scholarly journals 776. Reducing Central Line Associated Bloodstream Infections (CLABSI) in a High-Risk Cohort of Patients by Standardizing Skin Preparation Prior to Pulmonary Artery Catheter Insertion

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S485-S485
Author(s):  
Mylinh Yun ◽  
Jay Varkey ◽  
Daniel Linehan ◽  
Elizabeth Noriega
Keyword(s):  
Pulmonary Artery ◽  
Central Venous Access ◽  
Bloodstream Infections ◽  
Venous Access ◽  
Central Line ◽  
Early Summer ◽  
Coverage Area ◽  
Skin Preparation ◽  
Correct Application ◽  
Instructions For Use

Abstract Background Central line associated bloodstream infections (CLABSI) are a recognized complication of all central venous access devices including pulmonary artery catheters (PAC). At our institution, PACs are utilized frequently, often for prolonged durations, for patients with advanced heart failure in the cardiac care unit (CCU) who are awaiting heart transplant. In early summer 2018, our hospital infection prevention (IP) department detected an uptick in CLABSI attributable to the CCU. After 9 months of zero CLABSI, two CLABSIs attributable to the CCU were identified during a 3 month period from November 2017-January 2018. Four additional CLABSIs were identified between May-July 2018 prompting an investigation by IP. Review of the 9 CLABSIs attributed to the CCU from May 2018 – June 2019 led IP to prioritize improving PAC insertion practices in our cardiac catheterization lab as a mean to reducing CLABSI (see table 1). Methods IP performed 5 observations of PAC insertion in the cath lab. During the observations of skin preparation, the prep time was performed correctly 40% of the time, correct application 60% of the time and dry time 60% of the time (see table 2, Figure1). Interventions included scheduling a training day for all cath lab staff with the skin prep vendor, performing competency check-offs, and identifying super-users to train future staff. Furthermore, skin antiseptic utilization according the manufacturer's instructions for use was implemented, the coverage area for the applicator was reviewed and a chart for reference was provided.The staff was provided with posters on correct skin prep technique as a visual cue in the procedure room. Results Since the project was implemented in September 2019, there has been 1 CLABSI identified that was possibly related to a PAC inserted in the cath lab. During this time 3 CLABSIs were identified in the CCU but were felt to be unrelated to cath lab insertion. Conclusion Since the project was implemented in September 2019, there has been 1 CLABSI identified that was possibly related to a PAC inserted in the cath lab. During this time 3 CLABSIs were identified in the CCU but were felt to be unrelated to cath lab insertion. Disclosures All Authors: No reported disclosures

Quality Improvement to Reduce Neonatal CLABSI: The Journey to Zero

2020 ◽  
Vol 37 (S 02) ◽  
pp. S14-S17
Author(s):  
Stephen A. Pearlman
Keyword(s):  
Quality Improvement ◽  
Central Venous Access ◽  
Bloodstream Infections ◽  
Venous Access ◽  
Central Line ◽  
Central Lines ◽  
The Past ◽  
Healthcare Improvement ◽  
Key Points ◽  
Innovative Techniques

Neonatal infections, including those associated with central lines, continue to be a major cause of morbidity and mortality despite many other improvements in neonatal outcomes. Over the past decades, significant advances have been made to reduce central line-associated bloodstream infections (CLABSIs) using quality improvement methodology. This article will review pertinent studies that used both the Institute for Healthcare Improvement Model for Improvement and other innovative techniques such as orchestrated testing and health care failure mode and effects analysis. These studies, by applying best practices, have demonstrated substantial and sustainable reductions in CLABSI. Some initiatives have been able to achieve rates of zero CLABSI for prolonged periods of time. While neonates often require prolonged central venous access and suffer from impaired immunity which increases the risk of CLABSI, this review demonstrates the journey to zero is feasible. Key Points

Prevention of Infection in Adults Receiving Intravenous Antibiotic Treatment via Indwelling Central Venous Access Devices

2019 ◽  
Vol 14 (1) ◽  
pp. 47-49
Author(s):  
Basant K. Puri ◽  
Anne Derham ◽  
Jean A. Monro
Keyword(s):  
Bloodstream Infection ◽  
Antibiotic Treatment ◽  
Central Venous Access ◽  
Case Series ◽  
Bloodstream Infections ◽  
Venous Access ◽  
Host Cells ◽  
Central Venous ◽  
Intravenous Antibiotic ◽  
Venous Access Devices

