Effects of Reminder Program for Healthcare Providers on Central Line-Associated Blood Stream Infection in an Intensive Care Unit

2021 ◽  
Vol 26 (2) ◽  
pp. 93-103
Author(s):  
Ok-Ja Choi ◽  
Bok-Hee Cho ◽  
Kyung-Hwa Park ◽  
Minjeong An
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Stream Infection ◽  
Healthcare Providers ◽  
Blood Stream ◽  
Central Line

Inpatient Peripherally Inserted Central Venous Catheter Complications: Should Peripherally Inserted Central Catheter Lines be Placed in the Intensive Care Unit Setting?

2017 ◽  
Vol 83 (8) ◽  
pp. 925-927 ◽  
Author(s):  
Michael Martyak ◽  
Ishraq Kabir ◽  
Rebecca Britt
Keyword(s):  
Intensive Care Unit ◽  
Interventional Radiology ◽  
Intensive Care ◽  
Infection Rate ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
Central Line ◽  
Complication Rates ◽  
Central Venous ◽  
Icu Patients

Peripherally inserted central venous catheters (PICCs) are now commonly used for central access in the intensive care unit (ICU) setting; however, there is a paucity of data evaluating the complication rates associated with these lines. We performed a retrospective review of all PICCs placed in the inpatient setting at our institution during a 1-year period from January 2013 to December 2013. These were divided into two groups: those placed at the bedside in the ICU and those placed by interventional radiology in non-ICU patients. Data regarding infectious and thrombotic complications were collected and evaluated. During the study period, 1209 PICC line placements met inclusion criteria and were evaluated; 1038 were placed by interventional radiology in non-ICU patients, and 171 were placed at the bedside in ICU patients. The combined thrombotic and central line associated blood stream infection rate was 6.17 per cent in the non-ICU group and 10.53 per cent in the ICU group (P = 0.035). The thrombotic complication rate was 5.88 per cent in the non-ICU group and 7.60 per cent in the ICU group (P = 0.38), whereas the central line associated blood stream infection rate was 0.29 per cent in the non-ICU group and 2.92 per cent in the ICU group (P = 0.002). This study seems to suggest that PICC lines placed at the bedside in the ICU setting are associated with higher complication rates, in particular infectious complications, than those placed by interventional radiology in non-ICU patients. The routine placement of PICC lines in the ICU settings needs to be reevaluated given these findings.

scholarly journals Quality Outcomes in the Surgical Intensive Care Unit after Electronic Health Record Implementation

2015 ◽  
Vol 06 (04) ◽  
pp. 611-618 ◽  
Author(s):  
V. H. Flatow ◽  
N. Ibragimova ◽  
C. M. Divino ◽  
D. S. A. Eshak ◽  
B. C. Twohig ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
Central Line ◽  
Surgical Intensive Care Unit ◽  
Readmission Rates ◽  
Surgical Intensive Care ◽  
The Impact

Summary Background: The electronic health record (EHR) is increasingly viewed as a means to provide more coordinated, patient-centered care. Few studies consider the impact of EHRs on quality of care in the intensive care unit (ICU) setting. Objectives: To evaluate key quality measures of a surgical intensive care unit (SICU) following implementation of the Epic EHR system in a tertiary hospital. Methods: A retrospective chart review was undertaken to record quality indicators for all patients admitted to the SICU two years before and two years after EHR implementation. Data from the twelve-month period of transition to EHR was excluded. We collected length of stay, mortality, central line associated blood stream infection (CLABSI) rates, Clostridium difficile (C. diff.) colitis rates, readmission rates, and number of coded diagnoses. To control for variation in the patient population over time, the case mix indexes (CMIs) and APACHE II scores were also analyzed. Results: There was no significant difference in length of stay, C. diff. colitis, readmission rates, or case mix index before and after EHR. After EHR implementation, the rate of central line blood stream infection (CLABSI) per 1 000 catheter days was 85% lower (2.16 vs 0.39; RR, 0.18; 95% CI, 0.05 to 0.61, p < .005), and SICU mortality was 28% lower (12.2 vs 8.8; RR, 1.35; 95% CI, 1.06 to 1.71, p < .01). Moreover, after EHR there was a significant increase in the average number of coded diagnoses from 17.8 to 20.8 (p < .000). Conclusions: EHR implementation was statistically associated with reductions in CLABSI rates and SICU mortality. The EHR had an integral role in ongoing quality improvement endeavors which may explain the changes in CLABSI and mortality, and this invites further study of the impact of EHRs on quality of care in the ICU.

