scholarly journals Automated Surveillance for Central Line–Associated Bloodstream Infection in Intensive Care Units

2008 ◽  
Vol 29 (9) ◽  
pp. 842-846 ◽  
Author(s):  
Keith F. Woeltje ◽  
Anne M. Butler ◽  
Ashleigh J. Goris ◽  
Nhial T. Tutlam ◽  
Joshua A. Doherty ◽  
...  
Keyword(s):  
Intensive Care ◽  
Negative Predictive Value ◽  
Bloodstream Infection ◽  
Intensive Care Units ◽  
Predictive Value ◽  
Infection Prevention ◽  
Central Line ◽  
Computer Algorithms ◽  
Predictive Values ◽  
Blood Samples

Objective.To develop and evaluate computer algorithms with high negative predictive values that augment traditional surveillance for central line–associated bloodstream infection (CLABSI).Setting.Barnes-Jewish Hospital, a 1,250-bed tertiary care academic hospital in Saint Louis, Missouri.Methods.We evaluated all adult patients in intensive care units who had blood samples collected during the period from July 1, 2005, to June 30,2006, that were positive for a recognized pathogen on culture. Each isolate recovered from culture was evaluated using the definitions for nosocomial CLABSI provided by the National Healthcare Safety Network of the Centers for Disease Control and Prevention. Using manual surveillance by infection prevention specialists as the gold standard, we assessed the ability of various combinations of dichotomous rules to determine whether an isolate was associated with a CLABSI. Sensitivity, specificity, and predictive values were calculated.Results.Infection prevention specialists identified 67 cases of CLABSI associated with 771 isolates recovered from blood samples. The algorithms excluded approximately 40%-62% of the isolates from consideration as possible causes of CLABSI. The simplest algorithm, with 2 dichotomous rules (ie, the collection of blood samples more than 48 hours after admission and the presence of a central venous catheter within 48 hours before collection of blood samples), had the highest negative predictive value (99.4%) and the lowest specificity (44.2%) for CLABSI. Augmentation of this algorithm with rules for common skin contaminants confirmed by another positive blood culture result yielded in a negative predictive value of 99.2% and a specificity of 68.0%.Conclusions.An automated approach to surveillance for CLABSI that is characterized by a high negative predictive value can accurately identify and exclude positive culture results not representing CLABSI from further manual surveillance.

scholarly journals Central Line–Associated Bloodstream Infection Reduction and Bundle Compliance in Intensive Care Units: A National Study

2016 ◽  
Vol 37 (7) ◽  
pp. 805-810 ◽  
Author(s):  
E. Yoko Furuya ◽  
Andrew W. Dick ◽  
Carolyn T. A. Herzig ◽  
Monika Pogorzelska-Maziarz ◽  
Elaine L. Larson ◽  
...  
Keyword(s):  
Intensive Care ◽  
Bloodstream Infection ◽  
Intensive Care Units ◽  
Infection Prevention ◽  
National Level ◽  
Central Line ◽  
National Study ◽  
Cross Sectional ◽  
Bundle Compliance ◽  
The Impact

OBJECTIVESTo describe compliance with the central line (CL) insertion bundle overall and with individual bundle elements in US adult intensive care units (ICUs) and to determine the relationship between bundle compliance and central line–associated bloodstream infection (CLABSI) rates.DESIGNCross-sectional study.PARTICIPANTSNational sample of adult ICUs participating in National Healthcare Safety Network (NHSN) surveillance.METHODSHospitals were surveyed to determine compliance with CL insertion bundle elements in ICUs. Corresponding NHSN ICU CLABSI rates were obtained. Multivariate Poisson regression models were used to assess associations between CL bundle compliance and CLABSI rates, controlling for hospital and ICU characteristics.RESULTSA total of 984 adult ICUs in 632 hospitals were included. Most ICUs had CL bundle policies, but only 69% reported excellent compliance (≥95%) with at least 1 element. Lower CLABSI rates were associated with compliance with just 1 element (incidence rate ratio [IRR] 0.77; 95% confidence interval [CI], 0.64–0.92); however, ≥95% compliance with all 5 elements was associated with the greatest reduction (IRR, 0.67; 95% CI, 0.59–0.77). There was no association between CLABSI rates and simply having a written CL bundle policy nor with bundle compliance <75%. Additionally, better-resourced infection prevention departments were associated with lower CLABSI rates.CONCLUSIONSOur findings demonstrate the impact of transferring infection prevention interventions to the real-world setting. Compliance with the entire bundle was most effective, although excellent compliance with even 1 bundle element was associated with lower CLABSI rates. The variability in compliance across ICUs suggests that, at the national level, there is still room for improvement in CLABSI reduction.Infect Control Hosp Epidemiol 2016;37:805–810

