scholarly journals Analysis of survival for patients in relation to central venous catheter and nosocomial blood stream infections: A case study of Aga Khan University Hospital, Nairobi

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1770
Author(s):  
Francis Maina Kiroro ◽  
Majid Twahir
Keyword(s):  
Clinical Care ◽  
Survival Rates ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
University Hospital ◽  
P Value ◽  
Infection Status ◽  
Central Venous ◽  
Mortality And Morbidity ◽  
Significant Difference

Background: This study was focussed on survival rates of patients admitted to acute care units who utilized medical devices known as central venous catheters (CVC). CVCs are useful devices in clinical care; however some infections such as central line associated bloodstream infections (CLABSI) may occur, which are associated with increased lengths of stay and costs as well as higher morbidity and mortality rates. The overall objective of the present study was to determine survival probabilities and hazard rates for patients who used CVC devices and compare the subgroups by infection status. Methods: The study was focused on all patients who were admitted to Critical Care Units between 8th December 2012 and 31st March 2016 and utilized CVC devices. It was a retrospective study. Survival analysis techniques, test of equality of proportions, Man-Whitney test and Chi–square test of independence were used. Results: A total of 363 out of 1089 patients included in the study died during hospitalization. 47 patients developed nosocomial CLABSI. The average duration was 18.19 days and median of 12 days for hospitalized patients who did not develop a nosocomial CLABSI compared to an average of 56.79 days and a median of 51 days for those who did. There was a significantly higher proportion of mortality of those who developed nosocomial CLABSI compared to those that didn’t (p-value=0.01379). The results indicate that there was a significant association between infection status and discharge status, and significant difference to the survival rates of the patients based on infection status. Conclusions: There is a significant impact on mortality and morbidity of patients who develop nosocomial CLABSI. The duration of hospitalization by patients who developed CLABSI was significantly higher compared to patients who did not. Increased length of stay leads to higher cost of hospitalization.

Reducing Central Line-Associated Bloodstream Infection in Contaminated Central Venous Catheters: Case Studies of a Pediatric Contamination Guideline

2021 ◽  
Author(s):  
Tracy B. Chamblee ◽  
Lindsey J. Patton ◽  
Virginia B. Young ◽  
Jennifer Marusich ◽  
Cindy D. Bowens ◽  
...  
Keyword(s):  
Case Reports ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Healthcare Organizations ◽  
Central Venous ◽  
Mortality And Morbidity ◽  
Reduction Strategies ◽  
Contamination Events

Highlights Abstract Healthcare organizations have prioritized patient safety and quality improvement efforts to reduce central line-associated bloodstream infections (CLABSIs). Implementation of central venous catheter (CVC) insertion and maintenance bundles have significantly reduced infection rates. Nevertheless, CLABSIs continue to be a significant cause of mortality and morbidity in hospitals, and further efforts are necessary to improve CVC care practices. A hospital-wide committee at a tertiary care pediatric hospital identified gaps in our CVC maintenance practices resulting from CVC contamination events from a patient’s body fluids. A lack of published literature on the topic resulted in the need to create an institutional clinical practice guideline (CPG) to develop guidance to mitigate potential CLASBIs from CVC contamination. Utilization of the CVC CPG in all inpatient units and other reduction strategies resulted in a steady decline in our CLABSI rates, particularly in those related to CVC contamination events. Case reports illustrate the effectiveness of the CPG.

Improved Clinical Outcome of Patients With Candida Bloodstream Infections Through Direct Consultation by Infectious Diseases Physicians in a Japanese University Hospital

2006 ◽  
Vol 27 (9) ◽  
pp. 964-968 ◽  
Author(s):  
Shunji Takakura ◽  
Naoko Fujihara ◽  
Takashi Saito ◽  
Terumi Kimoto ◽  
Yutaka Ito ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Infectious Diseases ◽  
Intervention Group ◽  
Venous Catheter ◽  
Antifungal Treatment ◽  
University Hospital ◽  
First Year ◽  
Central Venous ◽  
Significant Difference ◽  
Baseline Group

