Bridging the gap: introduction of an antimicrobial peripherally inserted central catheter (PICC) in response to high PICC central line-associated bloodstream infection incidence

2021 ◽  
Vol 30 (19) ◽  
pp. S16-S22
Author(s):  
Michelle DeVries ◽  
Thomas Sleweon
Keyword(s):  
Bloodstream Infection ◽  
Gap Analysis ◽  
Central Line ◽  
Evidence Based ◽  
Institutional Practices ◽  
Improvement Project ◽  
New Device ◽  
Central Line Insertion ◽  
Control And Prevention ◽  
Guidelines And Standards

Objective: To reduce the incidence of central line-associated bloodstream infection (CLABSI) in peripherally inserted central catheters (PICC) through the introduction of an antimicrobial (AM) catheter as recommended in evidence-based guidelines and standards. Design: Quality improvement project comparing incidence of infections pre-implementation and postimplementation of the new catheter. Setting: A 582-bed community teaching hospital in Northwest Indiana. Methods: Pre-implementation analysis of surveillance data indicated that 50% of CLABSIs occurred inpatients with PICCs in situ. A gap analysis was performed to review institutional practices against evidence-based recommendations. The use of an AM catheter was supported in each of the documents consulted. After introduction of the new device, performance was measured in a prospective manner using standardized Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) surveillance protocols for CLABSI and internal data sources for other measures. Results: After 30 months of data collection, the PICC CLABSI incidence reduced from a baseline rate of 1.83/1000 PICC days to 0.162/1000 PICC days (91.15% reduction, P=0.0002). Conclusion: Combined with continued compliance with basic prevention strategies (ie use of a central line insertion checklist/insertion bundle) and optimization of device selection and lumen justification, the introduction of an antimicrobial/antithrombogenic (AM/AT) PICC was associated with a significant reduction in CLABSI.

Bridging the Gap. Introduction of an Antimicrobial Peripherally Inserted Central Catheter (PICC) in Response to High PICC Central Line-Associated Bloodstream Infection Incidence

2021 ◽  
Vol 26 (2) ◽  
Author(s):  
Michelle DeVries ◽  
Thomas Sleweon
Keyword(s):  
Bloodstream Infection ◽  
Gap Analysis ◽  
Central Line ◽  
Evidence Based ◽  
Design Quality ◽  
Improvement Project ◽  
New Device ◽  
Central Line Insertion ◽  
Control And Prevention ◽  
Guidelines And Standards

Highlights Abstract Objective: To reduce the incidence of central line-associated bloodstream infection (CLABSI) in peripherally inserted central catheters (PICC) through the introduction of an antimicrobial (AM) catheter as recommended in evidence-based guidelines and standards. Design: Quality improvement project comparing incidence of infections pre-implementation and postimplementation of the new catheter. Setting: A 582-bed community teaching hospital in Northwest Indiana. Methods: Pre-implementation analysis of surveillance data indicated that 50% of CLABSIs occurred in patients with PICCs in situ. A gap analysis was performed to review institutional practices against evidence-based recommendations. The use of an AM catheter was supported in each of the documents consulted. After introduction of the new device, performance was measured in a prospective manner using standardized Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) surveillance protocols for CLABSI and internal data sources for other measures. Results: After 30 months of data collection, the PICC CLABSI incidence reduced from a baseline rate of 1.83/1000 PICC days to 0.162/1000 PICC days (91.15% reduction, P = 0.0002). Conclusion: Combined with continued compliance with basic prevention strategies (i.e., use of a central line insertion checklist/insertion bundle) and optimization of device selection and lumen justification, the introduction of an antimicrobial/antithrombogenic (AM/AT) PICC was associated with a significant reduction in CLABSI.

QIM19-146: A Multidisciplinary Approach to Conquer Central-Line Associated Blood Stream Infections: Establishing the Continuum of Prevention

2019 ◽  
Vol 17 (3.5) ◽  
pp. QIM19-146
Author(s):  
Christine Wallace ◽  
Jennifer Sullivan ◽  
Erin Supan
Keyword(s):  
Best Practice ◽  
Multidisciplinary Approach ◽  
Nursing Practice ◽  
Gap Analysis ◽  
Blood Stream ◽  
Central Line ◽  
Comprehensive Cancer Center ◽  
Improvement Project ◽  
Central Line Insertion ◽  
Line Insertion

