scholarly journals Assessing effect of catheter type and position on central line-associated bloodstream infections in the NICU

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e59-e59 ◽  
Author(s):  
Ariane Leveillee ◽  
Anie Lapointe ◽  
Christian Lachance ◽  
Myriam Descarries ◽  
Julie Autmizguine ◽  
...  
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Dwell Time ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Catheter Insertion ◽  
Significant Difference ◽  
Picc Line ◽  
Clabsi Rate

Abstract BACKGROUND Central venous catheter usage in NICU remains associated with serious complications such as bloodstream infection. Also, low position (underdiaphragmatic) of umbilical venous catheter (UVC) is tolerated despite not recommended. To our knowledge, no previous study assessed the effect of such a position on central line associated bloodstream infections (CLABSI) rates in the NICU. OBJECTIVES The primary objectives of this study were to assess global CLABSI rates for each central catheter subtype and position, and specific rates according to birth weight and gestational age. Dwell time before infection and microorganisms involved were also evaluated. DESIGN/METHODS For this retrospective cohort study, all neonates hospitalized in Level 3 NICU, from April 1st 2011 to March 31st 2016, in whom a central line was inserted, were included. Data about catheter insertion, demographic characteristics and bloodstream infections was extracted from local CVC database, local CLABSI database, patient medical record, post catheter insertion X-rays and Canadian Neonatal Network database. Difference in CLABSI rates and type of microorganisms involved were analyzed using Cox regression and Chi2. Difference in dwell time was analyzed using a one-way ANOVA and evolution in time of the proportion of each type of catheter presented as observational data. RESULTS A total of 1577 neonates were included and 2440 CVC were studied. Median gestational age (GA) was 30 2/7 [26 6/, 37] weeks and birth weight (BW) was 1310 [680, 2796] g. Of the 2440 neonates, 1308 were boys (53.6%). There was a total of 197 CLABSI. Total number of catheter days over the study period was 23 479 days. CLABSI rate for high UVC was 11.49 per 1000 catheter days compared to 6.92 for PICC line (p < 0.001) and 5.14 for femoral CVC (p = 0.008). CLABSI rate for low UVC was 17.31 per 1000 catheter days (p = 0.002 when compared to high UVC). Median dwell time before infection is 7 days for high UVC, 5 days for low UVC and 11 days for PICC (p < 0.001). Microorganism involved in CLABSI was a majority of Coagulase-negative Staphylococcus in 57.1–71.9% without a statistically significant difference between groups (p= 0.33). CONCLUSION Evolution of CVC usage over years remained stable. CLABSI rates are significantly higher with all UVC compared with PICC line and femoral CVC, particularly for newborn < 1500g and < 32 weeks of GA. Low UVC are associated to higher CLABSI rates than high UVC. Health professionals should be cautious with indwelling UVC, especially when in low position. They might conisder replacing low lines by a PICC as soon as possible.

scholarly journals 771. COVID-19 on the Line: A Significant Increase in CLABSI in Hospitalized Patients with COVID-19 at a Major Teaching Hospital

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S482-S483
Author(s):  
Pishoy Haroun ◽  
Michael Ben-Aderet ◽  
Meghan Madhusudhan ◽  
Matthew J Almario ◽  
Ryan C Raypon ◽  
...  
Keyword(s):  
Real Time ◽  
Teaching Hospital ◽  
Nurse Staffing ◽  
Bloodstream Infections ◽  
Central Line ◽  
Contributing Factors ◽  
Subjective Data ◽  
Significant Difference ◽  
The Impact ◽  
Clabsi Rate

