Review of Best Practices for CLABSI Prevention and the Impact of Recent Legislation on CLABSI Reporting

Central line-associated bloodstream infections (CLABSI) are a very common source of healthcare-associated infection (HAI). Incidence of CLABSI has been significantly reduced through the efforts of nurses, healthcare providers, and infection preventionists. Extrinsic factors such as recently enacted legislation and mandatory reporting have not been closely examined in relation to changes in rates of HAI. The following review will examine evidence-based practices related to CLABSI and how they are reported, as well as how the Affordable Care Act, mandatory reporting, and pay-for-performance programs have affected these best practices related to CLABSI prevention. There is a disconnect in the methods and guidelines for reporting CLABSI between these programs, specifically among local monitoring agencies and the various federal oversight organizations. Future research will focus on addressing the gap in what defines a CLABSI and whether or not these programs to incentivize hospital to reduce CLABSI rates are effective.

Download Full-text

Impact of Expansion of Vascular Access Team on Central-line–Associated Bloodstream Infections

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.825 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s260-s260

Author(s):

Carolyn Holder ◽

Elizabeth Overton ◽

Sarah Kalaf ◽

Doris Wong ◽

Jill Holdsworh ◽

...

Keyword(s):

Interventional Radiology ◽

Best Practices ◽

Healthcare System ◽

Vascular Access ◽

Task Force ◽

Bloodstream Infections ◽

Central Line ◽

Radiology Department ◽

Full Time ◽

Healthcare Associated Infection

Background: Through participation in a system-wide healthcare-associated infection-reduction task force, we leveraged our ability to standardize best practices across hospitals in a university-owned healthcare system to reduce central-line–associated bloodstream infection (CLABSI) rates. Methods: Our multidisciplinary team had representation from all hospitals in our healthcare system. The team benchmarked practices in place and compared CLABSI standardized infection ratios (SIRs). One hospital had a robust vascular access team (VAT) and consistently low CLABSI SIRs; expanding and standardizing VAT across the hospitals in the system became the primary goal of the team. We developed a business case to justify VAT expansion that considered savings from decreasing CLABSIs and benefits to interventional radiology revenue by decreasing PICC insertion and comparing costs for added full-time equivalents (FTEs). CLABSI rates before and after VAT team expansion at 2 large hospitals were compared to the hospital with existing robust VAT. Other process improvement activities were implemented across all hospitals. The expanded VAT assumed responsibility for central-line maintenance, promoted removal of unneeded lines, expanded education efforts, and enhanced capacity for insertions. Results: The VAT expansion from 5.4 FTEs to 15.9 FTEs at 2 large hospitals (1,100 total beds) began in April 2017 and was phased over ~6 months. CLABSI SIRs for the 15 months preceding expansion were compared to the SIRs for the 15-month period after expansion for the 2 hospitals with expanded VAT (hospitals A and B) and for hospital C with preexisting robust VAT (Table 1). We observed a 33% decrease in PICC insertions in interventional radiology department in hospitals A and B. Overall return on investment (ROI) estimates using lower and upper cost per CLABSI ranged from a loss of $156,000 to a net gain of $623,000. Conclusions: A significant decrease in CLABSI rates temporally related to expansion of VAT occurred in 2 hospitals, whereas the hospital with existing robust VAT demonstrated a modest decrease in CLABSI rates. We were able to demonstrate a favorable ROI from the VAT expansion without an impact on HAC penalties. Using the model of standardizing best practices across a system and creative ROIs may help justify the addition of scarce resources.Funding: NoneDisclosures: None

Download Full-text

Effect of Removing Contact Precautions for Multidrug-Resistant Organisms on Hospital Infections in a Pediatric Health System

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.742 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s199-s200

Author(s):

Matthew Linam ◽

Dorian Hoskins ◽

Preeti Jaggi ◽

Mark Gonzalez ◽

Renee Watson ◽

...

