Comparison of clinical and cost effectiveness of accelerated study of sterility of intravascular catheters and drains

The results of a new method for detecting the contamination of intravascular catheters and drains are presented to assess its clinical and cost-effectiveness. Catheters are one of the most widely used devices in critically ill patients. The insertion of a catheter into the central venous system is an invasive procedure that can potentially lead to life-threatening complications for the patient. Catheters are a gateway for infection as they connect the external environment to the internal parts of the human body, causing catheter-associated infections. More than 15 % of patients with an established IVC develop complications, of which the most frequent and requiring removal of the vascular catheter are infectious (5–26 %) and mechanical (up to 25 %). Risk factors for catheter-associated conditions are crucial for hospital mortality.

Upper Extremity Deep Vein Thrombosis: Current Knowledge and Future Directions

Upper extremity deep vein thrombosis (UEDVT) has been increasing in incidence due to the escalating use of central venous catheters such as peripherally inserted central catheters. UEDVT can be primary idiopathic or secondary to pacemaker leads, intravascular catheters or cancer. In comparison to conventional venous thromboembolism such as lower limb deep vein thrombosis or pulmonary embolism the risk factors, investigations, and management are not well defined. We review current evidence in primary and secondary UEDVT, highlighting areas in need of further research. We also explore the entity of venous thoracic outlet syndrome, which is said to be a risk factor for recurrent primary UEDVT and is the rationale behind surgical interventions.

Biofilm and catheter-related bloodstream infections

Careful attention to detail and adherence to procedure guidelines when inserting and managing intravascular catheters has decreased the incidence of catheter-related bloodstream infections (CRBSIs). In order to limit these, health professionals must understand the underlying microbiology. Biofilms can explain the clinical findings most often seen with CRBSIs, yet they are poorly understood within medicine. Bacteria growing on solid surfaces such as a catheter are predominantly in biofilm phenotype, with a group of genes active that allow the bacteria to be tolerant to antiseptics and antibiotics by producing a self-secreted protective matrix. It is unclear whether it is planktonic seeding or small fragments of biofilm breaking off into the bloodstream that eventually results in the acute infection. The literature identifies four routes for microbes to adhere to a catheter and start biofilm formation: catheter contact, catheter insertion, catheter management and non-catheter-related sources. Routine clinical culture methods are inadequate to fully identify microbes producing catheter biofilm and/or bloodstream infection, therefore DNA methods may be required to diagnose CRBSIs. Treatment is removal and reinsertion of the catheter in a different site when possible. However, antibiofilm strategies can be employed to try to salvage the catheter. The use of high-dose antiseptics or antibiotics for long durations inside the catheter and hub (antibiotic/antiseptic lock) can suppress biofilm enough to reduce the seeding of the blood below a level where the patient's immune system can prevent bloodstream infection.

IMPACT OF SELF-INSTRUCTIONAL MODULE ON PERCEPTION REGARDING CATHETER RELATED BLOOD STREAM INFECTIONS AMONG NURSING OFFICERS IN SELECTED HOSPITALS OF MADHYA PRADESH

Infections associated with intravascular catheters account for 10% to 20% of all nosocomial infections. Healthcare-associated infections are a significant problem and 20-40 percent of healthcare-associated bloodstream infections may be linked to a central venous catheter. This infection is referred to as central line associated bacteremia. At posttest stage, the average (Mean ± Standard Deviation) perception scoring (38.04±5.75 points) among nursing officers of experimental group found to be significantly higher and improved after administration of self-instructional module as compared to average perception scoring (29.47±6.23 points) of nursing officers of control group who received placebo.

