Download citation

Share

Download full-text PDF

Effect of Central Line Bundle Compliance on Central Line-Associated

Bloodstream Infections

Article (PDF Available) in Yonsei Medical Journal 59(3):376 · May 2018 with 613
Reads

DOI: 10.3349/ymj.2018.59.3.376

Cite this publication

Kyoung Hwa Lee

Nan Hyoung Cho

 +2

Sujin Jeong

o 38.79
o CHA University

Mi Na Kim

Show more authors

Abstract
Purpose: The present study aimed to evaluate the effect of central line (CL) bundle compliance
on central line-associated bloodstream infections (CLABSIs) in different departments of the
same hospital, including the intensive care unit (ICU) and other departments. Materials and
methods: The four components of the CL bundle were hand hygiene, use of maximal sterile
barrier precautions, chlorhexidine use, and selection of an appropriate site for venous access.
Compliance of the CL bundle and CLABSIs were measured for every department [emergency
room (ER), ICU, general ward (GW), and operating room (OR)]. A total of 1672 patients were
included over 3 years (August 2013 through July 2016). Results: A total of 29 CLABSI episodes
(1.73%) were identified, and only 53.7% of the patients completed CL bundles. The
performance rates of all components of the CL bundle were 22.3%, 28.5%, 36.5%, and 84.6%
for the ER, ICU, GW, and OR, respectively. The highest CLABSI rate was observed in patients
of the ICU, for whom all components were not performed perfectly. Conversely, the lowest
CLABSI rate was observed for patients of GWs, for whom all components were performed.
Among individual components, femoral insertion site [relative risk (RR), 2.26; 95% confidence
interval (CI), 1.09-4.68], not using a full body drape (RR, 3.55; 95% CI, 1.44-8.71), and not
performing all CL bundle components (RR, 2.79; 95% CI, 1.19-6.54) were significant variables
associated with CLABSIs. Conclusion: This study provides direct evidence that completing all
CL bundle components perfectly is essential for preventing CLABSIs. Customized education
should be provided, according to specific weaknesses of bundle performance.

http:// academic.oup.com/articles/abstract

koen bolt, jochen bregs et.al ( jun 2020)

This systematic review and meta-analysis examines the impact of quality improvement interventions on
central line–associated bloodstream infections in adult intensive care units. Studies were identified
through Medline and manual searches (1995–June 2012). Random-effects meta-analysis obtained
pooled odds ratios (ORs) and 95% confidence intervals (CIs). Meta-regression assessed the impact of
bundle/checklist interventions and high baseline rates on intervention effect. Forty-one before–after
studies identified an infection rate decrease (OR, 0.39 [95% CI, .33–.46]; P < .001). This effect was more
pronounced for trials implementing a bundle or checklist approach (P = .03). Furthermore, meta-analysis
of 6 interrupted time series studies revealed an infection rate reduction 3 months postintervention (OR,
0.30 [95% CI, .10–.88]; P = .03). There was no difference in infection rates between studies with low or
high baseline rates (P = .18). These results suggest that quality improvement interventions contribute to
the prevention of central line–associated bloodstream infections. Implementation of care bundles and
checklists appears to yield stronger risk reductions.

www. Ncbi. Nlm. Nih. Gov/pmc/articles/pmc5666696 Central venous catheters (CVC) are often essential in
the care of the critically ill patient. They allow safe administration of intravenous medications that cannot be
given peripherally, aid in the administration of intravenous fluid resuscitation, and help in monitoring
hemodynamic parameters in the management of patients with syndromes such as septic shock, cardiogenic
shock, decompensated heart failure and pulmonary hypertension. Despite the benefits of CVCs, they also
serve as potential portals for localized and systemic bloodstream infections. For this reason, considerable
effort has gone into reducing the incidence of bloodstream infections from CVCs.

TAISON BELL,NAOMI O’GEADY(JUL 2017)Central venous catheters (CVC) are commonly used in
critically ill patients and offer several advantages to peripheral intravenous access. However, indwelling CVCs
have the potential to lead to blood stream infections, with the risk increasing with an array of characteristics
such as catheter choice, catheter location, insertion technique and catheter maintenance. Evidence-based
guidelines have led to a significant reduction in the incidence of blood stream infections associated with CVCs.
The combination of guideline implementation combined with newer technologies has the potential to further
reduce morbidity and mortality from infections related to CVCs.

