Impact of multiple concurrent central lines on central-line–associated bloodstream infection rates

AbstractBackground:The current methodology for calculating central-line–associated bloodstream infection (CLABSI) rates, used for pay-for-performance measures, does not account for multiple concurrent central lines.Objective:To compare CLABSI rates using standard National Healthcare Safety Network (NHSN) denominators to rates accounting for multiple concurrent central lines.Design:Descriptive analysis and retrospective cohort analysis.Methods:We identified all adult patients with central lines at 2 academic medical centers over an 18-month period. CLABSI rates were calculated for intensive care units (ICUs) and non-ICUs using the standard NHSN methodology and denominator (a patient could only have 1 central-line day for a given patient day) and a modified denominator (number of central lines in 1 patient in 1 day count as number of line days). We also compared characteristics of patients with and without multiple concurrent central lines.Results:Among 18,521 hospital admissions, there were 156,574 central-line days and 239 CLABSIs (ICU, 105; non-ICU, 134). Our modified denominator reduced CLABSI rates by 25% in ICUs (1.95 vs 1.47 per 1,000 line days) and 6% (1.30 vs 1.22 per 1,000 line days) in non-ICUs. Patients with multiple concurrent central lines were more likely to be in an ICU, to have a longer admission, to have a dialysis catheter, and to have a CLABSI.Conclusions:Using the number of central lines as the denominator decreased CLABSI rates in ICUs by 25%. The presence of multiple concurrent central lines may be a marker of severity of illness. The risk of CLABSI per lumen of a central line is similar in ICUs compared to wards.

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Types of Interventions

Preventing Hospital Infections ◽

10.1093/med/9780197509159.003.0004 ◽

2021 ◽

pp. 40-51

Author(s):

Jennifer Meddings ◽

Vineet Chopra ◽

Sanjay Saint

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Bloodstream Infection ◽

Infection Prevention ◽

Central Line ◽

Peripherally Inserted Central Catheters ◽

Trade Off ◽

Central Lines ◽

The Past ◽

Central Catheters

Prevention of central line–associated bloodstream infection (CLABSI), while initially making great strides in 2003, has declined as use of peripherally inserted central catheters (PICCs) has grown tremendously over the past two decades. The convenience of a PICC has led to sicker patients being treated outside the intensive care unit, and there has been little recognition of a trade-off between benefits and risks after PICC placement. For these reasons, CLABSI prevention has become more challenging. This chapter describes the contents of an infection prevention bundle for CLABSI. In the case of CLABSI, the intervention outlines appropriate and inappropriate uses of central lines. Several new tools are discussed, which help doctors and nurses think through which device is most appropriate for any given patient.

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Universal Glove and Gown Use Is Associated With a Significant Reduction in the Central Line-Associated Bloodstream Infection Rate in the Medical Intensive Care Unit at an Academic Medical Center: 5 Years of Evaluation

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw172.280 ◽

2016 ◽

Vol 3 (suppl_1) ◽

Author(s):

Jason E. Bowling ◽

Anthony D. Harris ◽

Daniel Morgan ◽

Ronald Estrella ◽

Stephanie Levine ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Bloodstream Infection ◽

Infection Rate ◽

Medical Intensive Care Unit ◽

Medical Center ◽

Academic Medical Center ◽

Central Line ◽

Academic Medical ◽

Medical Intensive Care

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Impact of emergency hospital admissions on patterns of primary care prescribing: a retrospective cohort analysis of electronic records in England

British Journal of General Practice ◽

10.3399/bjgp20x709385 ◽

2020 ◽

Vol 70 (695) ◽

pp. e399-e405

Author(s):

Rachel Denholm ◽

Richard Morris ◽

Sarah Purdy ◽

Rupert Payne

Keyword(s):