Morphological characteristics of an experimental catheter-associated infection following immunosuppression and the use of a low-molecular cationic peptide of the lantibiotic family – warnerin

Introduction. Catheter-associated infection is caused by microorganism colonization of the surface of the implanted catheter with a biofilm formation that significantly increases their resistance to antiseptics and antibiotics, especially in immunosuppression. Low-molecular antibacterial peptides are compounds capable of combating biofilm formation. The aim of the study was to describe morphological characteristics of a catheter-associated infection model on laboratory mice secondary to immunosuppression and to assess the efficacy of the low-molecular cationic antibacterial peptide (warnerin). Materials and methods. An experiment included white outbred mice (25–30 g body weight) under ether anesthesia that received 1.0-cm fragments of intravascular catheters under the skin of the backs. The animals underwent preliminary immunosuppression with cyclophosphamide. We used Staphylococcus epidermidis 33 (in the form of suspensions or biofilms previously grown on catheter segments) and low-molecular cationic peptide warnerin. All animals were sacrificed by ether overdose on days 1, 2, and 3 after the manipulation. We took the tissues surrounding the catheter for histological and immunohistochemical studies with antibodies to CD34, vimentin, CD68, CD3, and CD20. Results. The warnerin administration at the site of the catheter implantation led to disappearance of or a significant decrease in the number of bacterial. In the infiltrate, the number of neutrophils significantly increased, whereas that of fibroblasts decreased. Immunohistochemistry confirmed the features of the cellular reactions around the catheters with bacterial contamination with warnerin administration. Conclusion. In a model of catheter-associated infection in immunosuppressed mice, the warnerin antibacterial manifests in characteristic histological alterations in the inflammatory infiltrate composition. Keywords: catheter-associated infection model, morphology of inflammation, warnerin antibacterial cationic peptide

Epidemiology, Management, and Outcomes of Accidental Hypothermia: A Multicenter Study of Regional Care

Background Hypothermia is an uncommon, potentially life-threatening condition. We hypothesized (1) advanced rewarming techniques were more frequent with increased hypothermia severity, (2) active rewarming is increasingly performed with smaller intravascular catheters and decreased cardiopulmonary bypass, and (3) mortality was associated with age, hypothermia severity, and type. Methods Trauma patients with temperatures <35°C at 4 ACS-verified trauma centers in Wisconsin and Minnesota from 2006 to 2016 were reviewed. Statistical analysis included chi-square and Fisher’s exact tests. A P value < .05 was considered significant. Results 337 patients met inclusion criteria; primary hypothermia was identified in 127 (38%), secondary in 113 (34%), and mixed primary/secondary in 96 (28%) patients. Hypothermia was mild in 69%, moderate in 26%, and severe in 5% of patients. Intravascular rewarming catheter was the most frequent advanced modality (2%), used increasingly since 2014. Advanced techniques were used for primary (12%) vs. secondary (0%) and mixed (5%) ( P = .0002); overall use increased with hypothermia severity but varied by institution. Dysrhythmia, acute kidney injury, and frostbite risk worsened with hypothermia severity ( P < .0001, P = .031, and P < .0001, respectively). Mortality was greatest in patients with mixed hypothermia (39%, P = .0002) and age >65 years (33%, P = .03). Thirty-day mortality rates were similar among severe, moderate, and mild hypothermia ( P = .44). Conclusion Advanced rewarming techniques were used more frequently in severe and primary hypothermia but varied among institutions. Advanced rewarming was less common in mixed hypothermia; mortality was highest in this subgroup. Reliance on smaller intravascular catheters for advanced rewarming increased over time. Given inconsistencies in management, implementation of guidelines for hypothermia management appears necessary.