Abstract Background We observed an increase in central line associated bloodstream infections (CLABSI) associated with the 2020 COVID-19 pandemic and performed a retrospective analysis to better understand the impact of COVID-19 on CLABSI rates. Figure 1. CLABSI rate in 2019 vs CLABSI rate in 2020 A comparison of CLABSI rates (displayed in infections/1000 catheter days) in all adult inpatients at our institution for calendar-years 2019 and 2020 Methods Retrospective review was done for all CLABSI in adults meeting National Healthcare Safety Network (NHSN) criteria in 2020 at an 889-bed teaching hospital. CLABSIs in encounters with PCR-confirmed COVID-19 (COVID CLABSI) were compared with CLABSIs in encounters without a COVID diagnosis (non-COVID CLABSI). As a secondary analysis, we also reviewed all CLABSI occurrence in 2019. Characteristics were compared using Mid-P Exact (Poisson) and Chi Squared (categorical) Tests. Subjective data collected by infection preventionists during real-time case reviews with clinical staff of each CLABSI was also reviewed. Results In 2020, the rate of COVID CLABSI (CLABSI/1000 catheter days) was 6.6 times greater than the rate of non-COVID CLABSI (5.47 vs. 0.83, p&lt; 0.001). In the COVID CLABSI group we observed higher rates of occurrence in the ICU setting (94% vs 28%, p&lt; 0.001), in house mortality (53% vs 26% P=0.0187), presence of arterial lines (91% vs 20%, p&lt; 0.001) and increased number of catheter lumens (4 vs 3, p&lt; 0.001). No significant difference was observed in the distribution of pathogens. No significant differences were observed between 2019 CLABSI and 2020 non-COVID CLABSI. Real-time case reviews identified changes in nurse staffing, increased nurse: patient ratios, delays in routine central line dressing changes, and inconsistent use of alcohol-impregnated port protectors as possible contributing factors. Table 1. 2020 COVID CLABSI vs 2020 non-COVID CLABSI A comparison of selected patient and catheter characteristics in COVID CLABSI vs non-COVID CLABSI in 2020 Table 2. 2019 CLABSI vs 2020 non-COVID CLABSI A comparison of selected patient and catheter characteristics in CLABSI in 2019 vs non-COVID CLABSI in 2020 Figure 2. CLABSI rate in 2019 vs COVID CLABSI and non-COVID CLABSI in 2020 A comparison of CLABSI rates (displayed in infections/1000 catheter days) in all adult inpatients at our institution for calendar years 2019 and 2020, with the infections in 2020 divided into those that occurred during an encounter with a PCR -confirmed diagnosis of COVID-19 and those without. Conclusion We observed a dramatically higher rate of CLABSI in patients with COVID-19 in 2020, while the rate of CLABSI in patients without COVID-19 remained unchanged from the year prior. Higher rates of ICU admission, critical illness, increased numbers of lumens, increased presence of arterial lines, nurse staffing changes, and gaps in routine line prevention processes associated with emergency measures in the COVID-19 cohort ICU may have contributed to this finding. Further work is needed to better understand how to minimize process-related disruptions in central line care during a hospital response to a pandemic. Disclosures Jonathan Grein, MD, Gilead (Other Financial or Material Support, Speakers fees)

CE Article: A Quality Improvement Approach in Standardizing Pediatric Central Venous Catheter Dressings and Its Impact on the Reduction of Central Line-Associated Bloodstream Infections and Costs

2019 ◽  
Vol 24 (2) ◽  
pp. 11-19
Author(s):  
Christopher Kramer ◽  
Darcy Doellman ◽  
Casey Blaser ◽  
Robin Huneke Rosenberg ◽  
Stéphanie F. Bernatchez
Keyword(s):  
Quality Improvement ◽  
Central Venous Catheter ◽  
Pediatric Patients ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Central Venous ◽  
Clabsi Rate

Highlights A CVC dressing inventory is beneficial to pediatric patients. Dressing standardization reduced unplanned dressing changes and costs. In our study, the new dressing inventory helped reduce the CLABSI rate.

scholarly journals Association of Calcium Supplementation During Pregnancy with the Birth Weight of Single-Born Neonates in Rural Northwest China

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1106-1106
Author(s):  
Gao Xiangyu ◽  
Mi Baibing ◽  
Dang Shaonong ◽  
Yan Hong
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Regression Models ◽  
Calcium Supplementation ◽  
Northwest China ◽  
Incidence Rates ◽  
Shaanxi Province ◽  
Significant Difference ◽  
Birth Weight Percentile ◽  
Weight Percentile

