Faculty Opinions recommendation of Impact of alcohol-impregnated port protectors and needleless neutral pressure connectors on central line-associated bloodstream infections and contamination of blood cultures in an inpatient oncology unit.

2016 ◽  
Author(s):  
Edward J Septimus
Keyword(s):  
Bloodstream Infections ◽  
Central Line ◽  
Blood Cultures ◽  
Oncology Unit

Reducing Oncology Unit Central Line–Associated Bloodstream Infections: Initial Results of a Simulation-Based Educational Intervention

2016 ◽  
Vol 12 (1) ◽  
pp. e83-e87 ◽  
Author(s):  
Jenna Page ◽  
Maureen Tremblay ◽  
Cate Nicholas ◽  
Ted A. James
Keyword(s):  
Educational Intervention ◽  
Bloodstream Infections ◽  
Central Line ◽  
Care Model ◽  
Simulation Based ◽  
Oncology Unit ◽  
Initial Results

A targeted educational intervention using a simulated central line care model improved competence in central line care and resulted in decreased CLABSI rates for oncology inpatients.

scholarly journals 2143. Attempting to Add Clarity to “Indeterminates” on a Deployed Rapid Diagnostic with Antimicrobial Stewardship Program (ASP) Intervention

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S726-S726
Author(s):  
Heather L Cox ◽  
April E Attai ◽  
Allison M Stilwell ◽  
Kasi B Vegesana ◽  
Frankie Brewster ◽  
...  
Keyword(s):  
Pasteurella Multocida ◽  
Diagnostic Testing ◽  
Bloodstream Infections ◽  
Empiric Therapy ◽  
Central Line ◽  
Blood Cultures ◽  
University Hospital ◽  
Salmonella Spp ◽  
Gram Negative ◽  
Stewardship Program

Abstract Background Rapid diagnostic testing paired with ASP intervention optimizes therapy and improves outcomes but few data guide ASP response in the absence of organism identification (ID). We describe the microbiology for organisms unidentified by Accelerate Pheno™ Gram-negative platform (AXDX) in order to inform ASP-provider team communication (PTC). Methods Consecutive, non-duplicate inpatient blood cultures with Gram-negative bacilli (GNB) following AXDX implementation at a single university hospital between April 2018 and March 2019 were included. Standard of care (SOC) ID and susceptibility followed AXDX. Clinical Microbiology emailed AXDX results to the ASP in real time; results were released into the EMR paired with telephone PTC or withheld after ASP review. Bloodstream Infections (BSIs) and patient outcomes for organisms labeled no/indeterminate ID by the AXDX were characterized. Results AXDX was performed on 351 blood cultures. Among 52 (15%) labeled no/indeterminate ID, SOC methods revealed: Enterobacteriaceae (40%; 9 monomicrobial with AXDX targets), anaerobes (21%), non-lactose fermenters (NLFs) other than Pseudomonas aeruginosa (21%), and fastidious GNB (10%). Frequent organisms without AXDX targets included: Raoultella planticola (4); Bacteroides fragilis, Cupriavidus spp., Haemophilus spp., Prevotella spp., Providencia spp., non-aeruginosa Pseudomonas spp., Salmonella spp. (3 each); Pasteurella multocida, Stenotrophomonas maltophilia (2 each). BSI sources were most commonly intra-abdominal (21%), central line-associated (17%), or unknown (17%). CLABSIs were associated with immune suppression and/or substance abuse in all but 1 case. BSIs without active empiric therapy included: NDM-producing Providencia stuartii SSSI; OXA-48-producing R. planticola intraabdominal infection (IAI); Pandoraea spp. CLABSI after liver transplant; enteric fever; B. fragilis, Leptotrichia wadei, and S. maltophilia, each of unknown source. In-hospital mortality occurred in 4 of these cases. Conclusion When AXDX yields no/indeterminate ID, ASP chart review for possible anaerobic/IAI, unique environmental exposures, and travel history may assist in guiding empiric therapy. GNB with AXDX targets are not excluded. Disclosures All authors: No reported disclosures.