www.ncbi.nlm.nih.gov/pubmed/29543306

Sami M. Aloush, Faris A. Alsaraireh(mar2018)To

assess nurses' compliance with central line
associated bloodstream infection (CLABSI) prevention guidelines related to maintenance
of the central line and the predictors of compliance. Method: This was an observational
study that used a descriptive cross-sectional design. A sample of 171 intensive care unit
(ICU) nurses were observed and their compliance was recorded on a structured
observational sheet. The study was conducted in the ICUs of 15 hospitals located in 5
cities in Jordan. Data were collected over a 5-month period from March to July 2017.
Central lines were all inserted by physicians inside the ICUs. One hundred and twenty
participants (70%) showed sufficient compliance. The mean compliance scores were
14.2±4.7 (min=8, max=20); however, the rate of CLABSI was variable across the
participating ICUs. Logistic regression with 4 independent variables (years of
experience, previous education with CLABSI, nurse-patient ratio and the ICU's bed
capacity) was conducted to investigate predictors of sufficient compliance. The model
was significant (χ2(4)=133.773, p=0.00). The nurse-patient ratio was the only
significant predictor. Nurses with a 1:1 nurse:patient ratio demonstrated superior
compliance over their counterparts with a 1:2 ratio. Further improvement in compliance
and patients' outcomes could be achieved by lowering the nurse-patient ratio.

www.cambridge.org/core/journals/infection...

Shannon A. Novosad (jan2020)

Objective:
To describe pathogen distribution and rates for central-line–associated bloodstream infections (CLABSIs)
from different acute-care locations during 2011–2017 to inform prevention efforts.
Methods:
CLABSI data from the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network
(NHSN) were analyzed. Percentages and pooled mean incidence density rates were calculated for a variety
of pathogens and stratified by acute-care location groups (adult intensive care units [ICUs], pediatric ICUs
[PICUs], adult wards, pediatric wards, and oncology wards).
Results:
From 2011 to 2017, 136,264 CLABSIs were reported to the NHSN by adult and pediatric acute-care locations;
adult ICUs and wards reported the most CLABSIs: 59,461 (44%) and 40,763 (30%), respectively. In 2017, the
most common pathogens were Candida spp/yeast in adult ICUs (27%) and Enterobacteriaceae in adult
wards, pediatric wards, oncology wards, and PICUs (23%–31%). Most pathogen-specific CLABSI rates
decreased over time, excepting Candida spp/yeast in adult ICUs and Enterobacteriaceae in oncology wards,
which increased, and Staphylococcus aureus rates in pediatric locations, which did not change.
Conclusions:
The pathogens associated with CLABSIs differ across acute-care location groups. Learning how pathogen-
targeted prevention efforts could augment current prevention strategies, such as strategies aimed at
preventing Candida spp/yeast and Enterobacteriaceae CLABSIs, might further reduce national rates.

aricjournal.biomedcentral.com/articles/10.1186/s.

Suhui ko et.al(oct2017)Central line-associated bloodstream infections

(CLABSIs) can be prevented through well-coordinated, multifaceted programs.
However, implementation of CLABSI prevention programs requires
individualized strategies for different institutional situations, and the best
strategy in resource-limited settings is uncertain. Peer tutoring may be an
efficient and effective method that is applicable in such settings.

Methods
A prospective intervention was performed to reduce CLABSIs in a surgical
intensive care unit (SICU) at a tertiary hospital. The core interventions
consisted of implementation of insertion and maintenance bundles for CLABSI
prevention. The overall interventions were guided and coordinated by active
educational programs using peer tutoring. The CLABSI rates were compared
for 9 months pre-intervention, 6 months during the intervention and 9 months
post-intervention. The CLABSI rate was further observed for three years after
the intervention.

Results
The rate of CLABSIs per 1000 catheter-days decreased from 6.9 infections in
the pre-intervention period to 2.4 and 1.8 in the intervention (6 m; P = 0.102)
and post-intervention (9 m; P = 0.036) periods, respectively. A regression
model showed a significantly decreasing trend in the infection rate from the
pre-intervention period (P < 0.001), with incidence-rate ratios of 0.348 (95%
confidence interval [CI], 0.98–1.23) in the intervention period and 0.257 (95%
CI, 0.07–0.91) in the post-intervention period. However, after the 9-month post-
intervention period, the yearly CLABSI rates reverted to 3.0–5.4 infections per
1000 catheter-days over 3 years.
Conclusions
Implementation of CLABSI prevention bundles using peer tutoring in a
resource-limited setting was useful and effectively reduced CLABSIs. However,
maintaining the reduced CLABSI rate will require further strategies.

journals.lww.com/pqs/Fulltext/2020/03000/.

Mathew, roshni md et.al(mar 2020) Efforts to reduce central line-associated bloodstream infection
(CLABSI) rates require strong microsystems for success. However, variation in practices across
units leads to challenges in ensuring accountability. We redesigned the organization’s mesosystem
to provide oversight and alignment of microsystem efforts and ensure accountability in the context of
the macrosystem. We implemented an A3 framework to achieve reductions in CLABSI through
adherence to known evidence-based bundles.