Objective.To examine whether intervention by infectious diseases physicians (IDPs) in the treatment decisions that emphasize adequate antifungal treatment and early removal of central venous catheter for patients with Candida bloodstream infection (BSI) improves prognosis.Design.Retrospective cohort study of patients with Candida BSI, comparing the prognosis of patients before and after the start of the intervention.Setting.A 1,240-bed, tertiary care university hospital.Patients.Forty patients with Candida BSI during a 2-year period, from January 2001 to December 2002, were included in the study Twenty-three patients in the first year after the start of intervention by IDPs (intervention group) were compared with 17 patients in the first year before the start of the IDP intervention (baseline group).Interventions.In January 2002, a total of 5 IDPs at Kyoto University Hospital gave unsolicited recommendations on antifungal treatment and advised all physicians treating inpatients who had Candida BSI to remove the central venous catheter.Results.No significant difference was seen between the 2 groups in patients' clinical background, species, and fluconazole susceptibility of the causative organisms. The 30-day survival rate was significantly better in the intervention group (18 [78%] of 23 patients) than in the baseline group (7 [44%] of 16 patients; P = .04 by Fisher's exact test). More patients in the intervention group than in the baseline group received appropriate antifungal therapy (81% vs 50%) and had their central venous catheter removed at an appropriate time (95% vs 81%)Conclusion.The introduction of an active system of IDP consultation for every case of Candida BSI in our hospital substantially improved patient outcomes.

scholarly journals Chlorhexidine and gauze and tape dressings for central venous catheters: a randomized clinical trial

2014 ◽  
Vol 22 (5) ◽  
pp. 764-771 ◽  
Author(s):  
Edivane Pedrolo ◽  
Mitzy Tannia Reichembach Danski ◽  
Stela Adami Vayego
Keyword(s):  
Clinical Trial ◽  
Intensive Care ◽  
Randomized Clinical Trial ◽  
Intervention Group ◽  
Bloodstream Infections ◽  
Central Venous Catheters ◽  
University Hospital ◽  
Control Group ◽  
P Value ◽  
Central Venous

OBJECTIVE: to assess the effectiveness of the chlorhexidine antimicrobial dressing in comparison to the gauze and tape dressing in the use of central venous catheters.METHOD: a randomized clinical trial was conducted in the intensive care and adult semi intensive care units of a university hospital in the south of Brazil. The subjects were patients using short-term central venous catheters, randomly assigned to the intervention (chlorhexidine antimicrobial dressing) or control (gauze and micro porous tape) groups.RESULTS: a total of 85 patients were included: 43 in the intervention group and 42 in the control group. No statistically significant differences were found between dressings in regard to the occurrence of: primary bloodstream infections (p-value = 0.5170); local reactions to the dressing (p-value = 0.3774); and dressing fixation (p-value = 0.2739).CONCLUSION: both technologies are effective in covering central venous catheters in regard to the investigated variables and can be used for this purpose. Registry ECR: RBR-7b5ycz.

Central Line–Associated Bloodstream Infections in Children With Hematologic and Oncologic Diseases: First Prevalence Results From a University Hospital

2019 ◽  
Vol 36 (5) ◽  
pp. 327-336
Author(s):  
Gülçin Özalp Gerçeker ◽  
Figen Yardımcı ◽  
Yeşim Aydınok
Keyword(s):  
Central Venous Catheter ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
University Hospital ◽  
High Rate ◽  
Central Venous ◽  
Coagulase Negative Staphylococci ◽  
Cross Sectional ◽  
Pediatric Hematology

Central line–associated bloodstream infections (CLABSIs) are still a major cause of morbidity and mortality in pediatric hematology-oncology patients in many countries. This cross-sectional study was a retrospective review of CLABSI in inpatient pediatric hematology-oncology cases with long-term central venous catheter at the Pediatric Hematology Department from January 2013 to June 2014. Characteristics of CLABSI events in pediatric patients with hematologic malignancies and related nonmalignant hematologic conditions are documented. CLABSI developed in 61.8% ( n = 21) of the 34 hospitalized patients included in the study. The CLABSI rate was 7.8 per 1,000 inpatient central venous catheter days. Coagulase-negative staphylococci was the predominant pathogen in 47.6% of the patients with CLABSI. The high rate of CLABSI requires prevention strategies to reduce CLABSI immediately. This study provides guidance in prioritizing strategies for reducing rates of infection.

scholarly journals Incidence of Central Venous Catheter-Related Bloodstream Infections: Evaluation of Bundle Prevention in Two Intensive Care Units in Central Brazil

