The Role of Understaffing in Central Venous Catheter-Associated Bloodstream Infection

1996 ◽  
Vol 17 (3) ◽  
pp. 150-158
Author(s):  
Scott K. Fridkin ◽  
Suzanne M. Pear ◽  
Theresa H. Williamson ◽  
John N. Galgiani ◽  
William R. Jarvis
Keyword(s):  
Central Venous Catheter ◽  
Medical Center ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Case Control ◽  
Assisted Ventilation ◽  
Surgical Intensive Care Unit ◽  
Central Venous ◽  
Surgical Intensive Care ◽  
Outbreak Period

AbstractObjective:To determine risk factors for central venous catheter-associated bloodstream infections (CVC-BSI) during a protracted outbreak.Design:Case-control and cohort studies of surgical intensive care unit (SICU) patients.Setting:A university-affiliated Veterans Affairs medical center.Patients:Case-control study: all patients who developed a CVC-BSI during the outbreak period (January 1992 through September 1993) and randomly selected controls. Cohort study: all SICU patients during the study period (January 1991 through September 1993).Measurements:CVC-BSI or site infection rates, SICU patient clinical data, and average monthly SICU patient-to-nurse ratio.Results:When analyzed by hospital location and site, only CVC-BSI in the SICU had increased significantly in the outbreak period compared to the previous year (January 1991 through December 1991: pre-outbreak period). In SICU patients, CVC-BSI were associated with receipt of total parenteral nutrition [TPN]; odds ratio, 16; 95% confidence inter val, 4 to 73). When we controlled for TPN use, CVC-BSI were associated with increasing severity of illness and days on assisted ventilation. SICU patients in the out-break period had shorter SICU and hospital stays, were younger, and had similar mortality rates, but received more TPN compared with patients in the pre-outbreak period. Furthermore, the patient-to-nurse ratio significantly increased in the outbreak compared with the pre-outbreak period. When we controlled for TPN use, assisted ventilation, and the period of hospitalization, the patient-to-nurse ratio was an independent risk factor for CVC-BSI in SICU patients.Conclusions:Nursing staff reductions below a critical level, during a period of increased TPN use, may have contributed to the increase in CVC-BSI in the SICU by making adequate catheter care difficult. During healthcare reforms and hospital downsizing, the effect of staffing reductions on patient outcome (ie, nosocomial infection) needs to be critically assessed.

Preventing Central Venous Catheter-Related Infection in a Surgical Intensive-Care Unit

1999 ◽  
Vol 20 (9) ◽  
pp. 618-620 ◽  
Author(s):  
Rens Bijma ◽  
Armand R. Girbes ◽  
Dick J. Kleijer ◽  
Jan H. Zwaveling
Keyword(s):  
Central Venous Catheter ◽  
Cumulative Effect ◽  
Venous Catheter ◽  
Surgical Intensive Care Unit ◽  
Hand Disinfection ◽  
Catheter Colonization ◽  
Central Venous ◽  
Surgical Intensive Care ◽  
Infection Control Practitioner ◽  
New Type

AbstractThe cumulative effect of five measures (introduction of hand disinfection with alcohol, a new type of dressing, a one-bag system for parenteral nutrition, a new intravenous connection device, and surveillance by an infection control practitioner) on central venous catheter colonization and bacteremia was studied. Colonization was significantly reduced (P<.025); the decrease in bacteremia was not statistically significant.

scholarly journals Bedside ultrasound as a screening test for the diagnosis of catheter-related bloodstream infection (CRBI)

2021 ◽  
Author(s):  
Chiara de Sio ◽  
Mario Venafro ◽  
Giampiero Foccillo ◽  
Riccardo Nevola ◽  
Lucio Monaco
Keyword(s):  
Central Venous Catheter ◽  
Bloodstream Infections ◽  
Signs And Symptoms ◽  
Venous Catheter ◽  
Central Catheter ◽  
Central Venous ◽  
Roc Curve Analysis ◽  
Suspected Infection ◽  
Intravascular Devices ◽  
A Prospective Study

Abstract Purpose Between 15 and 30% of all nosocomial bacteremias and sepsis are associated with the use of intravascular devices. Catheter-related bloodstream infections (CRBI) are infections in which the organism identified in the blood is also present on the tip of the catheter itself or in a blood sample taken through it. The aim of the study was to evaluate the role of ultrasound in the diagnosis of infections related to the use of central catheters. Methods Between January 2018 and June 2019, we carried out a prospective study on 36 patients with a central catheter, such as a central venous catheter (CVC), a central catheter with peripheral insertion (PICC), or a fully implanted central venous catheter (PORT-a-cath) and who had signs and symptoms of infection. These patients were submitted to an ultrasound of the catheter upon arrival in the ward in case of suspected infection, or at the time of the onset of signs and symptoms of infection (if these arose during hospitalization). Patients with a central catheter but without signs and symptoms of infection were not included in the study. The end point of the study was to evaluate sensitivity (SENS), specificity (SPEC), positive and negative predictive value (PPV-NPV) and overall diagnostic accuracy (ODA) of ultrasound in the diagnosis of CRBI through Receiver Operating Characteristic (ROC) curve analysis. Results US showed a SENS of 94%, a SPEC of 84%, a PPV of 84%, an NPV of 94% and an ODA of 88.8% for the diagnosis of CRBI. Conclusions Preliminary data from our study show that US of intravascular devices has a high SENS and SPEC in the diagnosis of CRBI, and can, therefore, be used as a valid tool to decide whether to remove the device early or leave it in place.

Microbiological screening for earlier detection of central venous catheter-related bloodstream infections

2013 ◽  
Vol 43 (9) ◽  
pp. 964-969 ◽  
Author(s):  
Jasmin Wagner ◽  
Gernot Schilcher ◽  
Ines Zollner-Schwetz ◽  
Martin Hoenigl ◽  
Thomas Valentin ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Venous
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