Fever

2018 ◽  
pp. 176-179
Author(s):  
Sarah Morgan
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Key Management ◽  
Complete Blood Count ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
Central Line ◽  
Source Control ◽  
Empiric Antibiotics ◽  
Hospital Acquired

This chapter focuses on evaluation of a patient in the intensive care unit who develops fever in the setting of an indwelling central line and urinary catheter. Focus is on the development of a differential including central line associated blood stream infection, catheter-associated urinary tract infection, and hospital-acquired pneumonia as the most likely etiology of the patient’s decompensation. Emphasis is on rapid source control and treatment to control sepsis and decompensation to shock. Key management steps include consideration of the most likely sources of infection in the patient who develops fever while in the intensive care unit; securing a complete blood count, lactate, and blood cultures prior to empiric antibiotics; the rapid source control with removal and, if needed, replacement of indwelling lines; and administering appropriate empiric antibiotics within 6 hours of diagnosis of infection.

Central Line-associated Blood Stream Infection Reduction in an Intensive Care Unit Utilizing a Maintenance Bundle Audit Tool

2017 ◽  
Vol 45 (6) ◽  
pp. S95
Author(s):  
Michelle Engle ◽  
Kelsey Wick ◽  
Rebecca Siebenaler ◽  
Courtney Czech ◽  
Jennifer Craig ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
Central Line ◽  
Audit Tool ◽  
Infection Reduction

Understanding Gram-negative Central Line-Associated Blood Stream Infection in a Surgical Trauma ICU

2015 ◽  
Vol 81 (8) ◽  
pp. 816-819 ◽  
Author(s):  
Therese M. Duane ◽  
Rashid M. Kikhia ◽  
Luke G. Wolfe ◽  
Janis Ober ◽  
Jeffrey M. Tessier
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Stream Infection ◽  
Average Length ◽  
Blood Stream ◽  
Central Line ◽  
Surgical Trauma ◽  
Gram Negative ◽  
Line Placement

The purpose of this study was to review central line-associated blood stream infection (CLABSI) data from a surgical trauma intensive care unit to better understand patient risk factors, pathogens, and treatment interventions. We performed a retrospective review of all surgical ICU patients who met the Centers for Disease Control definition for Gram-negative CLABSI from 2006 through 2013. Demographics, pathogens, interventions, and outcomes were evaluated. A total of 40 patients were included with an average age of 49.9 ± 19 years and 72.5 per cent male. The average length of central venous line (CVL) was 11 ± 5.9 days with average time from line placement to positive culture 9.4 ± 6.8 days. Most common organisms were Enterobacter species (37.5%) with 17.8 per cent of all cultured organisms considered multidrug resistant. Piperacillin–tazobactam (67.5%) was the most commonly used antibiotic. Overall mortality rate was 22.5 per cent. A total of 11 patients who developed a recurrence did so at 10.7 ± 8 days and were similar to those without recurrence. Predominant pathogens associated with surgical trauma intensive care unit CLABSI in this study are different from those Gram-negative bacteria associated with published studies in the general hospital population. Further investigation into risk factors for infection and relapse is important to minimize such consequences. Understanding appropriate line placement and use as well as clarifying optimal duration of therapy is integral in improving outcomes.

Sign in / Sign up

Export Citation Format

Share Document