Keyword(s):

Hand Hygiene ◽

Antibiotic Stewardship ◽

Infection Prevention ◽

Tertiary Care ◽

Bloodstream Infections ◽

Central Line ◽

Contact Precautions ◽

Stewardship Program ◽

Tract Infections ◽

The Impact

Background: Discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE) have failed to show an increase in associated transmission or infections in adult healthcare settings. Pediatric experience is limited. Objective: We evaluated the impact of discontinuing contact precautions for MRSA, VRE, and extended-spectrum β-lactamase–producing gram-negative bacilli (ESBLs) on device-associated healthcare-associated infections (HAIs). Methods: In October 2018, contact precautions were discontinued for children with MRSA, VRE, and ESBLs in a large, tertiary-care pediatric healthcare system comprising 2 hospitals and 620 beds. Coincident interventions that potentially reduced HAIs included blood culture diagnostic stewardship (June 2018), a hand hygiene education initiative (July 2018), a handshake antibiotic stewardship program (December 2018) and multidisciplinary infection prevention rounding in the intensive care units (November 2018). Compliance with hand hygiene and HAI prevention bundles were monitored. Device-associated HAIs were identified using standard definitions. Annotated run charts were used to track the impact of interventions on changes in device-associated HAIs over time. Results: Average hand hygiene compliance was 91%. Compliance with HAI prevention bundles was 81% for ventilator-associated pneumonias, 90% for catheter-associated urinary tract infections, and 97% for central-line–associated bloodstream infections. Overall, device-associated HAIs decreased from 6.04 per 10,000 patient days to 3.25 per 10,000 patient days after October 2018 (Fig. 1). Prior to October 2018, MRSA, VRE and ESBLs accounted for 10% of device-associated HAIs. This rate decreased to 5% after October 2018. The decrease in HAIs was likely related to interventions such as infection prevention rounds and handshake stewardship. Conclusions: Discontinuation of contact precautions for children with MRSA, VRE, and ESBLs were not associated with increased device-associated HAIs, and such discontinuation is likely safe in the setting of robust infection prevention and antibiotic stewardship programs.Funding: NoneDisclosures: None

Download Full-text

COVID-19 Pandemic, CLABSI, and CAUTI: The Urgent Need to Refocus on Hardwiring Prevention Efforts

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.70 ◽

2021 ◽

pp. 1-22

Author(s):

Mohamad G. Fakih ◽

Angelo Bufalino ◽

Lisa Sturm ◽

Ren-Huai Huang ◽

Allison Ottenbacher ◽

...

Keyword(s):

Urinary Catheter ◽

Bloodstream Infections ◽

Central Line ◽

Coagulase Negative Staphylococcus ◽

Safe Environment ◽

Candida Sp ◽

Optimal Line ◽

Considerable Impact ◽

Tract Infections ◽

The Impact

Abstract Background: The coronavirus disease 2019 (COVID-19) pandemic has had a considerable impact on US hospitalizations, affecting processes and patient population. Methods: We evaluated the impact of COVID-19 pandemic in 78 US hospitals on central line associated bloodstream infections (CLABSI) and catheter associated urinary tract infections (CAUTI) events 12 months pre-COVID-19 and 6 months during COVID-19 pandemic. Results: There were 795,022 central line-days and 817,267 urinary catheter-days over the two study periods. Compared to pre-COVID-19 period, CLABSI rates increased during the pandemic period from 0.56 to 0.85 (51.0%) per 1,000 line-days (p<0.001) and from 1.00 to 1.64 (62.9%) per 10,000 patient-days (p<0.001). Hospitals with monthly COVID-19 patients representing >10% of admissions had a NHSN device standardized infection ratio for CLABSI that was 2.38 times higher compared to those with <5% prevalence during the pandemic period (p=0.004). Coagulase-negative staphylococcus CLABSI increased by 130% from 0.07 to 0.17 events per 1,000 line-days (p<0.001), and Candida sp. by 56.9% from 0.14 to 0.21 per 1,000 line-days (p=0.01). In contrast, no significant changes were identified for CAUTI (0.86 vs. 0.77 per 1,000 catheter-days; p=0.19). Conclusions: The COVID-19 pandemic was associated with substantial increases in CLABSI but not CAUTI events. Our findings underscore the importance of hardwiring processes for optimal line care, and regular feedback on performance to maintain a safe environment.

