Epidemiology and impact of a multifaceted approach in controlling central venous catheter associated blood stream infections outside the intensive care unit

Abstract

BackgroundOutside ICUs, CVC-ABSIs epidemiology and the results of strategies for their prevention are not well known. The aim of this study was to investigate the epidemiology and the impact of a multifaceted “bundle” approach in controlling CVC-ABSIs outside ICU.MethodsFrom 1991 we performed prevalence studies of device and parenteral nutrition use, and prospective surveillance of all episodes of CVC-ABSIs in a 350-bed teaching hospital. CVC-ABSIs incidence/1,000 inpatient-days was calculated. An estimated CVC-ABSIs incidence/1,000 catheter-days was calculated based on the prevalence rates of catheter use and the total number of inpatient-days in each year. On november 2008, an education programme was instituted for care of catheter lines: reinforcing instructions in aseptic insertion technique, after care and hand-washing; in order to assess the adherence to these measures the quantity of alcohol-based hand-rub consumption/1,000 patient-days was quoted in litres. From January 2009, a checklist intervention for CVC insertion in ICU was started: hand hygiene, using full barrier precautions, cleaning the skin with alcoholic chlorhexidine, avoiding femoral access and removing unnecessary catheters. Compliance with the central line insertion checklist was measured by real-time audits and was achieved in 80% of cases.ResultsPrevalence of use of CVC and parenteral nutrition was similar throughout the study. We followed-up 309 CVC-ABSIs cases. Estimated CVC-ABSIs rate progressively increased to 15.1/1,000 catheter-days in 2008 (0.36/1,000 inpatient-days). After the intervention, the alcohol-based hand-rub consumption increased slightly and estimated CVC-ABSIs rate fell to 10.1 /1,000 catheter-days in last three years (0.19/1,000 inpatient-days), showing a 32.9% decrease. The infection rates achieved were lower in Internal Medicine wards: decreased from 14.1/1,000 catheter-days (0.17/patient-days) in 2008 to 5.2/1,000 catheter-days (0.05/1,000 inpatient-days) in last three years, showing a 63.1% decrease. In 2009, the estimated CVC-ABSIs incidence rate was significantly lower in the Internal Medicine ward compared to the Surgery ward: rate ratio (RR) = 0.14, 95%CI: 0.03-0.60), and within the Internal Medicine ward, the estimated CVC-ABSIs incidence rate was significantly lower in 2009 compared to 2008 (RR = 0.20, 95%CI: 0.04-0.91).ConclusionThe rate of CVC-ABSIs increased outside-ICU, and the implementation of multifaceted infection control programme decreased their clinical impact.

Contaminação de torniquetes para punção intravenosa periférica

“…(3) Bloodstream infections, mainly when catheter-related, figure among the most frequent healthcare-associated infections and have been related with high mortality rates, extended hospitalization and higher financial burden. (4) The pathogens most commonly reported in BSI include coagulase-negative Staphylococcus, Staphylococcus aureus, enterococci and Candida spp. Infections by resistant microorganisms are also highlighted, such as methicillin-resistant Staphylococcus aureus and Candida spp.…”

Do Clinicians Know Which of Their Patients Have Central Venous Catheters?

“…However, with the advent and expanding use of PICCs in general medical and surgical patients, the epidemiology of CVCs has changed such that most are now found in non-ICU settings (1, 2, 4, 16). With these important shifts, accumulating evidence suggests the emergence of new and important problems associated with their use.…”

“…Often inserted in intensive care unit (ICU) and non-ICU settings, CVCs provide reliable venous access for tasks ranging from hemodynamic monitoring to delivery of irritants, vesicants, and intravenous antibiotics. In adults, 2 devices are most used in this context: nontunneled triple-lumen catheters placed in the subclavian, jugular, or femoral veins and peripherally inserted central catheters (PICCs) inserted into upper-extremity veins (1, 2). …”

De-implementation strategy to Reduce the Inappropriate use of urinary and intravenous CATheters: study protocol for the RICAT-study

“…A multifaceted ‘bundle’ approach (education, hospital protocol, national program, and checklist intervention) to control CVC-associated bloodstream infection in an internal medicine department in Spain showed a decrease of 63.1% (14.1 to 5.2 per 1000 catheter days) [25]. …”