Hospital Admission ◽

Retrospective Cohort ◽

Hospital Admissions ◽

Cohort Analysis ◽

Post Discharge ◽

Emergency Hospital ◽

Obstetrics And Gynaecology ◽

Emergency Hospital Admission ◽

Retrospective Cohort Analysis ◽

The Impact

BackgroundLittle is known about the impact of hospitalisation on prescribing in UK clinical practice.AimTo investigate whether an emergency hospital admission drives increases in polypharmacy and potentially inappropriate prescriptions (PIPs).Design and settingA retrospective cohort analysis set in primary and secondary care in England.MethodChanges in number of prescriptions and PIPs following an emergency hospital admission in 2014 (at admission and 4 weeks post-discharge), and 6 months post-discharge were calculated among 37 761 adult patients. Regression models were used to investigate changes in prescribing following an admission.ResultsEmergency attendees surviving 6 months (N = 32 657) had a mean of 4.4 (standard deviation [SD] = 4.6) prescriptions before admission, and a mean of 4.7 (SD = 4.7; P<0.001) 4 weeks after discharge. Small increases (<0.5) in the number of prescriptions at 4 weeks were observed across most hospital specialties, except for surgery (−0.02; SD = 0.65) and cardiology (2.1; SD = 2.6). The amount of PIPs increased after hospitalisation; 4.0% of patients had ≥1 PIP immediately before pre-admission, increasing to 8.0% 4 weeks post-discharge. Across hospital specialties, increases in the proportion of patients with a PIP ranged from 2.1% in obstetrics and gynaecology to 8.0% in cardiology. Patients were, on average, prescribed fewer medicines at 6 months compared with 4 weeks post-discharge (mean = 4.1; SD = 4.6; P<0.001). PIPs decreased to 5.4% (n = 1751) of patients.ConclusionPerceptions that hospitalisation is a consistent factor driving rises in polypharmacy are unfounded. Increases in prescribing post-hospitalisation reflect appropriate clinical response to acute illness, whereas decreases are more likely in patients who are multimorbid, reflecting a focus on deprescribing and medicines optimisation in these individuals. Increases in PIPs remain a concern.

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A COMPREHENSIVE UPDATE ON INCIDENCE, PREVALENCE AND COMPLEX ETIOLOGY OF CENTRAL LINE–ASSOCIATED BLOODSTREAM INFECTION IN PEDIATRIC INTENSIVE CARE UNITS IN KING SAUD MEDICAL CITY

International Journal of Research -GRANTHAALAYAH ◽

10.29121/granthaalayah.v9.i5.2021.3907 ◽

2021 ◽

Vol 9 (5) ◽

pp. 56-63

Author(s):

Juhaina Abdulrahiem ◽

Asia Sultan ◽

Faisl Alaklobi ◽

Hala Amer ◽

Hind Alzoman

Keyword(s):

Intensive Care ◽

Bloodstream Infection ◽

Intensive Care Units ◽

Age Groups ◽

Pediatric Intensive Care ◽

Central Line ◽

Central Lines ◽

Medical City ◽

Underlying Diseases ◽

Paediatric Intensive Care Units

Central Line Associated Bloodstream Infection (CLABSI) is a type of bloodstream infection that is caused by microorganisms after the insertion of central lines. Paediatric Intensive Care Units have been studied to conduct this research on CLABSI in children from 2 to 15 years old. Children have been divided in two age groups that are 2-5 and 5-15 years. The Royal Children’s Hospital, Melbourne has been chosen as a sample of this besides other five hospitals of Australia. A total of 350 patients are studied in the course of this research and 216 among them were inserted with central lines. Bloodstream infection has been identified in 49 patients from these 216 patients and CLABSI occurred in 75.51% of them that is 37 patients. Associated microorganisms and other underlying diseases are listed in this study to develop an idea about factors responsible for CLABSI.

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Reducing Bloodstream Infection Risk in Central and Peripheral Intravenous Lines: Initial Data on Passive Intravenous Connector Disinfection

Journal of the Association for Vascular Access ◽

10.1016/j.java.2014.02.002 ◽

2014 ◽

Vol 19 (2) ◽

pp. 87-93 ◽

Cited By ~ 14

Author(s):

Michelle DeVries ◽

Patricia S. Mancos ◽

Mary J. Valentine

Keyword(s):