The Efficacy of Blood Culture in Postoperative Patients

2010 ◽  
Vol 76 (10) ◽  
pp. 1172-1175 ◽  
Author(s):  
Jenny J. Lee ◽  
David R. Martin
Keyword(s):  
National Research Council ◽  
Bloodstream Infections ◽  
Central Line ◽  
Blood Cultures ◽  
Blood Cell Count ◽  
Blood Draw ◽  
Suspected Sepsis ◽  
Wound Classification ◽  
Preoperative Antibiotics ◽  
Rule Out

Blood cultures are often obtained in postoperative patients to rule out bloodstream infections. Our study objectives were to determine the efficacy of blood cultures in postoperative patients with suspected sepsis and to determine variables predisposing patients to positive cultures. This was a retrospective study including patients with blood cultures drawn from January to March 2009 at our institution. We recorded demographics, presence of fever (temperature 101.5°F or higher), elevated white blood cell count (12,000/μL or greater), central line, diabetes, intensive care unit admission, postoperative day of blood draw, National Research Council surgical wound classification, and pre- or postoperative antibiotics. Blood cultures were drawn from 150 patients undergoing surgery within 30 days prior. Sixteen had positive cultures and nine were true-positives (6.3%). There was no statistical difference ( P > 0.05) between patients with positive and negative cultures except that those with negative cultures were more likely to have received preoperative antibiotics ( P = 0.0186). Blood cultures are invasive, expensive tests with low yield. We recommend that blood cultures be drawn in patients not receiving preoperative antibiotics who have undergone surgery more than 4 days before culture.

scholarly journals 81. Reducing Unnecessary Blood Cultures Through Diagnostic Stewardship

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S157-S157
Author(s):  
Sujeet Govindan ◽  
Luke Strnad
Keyword(s):  
Blood Culture ◽  
Positive Blood Culture ◽  
Cost Savings ◽  
Bloodstream Infections ◽  
Central Line ◽  
Blood Cultures ◽  
Coagulase Negative Staphylococci ◽  
Candida Sp ◽  
Daily Frequency ◽  
Oregon Health

Abstract Background At our institution, we learned the frequency of blood cultures was sometimes being changed from “Once” to “Daily” without a defined number of days. We hypothesized this led to unnecessary blood cultures being performed. Methods Over a 3 month period from 12/6/2019-3/6/2020, we retrospectively evaluated the charts of patients who had a blood culture frequency changed to “Daily”. We evaluated if there was an initial positive blood culture within 48 hours of the “Daily” order being placed and the number of positive, negative, or “contaminant” sets of cultures drawn with the order. Contaminant blood cultures were defined as a contaminant species, present only once in the repeat cultures, and not present in initial positive cultures. Results 95 unique orders were placed with 406 sets of cultures drawn from 89 adults. ~20% of the time (17 orders) the order was placed without an initial positive blood culture. This led to 62 sets of cultures being drawn, only 1 of which came back positive. 78/95 orders had an initial positive blood culture. The most common initial organisms were Staphylococcus aureus (SA) (38), Candida sp (10), Enterobacterales sp (10), and coagulase negative staphylococci (7). 43/78 (55%) orders with an initial positive set had positive repeat cultures. SA (26) and Candida sp (8) were most common to have positive repeats. Central line associated bloodstream infections (CLABSI) were found in 5 of the orders and contaminant species were found in 4 of the orders. 54% of the patients who had a “Daily” order placed did not have positive repeat cultures. The majority of the cultures were drawn from Surgical (40 orders) and Medical (35 orders) services. Assuming that SA and Candida sp require 48 hours of negative blood cultures to document clearance and other species require 24 hours, it was estimated that 51% of the cultures drawn using the "Daily" frequency were unnecessary. Cost savings over a year of removing the "Daily" frequency would be ~&14,000. Data from "Daily" blood culture orders drawn at Oregon Health & Science University from 12/6/2019-3/6/2020 Conclusion Unnecessary blood cultures are drawn when the frequency of blood cultures is changed to "Daily". Repeat blood cultures had the greatest utility in bloodstream infections due to SA or Candida sp, and with CLABSI where the line is still in place. These results led to a stewardship intervention to change blood culture ordering at our institution. Disclosures All Authors: No reported disclosures

scholarly journals Central Line–Associated Bloodstream Infections in Adult Hematology Patients with Febrile Neutropenia An Evaluation of Surveillance Definitions Using Differential Time to Blood Culture Positivity

