scholarly journals 1169. Preventing Central Line-Associated Bloodstream Infections in Long-Term Acute Care

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S418-S419
Author(s):  
Jerry Jacob ◽  
Ann Morace ◽  
Jisuk Park ◽  
Nina Renzi
Keyword(s):  
Blood Culture ◽  
Bloodstream Infections ◽  
Central Line ◽  
Culture Collection ◽  
Blood Cultures ◽  
Fiscal Year ◽  
Intervention Period ◽  
Central Lines ◽  
Clabsi Rate

Abstract Background Long-term acute care hospitals (LTACHs) care for chronically, critically ill patients with high utilization of central lines and high risk for morbidity from central line-associated bloodstream infections (CLABSIs). Our 38-bed LTACH noted a substantial increase in the incidence of CLABSIs (as defined by the National Healthcare Safety Network) between fiscal year (FY) 2016 and FY 2018 (Figure 1). Detailed case review identified a large number of CLABSIs which were clinically consistent with blood culture contaminants from central lines. Feedback from bedside staff also suggested gaps between practice and evidence-based measures for central line care. Methods A three-pronged CLABSI prevention project was implemented in July 2018 consisting of (1) staff education regarding daily chlorhexidine (CHG) bathing for all patients, combined with an electronic audit report to identify patients without active CHG orders; (2) change in practice to the use of venipuncture alone for blood culture collection, combined with an electronic audit report to identify blood cultures collected from central lines; and (3) a recurring 6-part educational series for nurses focused on central line care. The pre-intervention period was defined as the 12-month period between July 1, 2017 and June 30, 2018 (FY 2018). The primary outcome was the fiscal year CLABSI rate. A secondary outcome was the proportion of blood cultures drawn from central lines. Results After 9 months of the intervention, one CLABSI had been reported for FY 2019 year-to-date at a rate of 0.4 per 1,000 CL-days, representing an 86% decrease from the FY 2018 rate of 2.8 per 1,000 CL-days. The 12-month rolling CLABSI rate decreased to 1.6 per 1,000 CL-days (Figure 2). The proportion of blood cultures collected from central lines decreased from 10.5% (69/658) to 4.5% (15/334), representing a 57% reduction. The proportion of patients ordered and receiving CHG bathing in the intervention period was >95%. Conclusion A multidisciplinary effort focused on CHG bathing, central line care, and blood culture collection led to a substantial reduction in CLABSIs in our LTACH. The use of electronic audit reports was particularly useful in achieving high adherence to practice changes. Disclosures All authors: No reported disclosures.

scholarly journals 583. Improving Catheter Scrub Technique and Compliance in a Level IV Neonatal ICU

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S275-S275
Author(s):  
Misti G Ellsworth ◽  
Sarah Milligan ◽  
Lauren Yager ◽  
Ann Kubanda ◽  
Krysten Webber ◽  
...  
Keyword(s):  
Real Time ◽  
Bloodstream Infections ◽  
Central Line ◽  
Fiscal Year ◽  
Intervention Period ◽  
New Strategy ◽  
Neonatal Icu ◽  
Correct Technique ◽  
Residual Product ◽  
Clabsi Rate

