Impact of Phlebotomist-Only Venipuncture and Central Line Avoidance for Blood Culture in a Large Tertiary Care University Hospital

Objective: To determine the frequency of Ventilator associated Pneumonia (VAP), Central Line Associated Blood Stream Infection (CLABSI) and Catheter Associated Urinary Tract infection (CAUTI) by using standardized criteria established by Center of disease control and prevention. Study Design: Cross-sectional study. Setting: PICU of Aga Khan University Hospital (AKUH). Period: (August 2015 to January 2016). Material & Methods: Data was collected on a pre-coded proforma. Data was entered and analyzed through SPSS. Results: 156 patients were enrolled. 102 (65.4%) were male. Mean age was 57.59 months. Mean length of stay was 5.6 days. Patient and Device days were 546 and 958 respectively. Device utilization ratio was 0.56. Four Device associated infections (DAI) were identified during study period with a DAI Rate of 4.17 per 1000 device days. All DAI were CLABSIs. Enterococcus was the most frequent bacterial isolate. Conclusion: DAI are highly prevalent in low resource countries, especially in intensive care areas including PICUs. In our setup, CLABSI are increasing while VAP and CAUTI are decreasing.

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Who needs prenatal counselling with a pediatric surgeon? Experience from a large tertiary care university hospital

Journal of Perinatal Medicine ◽

10.1515/jpm-2021-0130 ◽

2022 ◽

Vol 0 (0) ◽

Author(s):

Alizée Froeliger ◽

Luke Harper ◽

Sara Tunon de Lara ◽

Frédéric Lavrand ◽

Maya Loot ◽

...

Keyword(s):

Tertiary Care ◽

Fetal Mri ◽

University Hospital ◽

First Year ◽

Pediatric Surgeon ◽

Prenatal Consultation ◽

Prenatal Counselling ◽

Large Tertiary Care ◽

Surgeon Experience ◽

First Year Of Life

Abstract Objectives To describe our experience with prenatal counselling for surgical anomalies in a large volume center. The secondary aim is to suggest a list of prenatal abnormalities warranting counselling by a pediatric surgeon. Methods We reviewed all prenatal counselling consultations performed by the pediatric surgery team between January 1st, 2015 and December 31st, 2016. Results A total of 169 patients or couples had a prenatal consultation with a pediatric surgeon. Prenatal work-up included a fetal MRI in 26% of cases, mainly for digestive and thoracic pathologies (56.1% of cases). Consultation with the pediatric surgeon led mainly to recommendations concerning the place of delivery. Induction for reasons related to the fetal anomaly occurred in 22.2% of cases. Most children were surgically treated within the first year of life (63.5%). Correlation between predicted prognosis and actual status at four years of life was 96.9%. Correlation between prenatal and postnatal diagnosis was 87.4%. Conclusions Prenatal counselling by a pediatric surgeon allows couples to obtain clear information on the pathology of their unborn child, giving them greater autonomy in their decision to continue the pregnancy.

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CLABSI reduction using evidence based interventions and nurse empowerment: a quality improvement initiative from a tertiary care NICU in Pakistan

Archives of Disease in Childhood ◽

10.1136/archdischild-2019-318779 ◽

2020 ◽

pp. archdischild-2019-318779

Author(s):

Ali Shabbir Hussain ◽

Anjum Mohyuddin Ahmed ◽

Saba Arbab ◽

Shabina Ariff ◽

Rehan Ali ◽

...

Keyword(s):

Quality Improvement ◽

Neonatal Intensive Care ◽

Fungal Infections ◽

Tertiary Care ◽

Central Line ◽

University Hospital ◽

Quality Improvement Initiative ◽

Evidence Based ◽

Post Intervention ◽

Nurse Empowerment

ObjectiveCentral line associated bloodstream infection (CLABSI) is an important cause of morbidity and mortality in the neonatal intensive care unit (NICU). We designed a CLABSI Prevention Package (CPP) to decrease NICU CLABSI rates, using evidence-proven interventions.DesignThis was a quality improvement (QI) project. Data collection was divided into three phases (pre-implementation, implementation and post implementation). SQUIRE2.0 guidelines were used to design, implement and report this QI initiative.SettingA tertiary care level 3 NICU at the Aga Khan University Hospital (AKUH), Karachi, Pakistan.PatientsAll patients admitted to the AKUH NICU from 1 January 2016 to 31 March 2018 who had a central line in place during their NICU admission.InterventionsCPP used evidence-based interventions focusing on hand hygiene, aseptic central line insertion techniques and central line care, prevention of fungal infections and nurse empowerment.Main outcome measuresCLABSI rates pre and post intervention were recorded. Secondary outcomes were risk factors for CLABSI, device (central line) utilisation ratio, CLABSI related mortality and micro-organism profile.ResultsCLABSI rates decreased from 17.1/1000 device days to 5.0/1000 device days (relative risk (RR)=0.36, CI=0.17–0.74). Device (central line) utilisation ratio declined from 0.30 to 0.25. Out of 613 patients enrolled in our study, 139 (22.7%) died. Mortality was higher in CLABSI group (n=20, 44%) as compared with non CLABSI group (n=119, 21.1%) (p<0.001). Gestational age of <27 weeks was an independent risk factor for CLABSI (RR=4.45, CI=1.10–18.25, p=0.03). A total of 158 pathogens were isolated among which 68 were associated with CLABSI. Gram-negative bacteria 31 (47.7%) were the most common cause of CLABSI. Ninety-seven (61%) micro-organisms were multi-drug resistant.ConclusionsCPP was effective in decreasing NICU CLABSI rates and can be used as a model to decrease NICU CLABSI rates in low or middle-income countries.

