Pre-emptive replacement of peripherally inserted central catheters (PICCs) to prevent a ‘possible’ central line-associated bloodstream infection (CLABSI) in patients with haematological malignancies

2016 ◽  
Author(s):  
Nick de Jonge
Keyword(s):  
Bloodstream Infection ◽  
Central Line ◽  
Haematological Malignancies ◽  
Peripherally Inserted Central Catheters ◽  
Central Catheters

Types of Interventions

2021 ◽  
pp. 40-51
Author(s):  
Jennifer Meddings ◽  
Vineet Chopra ◽  
Sanjay Saint
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Bloodstream Infection ◽  
Infection Prevention ◽  
Central Line ◽  
Peripherally Inserted Central Catheters ◽  
Trade Off ◽  
Central Lines ◽  
The Past ◽  
Central Catheters

Prevention of central line–associated bloodstream infection (CLABSI), while initially making great strides in 2003, has declined as use of peripherally inserted central catheters (PICCs) has grown tremendously over the past two decades. The convenience of a PICC has led to sicker patients being treated outside the intensive care unit, and there has been little recognition of a trade-off between benefits and risks after PICC placement. For these reasons, CLABSI prevention has become more challenging. This chapter describes the contents of an infection prevention bundle for CLABSI. In the case of CLABSI, the intervention outlines appropriate and inappropriate uses of central lines. Several new tools are discussed, which help doctors and nurses think through which device is most appropriate for any given patient.

scholarly journals Peripherally Inserted Central Catheters Present on Admission and the Risk of Central-Line–Associated Bloodstream Infection

2020 ◽  
Vol 41 (S1) ◽  
pp. s349-s349
Author(s):  
Patrick Burke ◽  
Elise Nickoli ◽  
Joanne Sitaras ◽  
Wanda Mullins ◽  
Patricia Dandache
Keyword(s):  
Health System ◽  
Bloodstream Infection ◽  
Cleveland Clinic ◽  
Central Line ◽  
Admission Diagnosis ◽  
Peripherally Inserted Central Catheters ◽  
Unknown Risk ◽  
Vascular Catheters ◽  
Present On Admission ◽  
Central Catheters

Background: Patients presenting to hospitals often arrive with peripherally inserted central catheters (PICC) in place upon admission. The admitting facility may not be familiar with that device’s history and the unknown risk for bloodstream infection associated with it often prompts requests for device replacement. A blanket approach to “change all lines” must be balanced with the potential for patient discomfort and insertion-related complications. To better inform our approach to prevention, we determined the incidence of central-line–associated bloodstream infection (CLABSI) in adult patients presenting to hospitals in our health system with a PICC present on admission (POA), relative to those who have a PICC placed after admission (PAA). Methods: This retrospective cohort study included all adult hospital encounters at 11 Cleveland Clinic acute-care hospitals lasting > 2 days in 2018 with electronic medical record nursing care flowsheet documentation of a PICC during the stay. Patients whose admission diagnosis was related to intravascular catheter infection, children aged <18 years, and observation unit encounters were excluded. Patients were categorized as having a PICC POA if a nurse selected that option on a PICC flowsheet, otherwise the patient was categorized has having a PICC PAA. Surveillance for CLABSI was performed in all inpatient locations at all hospitals according to the NHSN protocol. Patients with ≥1 CLABSI were matched to encounters by name and date of admission. Repeat infections occurring to the same patient were excluded. Results: Of the 8,827 eligible hospital encounters, 1,799 (20%) involved a PICC POA and 7,028 (80%) had PICCs PAA. Across 11 hospitals, the median proportion of PICC-associated encounters with a device POA was 15% (range, 8%–25%). Moreover, 23 of the 112 CLABSIs (21%) in our cohort occurred in patients with a PICC POA and 89 (79%) occurred in patients with a PICC PAA (Table 1). The overall relative risk of CLABSI, whether the PICC was placed before or after admission, was 1.00 (95% CI, 0.64–1.60). Conclusions: Patients with a PICC present on admission to our hospitals were no more likely to experience a CLABSI than patients who had a PICC placed after admission. Replacing vascular catheters that are POA may not reduce the risk of CLABSI. With up to 25% of PICC-associated encounters having the device POA, universal device replacement at admission would involve hundreds of patients per year at our multihospital health system.Funding: NoneDisclosures: None

The microbial biofilm composition on peripherally inserted central catheters: A comparison of polyurethane and hydrophobic catheters collected from paediatric patients

2020 ◽  
pp. 112972982093242
Author(s):  
Maddie Higgins ◽  
Li Zhang ◽  
Rebecca Ford ◽  
Jeremy Brownlie ◽  
Tricia Kleidon ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Microbial Communities ◽  
Bloodstream Infection ◽  
Dwell Time ◽  
Central Line ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Peripherally Inserted Central Catheters ◽  
Microbial Biofilm ◽  
Central Catheters