Methods:
We conducted this CLABSI reduction improvement initiative at a 395-bed freestanding, academic,
university-affiliated children’s hospital. A mesosystem-focused A3 emphasized bundle adherence
through 3 key drivers (1) practice standardization, (2) data transparency, and (3) accountability. We
evaluated the impact of this intervention on CLABSI rates during the pre-intervention (01/15-09/17)
and post-intervention (07/18–06/19) periods using a Poisson model controlling for baseline trends.

Results:
Our quarterly CLABSI rates during the pre-intervention period ranged from 1.0 to 2.3 CLABSIs per
1,000 central line-days. With the mesosystem in place, CLABSI rates ranged from 0.4 to 0.7 per
1,000 central line days during the post-intervention period. Adjusting for secular trends, we observed
a statistically significant decrease in the post versus pre-intervention CLABSI rate of 71%.

Conclusion:
Our hospital-wide CLABSI rate declined for the first time in many years after the redesign of
the mesosystem and a focus on practice standardization, data transparency, and
accountability. Our approach highlights the importance of alignment across unit-level
microsystems to ensure high-fidelity implementation of practice standards throughout the
healthcare-delivery system.

INTRODUCTION

Central line-associated bloodstream infections (CLABSI) are a major healthcare-associated infection

(HAI). CLABSI is associated with both increased morbidity and duration of hospitalization, resulting
1

in a significant increase in hospital costs. The rate of CLABSI has been declining in the United
2

States, with standardized infection ratios (SIR) for acute care hospitals decreasing by 19% between
2016 and 2017 compared with national baseline. Despite these declines, the estimated total direct
3
medical costs due to CLABSIs is between $0.7 and $2.7 billion annually. Adherence to the central
4

line insertion and maintenance bundles, which are evidence-based practices performed together,
has been shown to reduce the rates of CLABSIs. However, having a hospital policy for a central
5–8

line bundle or having moderate adherence to the bundle is insufficient for the reduction of CLABSI.
An adherence of 95% or greater is associated with a decline in CLABSI. Despite knowing what to
8

do, implementation remains challenging.

Healthcare systems commonly rely on clinical microsystems—an interdependent group of healthcare

providers who work together regularly to provide direct care typically at a unit level—for
implementation of hospital initiatives. , Clinical microsystems are known to be important to optimize
9 10

quality, safety, and overall care delivery. , Despite having a robust microsystem infrastructure in our
11 12

healthcare system, we encountered challenges that can mitigate the strengths of a microsystem
approach. First, the reliance on microsystems to define optimal processes for various populations
results in variability from clinical unit to unit in whether and how standards are modified. Second, as
microsystems adopt and iterate on variations of the bundle, we moved away from adherence to all of
the bundle elements and focused instead on performance on individual elements to define success.
This focus led to a perception that despite following most of the bundle elements, CLABSI rates
were immutable. Third, microsystems also adapt performance measures specific to each unit, which
meant there was an emphasis on different measures in each unit. As an example, due to gestational
age restrictions on the use of chlorhexidine in neonates, the neonatal intensive care unit (NICU)
developed an alternate bathing protocol for their patients. These differences led to migration away
from common standards, limiting transparency/comparability, and making accountability challenging
for an entire system. This variation also led to confusion for providers, caregivers, and patients when
they moved between clinical units.

journals.lww.com/jhqonline/Fulltext/2018/11000/...

Mc craw, beth et.al(dec2018)Central line–associated bloodstream infections not only negatively

impact patient safety, but they are also a tremendous financial burden for healthcare
organizations. Central line–associated bloodstream infections per case costs are estimated at
$49,201. This financial impact is even more significant to organizations because CLABSIs are
4

included in the Center for Medicare and Medicaid Services' value-based purchasing and hospital-
acquired conditions pay-for-performance reimbursement progA data comparison of preintervention
and postintervention analysis included the number of CVL infections from the second quarter of
2017 (April, May, and June) compared with the second quarter of 2016 (April, May, and June). The
CLABSI rate for the second quarter of 2017 was 0.0 infections per 1,000 device days compared with
5.85 infections per 1,000 device days in 2016. The yearly ICU CLABSI rate decreased from 3.95
infections per 1,000 device days in 2016 to 2.83 infections per 1,000 device days in 2017. The CVL
intervention resulted in an overall improvement of the facility-wide CLABSI rate from 2.93 infections
per 1,000 device days in 2016 to 1.04 infections per 1,000 device days in 2017. The improvement
aim of a 50% reduction in the ICU CLABSI rates was met by the second quarter of 2017. However,
CLABSI reduction remains a focus of the leadership team to ensure sustainability. The principles of
high reliability may be used to improve quality and patient safety in healthcare. This improvement
project demonstrates how each of the high-reliability principles discussed may be used to develop
sustainable improvements in a clinical problem within the hospital setting such as CLABSIs. Table
1 provides measures addressing high-reliability principles to establish interventions used in this
project. The outcomes and results are provided for each of the bundled interventions.