Abstract Background Central line-associated bloodstream infections (CLABSIs) are challenging to prevent in the neonatal population due to the long-term necessity of central access for nutrition and medication. Neonates are a population at high risk for CLABSIs, and infections in this group are associated with prolonged hospitalization, greater healthcare costs, and increased mortality. Current bundles for CLABSI prevention include a friction scrub of the catheter hub prior to each use. Real-time audits of correct technique can be challenging. In July of 2018, our team developed a new strategy for auditing scrub technique in an attempt to reduce CLABSI rates. Methods This project took place in a NICU with 118 level 4 beds from July 2018 to February 2019. Our NICU is located in a large metropolitan area and serves as a referral center for complex neonates throughout the region. The intervention period encompassed 25,085 patient-days and 6,206 line days. Real-time friction scrub audits were performed for both dedicated line team staff as well as bedside nurses. In order to determine whether a healthcare worker’s (HCW) scrub technique was successful, a colorless luminescent product was applied to a practice catheter hub that adhered to the hub, but was not visible to the HCW. The HCW would then demonstrate a friction scrub on the practice catheter, and the hub was placed under a black light to show where any residual product may be present. This process was repeated until the staff member was able to remove the product from the hub. Once the staff was successful, monthly real-time audits were continued to reinforce the correct technique. Results Between July 2018 and February 2019, compliance with scrub technique and ability to clear product from catheter hubs increased by 50%. The CLABSI rate in the first 9 months after intervention was 0.806 per 1000 line days as compared with 2.170 per 1000 line days in the previous fiscal year. Conclusion The number of CLABSI’s during the intervention period was 63% less when compared with the previous fiscal year. This process, in conjunction with our other CLABSI prevention practices, has significantly decreased both our CLABSI rate and overall numbers. This project emphasizes the importance of focusing on the basics of infection prevention practices and continual auditing to prevent practice creep. Disclosures All authors: No reported disclosures.

scholarly journals Impact of the Revised Non–Culture-Based Methodology Criteria on Central-Line–Associated Bloodstream Infections

2020 ◽  
Vol 41 (S1) ◽  
pp. s266-s266
Author(s):  
Geehan Suleyman ◽  
Thomas Chevalier ◽  
Nisreen Murad ◽  
George Alangaden
Keyword(s):  
Blood Culture ◽  
Bloodstream Infections ◽  
Central Line ◽  
Blood Cultures ◽  
Molecular Test ◽  
Current Definition ◽  
Previous Definition ◽  
The Impact ◽  
Positive Results ◽  
Clabsi Rate

Background: The current NHSN guideline states that positive results from both blood cultures and non–culture-based testing (NCT) methodologies are to be used for central-line–associated bloodstream infection (CLABSI) surveillance determination. A positive NCT result in the absence of blood cultures or negative blood cultures in patients who meet CLABSI criteria is to be reported to NHSN. However, the reporting criteria for NCT changed starting January 1, 2020: If NCT is positive and the blood culture is negative 2 days before or 1 day after, the NCT result is not reported. If the NCT is positive with no blood culture within the 3-day window period, the NCT result is reported in patients who meet CLABSI criteria. We estimated the impact of the new NCT criteria on CLABSI numbers and rates compared to the previous definition. Methods: At our facility, the T2Candida Panel (T2), an NCT, was implemented for clinical use for the detection of early candidemia and invasive candidiasis. The T2 is a rapid molecular test performed directly on blood samples to detect DNA of 5 Candida spp: C. albicans/C. tropicalis, C. glabrata/C. krusei, and C. parapsilosis. In this retrospective study performed at an 877-bed teaching hospital in Detroit, we reviewed the impact of discordant T2 results (positive T2 with negative blood cultures) on CLABSI rates from January 1, 2017, to September 30, 2019, based on the current definition, and we applied the revised criteria to estimate the new CLABSI numbers and rates for the same period. Results: Of 343 positive T2 results, 202 (58.9%) were discordant and qualified for CLABSI determination during the study period. Of these, 109 (54%) met CLABSI criteria based on the current definition and 11 (5%) met CLABSI criteria using the new definition (proportional P < .001), resulting in an 89.9% reduction. The CLABSI rate per 1,000 central-line days, which includes discordant T2 results, based on the current and new NCT criteria, are listed in Table 1. Conclusions: In institutions that utilize NCT such as T2, application of the new 2020 NCT NHSN definition would significantly reduce the CLABSI number and have a significant impact on the CLABSI rates and standardized infection ratios (SIRs).Funding: NoneDisclosures: None

scholarly journals Reduction of Central-Line–Associated Bloodstream Infections in a Spinal Cord Injury Unit