2013 ◽  
Vol 34 (1) ◽  
pp. 89-92 ◽  
Author(s):  
Joshua T. Freeman ◽  
Anna Elinder-Camburn ◽  
Catherine McClymont ◽  
Deverick J. Anderson ◽  
Mary Bilkey ◽  
...  
Keyword(s):  
Blood Culture ◽  
Febrile Neutropenia ◽  
Positive Predictive Value ◽  
Bloodstream Infections ◽  
Central Line ◽  
Blood Cultures ◽  
National Healthcare ◽  
Culture Positivity ◽  
National Healthcare Safety Network ◽  
Blood Culture Positivity

We used differential time to positivity between central and peripheral blood cultures to evaluate the positive predictive value (PPV) of the National Healthcare Safety Network central line–associated bloodstream infection (CLABSI) surveillance definition among hematology patients with febrile neutropenia. The PPV was 27.7%, which suggests that, when the definition is applied to this population, CLABSI rates will be substantially overestimated.

scholarly journals 1169. Preventing Central Line-Associated Bloodstream Infections in Long-Term Acute Care

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S418-S419
Author(s):  
Jerry Jacob ◽  
Ann Morace ◽  
Jisuk Park ◽  
Nina Renzi
Keyword(s):  
Blood Culture ◽  
Bloodstream Infections ◽  
Central Line ◽  
Culture Collection ◽  
Blood Cultures ◽  
Fiscal Year ◽  
Intervention Period ◽  
Central Lines ◽  
Clabsi Rate

Abstract Background Long-term acute care hospitals (LTACHs) care for chronically, critically ill patients with high utilization of central lines and high risk for morbidity from central line-associated bloodstream infections (CLABSIs). Our 38-bed LTACH noted a substantial increase in the incidence of CLABSIs (as defined by the National Healthcare Safety Network) between fiscal year (FY) 2016 and FY 2018 (Figure 1). Detailed case review identified a large number of CLABSIs which were clinically consistent with blood culture contaminants from central lines. Feedback from bedside staff also suggested gaps between practice and evidence-based measures for central line care. Methods A three-pronged CLABSI prevention project was implemented in July 2018 consisting of (1) staff education regarding daily chlorhexidine (CHG) bathing for all patients, combined with an electronic audit report to identify patients without active CHG orders; (2) change in practice to the use of venipuncture alone for blood culture collection, combined with an electronic audit report to identify blood cultures collected from central lines; and (3) a recurring 6-part educational series for nurses focused on central line care. The pre-intervention period was defined as the 12-month period between July 1, 2017 and June 30, 2018 (FY 2018). The primary outcome was the fiscal year CLABSI rate. A secondary outcome was the proportion of blood cultures drawn from central lines. Results After 9 months of the intervention, one CLABSI had been reported for FY 2019 year-to-date at a rate of 0.4 per 1,000 CL-days, representing an 86% decrease from the FY 2018 rate of 2.8 per 1,000 CL-days. The 12-month rolling CLABSI rate decreased to 1.6 per 1,000 CL-days (Figure 2). The proportion of blood cultures collected from central lines decreased from 10.5% (69/658) to 4.5% (15/334), representing a 57% reduction. The proportion of patients ordered and receiving CHG bathing in the intervention period was >95%. Conclusion A multidisciplinary effort focused on CHG bathing, central line care, and blood culture collection led to a substantial reduction in CLABSIs in our LTACH. The use of electronic audit reports was particularly useful in achieving high adherence to practice changes. Disclosures All authors: No reported disclosures.