INTRODUCTION According to the Centers for Disease Control and Prevention, central line–
associated bloodstream infections (CLABSIs) are considered the deadliest healthcare-associated
infection (HAI). Patients who require central venous line (CVL) access for treatments are often the
1

sickest and most vulnerable to HAIs. Patients in the intensive care unit (ICU) are at an even greater
risk of CLABSIs due to the emergent circumstances under which CVLs are often placed, the
frequency they are accessed, and an extended number of device days. Vital statistics indicate that
2

one in four patients who acquire a CLABSI will die, making this the most devastating consequence
of hospital-acquired infections.1,3

Central line–associated bloodstream infections not only negatively impact patient safety, but they are
also a tremendous financial burden for healthcare organizations. Central line–associated
bloodstream infections per case costs are estimated at $49,201. This financial impact is even more
4

significant to organizations because CLABSIs are included in the Center for Medicare and Medicaid
Services' value-based purchasing and hospital-acquired conditions pay-for-performance
reimbursement programs. In addition, individual hospital CLABSI rates are compared with other
5

organizations and are visible to the public through the Medicare.gov Hospital Compare web site with
the potential to significantly impact the consumer perception of an organization. The financial and
5

reputational impact of poor performance in this area has increased the nation's healthcare industries'
attention on improvement efforts.

To improve patient safety and positively impact the financial burden associated with CLABSIs,
organizations should strive to achieve a culture of high reliability. The culture of high reliability is not
an individual performance improvement project, but rather a continuous commitment toward ongoing
patient safety and high-quality care. High-reliability organizations (HROs) consistently maintain a
6

high level of organizational safety. A key aspect of HROs is their ability to eliminate safety
deficiencies through robust process improvement that creates constant awareness and a collective
mindfulness for high-quality care. Creating a HRO culture may be an effective method for preventing
6

CLABSIs. The purpose of this article is to describe the process of using high-reliability methodology
to maintain zero tolerance for CLABSIs in an acute care patient setting.

BACKGROUND OF THE STUDY Although the Centers for Disease Control and Prevention cites an
overall 46% decrease in CLABSIs nationwide, there continues to be increasing national attention on
the sustainability of CLABSI reduction. At the organization of study for this article, the CLABSI rates
5

appeared to increase between 2012 and 2016 in contrast to the national trend. Sensing an
opportunity, nursing leadership at the organization analyzed these data and found that overall HAI
rates and specifically, CLABSI rates were on the rise. In 2015, the ICU CLABSI rate was 3.15
infections per 1,000 device days, with a 2.10 National Healthcare Safety Network (NHSN)
Standardized Infection Ratio (SIR). During the first 2 quarters of 2016, the rate continued to increase
to 5.88 infections per 1,000 device days and a preliminary SIR of 3.9. Both rates were considerably
higher than the national benchmark and posed a cause for concern. On further analysis, each
CLABSI occurred approximately 10–12 days after the insertion date of the device demonstrating that
the infection was not caused during the insertion process but rather during the daily maintenance.

Nursing leadership analysis found an increase in nurse turnover ranging from 8.57% to 55.17%
between 2012 and 2016, which coincided with the increase in CLABSI rates. This rise in nursing
turnover created instability in the ICU contributing to a decrease in Registered Nurse (RN)
experience and an increased knowledge deficit surrounding the key aspects of the CVL
maintenance care bundle. Further analysis indicated the higher turnover rate created a deficient
onboarding program for newly hired nurses, and a failure to ensure initial or continued CVL
competence and maintenance education.

: https://doi.org/10.17511/ijmrr.2017.i04.09

www.medresearch.in>ijmrr>articles

Dr. Prasad y.bansod dr. avinash rathore et.al (apr2017)Central line associated blood stream
infection (CLABSI) is a primary blood stream infection in a patient that had a central line
within the 48-hour period before the development of bacteraemia and is not related to an
infection at another site. It is often associated with serious infectious complications resulting
in significant morbidity, increased duration of hospitalization and additional medical
costs. Objective: We aimed to study the course of infection, microbiology of CLABSI, & to
identify the degrees of severity of sepsis associated with CLABSI. Materials & Methods:
Patients admitted in Intensive care units who fulfilled the inclusion criteria were enrolled.
Various demographic, microbial and patients characteristics were noted along with outcome
using a prestructured proforma. Results: We studied 58 patients in ICU in which males were
common, Sepsis seen in 43% of patients, 37% had Staph. Aureus, and the mortality was
24.1%. Conclusion: CLABSI infection is best prevented rather than cured. It has mortality
as high as 24.13%. It can manifest with varying degrees of severity of sepsis. Organ
Dysfunction, multi organ involvement, TLC abnormalities, Oliguria, altered mental status,
Hypotension are all markers of poor prognosis. More scientific data on the subject is required
to formulate guidelines and protocols for prevention and treatment of CLABSI.