2020 ◽  
Vol 41 (S1) ◽  
pp. s370-s370
Author(s):  
Stephanie L. Baer ◽  
Amy Halcyon Larsh ◽  
Annalise Prunier ◽  
Victoria Thurmond ◽  
Donna Goins ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Patient Population ◽  
Bloodstream Infections ◽  
Central Line ◽  
Fiscal Year ◽  
Improvement Project ◽  
Central Lines ◽  
Cord Injury ◽  
Bundle Compliance

Background: Central-line–associated bloodstream infections (CLABSIs) are a complication of indwelling central venous catheters, which increase morbidity, mortality, and cost to patients. Objective: Due to increased rates in a spinal cord injury unit (SCIU), a performance improvement project was started to reduce CLABSI in the patient population. Methods: To reduce the incidence of CLABSI, a prevention bundle was adopted, and a peer-surveillance tool was developed to monitor compliance with the bundle. Staff were trained to monitor their peers and submit weekly surveillance. Audits were conducted by the clinical nurse leader with accuracy feedback. Bundle peer-surveillance was implemented in February of 2018 with data being fed back to leadership, peer monitors, and stakeholders. Gaps in compliance were addressed with peer-to-peer education, changes in documentation requirements, and meetings to improve communication and reduce line days. In addition, the use of an antiseptic-impregnated disc for vascular accesses was implemented for dressing changes. Further quality improvement cycles during the first 2 quarters of fiscal year 2019 included service-wide education reinforcement, identification in variance of practice, and reporting to staff and stakeholders. Results: CLABSI bundle compliance increased from 67% to 98% between February and October 2018. The weekly audit reporting accuracy improved from 33% to 100% during the same period. Bundle compliance was sustained through the fourth quarter of 2019 at 98%, and audit accuracy was 99%. The initial CLABSI rates the quarter prior to the intervention were 6.10 infections per 1,000 line days for 1 of the 3 SCIUs and 2.68 infections per 1,000 line days for the service overall. After the action plan was initiated, no CLABSIs occurred for the next 3 quarters in all SCIUs despite unchanged use of central lines (5,726 line days in 2018). The improvement was sustained, and the line days decreased slightly for 2019, with a fiscal year rate of 0.61 per 1,000 line days (ie, 3 CLABSIs in 4,927 central-line days). Conclusions: The incidence of CLABSI in the SCIU was reduced by an intensive surveillance intervention to perform accurate peer monitoring of bundle compliance with weekly feedback, communication, and education strategies, improvement of the documentation, and the use of antiseptic-impregnated discs for dressings. Despite the complexity of the patient population requiring long-term central lines, the CLABSI rate was greatly impacted by evidence-based interventions coupled with reinforcement of adherence to the bundle.Funding: NoneDisclosures: None

scholarly journals 81. Reducing Unnecessary Blood Cultures Through Diagnostic Stewardship

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S157-S157
Author(s):  
Sujeet Govindan ◽  
Luke Strnad
Keyword(s):  
Blood Culture ◽  
Positive Blood Culture ◽  
Cost Savings ◽  
Bloodstream Infections ◽  
Central Line ◽  
Blood Cultures ◽  
Coagulase Negative Staphylococci ◽  
Candida Sp ◽  
Daily Frequency ◽  
Oregon Health