Bloodstream Infection ◽

Isopropyl Alcohol ◽

Central Line ◽

Infection Risk ◽

Central Venous ◽

Central Lines ◽

Related Risk ◽

Practice Audit ◽

Intravenous Catheters ◽

Central Catheters

Abstract Background: Although few facilities focus on it, bloodstream infection (BSI) risk from peripheral intravenous catheters (PIVs) may exceed central line-related risk. Over a 6-year period, Methodist Hospitals substantially reduced BSIs in patients with central lines but not in patients with PIVs. A practice audit revealed deficiencies in manual disinfection of intravenous connectors, thereby increasing BSI risk. Methodist thus sought an engineered approach to hub disinfection that would compensate for variations in scrubbing technique. Methods: Our institution involved bedside nurses in choosing new hub disinfection technology. They selected 2 devices to trial: a disinfection cap that passively disinfects hubs with isopropyl alcohol and a device that friction-scrubs with isopropyl alcohol. After trying both, nurses selected the cap for use in the facility's 3 intensive care units. After no BSIs occurred during a 3-month span, we implemented the cap throughout the hospital for use on central venous catheters; peripherally inserted central catheters; and peripheral lines, including tubing and Y-sites. Results: Comparing the postintervention period (December 2011-August 2013) to the preintervention span (September 2009–May 2011), the BSI rate dropped 43% for PIVs, 50% for central lines, and 45% overall (PIVs + central lines). The central line and overall results are statistically significant. The PIV BSI rate drop is attributable to cap use alone because the cap was the only new intervention during the postimplementation period. The other infection reductions appear to be at least partly due to cap use. Conclusions: Our institution achieved substantial BSI reductions, some statistically significant, by applying a disinfection cap to both PIVs and central lines.

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Excess Length of Stay Due to Central Line–Associated Bloodstream Infection in Intensive Care Units in Argentina, Brazil, and Mexico

Infection Control and Hospital Epidemiology ◽

10.1086/653028 ◽

2010 ◽

Vol 31 (11) ◽

pp. 1106-1114 ◽

Cited By ~ 8

Author(s):

Adrian G. Barnett ◽

Nicholas Graves ◽

Victor D. Rosenthal ◽

Reinaldo Salomao ◽

Manuel Sigfrido Rangel-Frausto

Keyword(s):

Intensive Care ◽

Length Of Stay ◽

Bloodstream Infection ◽

Latin American ◽

Severity Of Illness ◽

Central Line ◽

Risk Of Death ◽

Time Period ◽

Increased Risk ◽

Latin American Countries

Objective.To estimate the excess length of stay in an intensive care unit (ICU) due to a central line-associated bloodstream infection (CLABSI), using a multistate model that accounts for the timing of infection.Design.A cohort of 3,560 patients followed up for 36,806 days in ICUs.Setting.Eleven ICUs in 3 Latin American countries: Argentina, Brazil, and Mexico.Patients.All patients admitted to the ICU during a defined time period with a central line in place for more than 24 hours.Results.The average excess length of stay due to a CLABSI increased in 10 of 11 ICUs and varied from -1.23 days to 4.69 days. A reduction in length of stay in Mexico was probably caused by an increased risk of death due to CLABSI, leading to shorter times to death. Adjusting for patient age and Average Severity of Illness Score tended to increase the estimated excess length of stays due to CLABSI.Conclusions.CLABSIs are associated with an excess length of ICU stay. The average excess length of stay varies between ICUs, most likely because of the case-mix of admissions and differences in the ways that hospitals deal with infections.

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Republished: Reduction in Central Line–Associated Bloodstream Infection Rates After Implementations of Infection Control Measures at a Level 3 Neonatal Intensive Care Unit

American Journal of Medical Quality ◽

10.1177/1062860619873777 ◽

2019 ◽

Vol 34 (5) ◽

pp. 488-493

Author(s):

Vikramaditya Dumpa ◽

Bonny Adler ◽

Delena Allen ◽

Deborah Bowman ◽

Amy Gram ◽

...

Keyword(s):

Intensive Care ◽

Bloodstream Infection ◽

Neonatal Intensive Care ◽

Central Line ◽

Health Care Team ◽

Control Measures ◽

Care Staff ◽

Evidence Based ◽

Central Lines ◽

Infection Control Measures

Advances in neonatology led to survival of micro-preemies, who need central lines. Central line–associated bloodstream infection (CLABSI) causes prolonged hospitalization, morbidities, and mortality. Health care team education decreases CLABSIs. The objective was to decrease CLABSIs using evidence-based measures. The retrospective review compared CLABSI incidence during and after changes in catheter care. In April 2011, intravenous (IV) tubing changed from Interlink to Clearlink; IV tubing changing interval increased from 24 to 72 hours. CLABSIs increased. The following measures were implemented: July 2011, reeducation of neonatal intensive care staff on Clearlink; August 2011, IV tubing changing interval returned to 24 hours; September 2011, changed from Clearlink back to Interlink; November 2011, review of entire IV process and in-service on hand hygiene; December 2011, competencies on IV access for all nurses. CLABSIs were compared during and after interventions. Means were compared using the t test and ratios using the χ2 test; P <.05. CLABSIs decreased from 4.4/1000 to 0/1000 catheter-days; P < .05. Evidence-based interventions reduced CLABSIs.

