrease Incidence of Central Line–Associated Bloodstream Infection (CLABSI) in Intensive Care Units with Low Baseline Incidence of CLABSI

2010 ◽  
Vol 31 (9) ◽  
pp. 964-967 ◽  
Author(s):  
Alfonso Pérez Parra ◽  
María Cruz Menárguez ◽  
María Jesús Pérez Granda ◽  
María Jesús Tomey ◽  
Belén Padilla ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Educational Intervention ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Central Venous ◽  
Poisson Regression Analysis ◽  
Wilcoxon Rank Sum Test ◽  
Baseline Incidence

After an educational intervention in 3 intensive care units, 34 central line-associated bloodstream infections occurred in 11,582 central venous catheter [CVC]-days, compared with 45 episodes in 10,661 CVC-days before intervention (4.22 vs 2.94 episodes per 1,000 CVC-days [30.9% reduction]; P = .03, Wilcoxon rank sum test; P = .11, Poisson regression analysis).

Electronic Documentation of Central Venous Catheter—Days: Validation Is Essential

2013 ◽  
Vol 34 (09) ◽  
pp. 899-907 ◽  
Author(s):  
Sheri Chernetsky Tejedor ◽  
Gina Garrett ◽  
Jesse T. Jacob ◽  
Ellen Meyer ◽  
Mary Dent Reyes ◽  
...  
Keyword(s):  
Intensive Care ◽  
Central Venous Catheter ◽  
Intensive Care Units ◽  
Error Rate ◽  
Total Error ◽  
Venous Catheter ◽  
Central Line ◽  
Electronic Documentation ◽  
Central Venous ◽  
Electronic Data

Background.Measurement of central line-associated bloodstream infection (CLABSI) rates outside of intensive care units is challenged by the difficulty in reliably determining central venous catheter (CVC) use. The National Healthcare Safety Network (NHSN) allows for use of electronic data for determination of CVC-days, but validation of electronic data has not been studied systematically.Objective.To design and validate a process to reliably measure CVC-days outside of the intensive care units that leverages electronic documentation.Methods.Thirty-four inpatient wards at 2 academic hospitals using a common electronic platform for nursing documentation were studied. Electronic queries were created to capture patient and CVC information, and tools and processes for tracking and reporting errors in documentation were developed. Strategies to validate electronic data included comparisons with manual CVC-day determinations and automated data validation using customized tools. Interventions included redesign of documentation interface, real-time audit with feedback of errors, and education. The primary outcome was patient-level total error rate in electronic CVC-day measurement compared with manually counted CVC-days.Results.At baseline, there were a mean (± standard deviation) of 0.32 ± 0.25 electronic CVC-day errors (omission and commission errors summed and counted equally) per manually counted CVC-day. After several process improvement cycles over 7 months, the error rate decreased to <0.05 errors per CVC-day and remained at or below this level for 2 years.Conclusions.Baseline electronic CVC-day counts had a high error rate. Stepwise interventions reduced errors to consistently low levels. Validation of electronic calculation of CVC-days is essential to ensure accuracy, particularly if these data will be used for interinstitutional comparison.

Central Venous Catheter Protective Connector Caps Reduce Intraluminal Catheter-Related Infection

2012 ◽  
Vol 17 (4) ◽  
pp. 210-213 ◽  
Author(s):  
Chuck Ramirez ◽  
Antonina M. Lee ◽  
Ken Welch
Keyword(s):  
Intensive Care ◽  
Central Venous Catheter ◽  
Intensive Care Units ◽  
Blood Stream Infection ◽  
Prospective Trial ◽  
Venous Catheter ◽  
Blood Stream ◽  
Central Line ◽  
Central Venous ◽  
Adult Care

Abstract Background: Central line-associated blood stream infection (CLABSI) rates in adult care intensive care units have been decreasing across the board. However, we continued to see just a few infections in patients whose catheters are in for >4 days. Therefore, we looked at infections associated with intraluminal contamination to help reduce our infection rate. Methods: A protective cap trial was developed and implemented in 2 intensive care units. All of the central venous catheter and intravenous tubing access valves were covered with a protective cap saturated with alcohol. This intervention eliminated the need to wipe off intravenous access points with an alcohol swab. The study was done as a nonrandomized prospective trial occurring March 1, 2011 through February 29, 2012. Results: During 2010, there were 4 CLABSI-related infections. By the end of the trial, we had incurred 1 catheter-associated blood stream infection. CLABSI rate reduced from 1.9 in 2010 to 0.5 during the 1-year trial period. Conclusions: The implementation of the port protector cap system resulted in lower infection rates compared with an alcohol swab technique. Our results indicate that consistent use of the caps in tandem with strict compliance does influence CLABSI rates.