Journals.pols.org.>polsone>articles
Maria Rosaria Esposito, assunta guillaria et.al(jun2017)The objectives of the cross-sectional study were to delineate the
knowledge, attitudes, and behavior among nurses regarding the prevention of central line-associated bloodstream infections
(CLABSIs) and to identify their predisposing factors. A questionnaire was self-administered from September to November
2011 to nurses in oncology and outpatient chemotherapy units in 16 teaching and non-teaching public and private hospitals
in the Campania region (Italy). The questionnaire gathered information on demographic and occupational characteristics;
knowledge about evidence-based practices for the prevention of CLABSIs; attitudes towards guidelines, the risk of
transmitting infections, and hand-washing when using central venous catheter (CVC); practices about catheter site care; and
sources of information. The vast majority of the 335 nurses answered questions correctly about the main recommendations
to prevent CLABSIs (use sterile gauze or sterile transparent semipermeable dressing to cover the catheter site, disinfect the
needleless connectors before administer medication or fluid, disinfect with hydrogen peroxide the catheter insertion site, and
use routinely anticoagulants solutions). Nurses aged 36 to 50 years were less likely to know these main recommendations to
prevent CLABSIs, whereas this knowledge was higher in those who have received information about the prevention of these
infections from courses. Nurses with lower education and those who do not know two of the main recommendations on the
site’s care to prevent the CLABSIs, were more likely to perceive the risk of transmitting an infection. Higher education,
attitude toward the utility allow to dry antiseptic, and the need of washing hands before wearing gloves for access to port
infusion were predictors of performing skin antiseptic and aseptic technique for dressing the catheter insertion site.
Educational interventions should be implemented to address the gaps regarding knowledge and practice regarding the
prevention of CLABSIs and to ensure that nurses use evidence-based prevention interventions.

Arti nama, saroj golia (2019): Blood stream infections (BSIs) due to central venous catheterization are one of the major device-
associated infections in the ICU. It can be a source of dangerous sepsis, bacteremia, multi organ failure and even death 1

Objective: To determine the rate of central line associated blood stream infection (CLABSI), incidence rate and antibiotic
sensitivity pattern of isolated organisms.

Materials and Methods: Central Line and Peripheral line blood samples were collected with proper aseptic precautions. After
collection, blood samples were placed in BacT/ALERT 3D and Vitek 2 automated system for identification and their antibiotic
sensitivity pattern.

Results: Out of 95 Central Line and Peripheral line blood samples, 30 culture were identified as blood stream infections, among
them 14 have CLABSI. CLABSI rate in our study is 11 per 1000 catheter days. Coagulase negative staphylococci was the
commonest organism isolated in the current study those were about 6(43%). Second most common organism was Klebsiella
pneumoniae 4(29%) followed by Pseudomonas aeruginosa 3(21%) and Candida albicans 1(7%).

Conclusion: Central line blood stream infection, most commonly caused by colonization and duration of catheterization.
Septicemia and multi organ failure may occur because of CLBSI.

www. Hindawi.com>journals>tswj.

Thais yoshida, anaelisa bauer de camargo siva(oct2019)Central venous catheter-

associated bloodstream infections (CVC-BSIs) have been associated with increased
length of hospital stay, mortality, and healthcare costs, especially in intensive care units
(ICUs). The aim of this study was to evaluate the incidence density of CVC-BSIs before
and after implementation of the bundle in a hospital of infectious and dermatological
diseases in Central Brazil. Methods. A retrospective cohort study was conducted in two
ICUs (adult and pediatric) between 2012 and 2015. Two periods were compared to
assess the effect of the intervention in incidence density of CVC-BSIs: before and after
intervention, related to the stages before and after the implementation of the bundle,
respectively. Results. No significant reduction was observed in the incidence density of
CVC-BSIs in adult ICU (incidence rate ratio [IRR]: 0.754; 95.0% CI: 0.349 to 1.621; p-
value = 0.469), despite the high bundle application rate in the postintervention period.
Similarly, significant reduction in the incidence density in pediatric ICU has not been
verified after implementation of the bundle (IRR: 1.148; 95.0% CI: 0.314 to 4.193; p-
value = 0.834). Conclusion. Not significant reduction in the incidence density of CVC-
BSIs was observed after bundle implementation in ICUs, suggesting the need to review
the use of process, as well as continuing education for staffs in compliance and correct
application of the bundle. Further studies are needed to evaluate the effect of bundle in
the reduction of incidence density of CVC-BSIs in Brazil.

www. Cambridge.org>journals
John m boyce ( jan 2015)

The study aimed to measure the incidence, risk factors and most frequent causative organisms of
central line-associated bloodstream infections (CLA-BSI) in the Medical/Coronary and Surgical Intensive
Care Units (ICUs) at a private hospital.

