Attributable Mortality for Pediatric and Neonatal Central Line-Associated Bloodstream Infections in Greece

2021 ◽  
Author(s):  
Sofia Karagiannidou ◽  
Georgia Kourlaba ◽  
Theoklis Zaoutis ◽  
Nikolaos Maniadakis ◽  
Vassiliki Papaevangelou
Keyword(s):  
Infection Prevention ◽  
Statistical Significance ◽  
Pediatric Intensive Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Attributable Mortality ◽  
Time To Death ◽  
Study Enrollment ◽  
Pediatric Hospitals ◽  
Hospital Acquired

AbstractCentral line-associated bloodstream infections (CLABSIs) are the most frequent pediatric hospital-acquired infections and significantly impact outcomes. The aim of this study was to estimate the attributable mortality for CLABSIs in pediatric and neonatal patients in Greece. A retrospective matched-cohort study was performed, in two tertiary pediatric hospitals. Inpatients with a central line in neonatal and pediatric intensive care units (NICUs and PICUs), hematology/oncology units, and a bone marrow transplantation unit between June 2012 and June 2015 were eligible. Patients with confirmed CLABSI were enrolled on the day of the event and were matched (1:1) to non-CLABSI patients by hospital, hospitalization unit, and length of stay prior to study enrollment (188 children enrolled, 94 CLABSIs). Attributable mortality was estimated. During the study period, 22 CLABSIs and nine non-CLABSIs died (23.4 vs. 9.6%, respectively, p = 0.011), leading to an attributable mortality of 13.8% (95% confidence interval [CI] = 3.4–24.3%). Children in PICUs were more likely to die, presenting an attributable mortality of 20.2% (95% CI = − 1.4–41.8%), without reaching, however, statistical significance. After multiple logistic regression, CLABSIs were four times more likely to die (odds ratio [OR] = 4.29, 95% CI = 1.28–14.36, p = 0.018). Survival analysis showed no difference in time to death after study enrollment between CLABSIs and non-CLABSIs (log-rank p = 0.137, overall median survival time = 7.8 months). Greek pediatric mortality rates are increased by the CLABSI occurrence, highlighting the importance of infection prevention strategies.

Modern Trends in Infection Control Practices in Intensive Care Units

2013 ◽  
Vol 29 (6) ◽  
pp. 311-326 ◽  
Author(s):  
Sumanth Gandra ◽  
Richard T. Ellison
Keyword(s):  
Intensive Care ◽  
Infection Control ◽  
Infection Prevention ◽  
Bloodstream Infections ◽  
Central Line ◽  
Environmental Cleaning ◽  
Hospital Acquired Infections ◽  
New Methods ◽  
Tract Infections ◽  
Hospital Acquired

Hospital-acquired infections (HAIs) are common in intensive care unit (ICU) patients and are associated with increased morbidity and mortality. There has been an increasing effort to prevent HAIs, and infection control practices are paramount in avoiding these complications. In the last several years, numerous developments have been seen in the infection prevention strategies in various health care settings. This article reviews the modern trends in infection control practices to prevent HAIs in ICUs with a focus on methods for monitoring hand hygiene, updates in isolation precautions, new methods for environmental cleaning, antimicrobial bathing, prevention of ventilator-associated pneumonia, central line-associated bloodstream infections, catheter-associated urinary tract infections, and Clostridium difficile infection.

scholarly journals Effect of Removing Contact Precautions for Multidrug-Resistant Organisms on Hospital Infections in a Pediatric Health System

2020 ◽  
Vol 41 (S1) ◽  
pp. s199-s200
Author(s):  
Matthew Linam ◽  
Dorian Hoskins ◽  
Preeti Jaggi ◽  
Mark Gonzalez ◽  
Renee Watson ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Antibiotic Stewardship ◽  
Infection Prevention ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Contact Precautions ◽  
Stewardship Program ◽  
Tract Infections ◽  
The Impact

