Central Line-Associated Bloodstream Infection Prevention by Central Venous Catheter Management Staff in the Surgical Intensive Care Unit

Introduction: To determine the central-line associated bloodstream infection rate after implementation of central venous catheter-care practice bundles and guidelines and to compare it with the previous central-line associated bloodstream infection rate. Material and Methods: A prospective, longitudinal, observational descriptive study with an exploratory component was performed in a Pediatric Intensive Care Unit during five months. The universe was composed of every child admitted to Pediatric Intensive Care Unit who inserted a central venous catheter. A comparative study with historical controls was performed to evaluate the result of the intervention (group 1 versus group 2). Results: Seventy five children were included, with a median age of 23 months: 22 (29.3%) newborns; 28 (37.3%) with recent surgery and 32 (43.8%) with underlying illness. A total of 105 central venous catheter were inserted, the majority a single central venous catheter (69.3%), with a mean duration of 6.8 ± 6.7 days. The most common type of central venous catheter was the short-term, non-tunneled central venous catheter (45.7%), while the subclavian and brachial flexure veins were the most frequent insertion sites (both 25.7%). There were no cases of central-line associated bloodstream infection reported during this study. Comparing with historical controls (group 1), both groups were similar regarding age, gender, department of origin and place of central venous catheter insertion. In the current study (group 2), the median length of stay was higher, while the mean duration of central venous catheter (excluding peripherally inserted central line) was similar in both groups. There were no statistical differences regarding central venous catheter caliber and number of lumens. Fewer children admitted to Pediatric Intensive Care Unit had central venous catheter inserted in group 2, with no significant difference between single or multiple central venous catheter. Discussion: After multidimensional strategy implementation there was no reported central-line associated bloodstream infection Conclusions: Efforts must be made to preserve the same degree of multidimensional prevention, in order to confirm the effective reduction of the central-line associated bloodstream infection rate and to allow its maintenance.

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The Effect of Central Venous Catheter Maintenance Bundle Implementation on Central Line Associated Infection Rate in the Intensive Care Unit

American Journal of Nursing Research ◽

10.12691/ajnr-9-1-5 ◽

2020 ◽

Vol 9 (1) ◽

pp. 29-34

Author(s):

Mohammad S. Isaifan ◽

Asmaa M. Mostafa ◽

Farzana Kousar ◽

Ahmed Al-hosiny ◽

Nada Tariq

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Central Venous Catheter ◽

Infection Rate ◽

Venous Catheter ◽

Central Line ◽

Central Venous

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Central Line-Associated Blood Stream Infection in the Critically Ill Trauma Patient

The American Surgeon ◽

10.1177/000313481107700824 ◽

2011 ◽

Vol 77 (8) ◽

pp. 1038-1042 ◽

Cited By ~ 5

Author(s):

Jason W. Smith ◽

Michael Egger ◽

Glen Franklin ◽

Brian Harbrecht ◽

J. David Richardson

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Central Venous Catheter ◽

Injury Severity ◽

Venous Catheter ◽

Blood Stream ◽

Central Line ◽

Central Venous ◽

Blood Stream Infections ◽

Sterile Technique

Blood stream infections in the critically ill are a common cause of morbidity. Strict adherence to sterile technique can reduce central line-associated blood stream infections (CLBSIs) and has become a quality improvement measure. We did a retrospective review of 6,014 trauma admissions representing 10,370 catheter days. CLBSI was defined as a positive blood culture with central venous access without evidence of other infectious sources. Thirty-five CLBSIs were identified in the study period (3.26/1,000 line days). The average Injury Severity Score was 32, the average intensive care unit stay was 24 days, and the average overall length of stay was 34 days, which is higher than that of nonCLBSI patients. In 25/35 cases, there was a break in sterile technique during central venous catheter placement (71%). Of the 25 cases, 16 of them were performed in the intensive care unit (64%), five in the operating room (20%), and four in the emergency department (16%). Twenty of the 35 patients with CLBSI (57%) had a total of 24 infections, a 2-fold increase in infectious complications for a given Injury Severity Score. Seventeen (17) of the 25 “dirty” central lines (68%) were changed within 24 hours in an effort to reduce the risk of CLBSI without success. A large percentage of CLBSI can be traced to the initial placement of a central venous line under less than ideal sterile technique. Changing a line within 24 hours may not be sufficient to reduce the risk of CLBSI. Every effort should be made to adhere to proper sterile technique while placing central venous catheter.

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Use of dry dressings for central venous access devices (CVADs) to decrease central line-associated blood stream infections (CLABSI) in a trauma intensive care unit (ICU)

British Journal of Nursing ◽

10.12968/bjon.2021.30.8.s37 ◽

2021 ◽

Vol 30 (8) ◽

pp. S37-S42

Author(s):

France Paquet ◽

Janette Morlese ◽

Charles Frenette

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Central Venous Access ◽

Venous Access ◽

Blood Stream ◽

Central Line ◽

Surgical Intensive Care Unit ◽

Central Venous ◽

Surgical Intensive Care ◽

Venous Access Devices

This article reports the results of a pre-post study conducted in a trauma-medical-surgical intensive care unit (ICU) regarding dressings of central venous access devices (CVADs) for the reduction of central line-associated blood stream infection (CLABSI) and improvement of adherence and integrity of the dressing. Available evidence indicates that dry dressings changed every 48 hours are equivalent to transparent dressings, changed when soiled or loose, or routinely every seven days. In our intensive care unit, where the majority of CVADs are inserted in the internal jugular vein and where there is an important usage of cervical collars, we questioned if dry dressings would be more appropriate than transparent dressings. Results: In the 12 months following the change in practice, we noted a CLABSI reduction from 2.36/1,000 catheter days to zero, improvement in dressing audits from 19.61% to 85.34% of clean dressings (P=0.00001) and 62.75% to 90.58% of adherent dressings. Conclusion: In this pre-post study, a simple change in dressing type was implemented, resulting in a significant reduction in the CLABSI rate.

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