The burden of central line-associated bloodstream infections in children with medical complexity

2021 ◽  
pp. 112972982110274
Author(s):  
Alessia Scarselli ◽  
Andrea Smarrazzo ◽  
Francesco De Sanctis ◽  
Lucilla Ravà ◽  
Michaela Carletti ◽  
...  
Keyword(s):  
Pediatric Intensive Care ◽  
Bloodstream Infections ◽  
Neurological Impairment ◽  
Venous Access ◽  
Central Line ◽  
Critically Ill Children ◽  
Candida Spp ◽  
Children With Medical Complexity ◽  
Conservative Strategy ◽  
Medical Complexity

Background: Central line-associated bloodstream infections (CLABSI) are significant cause of complications in pediatric intensive care units (PICUs). An emerging challenge are CLABSIs in children with medical complexity (CMC) admitted to PICU. CMC are patients with chronic conditions with or without neurological impairment needing for tracheostomy and/or home mechanical or non-invasive ventilation and/or gastrostomy/jejunostomy. We evaluate CLABSI incidence in a PICU with high prevalence of CMC. Methods: This was a retrospective study in the PICU of the Bambino Gesù Children Hospital from January 2017 to December 2020. The medical records were reviewed and demographic, clinical and microbiological data were extracted. CLABSI were defined according to the Center for Disease Control and Prevention’s National Healthcare Safety Networks (NHSN) surveillance. Results: A total of 101 children with 125 central lines (CLs) were included; 79/101 (78%) patients were CMC and 50/101 (50%) had a thracheostomy. CLABSI incidence was 2.75/1000 CL-days (9 cases/3269 CL-days); incidence was 0 in patients without underling conditions and 3.14/1000 in CMC ( p < 0.001). CLABSI were due to gram negative bacteria in five patients, Candida spp in three and Staphylococcus hominis in one. CLs were removed in eight cases while in the later one, with CLABSI due to Pseudomonas aeruginosa, a conservative strategy was adopted cause of unavailable alternative venous access and removed at discharge with negative culture. All patients recovered. Conclusions: A target 0% CLABSI was possible in critically ill children without underling condition while a high incidence was reported in CMC and sustained by a peculiar CLABSI ecology. This ecology should be considered when a CLABSI was suspected in CMC for prompt antibiotics stewardship.

scholarly journals Peripheral Inotropes in Critically Ill Children: Is It Safe?

2021 ◽  
Vol 8 ◽  
pp. 2333794X2110222
Author(s):  
Ravi K. Mooli ◽  
Kalaimaran Sadasivam
Keyword(s):  
Central Venous Access ◽  
Pediatric Intensive Care ◽  
Venous Access ◽  
Critically Ill Children ◽  
Middle Income ◽  
Central Lines ◽  
Middle Income Countries ◽  
Peripheral Venous Access ◽  
Vasoactive Medications

Many children needing pediatric intensive care units care require inotropes, which are started peripherally prior to securing a central venous access. However, many hospitals in low- and middle-income countries (LMIC) may not have access to central lines and the vasoactive medications are frequently given through a peripheral venous access. Aim: The aim of our study was to describe the role of peripheral vasoactive inotropes in children. Methods: Children requiring peripheral vasoactive medications were included in this study. We retrospectively collected data at 2 time points on use and complications of peripheral vasoactive medications. Results: Eighty-four children (51 pre-COVID era and 33 COVID pandemic) received peripheral vasoactive medications. Only 3% of children (3/84) developed extravasation injury, all of whom recovered completely. Conclusions: Results from our study suggest that extravasation injury due to peripheral inotrope infusion is very low (3%) and it may be safely administered in children at a diluted concentration.

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.

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

scholarly journals Sustained Reduction and Prevention of Neonatal and Pediatric Central Line-Associated Bloodstream Infection Following a Nurse-Driven Quality Improvement Initiative in a Pediatric Facility

2018 ◽  
Vol 23 (1) ◽  
pp. 30-41 ◽  
Author(s):  
Tracie Savage ◽  
Darci E. Hodge ◽  
Kary Pickard ◽  
Pam Myers ◽  
Kristen Powell ◽  
...  
Keyword(s):  
Infection Control ◽  
Pediatric Intensive Care ◽  
Bloodstream Infections ◽  
Interrupted Time Series ◽  
Central Line ◽  
Quality Improvement Initiative ◽  
Hospital Units ◽  
Patient Morbidity ◽  
Sustained Reduction ◽  
Design And Methods