Methods:
This prospective study included 499 patients and was conducted between April 2014 and September
2014 in the Medical/Coronary ICU and Surgical ICU of a private hospital in Cairo, Egypt.

Results:
Approximately 44% of all the patients admitted to the ICUs underwent Central Venous Catheter (CVC)
insertion. The overall incidence density rate of CLA-BSI was 6 cases per 1000 central line-days. The
central line utilization rate was 0.94 per 1000 patient-days. The mortality rate among cases with CLA-
BSI was 16.8% (95% CI: 13.6% – 20.4%) during the study period. Risk factors for CLA-BSI were
detected by univariate analysis and included associated co-morbidities such as heart failure, APACHE II
scores of >15, an ICU stay of 5 days or more, duration of CVC placement, subclavian insertion of CVCs,
and mechanical ventilation. Additionally, logistic regression analysis identified a long ICU stay of 5
days or more, mechanical ventilation and the presence of heart failure as the only significant
predictors. Gram-negative bacteria, especially Enterobacter (36.8%: 95% CI: 16.3%–
61.6%), Pseudomonas aeruginosa (21.1%: 95% CI: 16.0% - 45.5%) were the predominant organisms
detected in CLA-BSI cases.
Conclusion:
CLA-BSI is an important cause of mortality in ICU patients. The infection rate is considerably higher
than that in recent studies from developed counties, but it is still lower than the rates reported in
comparable published studies in Egypt. Strict adherence to the standard infection prevention practices
for critically ill patients is highly recommended.

www.science direct.com>articles>pii
larrylutwick, amal saif al-manni(apr 2019)

A panel of experts was convened by the International Society for Infectious Diseases (ISID) to
overview recommendations on managing and preventing vascular catheter infections, specifically for
the prevention and management of central line-associated bloodstream infections. These
recommendations are intended to provide insight for healthcare professionals regarding the
prevention of infection in the placement and maintenance of the catheter and diagnosis as well as
treatment of catheter infection. Aspects of this area in pediatrics and in limited-resource situations
and a discussion regarding the selection of empiric or targeted antimicrobial therapy are particular
strengths of this position paper.
Journals.plos.org>ploson>articles.
Claas baier, lena linke( jan 2019)Non-implanted central vascular catheters (CVC) are frequently required for
therapy in hospitalized patients with hematological malignancies or solid tumors. However, CVCs may
represent a source for bloodstream infections (central line-associated bloodstream infections, CLABSI) and,
thus, may increase morbidity and mortality of these patients. A retrospective cohort study over 3 years was
performed. Risk factors were determined and evaluated by a multivariable logistic regression analysis.
Healthcare costs of CLABSI were analyzed in a matched case-control study. In total 610 patients got included
with a CLABSI incidence of 10.6 cases per 1,000 CVC days. The use of more than one CVC per case, CVC
insertion for conditioning for stem cell transplantation, acute myeloid leukemia, leukocytopenia (≤ 1000/μL),
carbapenem therapy and pulmonary diseases were independent risk factors for CLABSI. Hospital costs
directly attributed to the onset of CLABSI were 8,810 € per case. CLABSI had a significant impact on the
overall healthcare costs. Knowledge about risk factors and infection control measures for CLABSI prevention
is crucial for best clinical practice.

WWW. Jihs.in>articles

Ck Chudasama, MM Sheta( Aug2018)The Central line associated bloodstream infections (CLABSI) are the bloodstream infections
where central line was in situ for more than 48 hours from the time of event and the line was in place on the date of event or before
that and are confirmed by lab investigation. CLABSI are becoming common hospital acquired infections in indoor patients.
Materials and Methods: This was a prospective one-year study to assess the occurrence of CLABSI at a tertiary care hospital in
Gujarat. The study involved all hospitalized patients having a central line access during August 2015 to July 2016. CLABSI were
identified according to the ‘Center for Disease Control and Prevention’ definitions. Microsoft excel was used for calculation of
CLABSI rates and other statistical analysis.
Results: There was 3.69 per 1000 central line days of CLABSI. More CLABSI was seen with underlying medical co morbid
conditions. In this study, there were five infections caused by ESBL producing organisms and one carbapenemase producing K.
pneumoniae. This study shows multi drug resistant pathogens as causative agent of CLABSI. A higher rate of CLABSI in this study
might be due to underlying co-morbid conditions.
Conclusion: CLABSI is a common entity especially in ICU setting. It is more commonly seen in patients with comorbid
conditions. K. pneumoniae, S. aureus and CoNS are the common pathogens isolsted in CLABSI.

www. Innovative publication.com>issue

Arti Ninama, Saroj Golia(2019) Blood stream infections (BSIs) due to central venous catheterization are one of the major
device-associated infections in the ICU. It can be a source of dangerous sepsis, bacteremia, multi organ failure and even death 1

Objective: To determine the rate of central line associated blood stream infection (CLABSI), incidence rate and antibiotic
sensitivity pattern of isolated organisms.