Background: The use of indwelling Central Venous Access Devices (CVADs) is associated with the development of bloodstream infections. When CVADs are used to administer systemic antibiotics, particularly second- or higher-generation cephalosporins, there is a particular risk of developing Clostridium difficile infection. The overall bloodstream infection rate is estimated to be around 1.74 per 1000 Central Venous Catheter (CVC)-days. Objective: We hypothesised that daily oral administration of the anion-binding resin colestyramine (cholestyramine) would help prevent infections in those receiving intravenous antibiotic treatment via CVADs. Method: A small case series is described of adult patients who received regular intravenous antibiotic treatment (ceftriaxone, daptomycin or vancomycin) for up to 40 weeks via indwelling CVADs; this represented a total of 357 CVC-days. In addition to following well-established strategies to prevent C. difficile infection, during the course of the intravenous antibiotic treatment the patients also received daily oral supplementation with 4 g colestyramine. Results: There were no untoward infectious events. In particular, none of the patients developed any symptoms or signs of C. difficile infection, whereas approximately one case of a bloodstream infection would have been expected. Conclusion: It is suggested that oral colestyramine supplementation may help prevent such infection through its ability to bind C. difficile toxin A (TcdA) and C. difficile toxin B (TcdB); these toxins are able to gain entry into host cells through receptor-mediated endocytosis, while anti-toxin antibody responses to TcdA and TcdB have been shown to induce protection against C. difficile infection sequelae.

scholarly journals Prevalence of the Use of Central Venous Access Devices Within and Outside of the Intensive Care Unit: Results of a Survey Among Hospitals in the Prevention Epicenter Program of the Centers for Disease Control and Prevention

2003 ◽  
Vol 24 (12) ◽  
pp. 942-945 ◽  
Author(s):  
Michael Climo ◽  
Dan Diekema ◽  
David K. Warren ◽  
Loreen A. Herwaldt ◽  
Trish M. Perl ◽  
...  
Keyword(s):  
Central Venous Access ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Venous Access ◽  
Teaching Hospitals ◽  
Central Venous ◽  
Prevalence Survey ◽  
Icu Patients ◽  
Medical Centers ◽  
Control And Prevention

AbstractObjective:To determine the prevalence of central venous catheter (CVC) use among patients both within and outside the ICU setting.Design:A 1-day prevalence survey of CVC use among adult inpatients at six medical centers participating in the Prevention Epicenter Program of the CDC. Using a standardized form, observers at each Epicenter performed a hospital-wide survey, collecting data on CVC use.Setting:Inpatient wards and ICUs of six large urban teaching hospitals.Results:At the six medical centers, 2,459 patients were surveyed; 29% had CVCs. Among the hospitals, from 43% to 80% (mean, 59.3%) of ICU patients and from 7% to 39% (mean, 23.7%) of non-ICU patients had CVCs. Despite the lower rate of CVC use on non-ICU wards, the actual number of CVCs outside the ICUs exceeded that of the ICUs. Most catheters were inserted in the subclavian (55%) or jugular (22%) site, with femoral (6%) and peripheral (15%) sites less commonly used. The jugular (33.0% vs 16.6%; P < .001) and femoral (13.8% vs 2.7%; P < .001) sites were more frequently used in ICU patients, whereas peripherally inserted (19.9% vs 5.9%; P < .001) and subclavian (60.7% vs 47.3%; P < .001) catheters were more commonly used in non-ICU patients.Conclusions:Current surveillance and infection control efforts to reduce morbidity and mortality associated with bloodstream infections concentrate on the high-risk ICU patients with CVCs. Our survey demonstrated that two-thirds of identified CVCs were not in ICU patients and suggests that more efforts should be directed to patients with CVCs who are outside the ICU.

Cardiovascular monitoring

2011 ◽  
Author(s):  
Carl Waldmann ◽  
Neil Soni ◽  
Andrew Rhodes
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Artery Catheter ◽  
Central Venous Access ◽  
Venous Access ◽  
Central Venous Catheters ◽  
Ecg Monitoring ◽  
Cardiovascular Monitoring ◽  
Pressure Monitoring ◽  
Central Venous ◽  
Common Problems

ECG monitoring 98Arterial pressure monitoring 102Insertion of central venous catheters 104Common problems with central venous access 106Pulmonary artery catheter: indications and use 108Pulmonary artery catheter: insertion 110Echocardiography 112Clinical application of echocardiography in the ICU 116Doppler 118Pulse pressure algorithms ...

