Prevention of Central Venous Catheter–Related Bloodstream Infections Using Non-Technologic Strategies

2004 ◽  
Vol 25 (08) ◽  
pp. 675-677 ◽  
Author(s):  
Silvia Acosta Gnass ◽  
Luisa Barboza ◽  
Dafne Bilicich ◽  
Pablo Angeloro ◽  
Walter Treiyer ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Infectious Complications ◽  
Central Venous ◽  
Methicillin Resistant ◽  
Sterile Drape ◽  
Improvement Programs ◽  
A Prospective Study ◽  
Quality Improvement Programs

Abstract Objective: To evaluate the incidence of nosocomial bacteremias related to the use of non-impregnated central venous catheters (CVCs) when only non-technologic strategies were used to prevent them. Design: This was a prospective study of infectious complications of CVCs placed in intensive care unit (ICU) patients from April 1997 to December 2001. Setting: The medical–surgical ICU of a tertiary-care, university-affiliated hospital in Argentina. Methods: We studied all patients admitted to the ICU using non-impregnated CVCs. Maximal sterile barrier precautions (ie, use of cap, mask, sterile gown, sterile gloves, and large sterile drape), strict handwashing, preparation of the patients' skin with antiseptic solutions, insertion and management of catheters by trained personnel, and continuing quality improvement programs aimed at appropriate insertion and maintenance of catheters were employed. Results: During the study period, 2,525 patients were admitted to the ICU. Eight hundred sixty-eight patients had 1,037 CVCs inserted. The number of CVC-related bloodstream infections (BSIs), acquired in the ICU, was 2.7 per 1,000 CVC-days (13 nosocomial CVC-related BSIs during 4,770 days of CVC use). Microorganisms isolated included methicillin-susceptible Staphylococcus aureus (n = 6), methicillin-resistant S. aureus (n = 2), coagulase-negative methicillin-resistant Staphylococcus (n = 2), Escherichia coli (n = 1), Klebsiella pneumoniae (n = 1), and Enterobacter cloacae (n = 1). Conclusions: A low rate of catheter-related BSI was achieved without antimicrobial-impregnated catheters. The incidence of CVC-associated bacteremias corresponded to the 10th to 20th percentile range of the National Nosocomial Infections Surveillance System hospitals for the same type of ICU.

Prevention of Central Venous Catheter–Related Bloodstream Infections Using Non-Technologic Strategies

2004 ◽  
Vol 25 (8) ◽  
pp. 675-677 ◽  
Author(s):  
Silvia Acosta Gnass ◽  
Luisa Barboza ◽  
Dafne Bilicich ◽  
Pablo Angeloro ◽  
Walter Treiyer ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Infectious Complications ◽  
Central Venous ◽  
Methicillin Resistant ◽  
Sterile Drape ◽  
Improvement Programs ◽  
A Prospective Study ◽  
Quality Improvement Programs

AbstractObjective:To evaluate the incidence of nosocomial bacteremias related to the use of non-impregnated central venous catheters (CVCs) when only non-technologic strategies were used to prevent them.Design:This was a prospective study of infectious complications of CVCs placed in intensive care unit (ICU) patients from April 1997 to December 2001.Setting:The medical–surgical ICU of a tertiary-care, university-affiliated hospital in Argentina.Methods:We studied all patients admitted to the ICU using non-impregnated CVCs. Maximal sterile barrier precautions (ie, use of cap, mask, sterile gown, sterile gloves, and large sterile drape), strict handwashing, preparation of the patients' skin with antiseptic solutions, insertion and management of catheters by trained personnel, and continuing quality improvement programs aimed at appropriate insertion and maintenance of catheters were employed.Results:During the study period, 2,525 patients were admitted to the ICU. Eight hundred sixty-eight patients had 1,037 CVCs inserted. The number of CVC-related bloodstream infections (BSIs), acquired in the ICU, was 2.7 per 1,000 CVC-days (13 nosocomial CVC-related BSIs during 4,770 days of CVC use). Microorganisms isolated included methicillin-susceptible Staphylococcus aureus (n = 6), methicillin-resistant S. aureus (n = 2), coagulase-negative methicillin-resistant Staphylococcus (n = 2), Escherichia coli (n = 1), Klebsiella pneumoniae (n = 1), and Enterobacter cloacae (n = 1).Conclusions:A low rate of catheter-related BSI was achieved without antimicrobial-impregnated catheters. The incidence of CVC-associated bacteremias corresponded to the 10th to 20th percentile range of the National Nosocomial Infections Surveillance System hospitals for the same type of ICU.

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.