Abstract Objectives To investigate the association of calcium supplementation during the pregnancy with the birth weight of single-born neonates. Methods The survey employed a multistage, stratified and random sampling to investigate 15–49 aged pregnant women in 2010 to 2013 in Shaanxi province. A self - designed questionnaire was utilized. Birth weight between the 10(th) and 90(th) percentile was classified as appropriate for gestational age(AGA) infants. Chi-square test and logistic regression models were conducted to evaluate the association of calcium supplementation with single-born neonatal birth weight. Results A total of 28,490 women was enrolled in this study, 17 349 (60.9%) of participants had calcium supplementation during pregnancy. The incidence rates of small and large gestational age infants were 13.5% and 8.3%, respectively. The study conducted that calcium supplementation had a statistically significant difference in SGA (birth weight percentile &lt;10) (P &lt; 0.01). After adjusting the regression models by confounding factors, we found that calcium supplementation was still protective towards SGA birth, the difference was statistically significant (OR = 0.89, 95% CI: 0.82–0.96, P &lt; 0.05), but there was no significant difference in the birth to LGA (birth weight percentile &lt;10). Conclusions Calcium supplementation during pregnancy reduced the risk of SGA, but was not associated with the birth of LGA. Funding Sources

scholarly journals Central line associated bloodstream infections in cohort of abdominal surgical patients

2013 ◽  
Vol 60 (4) ◽  
pp. 23-30
Author(s):  
Vesna Mioljevic ◽  
Miroslav Milicevic ◽  
Vesna Bumbasirevic ◽  
Vesna Suljagic
Keyword(s):  
Risk Factors ◽  
Amino Acids ◽  
Intensive Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Aseptic Technique ◽  
Candida Spp ◽  
Anatomic Site ◽  
Study Results ◽  
Significant Difference

INTRODUCTION: Central venous catheter (CVC) placement is an unavoidable part of the everyday medical practice. At the same time CVC application is associated with high risk of development of central line-associated bloodstream infections (CLABSIs). These infections are cause of icreased morbidity and mortality rates as well as higer costs of the inpatient treatment2. Risk factors for onset of CLABSIs include duration of catheterization, length of hospital stay before catheterization, anatomic site of placement, CVC placement at the intensive care units (ICU), parenteral nutrition (PN) and ommisions diring CVC placement, use and care. CLABSI incidence rates vary depending on distribution of different risk factors associated with CVC and patient him/herself. The most significant causative organisms of CLABSIs are coagulase-negative Staphylococcocae, Staphylococcus aureus (S.aures), Enterococcus spp. i Candida spp. CLABSIs prevention measures include compliance with the rules of the aseptic technique upon placement, use and care of CVCs, which, based on the study results, may enable prevention of 65% to 70% of cases of CLABSIs. METHODS: A prospective cohort study included 200 patients hospitalized at the intensive care and therapy units of the CCS Clinic of Digestive Surgery in the period November 30th, 2006-November 31st, 2007 in whom CVC was placed for more than 48 hours. All the data necessary for the study were obtained based on the review of the case histories and they were recorded into the individual questionnaires for each patient. The questionnarire included patient information (age, gender, underlying disease, presence of other infections), information related to diagnostic and therapeutic procedures to which the patient was exposed. The incidence of CRBSIs in ICU patients, Institute of Digestive Diseases, CCS over the study period was 10.08 per 1,000 catheter-days. During the study CLABSI more often present in the females. Additionally, application of albumin and amino acids, ICU stay longer that 7 days and CVC application longer than 15 days, significantly more often present in patients with CRBSIs than in the group of patients without CRBSIs. Independent factors for development of CRBSI are gender, administration of albumin and amino acids. The most common microorganisms isolated from hemocultures and CVC were S. aureus and Klebsiella spp., with 31,8% of isolates each. Statistically significant difference was evidenced in frequency of resistance of S. aureus isolates to methicillin in the group of patients with CRBSI in comparison to the group of patients without CLABSIs. CLABSIs prevention measurs include compliance with the rules of the aseptic technique upon placement, use and care of CVCs.

