Skin Antisepsis Kits Containing Alcohol and Chlorhexidine Gluconate or Tincture of Iodine are Associated With Low Rates of Blood Culture Contamination

2002 ◽  
Vol 23 (7) ◽  
pp. 397-401 ◽  
Author(s):  
Barbara W. Trautner ◽  
Jill E. Clarridge ◽  
Rabih O. Darouiche
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Culture ◽  
Isopropyl Alcohol ◽  
Tertiary Care ◽  
Chlorhexidine Gluconate ◽  
The Other ◽  
Contamination Rate ◽  
Skin Preparation ◽  
Skin Antisepsis

Objective:Skin preparation is an important factor in reducing the rate of blood culture contamination. We assessed blood culture contamination rates associated with the use of skin antisepsis kits containing either 2% alcoholic chlorhexidine gluconate or 2% alcoholic tincture of iodine.Design:Prospective, blinded clinical trial.Setting:Tertiary-care teaching hospital.Patients:Adult patients in medical wards, the medical intensive care unit, and the cardiac intensive care unit who needed paired, percutaneous blood cultures.Interventions:House officers, medical students, and healthcare technicians drew the blood for cultures. We prepared sacks containing all of the necessary supplies, including two different types of antiseptic kits. In each sack, one kit contained 2% chlorhexidine in 70% isopropyl alcohol and the other contained 2% tincture of iodine in ethyl alcohol and 70% isopropyl alcohol. Each patient received chlorhexidine at one site and tincture of iodine at the other.Results:Four (0.9%) of 430 blood culture sets from 215 patients were contaminated. The contamination rate when using alcohol and chlorhexidine (1 of 215, 0.5%) did not differ significantly from the contamination rate when using tincture of iodine (3 of 215,1.4%;P= .62, McNemar test). There was an 87% probability that the two interventions differed by less than 2% in their rate of contamination.Conclusions:Both of these antiseptic kits were highly effective for skin preparation prior to drawing blood for cultures. The use of these kits may have contributed to the low contamination rate observed in this study.

scholarly journals Increased blood culture contamination rate during COVID-19 outbreak in intensive care unit: A brief report from a single-centre

2021 ◽  
pp. 175114372110121
Author(s):  
Emanuele Russo ◽  
Giuliano Bolondi ◽  
Emiliano Gamberini ◽  
Domenico Pietro Santonastaso ◽  
Alessandro Circelli ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Culture ◽  
Contamination Rate ◽  
Single Centre

Prospective Randomized Trial of 3 Antiseptic Solutions for Prevention of Catheter Colonization in an Intensive Care Unit for Adult Patients

2008 ◽  
Vol 29 (9) ◽  
pp. 847-853 ◽  
Author(s):  
J. Vallés ◽  
I. Fernández ◽  
D. Alcaraz ◽  
E. Chacón ◽  
A. Cazorla ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Relative Risk ◽  
Confidence Interval ◽  
Chlorhexidine Gluconate ◽  
Catheter Colonization ◽  
Central Venous ◽  
Gram Positive Bacteria ◽  
Skin Antisepsis ◽  
Antiseptic Solutions

Objective.To compare the effectiveness for prevention of central venous and arterial catheter colonization of 3 skin antisepsis with 1 of 3 antiseptic solutions: 10% aqueous povidone iodine (aqueous PI), 2% aqueous chlorhexidine gluconate (aqueous CG), and 0.5% alcoholic chlorhexidine gluconate (alcoholic CG).Design.Prospective, randomized controlled trial.Setting.Intensive care unit in a teaching hospital.Methods.Patients were randomly assigned to 1 of the 3 skin antisepsis groups. The distal tips of catheters were semiquantitatively cultured when the catheters were no longer necessary or if there was a suspicion of catheter-related infection. Rates of catheter colonization, catheter-related sepsis, and catheter-related bacteremia were compared among the 3 groups.Results.A total of 631 catheters were included in the study (194 from the aqueous PI group, 211 from the aqueous CG group, and 226 from the alcoholic CG group). The incidence of catheter colonization was significantly lower in the alcoholic CG than in the aqueous PI group (14.2% vs 24.7%; relative risk, 0.5 [95% confidence interval, 0.3-0.8; P < .01]); it was also significantly lower in the aqueous CG group than in the aqueous PI group (16.1 % vs 24.7%; relative risk, 0.6 [95% confidence interval, 0.4-0.9; P = .03]). There were no significant differences between the aqueous CG and the alcoholic CG groups. Incidences of catheter-related bacteremia were similar for all 3 groups. The aqueous and alcoholic CG solutions were superior to the aqueous PI solution in preventing catheter colonization due to gram-positive bacteria.Conclusions.The aqueous and alcoholic CG solutions for cutaneous antisepsis were similarly effective in preventing colonization of central venous catheters and arterial catheters. Both had significantly lower incidences of colonization than did the aqueous PI solution; this effect seems to be related to the CG solutions' more efficacious prevention of colonization with gram-positive bacteria.