The Role of Biofilm in Central Venous Catheter Related Bloodstream Infections: Evidence-based Nursing and Review of the Literature

2020 ◽  
Vol 15 (1) ◽  
pp. 22-27 ◽  
Author(s):  
Nicola Ielapi ◽  
Emanuela Nicoletti ◽  
Carmela Lorè ◽  
Giorgio Guasticchi ◽  
Tiziana Avenoso ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Infectious Complications ◽  
Evidence Based ◽  
Central Venous ◽  
Device Management ◽  
Bibliographic Search ◽  
Materials Used ◽  
Evidence Based Nursing

Background: Biofilm is a fundamental component in the pathogenesis of infections related to the use of the central venous catheter (CVC,) which can represent an important health issue in everyday practice of nursing and medical staff. Objective: The objective of the following review is to analyze the components of biofilm and their role in catheter-related infection determinism in an evidencebased nursing perspective in such a way as to give health professionals useful suggestions in the prevention and management of these complications. Methods: The following databases were consulted for the bibliographic search: Medline, Scopus, Science Direct. Biofilm can be the cause of CVC extraction and can lead to serious haematogenic infectious complications that can increase the morbidity and mortality of affected patients. Results: Updated pathophysiologic knowledge of biofilm formation and appropriate diagnostic methodology are pivotal in understanding and detecting CVC-related infections. Lock therapy appears to be a useful, preventive, and therapeutic aid in the management of CVCrelated infections. New therapies attempting to stop bacterial adhesion on the materials used could represent new frontiers for the prevention of CVC-related infections. Conclusion: The correct evidence-based nursing methods, based on the use of guidelines, provides the opportunity to minimize the risks of infection through the implementation of a series of preventive measures both during the CVC positioning phase and in the subsequent phase, for example, during device management which is performed by medical and nursing staff.

Reducing Central Line-Associated Bloodstream Infection in Contaminated Central Venous Catheters: Case Studies of a Pediatric Contamination Guideline

2021 ◽  
Author(s):  
Tracy B. Chamblee ◽  
Lindsey J. Patton ◽  
Virginia B. Young ◽  
Jennifer Marusich ◽  
Cindy D. Bowens ◽  
...  
Keyword(s):  
Case Reports ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Healthcare Organizations ◽  
Central Venous ◽  
Mortality And Morbidity ◽  
Reduction Strategies ◽  
Contamination Events

Highlights Abstract Healthcare organizations have prioritized patient safety and quality improvement efforts to reduce central line-associated bloodstream infections (CLABSIs). Implementation of central venous catheter (CVC) insertion and maintenance bundles have significantly reduced infection rates. Nevertheless, CLABSIs continue to be a significant cause of mortality and morbidity in hospitals, and further efforts are necessary to improve CVC care practices. A hospital-wide committee at a tertiary care pediatric hospital identified gaps in our CVC maintenance practices resulting from CVC contamination events from a patient’s body fluids. A lack of published literature on the topic resulted in the need to create an institutional clinical practice guideline (CPG) to develop guidance to mitigate potential CLASBIs from CVC contamination. Utilization of the CVC CPG in all inpatient units and other reduction strategies resulted in a steady decline in our CLABSI rates, particularly in those related to CVC contamination events. Case reports illustrate the effectiveness of the CPG.

scholarly journals Infectious Complications of Central Venous Catheters Increase the Risk of Catheter-Related Thrombosis in Hematology Patients: A Prospective Study

2005 ◽  
Vol 23 (12) ◽  
pp. 2655-2660 ◽  
Author(s):  
Cornelis J. van Rooden ◽  
Emile F. Schippers ◽  
Renée M.Y. Barge ◽  
Frits R. Rosendaal ◽  
Henri F.L. Guiot ◽  
...  
Keyword(s):  
Positive Culture ◽  
Venous Catheter ◽  
Infectious Complications ◽  
Intensive Chemotherapy ◽  
Central Venous ◽  
Surveillance Cultures ◽  
Single Positive ◽  
A Prospective Study ◽  
Micro Organisms ◽  
Risk For Thrombosis

Purpose We studied whether the risk of central venous catheter (CVC) -related thrombosis increased after an episode of CVC-related infection in patients undergoing intensive chemotherapy. Secondly, we determined whether thrombosis can be predicted or excluded by CVC lock fluid surveillance cultures. Patients and Methods In a prospective setting, 105 consecutive patients were carefully examined for CVC-related infection and thrombosis. In all patients, microbial surveillance cultures of CVC lock fluid were taken every other day. All patients with clinical suspicion of CVC-related thrombosis underwent Doppler ultrasound or additional venography. Results The cumulative incidence of CVC-related infection was 24% (25 of 105 patients). Clinically manifest thrombosis occurred in 13 (12%) of 105 patients. In patients with CVC-related infection, the risk of thrombosis increased markedly in comparison to those without infection (relative risk, 17.6; 95% CI, 4.1 to 74.1). In patients having two or more positive subsequent CVC lock fluid cultures with identical micro-organisms, 71.4% developed thrombosis, as compared with 3.3% in patients with negative or a single positive culture. Conclusion The risk of clinically manifest thrombosis is increased after an episode of CVC-related infection in patients undergoing intensive chemotherapy. Surveillance culturing of CVC lock fluid may be clinically useful in estimating the risk for thrombosis and the instigation of focused early intervention.