scholarly journals Impact of State Reporting Laws on Central Line-Associated Bloodstream Infection Rates in U.S. Adult Intensive Care Units

2016 ◽  
Vol 52 (3) ◽  
pp. 1079-1098 ◽  
Author(s):  
Hangsheng Liu ◽  
Carolyn T. A. Herzig ◽  
Andrew W. Dick ◽  
E. Yoko Furuya ◽  
Elaine Larson ◽  
...  
Keyword(s):  
Intensive Care ◽  
Bloodstream Infection ◽  
Intensive Care Units ◽  
Central Line ◽  
Infection Rates ◽  
Reporting Laws

Types of Interventions

2021 ◽  
pp. 40-51
Author(s):  
Jennifer Meddings ◽  
Vineet Chopra ◽  
Sanjay Saint
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Bloodstream Infection ◽  
Infection Prevention ◽  
Central Line ◽  
Peripherally Inserted Central Catheters ◽  
Trade Off ◽  
Central Lines ◽  
The Past ◽  
Central Catheters

Prevention of central line–associated bloodstream infection (CLABSI), while initially making great strides in 2003, has declined as use of peripherally inserted central catheters (PICCs) has grown tremendously over the past two decades. The convenience of a PICC has led to sicker patients being treated outside the intensive care unit, and there has been little recognition of a trade-off between benefits and risks after PICC placement. For these reasons, CLABSI prevention has become more challenging. This chapter describes the contents of an infection prevention bundle for CLABSI. In the case of CLABSI, the intervention outlines appropriate and inappropriate uses of central lines. Several new tools are discussed, which help doctors and nurses think through which device is most appropriate for any given patient.

Analysis of Central Line–Associated Bloodstream Infections in the Intensive Care Unit after Implementation of Central Line Bundles

2010 ◽  
Vol 31 (05) ◽  
pp. 551-553 ◽  
Author(s):  
Emily K. Shuman ◽  
Laraine L. Washer ◽  
Jennifer L. Arndt ◽  
Christy A. Zalewski ◽  
Robert C. Hyzy ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Bloodstream Infections ◽  
Central Line ◽  
Line Bundles ◽  
Blood Samples ◽  
Central Lines ◽  
Definition Of ◽  
Contaminated Blood

Central line-associated bloodstream infections (CLABSIs) have been reduced in number but not eliminated in our intensive care units with use of central line bundles. We performed an analysis of remaining CLABSIs. Many bloodstream infections that met the definition of CLABSI had sources other than central lines or represented contaminated blood samples.

scholarly journals Surveillance Length and Validity of Benchmarks for Central Line-Associated Bloodstream Infection Incidence Rates in Intensive Care Units

PLoS ONE ◽  
2012 ◽  
Vol 7 (5) ◽  
pp. e36582 ◽  
Author(s):  
Patricia S. Fontela ◽  
Caroline Quach ◽  
David Buckeridge ◽  
Madukhar Pai ◽  
Robert W. Platt
Keyword(s):  
Intensive Care ◽  
Bloodstream Infection ◽  
Intensive Care Units ◽  
Central Line ◽  
Incidence Rates ◽  
Infection Incidence

scholarly journals Electronic Surveillance for Healthcare-Associated Central Line—Associated Bloodstream Infections Outside the Intensive Care Unit