scholarly journals Microbial Contamination of Three-Way Taps on Arterial Lines

1998 ◽  
Vol 26 (1) ◽  
pp. 51-55 ◽  
Author(s):  
W. M. Widdowson ◽  
L. Walker ◽  
J. H. Havill ◽  
J. W. Sleigh
Keyword(s):  
Blood Pressure ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Culture ◽  
Microbial Contamination ◽  
General Intensive Care Unit ◽  
Contamination Rate ◽  
Coagulase Negative Staphylococcus ◽  
Potential Source ◽  
Measure Blood Pressure

Arterial lines with three-way taps are used to measure blood pressure and aspirate blood, and are a potential source of catheter-related sepsis. Swabs were taken daily from 118 three-way taps on 98 arterial lines in a general intensive care unit. Infusion lines were changed weekly but arterial cannulae were not changed routinely. An overall contamination rate of 24.6% was found with the predominant organism being coagulase negative staphylococcus. The three-way taps became increasingly contaminated with time but this was shown to be unrelated to the manipulation rates. Blood culture organisms in those showing contamination of the three-way taps showed no relationship to the bacteria causing the contamination.

#52: Role of Good Oral Hygiene in Reducing and Preventing Ventilator-associated Pneumonia (VAP) in the Intensive Care Unit (ICU) in a Tertiary Care Hospital

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S20-S20
Author(s):  
Mansoor Asma ◽  
Sohani Komal
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Oral Hygiene ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Oral Care ◽  
Chlorhexidine Gluconate ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Vap Bundle

Abstract Background Ventilator-associated pneumonia (VAP) is when a patient who received mechanical ventilation for at least 48 hours develops pneumonia. According to the literature, the prevalence rate of VAP in patients experiencing mechanical ventilation is 9%–68%, its resulting mortality is 30%–70%, it also extends hospital and ICU stay by 6–7 days, raises healthcare costs by $40,000 per patient. VAP is a serious complication in the critically ill one factor causing VAP is an aspiration of oral colonization which may result from poor oral hygiene care. Oral hygiene care using either a mouth rinse or with help of forceps and gauze or combination together with the aspiration of secretion can reduce the risk of VAP in these critically ill patients. Method The main aim of this study was to evaluate the effect of strengthening oral hygiene practices and develop cost-effective and easy to use protocols of oral hygiene for ventilator-dependent patients. This study is an observational study conducted in all intensive care unit at tertiary care hospital, 41 bedded inpatient critical care area including high dependency unit (HDU)/coronary care unit (CCU), medical intensive care unit (MICU), surgical intensive care unit (SICU), neonate intensive care unit (NICU) and pediatric intensive care unit (PICU). Approximately 500 patients were admitted monthly to the intensive care unit. All ventilated patients admitted to the intensive care unit are included. Intervention is done in three phases: firstly, VAP device-associated infection (DAI’s) surveillance initiated according to the CDC guideline. HAI’s surveillance was done on daily basis. Secondly, educate staff regarding DAI’s surveillance, VAP bundle, Oral care and suction technique of ventilated patient). Ongoing training and hands-on practice on mannequin and also perform sign-off on the patient first under supervision of Nurse instructor and infection control officers. Finally, VAP bundle was initiated which include elevation of head, daily sedation vacation, and assessment of readiness to extubate, daily oral hygiene care, and assessment of stress ulcer and deep venous thrombosis prophylaxis. Result Before implementation, we just calculate all pneumonia rates together not using proper guidelines. But after we follow CDC guideline for DAI’s surveillance, we trained more than 50% of critical care staff out of 93 staffs, and 90% to 95% compliance of using chlorhexidine gluconate for oral care at least per shift and also as per patient needed observed in ventilated patients. Conclusion The implementation of these changes in practices along with using chlorhexidine gluconate products has made it possible to achieve goal and staff perform work according to the best practice guideline. Oral care hygiene using chlorhexidine gluconate (CHG) as an element of the ventilator bundle is supposed to decontaminate the mouth, avoid aspiration of contaminated secretion into the respiratory tract and prevent VAP.