Abstract Background At our institution, we learned the frequency of blood cultures was sometimes being changed from “Once” to “Daily” without a defined number of days. We hypothesized this led to unnecessary blood cultures being performed. Methods Over a 3 month period from 12/6/2019-3/6/2020, we retrospectively evaluated the charts of patients who had a blood culture frequency changed to “Daily”. We evaluated if there was an initial positive blood culture within 48 hours of the “Daily” order being placed and the number of positive, negative, or “contaminant” sets of cultures drawn with the order. Contaminant blood cultures were defined as a contaminant species, present only once in the repeat cultures, and not present in initial positive cultures. Results 95 unique orders were placed with 406 sets of cultures drawn from 89 adults. ~20% of the time (17 orders) the order was placed without an initial positive blood culture. This led to 62 sets of cultures being drawn, only 1 of which came back positive. 78/95 orders had an initial positive blood culture. The most common initial organisms were Staphylococcus aureus (SA) (38), Candida sp (10), Enterobacterales sp (10), and coagulase negative staphylococci (7). 43/78 (55%) orders with an initial positive set had positive repeat cultures. SA (26) and Candida sp (8) were most common to have positive repeats. Central line associated bloodstream infections (CLABSI) were found in 5 of the orders and contaminant species were found in 4 of the orders. 54% of the patients who had a “Daily” order placed did not have positive repeat cultures. The majority of the cultures were drawn from Surgical (40 orders) and Medical (35 orders) services. Assuming that SA and Candida sp require 48 hours of negative blood cultures to document clearance and other species require 24 hours, it was estimated that 51% of the cultures drawn using the "Daily" frequency were unnecessary. Cost savings over a year of removing the "Daily" frequency would be ~&14,000. Data from "Daily" blood culture orders drawn at Oregon Health & Science University from 12/6/2019-3/6/2020 Conclusion Unnecessary blood cultures are drawn when the frequency of blood cultures is changed to "Daily". Repeat blood cultures had the greatest utility in bloodstream infections due to SA or Candida sp, and with CLABSI where the line is still in place. These results led to a stewardship intervention to change blood culture ordering at our institution. Disclosures All Authors: No reported disclosures

scholarly journals Central Line–Associated Bloodstream Infections in Adult Hematology Patients with Febrile Neutropenia An Evaluation of Surveillance Definitions Using Differential Time to Blood Culture Positivity

2013 ◽  
Vol 34 (1) ◽  
pp. 89-92 ◽  
Author(s):  
Joshua T. Freeman ◽  
Anna Elinder-Camburn ◽  
Catherine McClymont ◽  
Deverick J. Anderson ◽  
Mary Bilkey ◽  
...  
Keyword(s):  
Blood Culture ◽  
Febrile Neutropenia ◽  
Positive Predictive Value ◽  
Bloodstream Infections ◽  
Central Line ◽  
Blood Cultures ◽  
National Healthcare ◽  
Culture Positivity ◽  
National Healthcare Safety Network ◽  
Blood Culture Positivity

We used differential time to positivity between central and peripheral blood cultures to evaluate the positive predictive value (PPV) of the National Healthcare Safety Network central line–associated bloodstream infection (CLABSI) surveillance definition among hematology patients with febrile neutropenia. The PPV was 27.7%, which suggests that, when the definition is applied to this population, CLABSI rates will be substantially overestimated.

Obtaining Blood Cultures by Venipuncture versus from Central Lines Impact on Blood Culture Contamination Rates and Potential Effect on Central Line–Associated Bloodstream Infection Reporting

2013 ◽  
Vol 34 (10) ◽  
pp. 1042-1047 ◽  
Author(s):  
John M. Boyce ◽  
Jacqueline Nadeau ◽  
Diane Dumigan ◽  
Debra Miller ◽  
Cindy Dubowsky ◽  
...  
Keyword(s):  
Blood Culture ◽  
Bloodstream Infection ◽  
Hospital Costs ◽  
Cost Savings ◽  
Central Line ◽  
Potential Effect ◽  
Blood Cultures ◽  
Blood Samples ◽  
Central Lines ◽  
Contaminated Blood

