Catheter-Associated Bloodstream Infections in General Medical Patients Outside the Intensive Care Unit: A Surveillance Study

Self Cite

388

251

Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections. The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their central line–associated bloodstream infection (CLABSI) prevention efforts. Refer to the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections” Executive Summary and Introduction and accompanying editorial for additional discussion.1. Patients at risk for CLABSIs in acute care facilitiesa. Intensive care unit (ICU) population: The risk of CLABSI in ICU patients is high. Reasons for this include the frequent insertion of multiple catheters, the use of specific types of catheters that are almost exclusively inserted in ICU patients and associated with substantial risk (eg, arterial catheters), and the fact that catheters are frequently placed in emergency circumstances, repeatedly accessed each day, and often needed for extended periods.b. Non-ICU population: Although the primary focus of attention over the past 2 decades has been the ICU setting, recent data suggest that the greatest numbers of patients with central lines are in hospital units outside the ICU, where there is a substantial risk of CLABSI.2. Outcomes associated with hospital-acquired CLABSIa. Increased length of hospital stayb. Increased cost; the non-inflation-adjusted attributable cost of CLABSIs has been found to vary from $3,700 to $29,000 per episode

Section: Purposementioning

confidence: 99%

“…Surveillance for CLABSI in these settings requires additional resources. 4,5,57 6. Use antimicrobial ointments for hemodialysis catheter insertion sites (A-I).…”

Section: Remove Nonessential Catheters (A-ii)mentioning

confidence: 99%

Strategies to Prevent Central Line–Associated Bloodstream Infections in Acute Care Hospitals

Marschall

Mermel

Classen

et al. 2008

Self Cite

388

251

“…However, a number of studies have indicated that non-ICU patients have an equally high risk of CLABSI. 3,4 Furthermore, in many hospitals there may actually be more patients with catheters outside the ICU than in it. 5 The lower utilization rates of central lines outside the ICU and the larger, more widely distributed population exacerbate the effort required for adequate surveillance of CLABSI by means of the traditional manual methods.…”

mentioning

confidence: 99%

Electronic Surveillance for Healthcare-Associated Central Line—Associated Bloodstream Infections Outside the Intensive Care Unit

Woeltje

McMullen

Butler

et al. 2011

"Electronic surveillance for healthcare-associated central line-associated bloodstream infections outside the intensive care unit." Infection Control and Hospital Epidemiology.32,11. 1086-1090. (2011 http://www.jstor.org/page/info/about/policies/terms.jsp JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org. The University of Chicago Press and The Society for Healthcare Epidemiology of America are collaborating with JSTOR to digitize, preserve and extend access to Infection Control and Hospital Epidemiology.http://www.jstor.org infection control and hospital epidemiology november 2011, vol. 32, no. 11 o r i g i n a l a r t i c l e background. Manual surveillance for central line-associated bloodstream infections (CLABSIs) by infection prevention practitioners is time-consuming and often limited to intensive care units (ICUs). An automated surveillance system using existing databases with patientlevel variables and microbiology data was investigated.

“…In addition, this study was large: it included >10,000 patients with >140,000 central-line days, and it was conducted at 2 academic medical centers with relatively low baseline CLABSI rates compared with those in prior published literature. 9,31 Previously, a lower burden of organisms has been found in effluent from silver-coated NCs. 32 From a convenience sample of 62 patients enrolled in the current study, 151 NCs were prospectively obtained for biofilm analysis; biofilm was observed on the luminal surface of >90% of both silvercoated and standard NCs.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of CLABSIs now occur outside ICUs. 1,31,34 We were able to include all central lines inside and outside of ICUs, and we used a previously validated methodology to calculate the number of central-line days outside the ICUs.…”

Section: Discussionmentioning

confidence: 99%

Comparison of a Silver-Coated Needleless Connector and a Standard Needleless Connector for the Prevention of Central Line-Associated Bloodstream Infections

Jacob

Tejedor

Reyes

et al. 2014

objective. To assess the impact of a novel, silver-coated needleless connectors (NCs) on central-line-associated bloodstream infection (CLABSI) rates compared with a mechanically identical NCs without a silver coating. conclusions. The use of silver-coated NCs decreased the CLABSI rate by 32%. CLABSI reduction efforts should include efforts to minimize contamination of NCs. Infect Control Hosp Epidemiol 2015;36(3):294-301Central-line-associated bloodstream infection (CLABSI) is a major cause of patient harm, and prevention of such infections has received much attention over the past decade. A national effort to prevent CLABSIs has been undertaken through optimization of central-line insertion practices. With this and other strategies, including economic disincentives through payment reform and public reporting of infection rates, the incidence of CLABSI has decreased in U.S. hospitals; however, in 2009,~41,000 CLABSIs were reported. 1 The persistence of CLABSIs and their high associated mortality underscore the need for novel prevention efforts.CLABSIs occur through two major routes. Infection can occur via an extraluminal pathway when microorganisms, often from the skin surface, gain access to the bloodstream via the external catheter surface. This contamination of the catheter surface can occur at the time of catheter insertion, particularly if proper insertion practices are not used. Intraluminal colonization of the catheter with seeding of the bloodstream typically occurs following contamination of the catheter hub, which is frequently manipulated in the process of injecting medications or fluids. Molecular typing of blood, skin, and catheter hub isolates suggests that most CLABSIs occurring early after line insertion originate from the skin (and are likely insertion-related events), whereas many CLABSIs occurring after the first 1-2 weeks of line placement are related to catheter hub contamination. [2][3][4][5][6][7][8]