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Beyond the bundle - journey of a tertiary care medical intensive care unit to zero central line-associated bloodstream infections

INTRODUCTION: We set a goal to reduce the incidence rate of catheter-related bloodstream infections to rate of <1 per 1,000 central line days in a two-year period. METHODS: This is an observational cohort study with historical controls in a 25-bed intensive care unit at a tertiary academic hospit...

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Autores principales: Exline, Matthew C, Ali, Naeem A, Zikri, Nancy, Mangino, Julie E, Torrence, Kelly, Vermillion, Brenda, St Clair, Jamie, Lustberg, Mark E, Pancholi, Preeti, Sopirala, Madhuri M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3733431/
https://www.ncbi.nlm.nih.gov/pubmed/23497591
http://dx.doi.org/10.1186/cc12551
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author Exline, Matthew C
Ali, Naeem A
Zikri, Nancy
Mangino, Julie E
Torrence, Kelly
Vermillion, Brenda
St Clair, Jamie
Lustberg, Mark E
Pancholi, Preeti
Sopirala, Madhuri M
author_facet Exline, Matthew C
Ali, Naeem A
Zikri, Nancy
Mangino, Julie E
Torrence, Kelly
Vermillion, Brenda
St Clair, Jamie
Lustberg, Mark E
Pancholi, Preeti
Sopirala, Madhuri M
author_sort Exline, Matthew C
collection PubMed
description INTRODUCTION: We set a goal to reduce the incidence rate of catheter-related bloodstream infections to rate of <1 per 1,000 central line days in a two-year period. METHODS: This is an observational cohort study with historical controls in a 25-bed intensive care unit at a tertiary academic hospital. All patients admitted to the unit from January 2008 to December 2011 (31,931 patient days) were included. A multidisciplinary team consisting of hospital epidemiologist/infectious diseases physician, infection preventionist, unit physician and nursing leadership was convened. Interventions included: central line insertion checklist, demonstration of competencies for line maintenance and access, daily line necessity checklist, and quality rounds by nursing leadership, heightened staff accountability, follow-up surveillance by epidemiology with timely unit feedback and case reviews, and identification of noncompliance with evidence-based guidelines. Molecular epidemiologic investigation of a cluster of vancomycin-resistant Enterococcus faecium (VRE) was undertaken resulting in staff education for proper acquisition of blood cultures, environmental decontamination and daily chlorhexidine gluconate (CHG) bathing for patients. RESULTS: Center for Disease Control/National Health Safety Network (CDC/NHSN) definition was used to measure central line-associated bloodstream infection (CLA-BSI) rates during the following time periods: baseline (January 2008 to December 2009), intervention year (IY) 1 (January to December 2010), and IY 2 (January to December 2011). Infection rates were as follows: baseline: 2.65 infections per 1,000 catheter days; IY1: 1.97 per 1,000 catheter days; the incidence rate ratio (IRR) was 0.74 (95% CI = 0.37 to 1.65, P = 0.398); residual seven CLA-BSIs during IY1 were VRE faecium blood cultures positive from central line alone in the setting of findings explicable by noninfectious conditions. Following staff education, environmental decontamination and CHG bathing (IY2): 0.53 per 1,000 catheter days; the IRR was 0.20 (95% CI = 0.06 to 0.65, P = 0.008) with 80% reduction compared to the baseline. Over the two-year intervention period, the overall rate decreased by 53% to 1.24 per 1,000 catheter-days (IRR of 0.47 (95% CI = 0.25 to 0.88, P = 0.019) with zero CLA-BSI for a total of 15 months. CONCLUSIONS: Residual CLA-BSIs, despite strict adherence to central line bundle, may be related to blood culture contamination categorized as CLA-BSIs per CDC/NHSN definition. Efforts to reduce residual CLA-BSIs require a strategic multidisciplinary team approach focused on epidemiologic investigations of practitioner- or unit-specific etiologies.