Reducing Central Venous Catheter–Associated Primary Bloodstream Infections in Intensive Care Units Is Possible: Data From The German Nosocomial Infection Surveillance System

2003 ◽  
Vol 24 (7) ◽  
pp. 501-505 ◽  
Author(s):  
Irina Zuschneid ◽  
Frank Schwab ◽  
Christine Geffers ◽  
Henning Rüden ◽  
Petra Gastmeier
Keyword(s):  
Intensive Care ◽  
Central Venous Catheter ◽  
Nosocomial Infection ◽  
Intensive Care Units ◽  
Surveillance System ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Relative Reduction ◽  
Central Venous ◽  
Infection Surveillance

AbstractBackground And Objective:The German Nosocomial Infection Surveillance System (KISS) began in 1997 as a nationwide surveillance project for voluntary registration of nosocomial infections in intensive care units (ICUs). This study investigates trends in the rates of central venous catheter (CVC)–associated primary bloodstream infections (BSIs) in ICUs since participation in KISS.Methods:Eighty-four ICUs that had participated in KISS for at least 24 months were considered for more detailed analysis. Monthly rates of primary BSI for the 84 ICUs were pooled for the 24 months. The best model for describing the curve of reduction was sought. Additionally, incidence densities were compared using the z test.Results:For the 212 ICUs participating, a relative 25.7% decrease (from 2.1 to 1.6 primary BSIs per 1,000 CVC-days) was observed from January 1997 to June 2001. The 84 ICUs that participated in KISS for a minimum of 24 months accumulated 552,359 patient-days and 404,897 CVC-days during their 24 months. A linear regression model was selected to explain the curve of primary BSI reduction in the 84 ICUs. It showed a decrease from 2.1 to 1.5 primary BSIs per 1,000 CVC-days, meaning an overall relative reduction of 28.6% during the 2-year observation period. These results were significant (Student's t test for the monthly reduction coefficient; P = .04). The reduction of primary BSIs was shown for both clinical sepsis and laboratory-confirmed, CVC-associated primary BSIs.Conclusion:Performing surveillance with KISS was associated with a reduction of the rates of CVC-associated primary BSIs in ICU patients (Infect Control Hosp Epidemiol 2003;24:501-505).

scholarly journals Incidence of Central Venous Catheter-Related Bloodstream Infections: Evaluation of Bundle Prevention in Two Intensive Care Units in Central Brazil

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Thais Yoshida ◽  
Ana Elisa Bauer de Camargo Silva ◽  
Luciana Leite Pineli Simões ◽  
Rafael Alves Guimarães
Keyword(s):  
Intensive Care ◽  
Central Venous Catheter ◽  
Intensive Care Units ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Incidence Density ◽  
P Value ◽  
Central Venous ◽  
Central Brazil ◽  
Before And After

Background. Central venous catheter-associated bloodstream infections (CVC-BSIs) have been associated with increased length of hospital stay, mortality, and healthcare costs, especially in intensive care units (ICUs). The aim of this study was to evaluate the incidence density of CVC-BSIs before and after implementation of the bundle in a hospital of infectious and dermatological diseases in Central Brazil. Methods. A retrospective cohort study was conducted in two ICUs (adult and pediatric) between 2012 and 2015. Two periods were compared to assess the effect of the intervention in incidence density of CVC-BSIs: before and after intervention, related to the stages before and after the implementation of the bundle, respectively. Results. No significant reduction was observed in the incidence density of CVC-BSIs in adult ICU (incidence rate ratio [IRR]: 0.754; 95.0% CI: 0.349 to 1.621; p-value = 0.469), despite the high bundle application rate in the postintervention period. Similarly, significant reduction in the incidence density in pediatric ICU has not been verified after implementation of the bundle (IRR: 1.148; 95.0% CI: 0.314 to 4.193; p-value = 0.834). Conclusion. Not significant reduction in the incidence density of CVC-BSIs was observed after bundle implementation in ICUs, suggesting the need to review the use of process, as well as continuing education for staffs in compliance and correct application of the bundle. Further studies are needed to evaluate the effect of bundle in the reduction of incidence density of CVC-BSIs in Brazil.

Central Line–Associated Bloodstream Infection in Neonatal Intensive Care Units

2013 ◽  
Vol 34 (11) ◽  
pp. 1167-1173 ◽  
Author(s):  
Ana C. Blanchard ◽  
Elise Fortin ◽  
Isabelle Rocher ◽  
Dorothy L. Moore ◽  
Charles Frenette ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Case Fatality ◽  
Bloodstream Infections ◽  
Central Line ◽  
Incidence Rates ◽  
Neonatal Intensive Care Units ◽  
Surveillance Program ◽  
Utilization Ratio

Objective.Describe the epidemiology of central line-associated bloodstream infections (CLABSIs) in neonatal intensive care units (NICUs) participating in a standardized and mandatory CLABSI surveillance program.Design.Retrospective cohort.Setting.We included patients admitted (April 2007-March 2011) to 7 level II/III NICUs who developed a CLABSI (as defined by the National Healthcare Safety Network).Methods. CLABSIs/1,000 central line–days and device utilization ratio were calculated; x2 test, Student t test, Kruskal-Wallis, and Poisson regression were used.Results.Overall, 191 patients had 202 CLABSI episodes for a pooled mean rate of 4.0 CLABSIs/1,000 central line-days and a device utilization ratio of 0.20. Annual pooled mean CLABSI rates increased from 3.6 in 2007-2008 to 5.1 CLABSIs/1,000 central line-days in 2010-2011 (P = .01). The all-cause 30-day case fatality proportion was 8.9% (n = 17) and occurred a median of 8 days after CLABSI. Coagulase-negative Staphylococcus was identified in 112 (50.5%) cases. Staphylococcus aureus was identified in 22 cases, and 3 (13.6%) were resistant to methicillin. An underlying intra-abdominal pathology was found in 20% (40/202) of CLABSI cases, 50% of which were reported in the last year of study. When adjusted for mean birth weight, annual CLABSI incidence rates were independently associated with the proportion of intra-abdominal pathology (P = .007) and the proportion of pulmonary pathology (P = .016) reported.Conclusion.The increase in CLABSI rates in Quebec NICUs seems to be associated with an increased proportion of cases with underlying intra-abdominal and pulmonary pathologies, which needs further investigation.

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