Central Venous Catheter-Associated Bloodstream Infections in Hemodialysis Patients: Another Patient Safety Bundle?

In a previous issue ofThe Canadian Journal of Infectious Diseases & Medical Microbiology, we reviewed the 'Safer Healthcare Now!' campaign's focus on reducing central venous catheter (CVC)-associated bloodstream infections (BSIs) as a way of improving patient safety (1). This initiative is focused on preventing CVC-associated BSIs in intensive care units. However, other patient groups are also at risk for CVC-related BSIs, suggesting that there are other individuals who would benefit from preventive efforts. A 1996 hospital-wide survey of nosocomial bacteremia in an Israeli university hospital (2) found that 9% of infected patients were on chronic hemodialysis. Surveillance in 73 hospitals in England between 1997 and 2001 found a CVC BSI rate of 21/1000 nephrology patients at risk who were hospitalized in teaching hospitals (3). This rate was similar to that found in special care neonatal units, although not quite one-half that of patients in a general intensive care unit. In a population-based survey performed in the Calgary Health Region from 2000 to 2002 (4), hemodialysis (HD) posed the greatest risk (RR 208.7; 95% CI 142.9 to 296.3) for acquiring severe BSI.

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Central venous catheter bundle implementation in an intensive care unit in Kuwait: Effect on central line-associated bloodstream infections

10.26226/morressier.56d5ba30d462b80296c95453 ◽

2016 ◽

Author(s):

Mona Salama

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Central Venous Catheter ◽

Bloodstream Infections ◽

Venous Catheter ◽

Central Line ◽

Central Venous

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Central venous catheter-related bloodstream infections in the intensive care unit

Indian Journal of Critical Care Medicine ◽

10.4103/0972-5229.92074 ◽

2011 ◽

Vol 15 (4) ◽

pp. 213-223 ◽

Cited By ~ 15

Author(s):

Virendra C. Patil ◽

Harsha V. Patil ◽

M. N. Ramteerthkar ◽

R. D. Kulkarni

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Central Venous Catheter ◽

Bloodstream Infections ◽

Venous Catheter ◽

Central Venous

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Prevention of Central Venous Catheter-Associated Bloodstream Infections in Pediatric Intensive Care Units A Performance Improvement Collaborative

Infection Control and Hospital Epidemiology ◽

10.1086/598341 ◽

2009 ◽

Vol 30 (7) ◽

pp. 645-651 ◽

Cited By ~ 82

Author(s):

Howard E. Jeffries ◽

Wilbert Mason ◽

Melanie Brewer ◽

Katie L. Oakes ◽

Esther I. Mufioz ◽

...

Keyword(s):

Intensive Care ◽

Central Venous Catheter ◽

Pediatric Intensive Care ◽

Bloodstream Infections ◽

Venous Catheter ◽

Evidence Based ◽

Central Venous ◽

Improvement Project ◽

Team Members ◽

Prevention Interventions

Objective.The goal of this effort was to reduce central venous catheter (CVC)-associated bloodstream infections (BSIs) in pediatric intensive care unit (ICU) patients by means of a multicenter evidence-based intervention.Methods.An observational study was conducted in 26 freestanding children's hospitals with pediatric or cardiac ICUs that joined a Child Health Corporation of America collaborative. CVC-associated BSI protocols were implemented using a collaborative process that included catheter insertion and maintenance bundles, daily review of CVC necessity, and daily goals. The primary goal was either a 50% reduction in the CVC-associated BSI rate or a rate of 1.5 CVC-associated BSIs per 1,000 CVC-days in each ICU at the end of a 9-month improvement period. A 12-month sustain period followed the initial improvement period, with the primary goal of maintaining the improvements achieved.Results.The collaborative median CVC-associated BSI rate decreased from 6.3 CVC-associated BSIs per 1,000 CVC-days at the start of the collaborative to 4.3 CVC-associated BSIs per 1,000 CVC-days at the end of the collaborative. Sixty-five percent of all participants documented a decrease in their CVC-associated BSI rate. Sixty-nine CVC-associated BSIs were prevented across all teams, with an estimated cost avoidance of $2.9 million. Hospitals were able to sustain their improvements during a 12-month sustain period and prevent another 198 infections.Conclusions.We conclude that our collaborative quality improvement project demonstrated that significant reduction in CVC-associated BSI rates and related costs can be realized by means of evidence-based prevention interventions, enhanced communication among caregivers, standardization of CVC insertion and maintenance processes, enhanced measurement, and empowerment of team members to enforce adherence to best practices.

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