Objective.Reduce the frequency of contaminated blood cultures that meet National Healthcare Safety Network definitions for a central line-associated bloodstream infection (CLABSI).Design.An observational study.Setting.A 500-bed university-affiliated hospital.Methods.A new blood culture policy discouraged drawing blood samples from central lines. Phlebotomists were reeducated regarding aseptic technique when obtaining blood samples by venipuncture. The intravenous therapy team was taught how to draw blood samples by venipuncture and served as a backup when phlebotomists were unable to obtain blood samples. A 2-nurse protocol and a special supply kit for obtaining blood samples from catheters were developed. Rates of blood culture contamination were monitored by the microbiology laboratory.Results.The proportion of blood samples obtained for culture from central lines decreased from 10.9% during January–June 2010 to 0.4% during July–December 2012 (P< .001). The proportion of blood cultures that were contaminated decreased from 84 (1.6%) of 5,274 during January–June 2010 to 21 (0.5%) of 4,245 during January–June 2012 (P< .001). Based on estimated excess hospital costs of $3,000 per contaminated blood culture, the reduction in blood culture contaminants yielded an estimated annualized savings of $378,000 in 2012 when compared to 2010. In mid-2010, 3 (30%) of 10 reported CLABSIs were suspected to represent blood culture contamination compared with none of 6 CLABSIs reported from mid-November 2010 through June 2012 (P= 0.25).Conclusions.Multiple interventions resulted in a reduction in blood culture contamination rates and substantial cost savings to the hospital, and they may have reduced the number of reportable CLABSIs.

scholarly journals A Bundled Approach to Decrease the Rate of Primary Bloodstream Infections Related to Peripheral Intravenous Catheters

2018 ◽  
Vol 23 (1) ◽  
pp. 15-22 ◽  
Author(s):  
Mary Duncan ◽  
Patricia Warden ◽  
Stéphanie F. Bernatchez ◽  
Dan Morse
Keyword(s):  
Lower Risk ◽  
Compliance Rate ◽  
Bloodstream Infections ◽  
Central Line ◽  
Risk Of Infection ◽  
Intervention Period ◽  
Central Lines ◽  
Intravenous Line ◽  
Study Intervention ◽  
Intravenous Catheters

Abstract Background: Peripheral intravenous catheters (PIVs) have been considered as having lower risk of infection than central lines. However, research is limited regarding numbers of primary bloodstream infections related to peripheral lines and prevention of peripheral line-associated bloodstream infections (PLABSI). Methods: Our aim was to create and monitor compliance with a new PIV maintenance bundle using disinfecting caps and tips and to assess whether this bundle would lead to a decrease in PLABSI rates. Weekly audits were conducted to measure compliance with both the new PIV bundle and our existing central line-associated bloodstream infection (CLABSI) bundle. We also audited the disconnection method used for intravenous line tubing (peripheral and central lines) before and during the study intervention period. Results: A compliance rate of close to 90% with the use of the disinfecting caps and tips was attained. Using a PLABSI bundle successfully decreased primary bloodstream infections due to PIVs (from 0.57 infections per 1000 patient-days preintervention to 0.11 infections per 1000 patient-days; p &lt; 0.001). We confirmed that improving care for PIVs would decrease primary bloodstream infections associated with these devices. Conclusions: Using a PIV maintenance bundle including disinfecting caps and tips can effectively lower the rate of primary bloodstream infections attributable to PIV lines.

scholarly journals Blood Culturing Practices at an Academic Medical Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s142-s143
Author(s):  
Priya Sampathkumar ◽  
Kyle Rodino ◽  
Stacy (Tram) Ung
Keyword(s):  
Blood Culture ◽  
Care Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Central Line ◽  
Blood Cultures ◽  
High Rate ◽  
Contamination Rate ◽  
Blood Samples ◽  
Central Lines