Background: Central line associated blood stream infection (CLABSI) rates have been above the benchmark for our academic medical center that includes a comprehensive cancer center. In response, a 20% CLABSI reduction rate was set by the hospital Chief Medical and Associate Chief Nursing Officers. A multidisciplinary group convened to standardize central line insertion and maintenance practices. Product review showed 20 different central line insertion kits and 6 different dressing kits throughout the system. Hospital central line policy focused solely on nursing practice and there was not a policy including provider practice regarding central line insertion. A gap analysis determined dressing and insertion site integrity was compromised in 53% of our patients, including visible blood under 38% of the dressings, with oncology patients having some of our highest rates of bleeding. Objective: The purpose of this quality improvement project was to collaborate amongst disciplines to review practice, products, and policy for central line insertion and maintenance. We aimed to systematically improve practice across the central line continuum of prevention. Methods: A multidisciplinary team evaluated and defined current and best practice for policy and product changes. Implementation of best practice checklists included a team checklist to be used during insertion of every central line in the intensive care units and checklists that detailed practice steps in accordance with the updated central line policy. Central line dressing change prototypes were designed, products were compared, and approval for a standardized kit to support practice occurred. A new antimicrobial and hemostatic dressing was selected for line care to improve site integrity. The number of central line insertion kits was reduce by half and dressing kits were reduced to just one standard kit for the hospital system. Results: CLABSI rates have decreased from 7.43 cases/month to 3.6 cases/month following. Trends post-product rollout and repeat gap analysis data will be included at time of presentation. Conclusion: Reduction of CLABSI requires a multidisciplinary approach focusing simultaneously on best practices for central line insertion and maintenance. Best evidence for provider and nursing practice needs to be bundled in a comprehensive policy with checklist and products to support the standardization. Clinician evaluation and input on choosing products is critical to positive patient outcomes.

scholarly journals The Effect of Adding Comorbidities to Current Centers for Disease Control and Prevention Central-Line–Associated Bloodstream Infection Risk-Adjustment Methodology

2017 ◽  
Vol 38 (9) ◽  
pp. 1019-1024 ◽  
Author(s):  
Sarah S. Jackson ◽  
Surbhi Leekha ◽  
Laurence S. Magder ◽  
Lisa Pineles ◽  
Deverick J. Anderson ◽  
...  
Keyword(s):  
Disease Control ◽  
Bloodstream Infection ◽  
Risk Adjustment ◽  
Central Line ◽  
Case Mix ◽  
Type Model ◽  
Patient Case ◽  
Icu Patients ◽  
Control And Prevention ◽  
Centers For Disease Control

BACKGROUNDRisk adjustment is needed to fairly compare central-line–associated bloodstream infection (CLABSI) rates between hospitals. Until 2017, the Centers for Disease Control and Prevention (CDC) methodology adjusted CLABSI rates only by type of intensive care unit (ICU). The 2017 CDC models also adjust for hospital size and medical school affiliation. We hypothesized that risk adjustment would be improved by including patient demographics and comorbidities from electronically available hospital discharge codes.METHODSUsing a cohort design across 22 hospitals, we analyzed data from ICU patients admitted between January 2012 and December 2013. Demographics and International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) discharge codes were obtained for each patient, and CLABSIs were identified by trained infection preventionists. Models adjusting only for ICU type and for ICU type plus patient case mix were built and compared using discrimination and standardized infection ratio (SIR). Hospitals were ranked by SIR for each model to examine and compare the changes in rank.RESULTSOverall, 85,849 ICU patients were analyzed and 162 (0.2%) developed CLABSI. The significant variables added to the ICU model were coagulopathy, paralysis, renal failure, malnutrition, and age. The C statistics were 0.55 (95% CI, 0.51–0.59) for the ICU-type model and 0.64 (95% CI, 0.60–0.69) for the ICU-type plus patient case-mix model. When the hospitals were ranked by adjusted SIRs, 10 hospitals (45%) changed rank when comorbidity was added to the ICU-type model.CONCLUSIONSOur risk-adjustment model for CLABSI using electronically available comorbidities demonstrated better discrimination than did the CDC model. The CDC should strongly consider comorbidity-based risk adjustment to more accurately compare CLABSI rates across hospitals.Infect Control Hosp Epidemiol 2017;38:1019–1024

scholarly journals Prevention of central line-associated bloodstream infections: a survey of ICU nurses’ knowledge and practice in China

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Xiuwen Chi ◽  
Juan Guo ◽  
Xiaofeng Niu ◽  
Ru He ◽  
Lijuan Wu ◽  
...  
Keyword(s):  
Insertion Site ◽  
Bloodstream Infections ◽  
Guangdong Province ◽  
Central Line ◽  
Evidence Based ◽  
Department Of Health ◽  
Control And Prevention ◽  
Knowledge And Practice ◽  
Evidence Based Guidelines ◽  
Nurses Knowledge

Abstract Background Central line-associated bloodstream infections (CLABSI) are largely preventable when evidence-based guidelines are followed. However, it is not clear how well these guidelines are followed in intensive care units (ICUs) in China. This study aimed to evaluate Chinese ICU nurses’ knowledge and practice of evidence-based guidelines for prevention of CLABSIs issued by the Centers for Disease Control and Prevention, US and the Department of Health UK. Method Nurses completed online questionnaires regarding their knowledge and practice of evidence-based guidelines for the prevention of CLABSIs from June to July 2019. The questionnaire consisted of 11 questions, and a score of 1 was given for a correct answer (total score = 0–11). Results A total of 835 ICU nurses from at least 104 hospitals completed the questionnaires, and 777 were from hospitals in Guangdong Province. The mean score of 11 questions related to evidence-based guidelines for preventing CLABSIs was 4.02. Individual total scores were significantly associated with sex, length of time as an ICU nurse, educational level, professional title, establishment, hospital grade, and incidence of CLABSIs at the participant’s ICU. Importantly, only 43% of nurses reported always using maximum barrier precautions, 14% of nurses reported never using 2% chlorhexidine gluconate for antisepsis at the insertion site, only 40% reported prompt removal of the catheter when it was no longer necessary, and 33% reported frequently and routinely changing catheters even if there was no suspicion of a CLABSI. Conclusion Chinese ICU nurses in Guangdong Province lack of knowledge and practice of evidence-based guidelines for the prevention of CLABSIs. National health administrations should adopt policies to train ICU nurses to prevent CLABSIs.