Background: Discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE) have failed to show an increase in associated transmission or infections in adult healthcare settings. Pediatric experience is limited. Objective: We evaluated the impact of discontinuing contact precautions for MRSA, VRE, and extended-spectrum β-lactamase–producing gram-negative bacilli (ESBLs) on device-associated healthcare-associated infections (HAIs). Methods: In October 2018, contact precautions were discontinued for children with MRSA, VRE, and ESBLs in a large, tertiary-care pediatric healthcare system comprising 2 hospitals and 620 beds. Coincident interventions that potentially reduced HAIs included blood culture diagnostic stewardship (June 2018), a hand hygiene education initiative (July 2018), a handshake antibiotic stewardship program (December 2018) and multidisciplinary infection prevention rounding in the intensive care units (November 2018). Compliance with hand hygiene and HAI prevention bundles were monitored. Device-associated HAIs were identified using standard definitions. Annotated run charts were used to track the impact of interventions on changes in device-associated HAIs over time. Results: Average hand hygiene compliance was 91%. Compliance with HAI prevention bundles was 81% for ventilator-associated pneumonias, 90% for catheter-associated urinary tract infections, and 97% for central-line–associated bloodstream infections. Overall, device-associated HAIs decreased from 6.04 per 10,000 patient days to 3.25 per 10,000 patient days after October 2018 (Fig. 1). Prior to October 2018, MRSA, VRE and ESBLs accounted for 10% of device-associated HAIs. This rate decreased to 5% after October 2018. The decrease in HAIs was likely related to interventions such as infection prevention rounds and handshake stewardship. Conclusions: Discontinuation of contact precautions for children with MRSA, VRE, and ESBLs were not associated with increased device-associated HAIs, and such discontinuation is likely safe in the setting of robust infection prevention and antibiotic stewardship programs.Funding: NoneDisclosures: None

The Past, Present, and Future of Healthcare-Associated Infection Prevention in Pediatrics: Catheter-Associated Bloodstream Infections

2010 ◽  
Vol 31 (S1) ◽  
pp. S27-S31 ◽  
Author(s):  
Kristina A. Bryant ◽  
Danielle M. Zerr ◽  
W. Charles Huskins ◽  
Aaron M. Milstone
Keyword(s):  
Infection Prevention ◽  
Bloodstream Infections ◽  
Central Line ◽  
Morbidity And Mortality ◽  
Prevention Strategies ◽  
Healthcare Associated Infection ◽  
Research Topics ◽  
The Past ◽  
Healthcare Associated ◽  
Current Practices

Central line–associated bloodstream infections cause morbidity and mortality in children. We explore the evidence for prevention of central line–associated bloodstream infections in children, assess current practices, and propose research topics to improve prevention strategies.

Distribution of Pathogens in Central Line–Associated Bloodstream Infections among Patients with and without Neutropenia following Chemotherapy Evidence for a Proposed Modification to the Current Surveillance Definition

2013 ◽  
Vol 34 (2) ◽  
pp. 171-175 ◽  
Author(s):  
James P. Steinberg ◽  
Chad Robichaux ◽  
Sheri Chernetsky Tejedor ◽  
Mary Dent Reyes ◽  
Jesse T. Jacob
Keyword(s):  
Bloodstream Infections ◽  
Central Line ◽  
University Hospitals ◽  
Central Venous ◽  
E Coli ◽  
National Healthcare Safety Network ◽  
Proposed Modification ◽  
Definition Of ◽  
Hospital Acquired ◽  
Study Hospital