Download Full-text

The Past, Present, and Future of Healthcare-Associated Infection Prevention in Pediatrics: Catheter-Associated Bloodstream Infections

Infection Control and Hospital Epidemiology ◽

10.1086/655994 ◽

2010 ◽

Vol 31 (S1) ◽

pp. S27-S31 ◽

Cited By ~ 18

Author(s):

Kristina A. Bryant ◽

Danielle M. Zerr ◽

W. Charles Huskins ◽

Aaron M. Milstone

Keyword(s):

Infection Prevention ◽

Bloodstream Infections ◽

Central Line ◽

Morbidity And Mortality ◽

Prevention Strategies ◽

Healthcare Associated Infection ◽

Research Topics ◽

The Past ◽

Healthcare Associated ◽

Current Practices

Central line–associated bloodstream infections cause morbidity and mortality in children. We explore the evidence for prevention of central line–associated bloodstream infections in children, assess current practices, and propose research topics to improve prevention strategies.

Download Full-text

2091. The Impact of Infection Control Cost Reimbursement Policy on Trends in Central Line-Associated Bloodstream Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1747 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S613-S613 ◽

Cited By ~ 2

Author(s):

Ki Tae Kwon ◽

Won Kee Lee ◽

Mi Hyae Yu ◽

Hyun Ju Park ◽

Kyeong Hee Lee ◽

...

Keyword(s):

Infection Control ◽

Bloodstream Infections ◽

Central Line ◽

Reimbursement Policy ◽

Control Cost ◽

The Impact

Download Full-text

Telemedicine in critical care

10.1093/med/9780199600830.003.0012 ◽

2016 ◽

Author(s):

Bela Patel ◽

Eric J. Thomas

Keyword(s):

Critical Care ◽

Best Practices ◽

Bloodstream Infections ◽

Ventilator Associated Pneumonia ◽

Care Model ◽

Stress Ulcers ◽

Care Environment ◽

The Past ◽

The Usa ◽

The Impact

The majority of critically-ill patients are admitted to hospitals that do not have physician intensivist coverage, despite strong evidence that clinical outcomes are improved with intensivist staffing. Telemedicine can leverage clinical resources by providing critical care expertise to patients in intensive care units (ICUs) by off-site clinicians using video, audio, and electronic links. In the past 10 years, telemedicine in critical care has seen tremendous growth in the number of ICU patients being supported by this care model across the USA. The impact of ICU telemedicine coverage has been studied rigorously only in a few studies and the outcomes have been mixed and inconsistent. Telemedicine has been shown in some studies to improve adherence to ICU best practices for the prevention of deep venous thrombosis, stress ulcers, ventilator-associated pneumonia, and catheter-related bloodstream infections. Further research in ICU telemedicine is required to understand the variability of outcomes among the telemedicine programmes studied and to effectively implement the technology to consistently improve outcomes and reduce costs in the critical care environment.