2011 ◽  
Vol 32 (11) ◽  
pp. 1086-1090 ◽  
Author(s):  
Keith F. Woeltje ◽  
Kathleen M. McMullen ◽  
Anne M. Butler ◽  
Ashleigh J. Goris ◽  
Joshua A. Doherty
Keyword(s):  
Intensive Care ◽  
Blood Culture ◽  
Predictive Value ◽  
Chart Review ◽  
Positive Culture ◽  
Bloodstream Infections ◽  
Central Line ◽  
Electronic Surveillance ◽  
Predictive Values ◽  
Best Fit

Background.Manual surveillance for central line-associated bloodstream infections (CLABSIs) by infection prevention practitioners is time-consuming and often limited to intensive care units (ICUs). An automated surveillance system using existing databases with patient-level variables and microbiology data was investigated.Methods.Patients with a positive blood culture in 4 non-ICU wards at Barnes-Jewish Hospital between July 1, 2005, and December 31, 2006, were evaluated. CLABSI determination for these patients was made via 2 sources; a manual chart review and an automated review from electronically available data. Agreement between these 2 sources was used to develop the best-fit electronic algorithm that used a set of rules to identify a CLABSI. Sensitivity, specificity, predictive values, and Pearson's correlation were calculated for the various rule sets, using manual chart review as the reference standard.Results.During the study period, 391 positive blood cultures from 331 patients were evaluated. Eighty-five (22%) of these were confirmed to be CLABSI by manual chart review. The best-fit model included presence of a catheter, blood culture positive for known pathogen or blood culture with a common skin contaminant confirmed by a second positive culture and the presence of fever, and no positive cultures with the same organism from another sterile site. The best-performing rule set had an overall sensitivity of 95.2%, specificity of 97.5%, positive predictive value of 90%, and negative predictive value of 99.2% compared with intensive manual surveillance.Conclusions.Although CLABSIs were slightly overpredicted by electronic surveillance compared with manual chart review, the method offers the possibility of performing acceptably good surveillance in areas where resources do not allow for traditional manual surveillance.

scholarly journals A COMPREHENSIVE UPDATE ON INCIDENCE, PREVALENCE AND COMPLEX ETIOLOGY OF CENTRAL LINE–ASSOCIATED BLOODSTREAM INFECTION IN PEDIATRIC INTENSIVE CARE UNITS IN KING SAUD MEDICAL CITY

2021 ◽  
Vol 9 (5) ◽  
pp. 56-63
Author(s):  
Juhaina Abdulrahiem ◽  
Asia Sultan ◽  
Faisl Alaklobi ◽  
Hala Amer ◽  
Hind Alzoman
Keyword(s):  
Intensive Care ◽  
Bloodstream Infection ◽  
Intensive Care Units ◽  
Age Groups ◽  
Pediatric Intensive Care ◽  
Central Line ◽  
Central Lines ◽  
Medical City ◽  
Underlying Diseases ◽  
Paediatric Intensive Care Units

Central Line Associated Bloodstream Infection (CLABSI) is a type of bloodstream infection that is caused by microorganisms after the insertion of central lines. Paediatric Intensive Care Units have been studied to conduct this research on CLABSI in children from 2 to 15 years old. Children have been divided in two age groups that are 2-5 and 5-15 years. The Royal Children’s Hospital, Melbourne has been chosen as a sample of this besides other five hospitals of Australia. A total of 350 patients are studied in the course of this research and 216 among them were inserted with central lines. Bloodstream infection has been identified in 49 patients from these 216 patients and CLABSI occurred in 75.51% of them that is 37 patients. Associated microorganisms and other underlying diseases are listed in this study to develop an idea about factors responsible for CLABSI.

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