Objective.Many bloodstream infections (BSIs) occurring in patients with febrile neutropenia following cytotoxic chemotherapy are due to translocation of intestinal microbiota. However, these infections meet the National Healthcare Safety Network (NHSN) definition of central line-associated BSIs (CLABSIs). We sought to determine the differences in the microbiology of NHSN-defined CLABSIs in patients with and without neutropenia and, using these data, to propose a modification of the CLABSI definition.Design.Retrospective review.Setting.Two large university hospitals over 18 months.Methods.All hospital-acquired BSIs occurring in patients with central venous catheters in place were classified using the NHSN CLABSI definition. Patients with postchemotherapy neutropenia (500 neutrophils/mm3or lower) at the time of blood culture were considered neutropenic. Pathogens overrepresented in the neutropenic group were identified to inform development of a modified CLABSI definition.Results.Organisms that were more commonly observed in the neutropenic group compared with the nonneutropenic group includedEscherichia coli(22.7% vs 2.5%;P< .001) but not other Enterobacteriaceae,Enterococcus faecium(18.2% vs 6.1%;P= .002), and streptococci (18.2% vs 0%;P< .001). Application of a modified CLABSI definition (removing BSI with enterococci, streptococci, orE. coli) excluded 33 of 66 neutropenic CLABSIs and decreased the CLABSI rate in one study hospital with large transplant and oncology populations from 2.12 to 1.79 cases per 1,000 line-days.Conclusions.Common gastrointestinal organisms were more common in the neutropenia group, suggesting that many BSIs meeting the NHSN criteria for CLABSI in the setting of neutropenia may represent translocation of gut organisms. These findings support modification of the NHSN CLABSI definition.

scholarly journals Impact of a Central Line Infection Prevention Bundle in Newborn Infants

2016 ◽  
Vol 37 (9) ◽  
pp. 1029-1036 ◽  
Author(s):  
Rowena McMullan ◽  
Adrienne Gordon
Keyword(s):  
Neonatal Intensive Care ◽  
Dwell Time ◽  
Clinical Characteristics ◽  
Infection Prevention ◽  
Newborn Infants ◽  
Bloodstream Infections ◽  
Central Line ◽  
Before And After ◽  
Central Line Infection ◽  
Line Infection

OBJECTIVETo compare central line use and central line–associated bloodstream infection in newborn infants before and after the introduction of a central line infection prevention bundle in order to determine the effectiveness of the bundle and to identify areas for further improvement.DESIGNRetrospective cohort analysis of prospectively collected data.SETTINGLevel 5 neonatal intensive care unit in Sydney, Australia.PATIENTSNewborn infants admitted to the Royal Prince Alfred Hospital Neonatal Intensive Care Unit who had a central venous catheter (CVC) inserted.METHODSData regarding clinical characteristics, CVC use, and infection were collected before and after the introduction of a bundle of interventions. The bundles encompassed (1) insertion of CVC, (2) maintenance of CVC, (3) an education program, and (4) ongoing surveillance and feedback.RESULTSBaseline and intervention groups were comparable in clinical characteristics. The number of CVCs inserted was reduced in the intervention group (central line utilization rate, 0.16 vs 0.2, P<.0001). Overall CVC dwell time was reduced, resulting from significant reduction in peripherally inserted CVC dwell time (6 days [95% CI, 5.0–11.8 days] vs 7.3 days [4.0–10.4 days], P=.0004). Central line–associated bloodstream infections were significantly reduced, predominantly secondary to decreased peripherally inserted CVC–related bloodstream infections (1.2/1,000 central line–days vs 11.5/1,000 central line–days, P<.0001).CONCLUSIONThis central line infection bundle was effective in reducing CVC use, dwell time, and central line–associated bloodstream infections.Infect Control Hosp Epidemiol 2016;37:1029–1036

Impact of Hospital Operating Margin on Central Line–Associated Bloodstream Infections Following Medicare’s Hospital-Acquired Conditions Payment Policy

2015 ◽  
Vol 37 (1) ◽  
pp. 100-103 ◽  
Author(s):  
Michael S. Calderwood ◽  
Louise E. Vaz ◽  
Alison Tse Kawai ◽  
Robert Jin ◽  
Melisa D. Rett ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Central Line ◽  
Differential Impact ◽  
Payment Policy ◽  
Operating Margin ◽  
Hospital Acquired Conditions ◽  
Operating Margins ◽  
Additional Payment ◽  
Hospital Acquired ◽  
Present On Admission

AbstractIn October 2008, Medicare ceased additional payment for hospital-acquired conditions not present on admission. We evaluated the policy’s differential impact in hospitals with high vs low operating margins. Medicare’s payment policy may have had an impact on reducing central line–associated bloodstream infections in hospitals with low operating margins.Infect. Control Hosp. Epidemiol. 2015;37(1):100–103