Patient- and Device-Specific Risk Factors for Peripherally Inserted Central Venous Catheter—Related Bloodstream Infections

2013 ◽  
Vol 34 (2) ◽  
pp. 184-189 ◽  
Author(s):  
Makhawadee Pongruangporn ◽  
M. Cristina Ajenjo ◽  
Anthony J. Russo ◽  
Kathleen M. McMullen ◽  
Catherine Robinson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Venous Catheter ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Adult Patients ◽  
Chronic Obstructive ◽  
Central Venous ◽  
Obstructive Pulmonary Disease ◽  
Specific Risk

Objective.To determine the patient- and device-specific risk factors for hospital-acquired peripherally inserted central venous catheter–related bloodstream infections (PICC BSIs) in adult patients.Design.Nested case-control study.Setting.Barnes-Jewish Hospital, a 1,252-bed tertiary care teaching hospital.Patients.Adult patients with PICCs placed from January 1, 2006, through July 31, 2008.Methods.PICC BSI cases were identified using the National Healthcare Safety Network definition. Uninfected control patients with PICCs in place were randomly selected at a 3: 1 ratio. Patient- and device-related variables were examined using multivariate analysis.Results.The overall PICC BSI rate was 3.13 per 1,000 catheter-days. Independent risk factors for PICC BSIs included congestive heart failure (odds ratio [OR], 2.0 [95% confidence interval (CI), 1.26–3.17];P= .003), intra-abdominal perforation (OR, 5.66 [95% CI, 1.76–18.19];P= .004),Clostidium difficileinfection (OR, 2.25 [95% CI, 1.17–4.33];P= .02), recent chemotherapy (OR, 3.36 [95% CI, 1.15–9.78];P= .03), presence of tracheostomy (OR, 5.88 [95% CI, 2.99–11.55];P< .001), and type of catheter (OR for double lumen, 1.89 [95% CI, 1.15–3.10];P= .01; OR for triple lumen, 2.87 [95% CI, 1.39–5.92];P= .004). Underlying chronic obstructive pulmonary disease (OR, 0.48 [95% CI, 0.29–0.78];P= .03) and admission to surgical (OR, 0.43 [95% CI, 0.24–0.79];P= .006) or oncology and orthopedic (OR, 0.35 [95% CI, 0.13–0.99];P= .05) services were less likely to be associated with having a PICC BSI.Conclusions.We identified several novel factors related to PICC BSIs. These factors may inform preventive measures.

scholarly journals Preventing Catheter-Associated Bloodstream Infections: A Survey of Policies for Insertion and Care of Central Venous Catheters From Hospitals in the Prevention Epicenter Program

2006 ◽  
Vol 27 (1) ◽  
pp. 8-13 ◽  
Author(s):  
David K. Warren ◽  
Deborah S. Yokoe ◽  
Michael W. Climo ◽  
Loreen A. Herwaldt ◽  
Gary A. Noskin ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Nurse Managers ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
The United States ◽  
Evidence Based ◽  
Central Venous ◽  
Single Location ◽  
Evidence Based Guidelines

Objective.To determine the extent to which evidence-based practices for the prevention of central venous catheter (CVC)-associated bloodstream infections are incorporated into the policies and practices of academic intensive care units (ICUs) in the United States and to determine variations in the policies on CVC insertion, use, and care.Design.A 9-page written survey of practices and policies for nontunneled CVC insertion and care.Setting.ICUs in 10 academic tertiary-care hospitals.Participants.ICU medical directors and nurse managers.Results.Twenty-five ICUs were surveyed (1-6 ICUs per hospital). In 80% of the units, 5 separate groups of clinicians inserted 24%-50% of all nontunneled CVCs. In 56% of the units, placement of more than two-thirds of nontunneled CVCs was performed in a single location in the hospital. Twenty units (80%) had written policies for CVC insertion. Twenty-eight percent of units had a policy requiring maximal sterile-barrier precautions when CVCs were placed, and 52% of the units had formal educational programs with regard to CVC insertion. Eighty percent of the units had a policy requiring staff to perform hand hygiene before inserting CVCs, but only 36% and 60% of the units required hand hygiene before accessing a CVC and treating the exit site, respectively.Conclusion.ICU policy regarding the insertion and care of CVCs varies considerably from hospital to hospital. ICUs may be able to improve patient outcome if evidence-based guidelines for CVC insertion and care are implemented.

Sign in / Sign up

Export Citation Format

Share Document