Central line-associated bloodstream infection (CLABSI) in Cancer patients: Role of central line insertion practices and audit system in prevention

2018 ◽  
Vol 23 ◽  
pp. S19-S20
Author(s):  
Hitender Gautam ◽  
Abdul Hakim Choudhary ◽  
Sarita Mohapatra ◽  
Seema Sood ◽  
Bimal Kumar Das ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Bloodstream Infection ◽  
Central Line ◽  
Central Line Insertion ◽  
Audit System ◽  
Line Insertion

scholarly journals The impact of central line insertion bundle on central line-associated bloodstream infection

2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Hung-Jen Tang ◽  
Hsin-Lan Lin ◽  
Yu-Hsiu Lin ◽  
Pak-On Leung ◽  
Yin-Ching Chuang ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Central Line ◽  
Central Line Insertion ◽  
Line Insertion ◽  
The Impact

Clinical impact of needle-free connector design: A systematic review of literature

2020 ◽  
Vol 21 (6) ◽  
pp. 847-853 ◽  
Author(s):  
Victor Daniel Rosenthal
Keyword(s):  
Systematic Review ◽  
Bloodstream Infection ◽  
Systematic Reviews ◽  
Microbial Contamination ◽  
Open Systems ◽  
Central Line ◽  
Adverse Outcomes ◽  
Infection Rates ◽  
Positive Displacement ◽  
Control And Prevention

The objective of this systematic review is to analyze types of needle-free connectors and open systems and their effects on central line–associated bloodstream infection rates and other adverse outcomes through a research protocol consistent with the Preferred Reporting Items for Systematic Reviews’ recommendations. MEDLINE and Cochrane databases of systematic reviews were searched for relevant comparative studies published from January 2000 to September 2017. Eighteen studies compared central line–associated bloodstream infection (according to the Centers for Disease Control and Prevention/National Healthcare Safety Network definition), internal microbial contamination, occlusions, phlebitis, and other outcomes associated with needle-free connectors with a positive displacement device, negative displacement device, neutral displacement device, or three-way stopcock. Ten studies reported central line–associated bloodstream infection rates, which were lower with positive displacement devices versus negative displacement devices/neutral displacement devices (one study) and with negative displacement devices versus three-way stopcocks (three studies), but varied with different positive displacement device and negative displacement device/neutral displacement device designs (four studies). Seven studies reported internal microbial contamination rates, which were higher with three-way stopcocks versus negative displacement devices (two studies) and positive displacement devices (two studies), lower when positive displacement devices were used versus neutral displacement devices (one study), and varied with different types of negative displacement device (one study). Central line–associated bloodstream infection rates and most other outcomes analyzed were statistically significantly higher with three-way stopcocks (open devices) versus positive displacement device, negative displacement devices, and neutral displacement devices, but varied among closed device designs.

Republished: Reduction in Central Line–Associated Bloodstream Infection Rates After Implementations of Infection Control Measures at a Level 3 Neonatal Intensive Care Unit

2019 ◽  
Vol 34 (5) ◽  
pp. 488-493
Author(s):  
Vikramaditya Dumpa ◽  
Bonny Adler ◽  
Delena Allen ◽  
Deborah Bowman ◽  
Amy Gram ◽  
...  
Keyword(s):  
Intensive Care ◽  
Bloodstream Infection ◽  
Neonatal Intensive Care ◽  
Central Line ◽  
Health Care Team ◽  
Control Measures ◽  
Care Staff ◽  
Evidence Based ◽  
Central Lines ◽  
Infection Control Measures

Advances in neonatology led to survival of micro-preemies, who need central lines. Central line–associated bloodstream infection (CLABSI) causes prolonged hospitalization, morbidities, and mortality. Health care team education decreases CLABSIs. The objective was to decrease CLABSIs using evidence-based measures. The retrospective review compared CLABSI incidence during and after changes in catheter care. In April 2011, intravenous (IV) tubing changed from Interlink to Clearlink; IV tubing changing interval increased from 24 to 72 hours. CLABSIs increased. The following measures were implemented: July 2011, reeducation of neonatal intensive care staff on Clearlink; August 2011, IV tubing changing interval returned to 24 hours; September 2011, changed from Clearlink back to Interlink; November 2011, review of entire IV process and in-service on hand hygiene; December 2011, competencies on IV access for all nurses. CLABSIs were compared during and after interventions. Means were compared using the t test and ratios using the χ2 test; P <.05. CLABSIs decreased from 4.4/1000 to 0/1000 catheter-days; P < .05. Evidence-based interventions reduced CLABSIs.

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