Prospective Surveillance for Primary Bloodstream Infections Occurring in Canadian Hemodialysis Units

Objective:Bloodstream infections are a major cause of morbidity and mortality in patients receiving long-term hemodialysis. We wanted to determine the incidence of hemodialysis-related bloodstream infections in Canadian centers participating in the Canadian Nosocomial Infection Surveillance Program.Methods:Prospective surveillance for hemodialysis-related bloodstream infections was performed in 11 centers during a 6-month period. Bloodstream infections were defined by published criteria. Hemodialysis denominators included the number of dialysis procedures, the number of patient-days on dialysis, and the frequencies of different types of vascular access.Results:There were 184 bloodstream infections in 133,158 dialysis procedures (1.4 per 1,000) and 316,953 patient-days (0.6 per 1,000). Hemodialysis access through arteriovenous (AV) fistulae was associated with the lowest risk for bloodstream infection (0.2 per 1,000 dialysis procedures). The relative risk for infection was 2.5 with AV graft access, 15.5 with cuffed and tunneled central venous catheter (CVC) access, and 22.5 with uncuffed CVC access (P < .001). There was marked variation among the 11 centers in the means of vascular access used for hemodialysis. Significant variation in infection rates was observed among the centers when controlling for types of access.Conclusions:There was a hierarchy of risk of hemodialysis-related bloodstream infection according to type of vascular access. There was significant variation in the type of vascular access being used among the Canadian hemodialysis centers, and also variation in access-specific infection rates between centers.

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Targeting COVID-19 prevention in hemodialysis facilities is associated with a drastic reduction in central venous catheter-related infections

Journal of Nephrology ◽

10.1007/s40620-020-00900-3 ◽

2020 ◽

Author(s):

Marco Heidempergher ◽

Gianmarco Sabiu ◽

Maria Antonietta Orani ◽

Giovanni Tripepi ◽

Maurizio Gallieni

Keyword(s):

Central Venous Catheter ◽

Bloodstream Infection ◽

Bloodstream Infections ◽

Venous Catheter ◽

Chronic Hemodialysis ◽

Infection Rates ◽

Exit Site ◽

Central Venous ◽

Exit Site Infection ◽

Catheter Related Bloodstream Infection

Abstract Background In hemodialysis (HD) patients, central venous catheter (CVC) related bloodstream infections are a major cause of morbidity and mortality. Hygienic precautions are a key aspect of dialysis care for infection prevention, but they are not sufficient to completely avoid the occurrence of CVC related infections. During the COVID-19 pandemic, hygienic precautions for preventing viral transmission have been markedly reinforced. We evaluated their effects on CVC-related infection rates. Methods An observational retrospective study was conducted in two hemodialysis units of the same institution treating 215 chronic hemodialysis patients, 71 of whom are currently (33%) using a CVC. In the CVC cohort, we compared data on catheter-related infection rates during the maximum spread of the COVID-19 pandemic in Italy (February to May 2020) with data from the same period of the previous year and with the whole of 2019. Results In 2019, we recorded a catheter-related bloodstream infection (CRBSI) rate of 1.19 (95% CI 0.81–1.68)/1000 days [2.07 (95% CI 1.12–3.52)/1000 days in the Feb-May 2019 period] and a tunnel and exit-site infection rate of 0.82 (95% CI 0.51–1.24)/1000 days [1.04 (95% CI 0.41–2.15)/1000 days in the Feb–May 2019 period]. Infection rates drastically decreased during the COVID-19 pandemic, with just one catheter-related bloodstream infection being recorded. Catheter-related bloodstream infection rates showed a significant reduction to 0.20 (95% CI 0.01–0.9)/1000 days (p < 0.05 and p < 0.005 compared to 2019 and to Feb-May 2019, respectively) and a non-significant reduction in tunnel and exit-site infections to 0.6 (95% CI 0.15–1.6)/1000 days. Conclusions The observed 91% reduction in catheter-related bloodstream infections compared to the same period in 2019 [IRR 0.09 (95% CI 0.002–0.64)] and the 83% reduction compared to the whole of 2019 [IRR 0.17 (95% CI 0.004–1.009)] suggest that a stricter implementation of hygienic precautions in the dialysis setting can markedly improve the problem of CVC-related infections. Graphic abstract

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Emergence of Coagulase Negative Staphylococci as Major Nosocomial Bloodstream Pathogens

Infection Control ◽

10.1017/s0195941700067278 ◽

1987 ◽

Vol 8 (3) ◽

pp. 108-112 ◽

Cited By ~ 34

Author(s):

Richard I. Stillman ◽

Richard P. Wenzel ◽

Leigh C. Donowitz

Keyword(s):