Materials and Methods: Central Line and Peripheral line blood samples were collected with proper aseptic precautions. After
collection, blood samples were placed in BacT/ALERT 3D and Vitek 2 automated system for identification and their antibiotic
sensitivity pattern.

Results: Out of 95 Central Line and Peripheral line blood samples, 30 culture were identified as blood stream infections, among
them 14 have CLABSI. CLABSI rate in our study is 11 per 1000 catheter days. Coagulase negative staphylococci was the
commonest organism isolated in the current study those were about 6(43%). Second most common organism was Klebsiella
pneumoniae 4(29%) followed by Pseudomonas aeruginosa 3(21%) and Candida albicans 1(7%).

Conclusion: Central line blood stream infection, most commonly caused by colonization and duration of catheterization.
Septicemia and multi organ failure may occur because of CLBSI.
www.nursingcenter.com>articles

Layne Diana M.,Andesson Teresa(Dec2019)Central line-associated bloodstream infections (CLABSIs) are linked with
negative consequences such as increased length of stay, increased mortality rate, and increased costs.1,2 Various
hospital rating and ranking systems often include CLABSI as a measure of performance for defining overall quality of
patient care. In fiscal year 2016, our level 1 large academic trauma center located in the southeastern United States
experienced a 43% increase over prior year performance in CLABSI. Despite an overall increase in CLABSI, the
hospital remained a top performer in the state when compared with other academic peers for standardized infection
ratio calculation provided quarterly and annually by state surveillance for Healthcare-Associated and Resistant
Pathogens Patient Safety Program.

This overall increase in CLABSI inspired hospital leaders to analyze performance to identify opportunities for
improvement as well as develop strategies to reduce CLABSI. The first step was to garner support from key team
members, followed by identification of an operational leader to serve as project champion. A failure mode effect
analysis was conducted related to maintenance of central lines, and a line assessment was developed to review
maintenance practices across the hospital. Intentional collaboration from multiple experts to ensure a seamless
experience for frontline nursing staff is critical. To sustain improvement, the hospital adopted a quarterly sustainability
assessment to evaluate performance and share results with leadership to drive follow-up actions. The aim of this
article is to share our experience developing an innovative intervention to achieve and sustain highly reliable
performance with maintenance practices of central line catheters.

Jamanetwork.com journal

Williom c. dube, t. Jacob (mac. 2020)

National Healthcare Safety Network methods for central line–associated bloodstream infection
(CLABSI) surveillance do not account for potential additive risk for CLABSI associated with use of 2
central venous catheters (CVCs) at the same time (concurrent CVCs); facilities that serve patients
requiring high acuity care with medically indicated concurrent CVC use likely disproportionally incur
Centers for Medicare & Medicaid Services payment penalties for higher CLABSI rates.

Objective To quantify the risk for CLABSI associated with concurrent use of a second CVC.

Design, Setting, and Participants This retrospective cohort study included adult patients with 2 or
more days with a CVC at 4 geographically separated general acute care hospitals in the Atlanta,
Georgia, area that varied in size from 110 to 580 beds, from January 1, 2012, to December 31,
2017. Variables included clinical conditions, central line–days, and concurrent CVC use. Patients
were propensity score–matched for likelihood of concurrence (limited to 2 CVCs), and conditional
logistic regression modeling was performed to estimate the risk of CLABSI associated with
concurrence. Episodes of CVC were categorized as low or high risk and single vs concurrent use to
evaluate time to CLABSI with Cox proportional hazards regression models. Data were analyzed from
January to June 2019.
Exposures Two CVCs present at the same time.

Main Outcomes and Measures Hospitalizations in which a patient developed a CLABSI, allowing
estimation of patient risk for CLABSI and daily hazard for a CVC episode ending in CLABSI.