Blood Culture Contamination Rates after Skin Antisepsis with Chlorhexidine Gluconate versus Povidone-Iodine in a Pediatric Emergency Department

2010 ◽  
Vol 31 (2) ◽  
pp. 171-176 ◽  
Author(s):  
Lauren Marlowe ◽  
Rakesh D. Mistry ◽  
Susan Coffin ◽  
Kateri H. Leckerman ◽  
Karin L. McGowan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Blood Culture ◽  
Peripheral Blood ◽  
Povidone Iodine ◽  
Chlorhexidine Gluconate ◽  
Series Data ◽  
Control Group ◽  
Contamination Rate ◽  
Peripheral Blood Culture ◽  
Skin Antisepsis

Objective.To determine blood culture contamination rates after skin antisepsis with Chlorhexidine, compared with povidone-iodine.Design.Retrospective, quasi-experimental study.Setting.Emergency department of a tertiary care children's hospital.Patients.Children aged 2-36 months with peripheral blood culture results from February 2004 to June 2008. Control patients were children younger than 2 months with peripheral blood culture results.Methods.Blood culture contamination rates were compared using segmented regression analysis of time-series data among 3 patient groups: (1) patients aged 2-36 months during the 26-month preintervention period, in which 10% povidone-iodine was used for skin antisepsis before blood culture; (2) patients aged 2-36 months during the 26-month postintervention period, in which 3% Chlorhexidine gluconate was used; and (3) patients younger than 2 months not exposed to the Chlorhexidine intervention (ie, the control group).Results.Results from 11,595 eligible blood cultures were reviewed (4,942 from the preintervention group, 4,274 from the postintervention group, and 2,379 from the control group). For children aged 2-36 months, the blood culture contamination rate decreased from 24.81 to 17.19 contaminated cultures per 1,000 cultures (P< .05) after implementation of Chlorhexidine. This decrease of 7.62 contaminated cultures per 1,000 cultures (95% confidence interval, —0.781 to —15.16) represented a 30% relative decrease from the preintervention period and was sustained over the entire postintervention period. No change in contamination rate was observed in the control group (P= .337).Conclusion.Skin antisepsis with Chlorhexidine significantly reduces the blood culture contamination rate among young children, as compared with povidone-iodine.

scholarly journals Pattern of clinical manifestation and antibiotics sensitivity of Burkholderia Cepacia sepsis in Neonatal Intensive Care Unit of tertiary care centre of North India

2019 ◽  
Vol 6 (6) ◽  
pp. 2650 ◽  
Author(s):  
Sharad Bansal ◽  
Rambabu Sharma ◽  
Narendra Jangir
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Culture ◽  
Neonatal Intensive Care Unit ◽  
Clinical Manifestation ◽  
Neonatal Sepsis ◽  
Burkholderia Cepacia ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Antibiotic Sensitivity

Background: Neonatal sepsis is a major cause of morbidity and mortality worldwide. Now a days, neonatal sepsis due to Burkholderia cepacia is on rise. This study was conducted to delineate clinical presentation and antibiotic sensitivity pattern from blood culture proven Burkholderia sepsis. Methods: In this retrospective analytical study, thirty-six neonates admitted to Neonatal Intensive Care Unit of a tertiary care hospital with blood culture proven Burkholderia sepsis were included. Clinical manifestation, laboratory findings and antibiotic sensitivity patterns of blood culture proven Burkholderia sepsis were analyzed.Results: : All neonates were inborn and were admitted within 24 hours of birth. Difficulty in breathing was most common presenting symptom and seizure was second in number. There was no association with mode of delivery. Male to female ratio is 1.4:1. Progressive thrombocytopenia was the most consistent feature and in 6 patients also associated with anaemia. Average hospital stay was increased and more in preterm neonates. In this setup piperacillin + tazobactem was found to be most sensitive against Burkholderia cepacia and cotrimoxazole was 2nd in sensitivity.Conclusions: Proper and timely identification of Non Fermentative Gram Negative Bacilli (NFGNB) other than Pseudomonas can help confine morbidity due to such infections. High degree of suspicion helps in early recognition. Efficient housekeeping is necessary to prevent nosocomial infections due to these pathogens.

scholarly journals 2170. Xpert Carba-R Assay on Flagged Blood Culture Samples: Clinical Utility in Intensive Care Unit Patients with Gram-Negative Bacteremia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S736-S737
Author(s):  
Surendran Rajendran ◽  
Ram Gopalakrishnan ◽  
Anil Tarigopula ◽  
Sureshkumar Dorairajan ◽  
Senthur Nambi Panchatcharam ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Culture ◽  
Likelihood Ratio ◽  
Predictive Value ◽  
Tertiary Care ◽  
Carbapenem Resistance ◽  
Sensitivity Testing ◽  
Gram Negative ◽  
Gram Negative Bacteremia