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Obtaining Blood Cultures by Venipuncture versus from Central Lines Impact on Blood Culture Contamination Rates and Potential Effect on Central Line–Associated Bloodstream Infection Reporting

Infection Control and Hospital Epidemiology ◽

10.1086/673142 ◽

2013 ◽

Vol 34 (10) ◽

pp. 1042-1047 ◽

Cited By ~ 26

Author(s):

John M. Boyce ◽

Jacqueline Nadeau ◽

Diane Dumigan ◽

Debra Miller ◽

Cindy Dubowsky ◽

...

Keyword(s):

Blood Culture ◽

Bloodstream Infection ◽

Hospital Costs ◽

Cost Savings ◽

Central Line ◽

Potential Effect ◽

Blood Cultures ◽

Blood Samples ◽

Central Lines ◽

Contaminated Blood

Objective.Reduce the frequency of contaminated blood cultures that meet National Healthcare Safety Network definitions for a central line-associated bloodstream infection (CLABSI).Design.An observational study.Setting.A 500-bed university-affiliated hospital.Methods.A new blood culture policy discouraged drawing blood samples from central lines. Phlebotomists were reeducated regarding aseptic technique when obtaining blood samples by venipuncture. The intravenous therapy team was taught how to draw blood samples by venipuncture and served as a backup when phlebotomists were unable to obtain blood samples. A 2-nurse protocol and a special supply kit for obtaining blood samples from catheters were developed. Rates of blood culture contamination were monitored by the microbiology laboratory.Results.The proportion of blood samples obtained for culture from central lines decreased from 10.9% during January–June 2010 to 0.4% during July–December 2012 (P< .001). The proportion of blood cultures that were contaminated decreased from 84 (1.6%) of 5,274 during January–June 2010 to 21 (0.5%) of 4,245 during January–June 2012 (P< .001). Based on estimated excess hospital costs of $3,000 per contaminated blood culture, the reduction in blood culture contaminants yielded an estimated annualized savings of $378,000 in 2012 when compared to 2010. In mid-2010, 3 (30%) of 10 reported CLABSIs were suspected to represent blood culture contamination compared with none of 6 CLABSIs reported from mid-November 2010 through June 2012 (P= 0.25).Conclusions.Multiple interventions resulted in a reduction in blood culture contamination rates and substantial cost savings to the hospital, and they may have reduced the number of reportable CLABSIs.

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The Utility of Infectious and Neurodiagnostic Testing in Children With Complex Febrile Seizures Requiring Mechanical Ventilation

Journal of Child Neurology ◽

10.1177/08830738211000507 ◽

2021 ◽

pp. 088307382110005

Author(s):

Jennifer H. Yang ◽

Richard Villegas ◽

Sandeep Khanna ◽

Julie Kaswick ◽

Nicole G. Coufal ◽

...

Keyword(s):

Mechanical Ventilation ◽

Cohort Analysis ◽

Severity Of Illness ◽

Febrile Seizures ◽

Tertiary Hospital ◽

Surgical Interventions ◽

Retrospective Cohort Analysis ◽

Life Threatening

A retrospective cohort analysis was performed on 79 consecutive patients between 6 months and 5 years admitted to a tertiary hospital with a diagnosis of complex febrile seizures requiring mechanical ventilation from 2011 to 2017 to determine the utility of infectious and neurologic diagnostics. Intubation was used as a proxy for severity of illness. The overall intensive care unit stay was short (95% intubated <24 hours, 88% admitted <3 days). No life-threatening infections were identified, and none required surgical interventions. Electroencephalogram (EEG) was obtained on 43%, 26% of which were abnormal. Sixty-six percent of patients were discharged on rescue benzodiazepine and 20% with maintenance antiseizure medications. Duration of follow-up averaged 4 years (range 1 month to 9 years); 8 patients (10%) were subsequently diagnosed with epilepsy. Our findings suggest that extensive diagnostic evaluations may not be necessary for children with complex febrile seizures requiring mechanical ventilation although the role of EEG is less understood.

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