Abstract Purpose: Hospitals devote significant resources developing protocols to minimize the incidence of central line-associated bloodstream infections (CLABSIs), a source of increased patient morbidity and health care costs; however, few of these protocols, especially centralized protocols, are reported in the literature. This study characterizes the development and effectiveness of a pediatric hospital's centralized CLABSI prevention bundle. Design and Methods: The study was designed as a retrospective interrupted time series to quantify the effectiveness of the prevention bundle that was developed and implemented by nursing leadership in infection control, and both the neonatal and pediatric intensive care units between 2006 and 2014. The study period was subdivided into pre-, peri-, post-, and second peri-intervention periods based on the implementation status of the bundle. Segmented linear regression was used to model and compare the CLABSI rates for each intervention period overall as well as the 5 individual hospital units. Results: The hospital's modeled CLABSI rate during the preintervention period was 3.80 out of 1000 line days and was significantly reduced to 0.45 (P &lt; 0.001). Clear decreases in unit CLABSI rates were observed and all units were below corresponding National Healthcare Safety Network CLABSI rates after the study. Conclusions: The centralized CLABSI prevention bundle reduced and sustained low CLABSI rates overall and within each hospital unit demonstrating the success of the bundle. Practice Implications: A centralized CLABSI prevention bundle can universalize central line care, simplify infection control, and improve quality of care to help sustain low CLABSI rates throughout the hospital.

scholarly journals Glycopyrrolate for Drooling in Children with Medical Complexity Under Three Years of Age

2020 ◽  
Author(s):  
Eleonora Lovardi ◽  
Maria Antonietta De Ioris ◽  
Donatella Lettori ◽  
Caterina Geremia ◽  
Susanna Staccioli ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Neurological Impairment ◽  
The United States ◽  
Response To Treatment ◽  
Anticholinergic Drugs ◽  
Anticholinergic Agent ◽  
Children With Medical Complexity ◽  
Specific Subset ◽  
Impact Scale ◽  
Medical Complexity

Abstract Background: The aim of the study is to determine that Glycopirrolate is safe and effective in decreasing drooling in children with medical complexity under three years of age. Medical treatment is based on anticholinergic drugs as transdermal scopolamine, benzotropine and GLY. GLY (Glycopyrronium bromide) is a synthetic quaternary ammonium anticholinergic agent with poor blood–brain barrier penetration and consequently has limited central effects. Actually, the oral GLY formulation was approved by the United States Food and Drug Administration (FDA) to treat drooling in children aged 3-16 years. Five studies reported on GLY use for the treatment of drooling in children with cerebral palsy and other conditions with neurological impairment; four are prospective studies while one a retrospective review. Methods: this is a case report of eighteen children (sex ratio 11/8, median age 17 months, range 2-36 months) under three years of age, followed by a multidisciplinary team at the Bambino Gesù Children Hospital. The median follow-up was of 31.5 months (range 1-69 months). Response to treatment was assessed according to the Drooling Impact Scale administered at time 0 and after 1 month. All patients have an important neurological impairment: nine patients have a cerebral palsy (Gross Motor Function Classification System class V) and nine a genetic/malformative syndrome. Twelve patients have a tracheostomy and two need mechanical ventilation. Gastrostomy is present in 16 out of 18 patients. All patients received Glycopirrolate. The median starting daily dose was 0.065 mg/kg/die (range 0.02-0.21 mg/kg/die) three times a day. The drooling impact scale was administered at time O and after 1 month. Results: Four out 18 patients stopped treatment for adverse event, lack of efficacy or parental decision. The mean Drooling Impact Scale at time 0 was 89 (range 81-100) and after one month 61(range 43-78); the difference was statistically significant (P <0.001). The overall response to treatment was 94%. Conclusions: This is the first study to determine the safety and effectiveness of Glycopyrrolate in decreasing drooling in a specific subset of patients. No major side effects were observed. Further comparative studies are needed to confirm our results.

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

scholarly journals Central Line-Associated Bloodstream Infections in Pediatric Intensive Care Unit

2017 ◽  
Vol 4 (2) ◽  
pp. 42-46 ◽  
Author(s):  
Tanıl Kendirli ◽  
Ayhan Yaman ◽  
Çağlar Ödek ◽  
Halil Özdemir ◽  
Adem Karbuz ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Bloodstream Infections ◽  
Central Line

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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