Reducing central catheter-associated infections in pediatric surgery clinic: Implementation of a care bundle

2021 ◽  
Vol 11 (1) ◽  
pp. 57-65
Author(s):  
Eda Dolgun ◽  
Okgün Alcan Aliye ◽  
Ayşe Islamoğlu ◽  
Birsen Eroğlu ◽  
Meltem Polat ◽  
...  
Keyword(s):  
Pediatric Surgery ◽  
Healthcare Professionals ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Recovery Process ◽  
Central Line ◽  
Care Bundle ◽  
Central Venous ◽  
Implementation Period ◽  
Bundle Compliance

Purpose: Central line care bundle comprises a few evidence-based interventions for improving patients' outcomes and recovery process. This semi-experimental study aimed to determine the effect of pediatric central line care bundle implementation on central line-associated bloodstream infections (CLABSI) rates. Materials and methods: A central line care bundle was implemented for pediatric surgery patients (n=70). Baseline observations were made to determine the central line care bundle compliance of healthcare professionals for 435 catheter days. Subsequently, physicians and nurses were educated about the central line care bundle. After the implementation period, 722 catheter days were observed to determine post-implementation compliance. Baseline CLABSI rates were compared with post-implementation CLABSI rates. Results: It was found that the entire central line care bundle compliance was 32.4% pre-implementation and 86.3% post-implementation. After education, the physicians' and nurses' central line care bundle compliance showed statistically significant improvement (p= 0.0001). There were five CLABSI events in the pre-implementation period and three CLABSI events in the post-implementation period. It was determined that the number of CLABSI decreased in the post-implementation period compared to the pre-implementation period, but this difference was not statistically significant (p= 0.207). Conclusions: Central line care bundle implementation decreased the CLABSI rates. It is recommended the Implementation of a central line care bundle on the care of pediatric surgery patients with the central venous catheter.

Central Venous Catheter Salvage in Ambulatory Central Line–Associated Bloodstream Infections

PEDIATRICS ◽  
2021 ◽  
Author(s):  
William J.H. Ford ◽  
David G. Bundy ◽  
Suzette Oyeku ◽  
Moonseong Heo ◽  
Lisa Saiman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pediatric Patients ◽  
Secondary Analysis ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Type Number ◽  
Central Venous ◽  
Medical Centers ◽  
Associated Risk Factors

BACKGROUND Guidelines for treatment of central line–associated bloodstream infection (CLABSI) recommend removing central venous catheters (CVCs) in many cases. Clinicians must balance these recommendations with the difficulty of obtaining alternate access and subjecting patients to additional procedures. In this study, we evaluated CVC salvage in pediatric patients with ambulatory CLABSI and associated risk factors for treatment failure. METHODS This study was a secondary analysis of 466 ambulatory CLABSIs in patients &lt;22 years old who presented to 5 pediatric medical centers from 2010 to 2015. We defined attempted CVC salvage as a CVC left in place ≥3 days after a positive blood culture result. Salvage failure was removal of the CVC ≥3 days after CLABSI. Successful salvage was treatment of CLABSI without removal of the CVC. Bivariate and multivariable logistic regression analyses were used to test associations between risk factors and attempted and successful salvage. RESULTS A total of 460 ambulatory CLABSIs were included in our analysis. CVC salvage was attempted in 379 (82.3%) cases. Underlying diagnosis, CVC type, number of lumens, and absence of candidemia were associated with attempted salvage. Salvage was successful in 287 (75.7%) attempted cases. Underlying diagnosis, CVC type, number of lumens, and absence of candidemia were associated with successful salvage. In patients with malignancy, neutropenia within 30 days before CLABSI was significantly associated with both attempted salvage and successful salvage. CONCLUSIONS CVC salvage was often attempted and was frequently successful in ambulatory pediatric patients presenting with CLABSI.

scholarly journals 584. Use of Multi-Disciplinary Prevention Rounds to Reduce Central Line-Associated Bloodstream Infections in a Neonatal Intensive Care Unit

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S275-S276
Author(s):  
Matthew Linam ◽  
Jessica Wright ◽  
Kum Kim ◽  
Cara Van Treek ◽  
Patrick Spafford
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Central Venous Line ◽  
Patient Specific ◽  
Successful Implementation ◽  
Evidence Based ◽  
Clabsi Rate