Critical Care ◽

Bloodstream Infection ◽

Bloodstream Infections ◽

University Of Virginia ◽

Infection Rates ◽

Prospective Surveillance ◽

Coagulase Negative Staphylococci ◽

Gram Positive ◽

Critical Care Units ◽

The University

AbstractOver an eight year period, 1975 to 1982, 1,843 nosocomial bloodstream infections were identified by routine prospective surveillance at the University of Virginia Hospital (106/10,000 admissions). Despite a decline in overall bloodstream infection rates during the study period (P =.085), bloodstream infections due to gram positive organisms increased from 29 (1975-1978) to 43/10,000 (1979-1982), (P<0.001). Notably, rates for coagulase negative staphylococci increased from 5.2 (1975-1978) to 12.4/10,000 (1979-1982), (P<0.001). In 1982, coagulase negative staphylococci accounted for 17% of all bloodstream infections and were the most frequently isolated pathogens. Sixty-four percent of patients with coagulase negative staphylococci were in critical care units versus 41% with other bloodstream infections (P<.05). The recognition of coagulase negative staphylococci as significant bloodstream pathogens markedly alters the clinician's approach to nosocomial septicemia.

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Care of Peripheral Venous Catheter Sites: Advantages of Transparent Film Dressings Over Tape and Gauze

Journal of the Association for Vascular Access ◽

10.1016/j.java.2014.09.001 ◽

2014 ◽

Vol 19 (4) ◽

pp. 256-261 ◽

Cited By ~ 19

Author(s):

Stéphanie F. Bernatchez

Keyword(s):

Bloodstream Infections ◽

Venous Catheter ◽

The United States ◽

Central Venous ◽

Term Care ◽

Peripheral Venous Catheter ◽

Care Facilities ◽

Review Current ◽

Peripheral Venous Line

AbstractPeripheral intravenous (PIV) catheters are the most commonly used catheters in hospitals, with up to 70% of patients requiring a peripheral venous line during their hospital stay. This represents 200 million PIV catheters used per year in acute-care hospitals in the United States alone. These medical devices are also used in other health care settings, such as long-term care facilities and nursing homes, and common indications include the administration of medications, nutrients, and fluids. These catheters require proper maintenance and care to avoid complications such as phlebitis, infiltration, occlusion, local infection, and bloodstream infection. Recently it has been suggested that PIV catheter use may lead to a higher rate of complications than previously thought. This is important because some studies have claimed that the rate of bloodstream infections due to PIV catheters is actually comparable to the rates observed with central venous catheters, rather than much lower as previously thought. Moreover, catheter-related infections are now seen as largely preventable. Our goal was to review the current literature and provide an overview of the various approaches used to manage PIV catheter sites as well as review current recommendations.

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Diagnosis and management of catheter-related bloodstream infections in patients on home parenteral nutrition

Frontline Gastroenterology ◽

10.1136/flgastro-2018-101094 ◽

2019 ◽

Vol 11 (1) ◽

pp. 48-54 ◽

Cited By ~ 3

Author(s):

Ashley Bond ◽

Paul Chadwick ◽

Trevor R Smith ◽

Jeremy M D Nightingale ◽

Simon Lal

Keyword(s):

Parenteral Nutrition ◽

Bloodstream Infections ◽

Venous Catheter ◽

Nutrition Support ◽

Central Venous ◽

Short Term ◽

Qualitative And Quantitative ◽

Central Venous Catheter Removal ◽

Support Team

Catheter-related bloodstream infections (CRBSIs) commonly arise from a parenteral nutrition catheter hub. A target for a Nutrition Support Team is to have a CRBSI rate of less than 1 per 1000. The diagnosis of CRBSI is suspected clinically by a temperature shortly after setting up a feed, general malaise or raised blood inflammatory markers. It is confirmed by qualitative and quantitative blood cultures from the catheter and peripherally. Treatment of inpatients may involve central venous catheter removal and antibiotics for patients needing short-term parenteral nutrition, but catheter salvage is generally recommended for patients needing long-term parenteral nutrition, where appropriate.