scholarly journals Increasing the Reliability of Fully Automated Surveillance for Central Line–Associated Bloodstream Infections

2015 ◽  
Vol 36 (12) ◽  
pp. 1396-1400 ◽  
Author(s):  
Rachael E. Snyders ◽  
Ashleigh J. Goris ◽  
Kathleen A. Gase ◽  
Carole L. Leone ◽  
Joshua A. Doherty ◽  
...  
Keyword(s):  
Surveillance System ◽  
Secondary Infection ◽  
Bloodstream Infections ◽  
Central Line ◽  
Skin Wound ◽  
Blood Cultures ◽  
Electronic Surveillance ◽  
Predictive Values ◽  
Routine Surveillance ◽  
Automated Surveillance

OBJECTIVETo increase reliability of the algorithm used in our fully automated electronic surveillance system by adding rules to better identify bloodstream infections secondary to other hospital-acquired infections.METHODSIntensive care unit (ICU) patients with positive blood cultures were reviewed. Central line–associated bloodstream infection (CLABSI) determinations were based on 2 sources: routine surveillance by infection preventionists, and fully automated surveillance. Discrepancies between the 2 sources were evaluated to determine root causes. Secondary infection sites were identified in most discrepant cases. New rules to identify secondary sites were added to the algorithm and applied to this ICU population and a non-ICU population. Sensitivity, specificity, predictive values, and kappa were calculated for the new models.RESULTSOf 643 positive ICU blood cultures reviewed, 68 (10.6%) were identified as central line–associated bloodstream infections by fully automated electronic surveillance, whereas 38 (5.9%) were confirmed by routine surveillance. New rules were tested to identify organisms as central line–associated bloodstream infections if they did not meet one, or a combination of, the following: (I) matching organisms (by genus and species) cultured from any other site; (II) any organisms cultured from sterile site; (III) any organisms cultured from skin/wound; (IV) any organisms cultured from respiratory tract. The best-fit model included new rules I and II when applied to positive blood cultures in an ICU population. However, they didn’t improve performance of the algorithm when applied to positive blood cultures in a non-ICU population.CONCLUSIONElectronic surveillance system algorithms may need adjustment for specific populations.Infect. Control Hosp. Epidemiol. 2015;36(12):1396–1400

Using Practice-Based Evidence to Improve Supportive Care Practices to Reduce Central Line–Associated Bloodstream Infections in a Pediatric Oncology Unit

2016 ◽  
Vol 34 (3) ◽  
pp. 185-195 ◽  
Author(s):  
Lauri A. Linder ◽  
Cheryl Gerdy ◽  
Rouett Abouzelof ◽  
Andrew Wilson
Keyword(s):  
Supportive Care ◽  
Pediatric Oncology ◽  
Clinical Care ◽  
Oral Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Coagulase Negative Staphylococci ◽  
Principles Of Practice ◽  
Oncology Unit ◽  
Viridans Group Streptococci

Children with cancer are a subset of patients with central lines with distinct risk factors for infection including periods of prolonged neutropenia and compromised mucous membrane integrity. This article relates the implementation of principles of practice-based evidence to identify interventions in addition to best practice maintenance care bundles to reduce central line–associated bloodstream infections involving viridans group streptococci and coagulase-negative staphylococci on an inpatient pediatric oncology unit. Review of individual events combined with review of current clinical practice guided the development of structured protocols emphasizing routine oral care and general supportive cares. Key principles of the protocols emphasized a 1-2-3 mnemonic and included daily bathing, twice daily oral care, and out-of-bed activity 3 times daily. Poisson regression identified a significant main effect for time period for central line–associated bloodstream infection rates involving both viridans group streptococci and coagulase-negative staphylococci. Significant differences were present between the preintervention baseline and implementation of the supportive care protocols. Project outcomes demonstrate the added value of using principles of practice-based evidence to guide the development of interventions to improve clinical care when evidence-based sources are limited.

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