Practice Variation in Validation of Device Denominator Data for National Healthcare Safety Network Reporting

Background: The NHSN is a widely used CDC program for tracking healthcare-associated infections (HAIs). The goal of the NHSN is to help healthcare organizations to identify and track the incidence of HAI and to prevent adverse events as well as to simplify mandatory quality reporting to the CMS. Healthcare organizations provide both event data for HAIs and information about the population at risk. For device-related infections, device denominator data (eg, data related to urinary or intravascular catheters, and ventilators) must be collected and reported. NHSN guidelines require that electronic reporting of device denominator numbers be validated to be within 5% of manually collected counts over a period of 3 consecutive months. Little is known about current practical application of validation practices. Methods: We surveyed members of the SHEA Research Network (SRN) to assess awareness of and compliance with the current NHSN requirements for device denominator data validation. Results: The survey was sent to 89 member institutions of the SRN from November 20, 2018, to December 12, 2018. The response rate was 35.7%, and 90% of respondents are currently using an electronic system for device denominator count reporting. All except 1 institution manually validated the data. Of the facilities that had completed validation, 31% used <90 days of manual data. Moreover, 82% of these facilities found a difference of <5% between the electronic data and manual data without a statistically significant difference between those with at least 90 days of validation data and those with <90 days. Also, 21% of facilities validated data based on a subset of units. Conclusions: Although most respondents to the survey validate electronically collected device denominator data in accordance with NHSN’s requirements, nearly one-third reported using shorter validation periods than NHSN requires. However, shorter periods were not associated with worse concordance. The NHSN should evaluate whether the burden of a 3-month validation period is justified.Funding: NoneDisclosures: None

Minimising Blood Stream Infection: Developing New Materials for Intravascular Catheters

Catheter related blood stream infection is an ever present hazard for those patients requiring venous access and particularly for those requiring long term medication. The implementation of more rigorous care bundles and greater adherence to aseptic techniques have yielded substantial reductions in infection rates but the latter is still far from acceptable and continues to place a heavy burden on patients and healthcare providers. While advances in engineering design and the arrival of functional materials hold considerable promise for the development of a new generation of catheters, many challenges remain. The aim of this review is to identify the issues that presently impact catheter performance and provide a critical evaluation of the design considerations that are emerging in the pursuit of these new catheter systems.

Chlorhexidine-impregnated sponge versus chlorhexidine gel dressing for short-term intravascular catheters: which one is better?

Background Chlorhexidine-gluconate (CHG) impregnated dressings may prevent catheter-related bloodstream infections (CRBSI). Chlorhexidine-impregnated sponge dressings (sponge-dress) and gel dressings (gel-dress) have never been directly compared. We used the data collected for two randomized-controlled trials to perform a comparison between sponge-dress and gel-dress. Methods Adult critically ill patients who required short-term central venous or arterial catheter insertion were recruited. Our main analysis included only patients with CHG-impregnated dressings. The effect of gel-dress (versus sponge-dress) on major catheter-related infections (MCRI) and CRBSI was estimated using multivariate marginal Cox models. The comparative risks of dressing disruption and contact dermatitis were evaluated using logistic mix models for clustered data. An explanatory analysis compared gel-dress with standard dressings using either CHG skin disinfection or povidone iodine skin disinfection. Results A total of 3483 patients and 7941 catheters were observed in 16 intensive care units. Sponge-dress and gel-dress were utilized for 1953 and 2108 catheters, respectively. After adjustment for confounders, gel-dress showed similar risk for MCRI compared to sponge-dress (HR 0.80, 95% CI 0.28–2.31, p = 0.68) and CRBSI (HR 1.13, 95% CI 0.34–3.70, p = 0.85), less dressing disruptions (OR 0.72, 95% CI 0.60–0.86, p < 0.001), and more contact dermatitis (OR 3.60, 95% CI 2.51–5.15, p < 0.01). However, gel-dress increased the risk of contact dermatitis only if CHG was used for skin antisepsis (OR 1.94, 95% CI 1.38–2.71, p < 0.01). Conclusions We described a similar infection risk for gel-dress and sponge-dress. Gel-dress showed fewer dressing disruptions. Concomitant use of CHG for skin disinfection and CHG-impregnated dressing may significantly increase contact dermatitis. Trials registration These studies were registered within ClinicalTrials.gov (numbers NCT01189682 and NCT00417235).