Background: Blood cultures are part of the evaluation of hospital patients with fever. Patients with central lines in place, frequently have blood samples for culture drawn through lines. We sought to assess blood culturing practices at our institution. Methods: Retrospective review of BCs performed in hospitalized patients over a 12-month period (August 2018–July 2019) at an academic, tertiary-care center with 1,297 licensed beds and >62,000 admissions a year. A specialized phlebotomy team is involved in all peripherally drawn blood samples; however, the patient’s nurse obtains a blood sample through a central line. Results: Overall, 35,121 blood cultures were performed for an incidence rate of 106 BC per 1,000 patient days or 566 blood cultures per 1,000 admissions. Most blood samples (67%) were collected via peripheral venipuncture. We detected significant variation in culturing rates and the proportion of blood samples obtained through central lines among collecting units (Table 1). Overall, the blood culture contamination rate was 1.6%. Blood samples obtained through a central line had a higher contamination rate (2.2%) compared to samples obtained through peripheral venipuncture (1.3%; P < .0001). Blood culture rates were highest in intensive care units (ICUs) compared with other types of patient care units (Table 1). The blood culture positivity rate was significantly lower in ICUs (8.8%) compared with hematology-oncology (10%; HR, 0.88; CI, 0.80–0.96; P = .006), general medicine (10%; HR, 0.88; CI, 0.80–0.97; P = .013), and pediatrics (12%; HR, 0.74; CI, 0.59–0.92; P = .008). The ICUs had the lowest rate of BC contamination at 1.3%. Conclusions: Blood samples obtained through central lines for culture are more likely to be contaminated than peripherally drawn blood samples. Despite a relatively high rate of line-drawn blood samples for culture, ICUs had the lowest BC contamination rate, possibly reflecting high familiarity of ICU nurses with line draws. Blood samples collected through lines were most frequently performed in pediatrics and hematology-oncology, and these units had correspondingly higher rates of contamination. This information will be used to inform institutional guidelines on blood culturing and to identify ways to minimize blood culture contamination, which often results in additional testing and/or unnecessary antimicrobial use.Funding: NoneDisclosures: Consulting fee- Merck (Priya Sampathkumar)

From kamishibai card to key card: a family-targeted quality improvement initiative to reduce paediatric central line-associated bloodstream infections

2020 ◽  
Vol 30 (1) ◽  
pp. 72-81
Author(s):  
Ranjith Kamity ◽  
Melissa Grella ◽  
Maureen L Kim ◽  
Meredith Akerman ◽  
Maria Lyn Quintos-Alagheband
Keyword(s):  
Bloodstream Infections ◽  
Central Line ◽  
Quality Improvement Initiative ◽  
Successful Implementation ◽  
Plain Language ◽  
Audit Process ◽  
Frontline Staff ◽  
Central Lines ◽  
Bundle Compliance ◽  
Clabsi Rate

BackgroundCentral line-associated bloodstream infections (CLABSIs) are major contributors to preventable harm in the inpatient paediatric setting. Despite multiple guidelines to reduce CLABSI, sustaining reliable central line maintenance bundle compliance remains elusive. We identified frontline and family engagement as key drivers for this initiative. The baseline CLABSI rate for all our paediatric inpatient units (January 2016–January 2017) was 1.71/1000 central line days with maintenance bundle compliance at 87.9% (monthly range 44%–100%).ObjectiveTo reduce CLABSI by increasing central line maintenance bundle compliance to greater than 90% using kamishibai card (K-card) audits and family ‘key card’ education.MethodsWe transitioned our central line maintenance bundle audits from checklists to directly observed K-card audits. K-cards list the central line maintenance bundle elements to be reviewed with frontline staff. Key cards are cue cards developed using a plain-language summary of CLABSI K-cards and used by frontline staff to educate families. Key cards were distributed to families of children with central lines to simultaneously engage patients, families and frontline staff after a successful implementation of the K-card audit process. A survey was used to obtain feedback from families.ResultsIn the postintervention period (February 2017–December 2019), our CLABSI rate was 0.63/1000 central line days, and maintenance bundle compliance improved to 97.1% (monthly range 86%–100%, p<0.001). Of the 45 family surveys distributed, 20 (44%) were returned. Nineteen respondents (95%) reported being extremely satisfied with the key card programme and provided positive comments.ConclusionCombining the key card programme with K-card audits was associated with improved maintenance bundle compliance and a reduction in CLABSI. This programme has the potential for use in multiple healthcare improvement initiatives.

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