Download Full-text

Exploring the Effect of Disability, Race-Ethnicity, and Socioeconomic Status on Scores on the Self-Determination Inventory: Student Report

Council review ◽

10.1177/0014402918782150 ◽

2018 ◽

Vol 85 (1) ◽

pp. 10-27 ◽

Cited By ~ 18

Author(s):

Karrie A. Shogren ◽

Leslie A. Shaw ◽

Sheida K. Raley ◽

Michael L. Wehmeyer

Keyword(s):

Socioeconomic Status ◽

Best Practices ◽

Interactive Effect ◽

Autism Spectrum ◽

The Self ◽

Self Determination ◽

Future Research ◽

Assessment Development ◽

Race Ethnicity ◽

The Impact

The Self-Determination Inventory: Student Report (SDI:SR) was developed to address a need in the field for tools to assess self-determination that are aligned with current best practices in assessment development and administration, and emerging research and best practices in promoting self-determination. The present study explored patterns of differences in self-determination scores across students with and without disabilities (i.e., no disability, learning disabilities, intellectual disability, autism spectrum disorder, and other health impairments) of varying racial-ethnic backgrounds (i.e., White, African American or Black, Hispanic or Latino[a], and Other) as well as the impact of receiving free and reduced price lunch (as a proxy for socioeconomic status) on self-determination scores in these groups. Findings suggest an interactive effect of disability, race-ethnicity, and free and reduced price lunch status on self-determination scores. Implications for future research and practice are discussed.

Download Full-text

Chlorhexidine Bathing in a Tertiary Care Neonatal Intensive Care Unit: Impact on Central Line–Associated Bloodstream Infections

Infection Control and Hospital Epidemiology ◽

10.1086/674862 ◽

2014 ◽

Vol 35 (2) ◽

pp. 158-163 ◽

Cited By ~ 32

Author(s):

Caroline Quach ◽

Aaron M. Milstone ◽

Chantal Perpête ◽

Mario Bonenfant ◽

Dorothy L. Moore ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Birth Weight ◽

Adverse Events ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Tertiary Care ◽

Bloodstream Infections ◽

Central Line ◽

The Impact

Background.Despite implementation of recommended best practices, our central line-associated bloodstream infection (CLABSI) rates remained high. Our objective was to describe the impact of chlorhexidine gluconate (CHG) bathing on CLABSI rates in neonates.Methods.Infants with a central venous catheter (CVC) admitted to the neonatal intensive care unit from April 2009 to March 2013 were included. Neonates with a birth weight of 1,000 g or less, aged less than 28 days, and those with a birth weight greater than 1,000 g were bathed with mild soap until March 31, 2012 (baseline), and with a 2% CHG-impregnated cloth starting on April 1, 2012 (intervention). Infants with a birth weight of 1,000 g or less, aged 28 days or more, were bathed with mild soap during the entire period. Neonatal intensive care unit nurses reported adverse events. Adjusted incidence rate ratios (aIRRs), using Poisson regression, were calculated to compare CLABSIs/1,000 CVC-days during the baseline and intervention periods.Results.Overall, 790 neonates with CVCs were included in the study. CLABSI rates decreased during the intervention period for CHG-bathed neonates (6.00 vs 1.92/1,000 CVC-days; aIRR, 0.33 [95% confidence interval (CI), 0.15-0.73]) but remained unchanged for neonates with a birth rate of 1,000 g or less and aged less than 28 days who were not eligible for CHG bathing (8.57 vs 8.62/1,000 CVC-days; aIRR, 0.86 [95% CI, 0.17-4.44]). Overall, 195 infants with a birth weight greater than 1,000 g and 24 infants with a birth weight of 1,000 g or less, aged 28 days or more, were bathed with CHG. There was no reported adverse event.Conclusions.We observed a decrease in CLABSI rates in CHG-bathed neonates in the absence of observed adverse events. CHG bathing should be considered if CLABSI rates remain high, despite the implementation of other recommended measures.