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The Impact of COVID-19 Response on Central Line Associated Bloodstream Infections and Blood Culture Contamination Rates at a Tertiary Care Center in Greater Detroit Area

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1335 ◽

2020 ◽

pp. 1-15

Author(s):

Jennifer LeRose ◽

Avnish Sandhu ◽

Jordan Polistico ◽

Joe Ellsworth ◽

Mara Cranis ◽

...

Keyword(s):

Blood Culture ◽

Care Center ◽

Tertiary Care ◽

Bloodstream Infections ◽

Blood Stream ◽

Central Line ◽

Tertiary Care Center ◽

Blood Stream Infections ◽

Detroit Area ◽

The Impact

Abstract A comparative retrospective study to quantify the impact of Coronavirus Disease 2019 (COVID-19) on patient safety. We found a statistically significant increase in central line-associated blood stream infections and blood culture contamination rates during the pandemic. Increased length of stay and mortality was also observed during COVID-19.

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Central Line Associated Blood Stream Infection : A Prospective Study in Intensive Care of Tertiary Care Children’s University Hospital

Egyptian Journal of Pediatrics ◽

10.12816/0054725 ◽

2019 ◽

Vol 36 (3-4) ◽

pp. 565-579

Author(s):

Dalia A. Abdel Rahman ◽

Rania M. Amer ◽

Amany M. Abd Allah

Keyword(s):

Intensive Care ◽

Prospective Study ◽

Blood Stream Infection ◽

Tertiary Care ◽

Blood Stream ◽

Central Line ◽

University Hospital ◽

A Prospective Study

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Effectiveness of Implementing a Locally Developed Antibiotic Use Guideline for Community-Acquired Cellulitis at a Large Tertiary Care University Hospital in Thailand

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa411 ◽

2020 ◽

Vol 7 (10) ◽

Author(s):

Rujipas Sirijatuphat ◽

Pornboonya Nookeu ◽

Visanu Thamlikitkul

Keyword(s):

Antibiotic Treatment ◽

Broad Spectrum ◽

Group Treatment ◽

Tertiary Care ◽

Antibiotic Use ◽

University Hospital ◽

Local Data ◽

Interactive Education ◽

Large Tertiary Care ◽

Antibiotic Combination

Abstract Background To determine the effectiveness of implementing a locally developed clinical practice guideline (CPG) for antibiotic treatment in adults with community-acquired cellulitis at Siriraj Hospital in Bangkok, Thailand. Methods The CPG for antibiotic treatment of community-acquired cellulitis was developed based on local data during June to December 2016. The CPG was introduced by multifaceted interventions, including posters, brochures, circular letters, social media, conference, classroom training, and interactive education during January to September 2018. Results Among 360 patients with community-acquired cellulitis, 84.4% were ambulatory and 15.6% were hospitalized. The median age of patients was 62 years, and 59.4% were female. Antibiotic prescription according to CPG (CPG-compliant group) was observed in 251 patients (69.7%), and CPG noncompliance was found in 109 patients (30.3%) (CPG-noncompliant group). The demographics and characteristics of patients were comparable between groups. Patients in the CPG-compliant group had a significantly lower rate of intravenous antibiotics (18.7% vs 33.9%, P = .007), lower prescription rate of broad-spectrum antibiotics (14.7% vs 78.9%, P < .001) and antibiotic combination (6.4% vs 13.8%, P = .022), shorter median duration of antibiotic treatment (7 vs 10 days, P < .001), lower median cost of antibiotic treatment (US $3 vs $7, P < .001), and lower median hospitalization cost (US $601 vs $1587, P = .008) than those in the CPG-noncompliant group. Treatment outcomes were not significantly different between groups. Conclusions Adherence to CPG seems to reduce inappropriate prescription of broad-spectrum antibiotic or antibiotic combination and treatment costs in adults with community-acquired cellulitis without differences in favorable outcomes or adverse events.

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