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Thais Yoshida ◽  
Ana Elisa Bauer de Camargo Silva ◽  
Luciana Leite Pineli Simões ◽  
Rafael Alves Guimarães
Keyword(s):  
Intensive Care ◽  
Central Venous Catheter ◽  
Intensive Care Units ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Incidence Density ◽  
P Value ◽  
Central Venous ◽  
Central Brazil ◽  
Before And After

Background. Central venous catheter-associated bloodstream infections (CVC-BSIs) have been associated with increased length of hospital stay, mortality, and healthcare costs, especially in intensive care units (ICUs). The aim of this study was to evaluate the incidence density of CVC-BSIs before and after implementation of the bundle in a hospital of infectious and dermatological diseases in Central Brazil. Methods. A retrospective cohort study was conducted in two ICUs (adult and pediatric) between 2012 and 2015. Two periods were compared to assess the effect of the intervention in incidence density of CVC-BSIs: before and after intervention, related to the stages before and after the implementation of the bundle, respectively. Results. No significant reduction was observed in the incidence density of CVC-BSIs in adult ICU (incidence rate ratio [IRR]: 0.754; 95.0% CI: 0.349 to 1.621; p-value = 0.469), despite the high bundle application rate in the postintervention period. Similarly, significant reduction in the incidence density in pediatric ICU has not been verified after implementation of the bundle (IRR: 1.148; 95.0% CI: 0.314 to 4.193; p-value = 0.834). Conclusion. Not significant reduction in the incidence density of CVC-BSIs was observed after bundle implementation in ICUs, suggesting the need to review the use of process, as well as continuing education for staffs in compliance and correct application of the bundle. Further studies are needed to evaluate the effect of bundle in the reduction of incidence density of CVC-BSIs in Brazil.

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

2006 ◽  
Vol 17 (2) ◽  
pp. 99-102 ◽  
Author(s):  
B Lynn Johnston ◽  
John M Conly
Keyword(s):  
At Risk ◽  
Patient Safety ◽  
Intensive Care ◽  
Central Venous Catheter ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Chronic Hemodialysis ◽  
University Hospital ◽  
Teaching Hospitals ◽  
Central Venous

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.

Reducing central line-associated bloodstream infection in contaminated central venous catheters: case studies of a pediatric contamination guideline

2021 ◽  
Vol 30 (19) ◽  
pp. S24-S29
Author(s):  
Tracy B Chamblee ◽  
Lindsey J Patton ◽  
Virginia B Young ◽  
Jennifer Marusich ◽  
Cindy D Bowens ◽  
...  
Keyword(s):  
Case Reports ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Healthcare Organizations ◽  
Central Venous ◽  
Mortality And Morbidity ◽  
Reduction Strategies ◽  
Contamination Events

Healthcare organizations have prioritized patient safety and quality improvement efforts to reduce central line-associated bloodstream infections (CLABSIs). Implementation of central venous catheter (CVC) insertion and maintenance bundles have significantly reduced infection rates. Nevertheless, CLABSIs continue to be a significant cause of mortality and morbidity in hospitals, and further efforts are necessary to improve CVC care practices. A hospital-wide committee at a tertiary care pediatric hospital identified gaps in our CVC maintenance practices resulting from CVC contamination events from a patient's body fluids. A lack of published literature on the topic resulted in the need to create an institutional clinical practice guideline (CPG) to develop guidance to mitigate potential CLASBIs from CVC contamination. Utilization of the CVC CPG in all inpatient units and other reduction strategies resulted in a steady decline in our CLABSI rates, particularly in those related to CVC contamination events. Case reports illustrate the effectiveness of the CPG.

scholarly journals 1159. Multidisciplinary Leadership Rounds Are Associated with Decreased Urinary Catheter and Central Venous Catheter Device Utilization at a Tertiary Care, Academic Hospital

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S414-S415
Author(s):  
Jason Bowling ◽  
Barbara Taylor ◽  
Nelson Tuazon ◽  
Brian Lewis ◽  
Emily Volk ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
P Value ◽  
Central Venous ◽  
Post Intervention ◽  
Relative Ratio ◽  
Time Period ◽  
Tract Infections