Abstract Background Rapid molecular diagnostics that predict carbapenem resistance (CR) well before the availability of routine drug sensitivity testing (DST) can serve as an antimicrobial stewardship tool in the context of high rates of carbapenem-resistant enterobacteriaceae (CRE). Methods A retrospective observational study of patients more than 18 years of age on whom Xpert Carba-R (FDA approved for rectal swab specimen) was done on Gram-negative bacteria (GNB) flagged blood culture samples, in a tertiary care Indian intensive care unit between January 2015 and November 2018. Results The study included 160 patients who had a median (Sequential Organ Failure Assessment) SOFA score of 16. A total of 164 GNB were isolated with 4 patients having polymicrobial bacteremia. Klebsiella pneumoniae and Escherichia coli were the predominant isolates (Figure 1). Carba-R was positive in 58/164 (35.36%) samples (Figure 2) and 73/161 isolates (45.34%) were CR (after excluding intrinsic CR organisms) on routine DST. The distribution of CR genes overall was: OXA-48 like (29/58–50%), followed by NDM (19/58–32.7%), followed by OXA-48 and NDM co-expression (9/58–15.51%) and in individual groups as in Figure 3. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value (PPV) and negative predictive value (NPV) of Carba-R vs. routine DST were 90.74%, 93.15%, 13.25, 0.10, 83.58% and 96.31% for enterobacteriaceae (Figure 4). The median time to obtaining the Carba-R report was 30 hours 34 minutes vs. 74 hours and 20 minutes for carbapenem resistance on routine DST. Based on the Carba-R report, 9.72% of patients had escalation of antibiotics (e.g., colistin) to cover CR organisms and 27.08% had de-escalation from CR cover that had already been started. Conclusion Xpert Carba-R serves as a rapid diagnostic tool for CR Gram-negative bacteremia, particularly hospital-acquired enterobacteriaceae in intensive care units with a high CRE prevalence. It assists in initiating early appropriate therapy and early institution of infection control measures in these patients, as well as in de-escalation of colistin in patients without carbapenem resistance. We recommend that clinicians consider routinely utilizing this test in this setting. Disclosures All authors: No reported disclosures.

scholarly journals 1528. Rates of Peripheral Blood Culture Contamination in an Urban Children’s Hospital

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S556-S557
Author(s):  
Derek Tam ◽  
Kyle Hengel ◽  
Aparna Arun
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Culture ◽  
Peripheral Blood ◽  
Contamination Rate ◽  
Improvement Project ◽  
Culture Bottle ◽  
Children's Hospital ◽  
Peripheral Blood Culture ◽  
Children’S Hospital

Abstract Background Positive peripheral blood culture results are essential in guiding antimicrobial therapy in patients with bacteremia. However, false-positive results may frequently pose diagnostic issues in interpreting the test. These results can lead to increased costs and patient harm through the administration of unnecessary antibiotics and prolongation of hospital stay. The maximum acceptable contamination rate for peripheral blood cultures as suggested by the College of American Pathologists is 3%. Methods We initiated a longitudinal quality improvement project to monitor peripheral blood contamination rates at our children’s hospital in Brooklyn, NY. We reviewed positive blood culture results on a monthly basis and assessed whether they represented true infections vs. contamination based on review of patient charts. Residents and nurses in the pediatric emergency department (ED), neonatal intensive care unit (NICU), pediatric intensive care unit (PICU), inpatient unit, and newborn nursery were educated on proper skin sterilization techniques using video demonstration; the importance of avoiding palpating the venipuncture site after sterilization and the importance of cleaning the port on the blood culture bottle were reinforced. Results The pediatric ED and the PICU had the highest contamination rates in 2018 at 4.38% and 3.82%, respectively. The newborn nursery had the lowest contamination rate, at 0%. The NICU and pediatric inpatient units had contamination rates that met the goal as well, at 1.25% and 0.72%, respectively. Conclusion The departments in need of targeted interventions are the pediatric ED and the PICU, both of which had contamination rates greater than the 3% goal rate set for our project. Future interventions currently being considered include re-education of nursing and resident staff as well as the creation of equipment bundles to facilitate adequate skin preparation prior to venipuncture. Disclosures All authors: No reported disclosures.

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