The Influence of an Antimicrobial Peripherally Inserted Central Catheter on Central Line-Associated Bloodstream Infections in a Hospital Environment

2014 ◽  
Vol 19 (3) ◽  
pp. 172-179 ◽  
Author(s):  
Glenell S. Rutkoff
Keyword(s):  
Infection Rate ◽  
Infection Prevention ◽  
Intervention Group ◽  
Cost Savings ◽  
Bloodstream Infections ◽  
Central Line ◽  
Hospital Environment ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Specific Patient

Abstract Background: Federal agencies such as the Centers for Disease Control and Prevention have mandated reduction of hospital-acquired infections and recommended the use of antimicrobial catheters in clinical settings where central line-associated bloodstream infection (CLABSI) rates have remained high. The Infusion Nurses Society also recommends antimicrobial catheters for specific patient populations. At a California hospital, evidence-based infection prevention strategies for CLABSI prevention had been in effect for several years, but the CLABSI rate remained at an unacceptable level. For this reason, the effect of an antimicrobial peripherally inserted central catheter (PICC) on the incidence of CLABSI was studied. Methods: A quasiexperimental design was used with concurrent data collection on patients in an intervention group who received an antimicrobial PICC. Retrospective data were collected for patients in a nonintervention group who received nonantimicrobial PICCs the previous year. Results: The 257 patients in the nonintervention group experienced 8 CLABSIs with an infection rate of 4.18/1,000 line days. The 260 subjects in the intervention group experienced 1 CLABSI with an infection rate of 0.47/1,000 line days. The decrease in the number of infections per 1,000 line days for the intervention group was statistically significant. Conclusions: The use of an antimicrobial PICC in conjunction with current infection prevention practices resulted in a statistically significant decrease in infection rate, which supports the recommendation for continued use of antimicrobial catheters. Treatment cost savings, which overcame the higher initial cost for the devices, were found to be an additional benefit of using antimicrobial catheters.

scholarly journals Sustained Reduction and Prevention of Neonatal and Pediatric Central Line-Associated Bloodstream Infection Following a Nurse-Driven Quality Improvement Initiative in a Pediatric Facility

2018 ◽  
Vol 23 (1) ◽  
pp. 30-41 ◽  
Author(s):  
Tracie Savage ◽  
Darci E. Hodge ◽  
Kary Pickard ◽  
Pam Myers ◽  
Kristen Powell ◽  
...  
Keyword(s):  
Infection Control ◽  
Pediatric Intensive Care ◽  
Bloodstream Infections ◽  
Interrupted Time Series ◽  
Central Line ◽  
Quality Improvement Initiative ◽  
Hospital Units ◽  
Patient Morbidity ◽  
Sustained Reduction ◽  
Design And Methods

Abstract Purpose: Hospitals devote significant resources developing protocols to minimize the incidence of central line-associated bloodstream infections (CLABSIs), a source of increased patient morbidity and health care costs; however, few of these protocols, especially centralized protocols, are reported in the literature. This study characterizes the development and effectiveness of a pediatric hospital's centralized CLABSI prevention bundle. Design and Methods: The study was designed as a retrospective interrupted time series to quantify the effectiveness of the prevention bundle that was developed and implemented by nursing leadership in infection control, and both the neonatal and pediatric intensive care units between 2006 and 2014. The study period was subdivided into pre-, peri-, post-, and second peri-intervention periods based on the implementation status of the bundle. Segmented linear regression was used to model and compare the CLABSI rates for each intervention period overall as well as the 5 individual hospital units. Results: The hospital's modeled CLABSI rate during the preintervention period was 3.80 out of 1000 line days and was significantly reduced to 0.45 (P &lt; 0.001). Clear decreases in unit CLABSI rates were observed and all units were below corresponding National Healthcare Safety Network CLABSI rates after the study. Conclusions: The centralized CLABSI prevention bundle reduced and sustained low CLABSI rates overall and within each hospital unit demonstrating the success of the bundle. Practice Implications: A centralized CLABSI prevention bundle can universalize central line care, simplify infection control, and improve quality of care to help sustain low CLABSI rates throughout the hospital.

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