Background: Peripherally inserted central catheters are susceptible to microbial colonisation and subsequent biofilm formation, leading to central line–associated bloodstream infection, a serious peripherally inserted central catheter–related complication. Next-generation peripherally inserted central catheter biomaterials, such as hydrophobic materials (e.g. Endexo®), may reduce microbial biofilm formation or attachment, consequently reducing the potential for central line–associated bloodstream infection. Methods: Within a randomised controlled trial, culture-dependent and culture-independent methods were used to determine if the biomaterials used in traditional polyurethane peripherally inserted central catheters and hydrophobic peripherally inserted central catheters impacted microbial biofilm composition. This study also explored the impact of other clinical characteristics including central line–associated bloodstream infection, antibiotic therapy and dwell time on the microbial biofilm composition of peripherally inserted central catheters. Results: From a total of 32 patients, one peripherally inserted central catheter was determined to be colonised with Staphylococcus aureus, and on further analysis, the patient was diagnosed with central line–associated bloodstream infection. All peripherally inserted central catheters ( n = 17 polyurethane vs n = 15 hydrophobic) were populated with complex microbial communities, including peripherally inserted central catheters considered non-colonised. The two main microbial communities observed included Staphylococcus spp., dominant on the colonised peripherally inserted central catheter, and Enterococcus, dominant on non-colonised peripherally inserted central catheters. Both the peripherally inserted central catheter biomaterial design and antibiotic therapy had no significant impact on microbial communities. However, the diversity of microbial communities significantly decreased with dwell time. Conclusion: More diverse pathogens were present on the colonised peripherally inserted central catheter collected from the patient with central line–associated bloodstream infection. Microbial biofilm composition did not appear to be affected by the design of peripherally inserted central catheter biomaterials or antibiotic therapy. However, the diversity of the microbial communities appeared to decrease with dwell time.

A Model to Predict Central-Line–Associated Bloodstream Infection Among Patients With Peripherally Inserted Central Catheters: The MPC Score

2017 ◽  
Vol 38 (10) ◽  
pp. 1155-1166 ◽  
Author(s):  
Erica Herc ◽  
Payal Patel ◽  
Laraine L. Washer ◽  
Anna Conlon ◽  
Scott A. Flanders ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Model ◽  
Significant Risk ◽  
Hospital Medicine ◽  
Central Line ◽  
Cox Proportional Hazards Model ◽  
Operating Characteristics ◽  
Peripherally Inserted Central Catheters ◽  
Factors Associated ◽  
Central Catheters

BACKGROUNDPeripherally inserted central catheters (PICCs) are associated with central-line–associated bloodstream infections (CLABSIs). However, no tools to predict risk of PICC-CLABSI have been developed.OBJECTIVETo operationalize or prioritize CLABSI risk factors when making decisions regarding the use of PICCs using a risk model to estimate an individual’s risk of PICC-CLABSI prior to device placement.METHODSUsing data from the Michigan Hospital Medicine Safety consortium, patients that experienced PICC-CLABSI between January 2013 and October 2016 were identified. A Cox proportional hazards model with robust sandwich standard error estimates was then used to identify factors associated with PICC-CLABSI. Based on regression coefficients, points were assigned to each predictor and summed for each patient to create the Michigan PICC-CLABSI (MPC) score. The predictive performance of the score was assessed using time-dependent area-under-the-curve (AUC) values.RESULTSOf 23,088 patients that received PICCs during the study period, 249 patients (1.1%) developed a CLABSI. Significant risk factors associated with PICC-CLABSI included hematological cancer (3 points), CLABSI within 3 months of PICC insertion (2 points), multilumen PICC (2 points), solid cancers with ongoing chemotherapy (2 points), receipt of total parenteral nutrition (TPN) through the PICC (1 point), and presence of another central venous catheter (CVC) at the time of PICC placement (1 point). The MPC score was significantly associated with risk of CLABSI (P<.0001). For every point increase, the hazard ratio of CLABSI increased by 1.63 (95% confidence interval, 1.56–1.71). The area under the receiver-operating-characteristics curve was 0.67 to 0.77 for PICC dwell times of 6 to 40 days, which indicates good model calibration.CONCLUSIONThe MPC score offers a novel way to inform decisions regarding PICC use, surveillance of high-risk cohorts, and utility of blood cultures when PICC-CLABSI is suspected. Future studies validating the score are necessary.Infect Control Hosp Epidemiol2017;38:1155–1166

Reducing Bloodstream Infection Risk in Central and Peripheral Intravenous Lines: Initial Data on Passive Intravenous Connector Disinfection

2014 ◽  
Vol 19 (2) ◽  
pp. 87-93 ◽  
Author(s):  
Michelle DeVries ◽  
Patricia S. Mancos ◽  
Mary J. Valentine
Keyword(s):  
Bloodstream Infection ◽  
Isopropyl Alcohol ◽  
Central Line ◽  
Infection Risk ◽  
Central Venous ◽  
Central Lines ◽  
Related Risk ◽  
Practice Audit ◽  
Intravenous Catheters ◽  
Central Catheters

Abstract Background: Although few facilities focus on it, bloodstream infection (BSI) risk from peripheral intravenous catheters (PIVs) may exceed central line-related risk. Over a 6-year period, Methodist Hospitals substantially reduced BSIs in patients with central lines but not in patients with PIVs. A practice audit revealed deficiencies in manual disinfection of intravenous connectors, thereby increasing BSI risk. Methodist thus sought an engineered approach to hub disinfection that would compensate for variations in scrubbing technique. Methods: Our institution involved bedside nurses in choosing new hub disinfection technology. They selected 2 devices to trial: a disinfection cap that passively disinfects hubs with isopropyl alcohol and a device that friction-scrubs with isopropyl alcohol. After trying both, nurses selected the cap for use in the facility's 3 intensive care units. After no BSIs occurred during a 3-month span, we implemented the cap throughout the hospital for use on central venous catheters; peripherally inserted central catheters; and peripheral lines, including tubing and Y-sites. Results: Comparing the postintervention period (December 2011-August 2013) to the preintervention span (September 2009–May 2011), the BSI rate dropped 43% for PIVs, 50% for central lines, and 45% overall (PIVs + central lines). The central line and overall results are statistically significant. The PIV BSI rate drop is attributable to cap use alone because the cap was the only new intervention during the postimplementation period. The other infection reductions appear to be at least partly due to cap use. Conclusions: Our institution achieved substantial BSI reductions, some statistically significant, by applying a disinfection cap to both PIVs and central lines.

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