Abstract Background Optimizing use of urinary catheters (UCs) and central venous catheters (CVCs) is crucial to prevent catheter-associated urinary tract infections (CAUTIs), central line-associated bloodstream infections (CLABSIs), and other complications. Despite education and adoption of catheter removal protocols, indwelling devices not meeting approved indications were still noted. Methods Twice a week, UC and CVC surveillance rounds were conducted by a team of directors from nursing, vascular access, infection prevention, and hospital epidemiology. Different hospital units were selected each week in random distribution. Rounds emphasized face-to-face discussion with nurses and device observations to identify any removal opportunities and appropriate maintenance. Device utilization was monitored using CDC National Healthcare Safety Network (NHSN) standardized utilization ratio (SUR) and CAUTIs and CLABSIs were monitored using NHSN definitions. Relative ratios of SURs during pre-intervention (pre-INT) and post-intervention (post-INT) time periods for UCs and CVCs were compared using an exact binomial test and mid-P 95% confidence interval (CI). CAUTI and CLABSI rates were compared using Fisher’s exact test using mid-P value. Results A baseline time period A of 12 months pre-INT (June 2017-May 2018) was used to compare with the 10-month post-INT time period B (June 2018-March 2019). The UC SURs for periods A and B were 0.813 and 0.696 (Figure 1). The relative ratio shows a post-INT UC SUR that was 85.6% of the pre-INT period (95% CI: 84.1%, 87.2%, P < 0.001). CAUTI rates for periods A and B were not statistically significantly different at 2.276 vs. 2.164/1000 catheter days (P = 0.803). The CVC SURs for periods A and B were 1.244 and 1.081 (Figure 2). The relative ratio shows a post-INT CVC SUR that was 86.9% of the pre-INT period (95% CI: 85.7%, 88.0%, P < 0.001). CLABSI rates for periods A and B were statistically significantly different at 1.27 vs. 0.804/1000 central line days (P = 0.0335). Conclusion Leadership rounds were associated with a significant decrease in utilization of UCs and CVCs. A significant decrease was noted in CLABSI rates but not in CAUTI rates. Multidisciplinary oversight improved adherence to existing policies and should be considered for optimizing device utilization. Disclosures All authors: No reported disclosures.

scholarly journals Prognostic factors for COVID-19 patients

2021 ◽  
Author(s):  
Uğur Önal ◽  
Özge Aydın Güçlü ◽  
Halis AKALIN ◽  
Nilüfer Aylin Acet Öztürk ◽  
Cihan Semet ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Critical Illness ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
University Hospital ◽  
P Value ◽  
Mortality And Morbidity ◽  
Significant Difference ◽  
D Dimer

Background: Determination of the prognostic factors which affects the mortality and morbidity in COVID-19 patients, has an importance in terms of planning the treatment and follow-up strategy. Material and Method: Patients who had COVID-19 diagnosis via microbiologically and/or radiologically between March and October 2020 in a tertiary-care university hospital were recorded retrospectively. Only adult patients (≥18 years) with clinical spectrum of moderate, severe and critical illness were included in the study according to National Institutes of Health (NIH) guideline. A p value of less than 0.05 was considered significant. Ethical committee approval was given from the Uludag University with decision number 2020-22/11. Also, the permission from Republic of Turkey, Ministry of Health was given. Results: A total number of 257 patients were included in the study. 30-day mortality rate was recorded as 14.4%. In univariate analysis; age, chronic renal failure, malignancy, cerebrovascular disease, number of comorbidities >2, dyspnea, cough, NIH severe and critical illness, oxygen saturation, respiratory rate, systolic and diastolic blood pressure, qSOFA, GCS, MEWS, SOFA, CURB-65, CCI, CRP, procalcitonin, CK, D-dimer, lymphocyte and thrombocyte levels, neutrophile-to-lymphocyte ratio, AST, albumin, hemoglobin, CK-MB, fibrinogen, LDH and potassium levels were found as statistically significant (p<0.05). In logistic regression analysis one point increase of SOFA (p<0.001, OR:1.861, 95%CI:1.403-2.468) and CURB-65 scores (p=0.002, OR:2.484, 95%CI:1.401-4.406) were found as statistically significant for 30-day mortality. In mortal patients, there were significant difference between the baseline, day 3, 7 and 14 results of D-dimer (p=0.01), Ferritin (p=0.042), leucocyte (p=0.019) and neutrophile count (p=0.007). Conclusion: In our study, SOFA and CURB-65 scores on admission were associated with mortality and these score systems might be useful tools for the prognosis in COVID-19 patients.In addition to this, D-dimer, Ferritin, leucocyte and neutrophile counts were significantly increased during the follow up in patients with mortality.

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