Abstract Background Despite successful implementation of evidence-based prevention bundles, central line-associated bloodstream infections (CLABSIs) continue to occur in neonatal intensive care units (NICUs). We hypothesized that multi-disciplinary prevention rounds may be able to further reduce CLABSIs. Methods We implemented bedside rounds in a 39-bed tertiary NICU in November 2018 with the focus of reducing CLABSIs. Standardized rounds for all patients with a central venous line (CVL) occurred 2–3 times/week on weekdays during either the day or evening shifts. Rounds included NICU nursing leadership, the Hospital Epidemiologist and the patient’s nurse. Questions focused on the CVL maintenance bundle, reducing line access, and patient-specific CLABSI risk factors. Best practices were reinforced and solutions for identified risk factors were developed. Recommendations were communicated to the physician, as appropriate. Prevention rounds data were collected. Nurses and providers in the NICU were surveyed about their perceptions of the rounds. CLABSIs were identified by Infection Prevention using standard definitions. Results The average daily NICU census was 35.6, with an average of 14 patients with CVLs/day. The average duration of rounds was 45 minutes. Recommendations to physicians, such as changing medications from intravenous to oral or line removal, were accepted 85% of the time. 74.5% of nurses and 87.5% of providers thought that prevention rounds had at least some impact on CLABSI prevention. Nurse and provider responses to the perceived impact of CLABSI prevention rounds are in Tables 1 and 2, respectively. In the 12 months prior to starting prevention rounds, the CLABSI rate was 1.53 /1000 line days and the CLABSI rate for the 6 months after starting rounds was 0.99/1,000 line days, a 65% decrease. Conclusion CLABSI prevention rounds helped reinforce evidence-based prevention practices, identified patient-specific risk factors and improved physician-nurse communication. CLABSIs in NICU were reduced. Disclosures All authors: No reported disclosures.

scholarly journals Impact of a Central Line Infection Prevention Bundle in Newborn Infants

2016 ◽  
Vol 37 (9) ◽  
pp. 1029-1036 ◽  
Author(s):  
Rowena McMullan ◽  
Adrienne Gordon
Keyword(s):  
Neonatal Intensive Care ◽  
Dwell Time ◽  
Clinical Characteristics ◽  
Infection Prevention ◽  
Newborn Infants ◽  
Bloodstream Infections ◽  
Central Line ◽  
Before And After ◽  
Central Line Infection ◽  
Line Infection

OBJECTIVETo compare central line use and central line–associated bloodstream infection in newborn infants before and after the introduction of a central line infection prevention bundle in order to determine the effectiveness of the bundle and to identify areas for further improvement.DESIGNRetrospective cohort analysis of prospectively collected data.SETTINGLevel 5 neonatal intensive care unit in Sydney, Australia.PATIENTSNewborn infants admitted to the Royal Prince Alfred Hospital Neonatal Intensive Care Unit who had a central venous catheter (CVC) inserted.METHODSData regarding clinical characteristics, CVC use, and infection were collected before and after the introduction of a bundle of interventions. The bundles encompassed (1) insertion of CVC, (2) maintenance of CVC, (3) an education program, and (4) ongoing surveillance and feedback.RESULTSBaseline and intervention groups were comparable in clinical characteristics. The number of CVCs inserted was reduced in the intervention group (central line utilization rate, 0.16 vs 0.2, P<.0001). Overall CVC dwell time was reduced, resulting from significant reduction in peripherally inserted CVC dwell time (6 days [95% CI, 5.0–11.8 days] vs 7.3 days [4.0–10.4 days], P=.0004). Central line–associated bloodstream infections were significantly reduced, predominantly secondary to decreased peripherally inserted CVC–related bloodstream infections (1.2/1,000 central line–days vs 11.5/1,000 central line–days, P<.0001).CONCLUSIONThis central line infection bundle was effective in reducing CVC use, dwell time, and central line–associated bloodstream infections.Infect Control Hosp Epidemiol 2016;37:1029–1036

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