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Predicting Methicillin-Resistant Staphylococcus aureus (MRSA) Bloodstream Infection Incidence Rates using Canadian Nosocomial Infection Surveillance Program (CNISP)

University of Toronto Journal of Public Health ◽

10.33137/utjph.v2i2.36999 ◽

2021 ◽

Vol 2 (2) ◽

Author(s):

Jona Gjevori ◽

Kahina Abdesselam

Keyword(s):

Public Health ◽

Staphylococcus Aureus ◽

Nosocomial Infection ◽

Bloodstream Infection ◽

Methicillin Resistant Staphylococcus Aureus ◽

Incidence Rates ◽

Surveillance Program ◽

Methicillin Resistant ◽

Infection Surveillance ◽

Healthcare Associated

Methicillin-Resistant Staphylococcus aureus (MRSA) is among the most prevalent nosocomial pathogens globally, causing significant morbidity, mortality, and healthcare costs. MRSA bloodstream infection (BSI) incidence rates in Canadian hospitals have significantly risen by almost 60% and have a mortality of over 20% upon Intensive Care Unit admission. MRSA is believed to be spread through healthcare workers; thus, high hand hygiene compliancy in addition to environmental cleaning are the cornerstone countermeasures to disrupting its transmission. The Public Health Agency of Canada (PHAC), in collaboration with the Canadian Nosocomial Infection Surveillance Program (CNISP), conducts national, sentinel surveillance on healthcare-associated infections like MRSA. As a Student Epidemiologist, I developed a research proposal detailing two study objectives: 1) develop a regression model to predict all incident MRSA BSI rates among acute-care hospitals in Canada using CNISP MRSA BSI incident cases from 2000 to 2019, and 2) create a compartmental (Susceptible-Infected-Recovered-Deceased) model to determine the impact of various Infection Prevention and Control (IPC) measures on the risk of healthcare-associated MRSA BSI transmission specifically. This study hopes to demonstrate that proper IPC compliance is associated with lower incident MRSA BSI rates with the goal being to produce a manuscript draft by 2021. MRSA poses a serious threat to patient safety globally and is becoming a growing national public health concern in Canada; determining which IPC strategy is most effective at disrupting MRSA transmission is essential to reducing incidence and mortality rates.

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Bundle Approach to Reduce Bloodstream Infections in Neutropenic Hematologic

Acta Médica Portuguesa ◽

10.20344/amp.6002 ◽

2015 ◽

Vol 28 (4) ◽

pp. 474

Author(s):

Jose Manuel Martinez ◽

Luís Leite ◽

Daniela França ◽

Rita Capela ◽

Luísa Viterbo ◽

...

Keyword(s):

Relative Risk ◽

Central Venous Catheter ◽

Bloodstream Infections ◽

Mechanical Valve ◽

Venous Catheter ◽

Positive Pressure ◽

Control Group ◽

Study Group ◽

Central Venous

Introduction: The objective of the study was to reduce, by a bundle of interventions, the global bloodstream infections and catheterrelated bloodstream infections rates in neutropenic hematology patients with a long-term central venous catheter. Material and Methods: This was a non-randomized prospective study. It was conducted in a 20-bed hematology oncology unit (Portuguese Institute of Oncology, Porto, Portugal) between 1st of August 2010 and 31st of January 2012. In this period we introduced a bundle of interventions (study group) and compared the results with the six months prior to implementation (control group). The interventions consisted in the use of a neutral pressure mechanical valve connector instead of a positive pressure mechanical valve connector, a more frequent change of this connector and a more efficient clean solution. One hundred and sixteen hematology patients with a long-term central venous catheter at time superior of 72 h, with 8 867 central venous catheter days [6 756 central venous catheter days in the study group and 2 111 central venous catheter days in the control group] were included in the study. Results: A significant reduction in bloodstream infections rates and catheter-related bloodstream infections rates was achieved. Bloodstream infections rates: [32.69 (control group) vs. 9.43 (study group)], incidence reduction 71% [relative risk 0.2886, CI 95% (0.1793 – 0.4647), p < 0.001] and catheter-related bloodstream infections rates: [17.53 (control group) vs. 4.73 (study group)], incidence reduction 71% [relative risk 0.2936, CI 95% (0.1793 – 0.5615), p < 0.014]. No significant difference (p > 0.05) was found in the neutrophil count at the time of blood culture samples between groups: 69% (< 500 neutrophils/mm3) [71% (study group) vs. 68% (control group)]. Conclusions: The introduction of this bundle of interventions based on the variables of patient, product and practice, supported by the Healthcare and Technology Synergy framework, quickly resulted in a significant reduction of bloodstream infections and catheterrelated bloodstream infections rates.