Download Full-text

Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infections (MBI-LCBI): Descriptive Analysis of Data Reported to National Healthcare Safety Network (NHSN), 2013

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.245 ◽

2015 ◽

Vol 37 (1) ◽

pp. 2-7 ◽

Cited By ~ 18

Author(s):

Lauren Epstein ◽

Isaac See ◽

Jonathan R. Edwards ◽

Shelley S. Magill ◽

Nicola D. Thompson

Keyword(s):

Acute Care ◽

Descriptive Analysis ◽

Bloodstream Infections ◽

Central Line ◽

Mucosal Barrier ◽

National Healthcare ◽

National Healthcare Safety Network ◽

Mucosal Barrier Injury ◽

The Impact ◽

Clabsi Rate

OBJECTIVESTo determine the impact of mucosal barrier injury laboratory-confirmed bloodstream infections (MBI-LCBIs) on central-line–associated bloodstream infection (CLABSI) rates during the first year of MBI-LCBI reporting to the National Healthcare Safety Network (NHSN)DESIGNDescriptive analysis of 2013 NHSN dataSETTINGSelected inpatient locations in acute care hospitalsMETHODSA descriptive analysis of MBI-LCBI cases was performed. CLABSI rates per 1,000 central-line days were calculated with and without the inclusion of MBI-LCBIs in the subset of locations reporting ≥1 MBI-LCBI, and in all locations (regardless of MBI-LCBI reporting) to determine rate differences overall and by location type.RESULTSFrom 418 locations in 252 acute care hospitals reporting ≥1 MBI-LCBIs, 3,162 CLABSIs were reported; 1,415 (44.7%) met the MBI-LCBI definition. Among these locations, removing MBI-LCBI from the CLABSI rate determination produced the greatest CLABSI rate decreases in oncology (49%) and ward locations (45%). Among all locations reporting CLABSI data, including those reporting no MBI-LCBIs, removing MBI-LCBI reduced rates by 8%. Here, the greatest decrease was in oncology locations (38% decrease); decreases in other locations ranged from 1.2% to 4.2%.CONCLUSIONSAn understanding of the potential impact of removing MBI-LCBIs from CLABSI data is needed to accurately interpret CLABSI trends over time and to inform changes to state and federal reporting programs. Whereas the MBI-LCBI definition may have a large impact on CLABSI rates in locations where patients with certain clinical conditions are cared for, the impact of MBI-LCBIs on overall CLABSI rates across inpatient locations appears to be more modest.Infect. Control Hosp. Epidemiol. 2015;37(1):2–7

Download Full-text

The Effect of Head Inclination on Intraocular Pressure in the Prone Position

10.28971/532017mv91 ◽

2017 ◽

Author(s):

Vanessa Marzilli

Keyword(s):

Systematic Review ◽

Patient Care ◽

Situation Awareness ◽

High Reliability ◽

Healthcare Providers ◽

Information Management System ◽

Future Research ◽

Staff Satisfaction ◽

Patient Handoff ◽

The Impact

Patient safety relies on effective and efficient communication among healthcare providers. Tools, such as standardized checklists, ensure information sharing in a consistent, predictable format. In the perioperative setting, where handoffs occur at several points and among various disciplines, high reliability is essential. This systematic review focused on the impact of standardized communication practices on perioperative staff satisfaction as it relates to sustainability of the new practice. The electronic databases PubMed and Google Scholar were used. Six articles met inclusion for the systematic review and of these six, four were determined to be of high quality through the application of The CASE Worksheet. The handoff tools implemented in these four studies were the electronic anesthesia information management system (AIMS), I-PASS mnemonic that described the illness, patient summary, action list, situation awareness and synthesis by receiver, Peri-op Handoff Protocol and a variation of the ‘Surgical Safety Checklist’ originally developed by WHO. Results of this systematic review suggest that these standardized communication methods are effective in improving perioperative staff satisfaction. Further research may prove helpful to determine if one handoff tool design is superior to the others. While future research could be performed to provide a larger sample size, the limited data gathered from this systematic review shows promising results. Implementing a standardized approach to perioperative communication and patient handoff has been shown in these studies to be beneficial in terms of staff satisfaction. Furthermore, it would be valuable to examine the indirect impact these communication tools have on patient care. Healthcare providers have the responsibility and opportunity to improve patient care through the adoption of standardized communication processes.

Download Full-text