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spelling pubmed-37334312013-08-05 Beyond the bundle - journey of a tertiary care medical intensive care unit to zero central line-associated bloodstream infections Exline, Matthew C Ali, Naeem A Zikri, Nancy Mangino, Julie E Torrence, Kelly Vermillion, Brenda St Clair, Jamie Lustberg, Mark E Pancholi, Preeti Sopirala, Madhuri M Crit Care Research INTRODUCTION: We set a goal to reduce the incidence rate of catheter-related bloodstream infections to rate of <1 per 1,000 central line days in a two-year period. METHODS: This is an observational cohort study with historical controls in a 25-bed intensive care unit at a tertiary academic hospital. All patients admitted to the unit from January 2008 to December 2011 (31,931 patient days) were included. A multidisciplinary team consisting of hospital epidemiologist/infectious diseases physician, infection preventionist, unit physician and nursing leadership was convened. Interventions included: central line insertion checklist, demonstration of competencies for line maintenance and access, daily line necessity checklist, and quality rounds by nursing leadership, heightened staff accountability, follow-up surveillance by epidemiology with timely unit feedback and case reviews, and identification of noncompliance with evidence-based guidelines. Molecular epidemiologic investigation of a cluster of vancomycin-resistant Enterococcus faecium (VRE) was undertaken resulting in staff education for proper acquisition of blood cultures, environmental decontamination and daily chlorhexidine gluconate (CHG) bathing for patients. RESULTS: Center for Disease Control/National Health Safety Network (CDC/NHSN) definition was used to measure central line-associated bloodstream infection (CLA-BSI) rates during the following time periods: baseline (January 2008 to December 2009), intervention year (IY) 1 (January to December 2010), and IY 2 (January to December 2011). Infection rates were as follows: baseline: 2.65 infections per 1,000 catheter days; IY1: 1.97 per 1,000 catheter days; the incidence rate ratio (IRR) was 0.74 (95% CI = 0.37 to 1.65, P = 0.398); residual seven CLA-BSIs during IY1 were VRE faecium blood cultures positive from central line alone in the setting of findings explicable by noninfectious conditions. Following staff education, environmental decontamination and CHG bathing (IY2): 0.53 per 1,000 catheter days; the IRR was 0.20 (95% CI = 0.06 to 0.65, P = 0.008) with 80% reduction compared to the baseline. Over the two-year intervention period, the overall rate decreased by 53% to 1.24 per 1,000 catheter-days (IRR of 0.47 (95% CI = 0.25 to 0.88, P = 0.019) with zero CLA-BSI for a total of 15 months. CONCLUSIONS: Residual CLA-BSIs, despite strict adherence to central line bundle, may be related to blood culture contamination categorized as CLA-BSIs per CDC/NHSN definition. Efforts to reduce residual CLA-BSIs require a strategic multidisciplinary team approach focused on epidemiologic investigations of practitioner- or unit-specific etiologies. BioMed Central 2013 2013-03-04 /pmc/articles/PMC3733431/ /pubmed/23497591 http://dx.doi.org/10.1186/cc12551 Text en Copyright © 2013 Exline et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Exline, Matthew C
Ali, Naeem A
Zikri, Nancy
Mangino, Julie E
Torrence, Kelly
Vermillion, Brenda
St Clair, Jamie
Lustberg, Mark E
Pancholi, Preeti
Sopirala, Madhuri M
Beyond the bundle - journey of a tertiary care medical intensive care unit to zero central line-associated bloodstream infections
title Beyond the bundle - journey of a tertiary care medical intensive care unit to zero central line-associated bloodstream infections
title_full Beyond the bundle - journey of a tertiary care medical intensive care unit to zero central line-associated bloodstream infections
title_fullStr Beyond the bundle - journey of a tertiary care medical intensive care unit to zero central line-associated bloodstream infections
title_full_unstemmed Beyond the bundle - journey of a tertiary care medical intensive care unit to zero central line-associated bloodstream infections
title_short Beyond the bundle - journey of a tertiary care medical intensive care unit to zero central line-associated bloodstream infections
title_sort beyond the bundle - journey of a tertiary care medical intensive care unit to zero central line-associated bloodstream infections
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3733431/
https://www.ncbi.nlm.nih.gov/pubmed/23497591
http://dx.doi.org/10.1186/cc12551
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