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Use of an Estimation Method to Derive an Appropriate Denominator to Calculate Central Venous Catheter-Associated Bloodstream Infection Rates

Infection Control and Hospital Epidemiology ◽

10.1086/647703 ◽

1998 ◽

Vol 19 (1) ◽

pp. 28-31 ◽

Cited By ~ 2

Author(s):

Susan Temporado Cookson ◽

Melanie Ihrig ◽

Edward M. O'Mara ◽

Alan I. Hartstein ◽

William R. Jarvis

Keyword(s):

Central Venous Catheter ◽

Bloodstream Infection ◽

Estimation Method ◽

Venous Catheter ◽

Infection Rates ◽

Central Venous

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Impact of Catheter Management on Clinical Outcome in Adult Cancer Patients With Gram-Negative Bacteremia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz357 ◽

2019 ◽

Vol 6 (10) ◽

Cited By ~ 3

Author(s):

Johny Fares ◽

Melissa Khalil ◽

Anne-Marie Chaftari ◽

Ray Hachem ◽

Ying Jiang ◽

...

Keyword(s):

Central Venous Catheter ◽

Cancer Patients ◽

Bloodstream Infection ◽

Bloodstream Infections ◽

Venous Catheter ◽

Mucosal Barrier ◽

Central Venous ◽

Gram Negative ◽

Central Venous Catheter Removal ◽

Mucosal Barrier Injury

Abstract Objective Gram-negative organisms have become a major etiology of bloodstream infections. We evaluated the effect of central venous catheter management on cancer patients with gram-negative bloodstream infections. Method We retrospectively identified patients older than 14 years with central venous catheters who were diagnosed with gram-negative bloodstream infections to determine the effect of catheter management on outcome. Patients were divided into 3 groups: Group 1 included patients with central line-associated bloodstream infections (CLABSI) without mucosal barrier injury and those whose infection met the criteria for catheter-related bloodstream infection; group 2 included patients with CLABSI with mucosal barrier injury who did not meet the criteria for catheter-related bloodstream infection; and group 3 included patients with non-CLABSI. Results The study included 300 patients, with 100 patients in each group. Only in group 1 was central venous catheter removal within 2 days of bloodstream infection significantly associated with a higher rate of microbiologic resolution at 4 days compared to delayed central venous catheter removal (3–5 days) or retention (98% vs 82%, P = .006) and a lower overall mortality rate at 3-month follow-up (3% vs 19%, P = .01). Both associations persisted in multivariate analyses (P = .018 and P = .016, respectively). Conclusions Central venous catheter removal within 2 days of the onset of gram-negative bloodstream infections significantly improved the infectious outcome and overall mortality of adult cancer patients with catheter-related bloodstream infections and CLABSI without mucosal barrier injury.

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Impact of International Nosocomial Infection Control Consortium’s multidimensional approach on central line–associated bloodstream infection rates in Bahrain

The Journal of Vascular Access ◽

10.1177/1129729819888426 ◽

2019 ◽

Vol 21 (4) ◽

pp. 481-489

Author(s):

Safaa Alkhawaja ◽

Nermeen Kamal Saeed ◽

Victor Daniel Rosenthal ◽

Sana Abdul-Aziz ◽

Ameena Alsayegh ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Nosocomial Infection ◽

Infection Control ◽

Bloodstream Infection ◽

Infection Rate ◽

Bloodstream Infections ◽

Central Line ◽

Multidimensional Approach ◽

Infection Rates

Background: Central line–associated bloodstream infections are serious life-threatening infections in the intensive care unit setting. Methods: To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Approach (IMA) and INICC Surveillance Online System (ISOS) on central line–associated bloodstream infection rates in Bahrain from January 2013 to December 2016, we conducted a prospective, before-after surveillance, cohort, observational study in one intensive care unit in Bahrain. During baseline, we performed outcome and process surveillance of central line–associated bloodstream infection on 2320 intensive care unit patients, applying Centers for Disease Control and Prevention’s National Healthcare Safety Network definitions. During intervention, we implemented IMA through ISOS, including (1) a bundle of infection prevention interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback on central line–associated bloodstream infection rates and consequences, and (6) performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using a logistic regression model to estimate the effect of the intervention on the central line–associated bloodstream infection rate. Results: During baseline, 672 central line days and 7 central line–associated bloodstream infections were recorded, accounting for 10.4 central line–associated bloodstream infections per 1000 central line days. During intervention, 13,020 central line days and 48 central line–associated bloodstream infections were recorded. After the second year, there was a sustained 89% cumulative central line–associated bloodstream infection rate reduction to 1.2 central line–associated bloodstream infections per 1000 central line days (incidence density rate, 0.11; 95% confidence interval 0.1–0.3; p, 0.001). The average extra length of stay of patients with central line–associated bloodstream infection was 23.3 days, and due to the reduction of central line–associated bloodstream infections, 367 days of hospitalization were saved, amounting to a reduction in hospitalization costs of US$1,100,553. Conclusion: Implementing IMA was associated with a significant reduction in the central line–associated bloodstream infection rate in Bahrain.

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