Use of dry dressings for central venous access devices (CVADs) to decrease central line-associated blood stream infections (CLABSI) in a trauma intensive care unit (ICU)

2021 ◽  
Vol 30 (8) ◽  
pp. S37-S42
Author(s):  
France Paquet ◽  
Janette Morlese ◽  
Charles Frenette
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Central Venous Access ◽  
Venous Access ◽  
Blood Stream ◽  
Central Line ◽  
Surgical Intensive Care Unit ◽  
Central Venous ◽  
Surgical Intensive Care ◽  
Venous Access Devices

This article reports the results of a pre-post study conducted in a trauma-medical-surgical intensive care unit (ICU) regarding dressings of central venous access devices (CVADs) for the reduction of central line-associated blood stream infection (CLABSI) and improvement of adherence and integrity of the dressing. Available evidence indicates that dry dressings changed every 48 hours are equivalent to transparent dressings, changed when soiled or loose, or routinely every seven days. In our intensive care unit, where the majority of CVADs are inserted in the internal jugular vein and where there is an important usage of cervical collars, we questioned if dry dressings would be more appropriate than transparent dressings. Results: In the 12 months following the change in practice, we noted a CLABSI reduction from 2.36/1,000 catheter days to zero, improvement in dressing audits from 19.61% to 85.34% of clean dressings (P=0.00001) and 62.75% to 90.58% of adherent dressings. Conclusion: In this pre-post study, a simple change in dressing type was implemented, resulting in a significant reduction in the CLABSI rate.

scholarly journals Superior Vena Cava Duplication: The Red Herring of Central Line Placement

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Karin Gunther ◽  
Carmen Lam ◽  
David Siegel
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena ◽  
Central Venous Access ◽  
Vena Cava ◽  
Venous Catheter ◽  
Venous Access ◽  
The United States ◽  
Central Line ◽  
Central Venous ◽  
Central Venous Access Lines

5 million central venous access lines are placed every year in the United States, and it is a common surgical bedside procedure. We present a case of a central venous catheter placement with port for chemotherapy use, during which a duplication of a superior vena cava was discovered on CTA chest after fluoroscopy could not confirm placement of the guidewire. Due to its potential clinical implications, superior vena cava duplication must be recognized when it occurs.

scholarly journals The use, appropriateness and outcomes of outpatient parenteral antimicrobial therapy

2016 ◽  
Vol 101 (10) ◽  
pp. 886-893 ◽  
Author(s):  
Kate A Hodgson ◽  
Julie Huynh ◽  
Laila F Ibrahim ◽  
Bronwyn Sacks ◽  
Daniel Golshevsky ◽  
...  
Keyword(s):  
Adverse Events ◽  
Antimicrobial Therapy ◽  
Readmission Rate ◽  
Bloodstream Infections ◽  
Antibiotic Use ◽  
Venous Access ◽  
Central Line ◽  
Unplanned Readmission ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Inappropriate Choice

ObjectiveOutpatient parenteral antimicrobial therapy (OPAT) is increasingly used to treat children at home, but studies in children are scarce. We aimed to describe the use, appropriateness and outcomes of OPAT in children.DesignThis was a 12-month prospective observational study.SettingThe hospital-in-the-home programme of The Royal Children's Hospital Melbourne.PatientsAll patients receiving OPAT.InterventionsData were collected including demographics, diagnosis, type of venous access and antibiotic choice.Main outcome measuresLength of stay, adverse events, readmission rate and appropriateness of antibiotic use.Results228 patients received OPAT in 251 episodes. The median age was 7.4 years (range 1 week to 21 years), with 22 patients (10%) under 1 year. The most frequent diagnoses were exacerbation of cystic fibrosis (17%), urinary tract infection (12%) and cellulitis (9%). Most patients were transferred from the ward, but 18% were transferred directly from the emergency department, the majority with skin and soft-tissue infection (66%). Venous access was most commonly peripherally inserted central catheter (29%) and peripheral cannula (29%). 309 parenteral antibiotics were prescribed, most frequently ceftriaxone (28%) and gentamicin (19%). The majority of antibiotics (72%) were prescribed appropriately. However, 6% were deemed an inappropriate choice for the indication and 26% had inappropriate dose or duration. The incidence of central line-associated bloodstream infections was 0.9%. The unplanned readmission rate was 4%, with low rates of OPAT-related adverse events. Three children (1%) had an inadequate clinical response.ConclusionsOPAT is a safe and effective way of providing antibiotics to children. Despite high rates of appropriate antibiotic use, improvements can still be made.

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