Results Among a total of 50 254 patients (median [interquartile range] age, 59 [45-69] years; 26 661
[53.1%] women), 64 575 CVCs were used and 647 CLABSIs were recorded. Concurrent CVC use
was recorded in 6877 patients (13.7%); the most frequent indications for concurrent CVC use were
nutrition (554 patients [14.1%]) or hemodialysis (1706 patients [43.4%]). In the propensity score–
matched cohort, 74 of 3932 patients with concurrent CVC use (1.9%) developed CLABSI, compared
with 81 of 7864 patients with single CVC use (1.0%). Having 2 CVCs for longer than two-thirds of a
patient’s CVC use duration was associated with increased likelihood of developing a CLABSI,
adjusting for central line–days and comorbidities (adjusted risk ratio, 1.62; 95% CI, 1.10-2.33; P
= .001). In survival analysis adjusting for sex, receipt of chemotherapy or total parenteral nutrition,
and facility, compared with a single CVC, the daily hazard for 2 low-risk CVCs was 1.78 (95% CI,
1.35-2.34; P < .001), while the daily hazard for 1 low-risk and 1 high-risk CVC was 1.80 (95% CI,
1.42-2.28; P < .001), and the daily hazard for 2 high-risk CVCs was 1.78 (95% CI, 1.14-2.77; P
= .01).

Conclusions and Relevance These findings suggest that concurrent CVC use is associated with
nearly 2-fold the risk of CLABSI compared with use of a single low-risk CVC. Performance metrics
for CLABSI should change to account for variations of this intrinsic patient risk among facilities to
reduce biased comparisons and resultant penalties applied to facilities that are caring for more
patients with medically indicated concurrent CVC use.

Dr. mousa al Hassan, Dr. issa hweidi( aug 2017)

Central line associated blood stream

infection is one of the main oncerns worldwide.
Reduction of this problem is the main goal of nurses
working in intensive care units to improve patients’
safety and quality of care. Little is known about the
endemic burden of this problem in developing
countris. This study aimed to estimate the
prevalence of central line associated bloodstream
infection in adult patients hospitalized in intensive
care units, in Jordan. Moreover, the study aimed at
identifying significant predictors of central line
associated bloodstream infection. A retrospective design was
used. The setting
of this study was a University affiliated hospital in
northern Jordan. Data from 300 medical records for
adult patients hospitalized in intensive care units of
 the selected hospital, during the period from 1st
January 2014 to 1st December 2015 were retrieved
and recorded using researchers developed tools.
Results. The prevalence of central line-association
bloodstream infection in intensive care units was 17.7
per 1000 central line days. Smoking, respiratory
related disorders, blood transfusion, femoral site of
central venous catheter significantly predicted the
infection. Assessment for risk factors contributing
to infection in patients hospitalized in intensive care
units is essential to build nursing care strategies
targeting risky groups. Furthermore, establishing a national-wide
surveillance programs at hospitals of national and regional levels to
prevent such infection

in intensive care units are required.

www. Sciencedirect.com>articles

kuan-yin lin, yu-chin chang (jun2019)

Patients admitted to intensive care units (ICUs) are at high risk

for central line-associated bloodstream infections (CLABSIs).
Bundle care has been documented to reduce CLABSI rates in
Western countries, however, few reports were from Asian countries
and the differences in the epidemiology or outcomes of critically-ill
patients with CLABSIs after implementation of bundle care remain
unknown. We aimed to evaluate the incidence, microbiological
characteristics, and factors associated with mortality in critically-ill
patients after implementation of bundle care. Prospective
surveillance was performed on patients admitted to ICUs at the
National Taiwan University Hospital, Taipei, Taiwan from January
2012 to June 2013. The demographic, microbiological, and clinical
data of patients who developed CLABSI according to the National
Healthcare Safety Network definition were reviewed. A total of 181
episodes of CLABSI were assessed in 156 patients over 46,020
central-catheter days. The incidence of CLABSI was 3.93 per 1000
central-catheter days. The predominant
causative microorganisms isolated from CLABSI episodes
were gram-negative bacteria (39.2%), followed by gram-positive
bacteria (33.2%) and Candida spp. (27.6%). Median time from
insertion of a central catheter to occurrence of CLABSI was 8 days.
In multivariate analysis, the independent factors associated with
mortality were higher Pitt bacteremia score [odds ratio (OR) 1.41;
95% confidence interval (CI) 1.18–1.68] and longer interval
between onset of CLABSIs and catheter removal (OR 1.10; 95% CI
1.02–1.20), respectively. In institutions with a high proportion of
CLABSI caused by Gram-negative bacteria, severity of bacteremia
and delay in catheter removal were significant factors associated
with mortality.

www.ajic journals.org>articles

paolo paioni, sereina Kuhn(aug 2019)

Central line–associated bloodstream infections (CLABSIs) are among the most common
complications of central venous catheters (CVCs). The aim of this study was to examine the
epidemiology of CLABSIs in tunneled CVCs and analyze their risk factors in a general
pediatric population.

Methods
Children with a tunneled CVC inserted at the University Children's Hospital Zürich between
January 2009 and December 2015 were eligible for the study. The influence of CVC dwell
time on the risk of CLABSI was examined using life tables. Hazard ratios (HRs) for
CLABSIs were analyzed using Cox regression for age and diagnosis with cluster robust
standard errors.

Results
Fifty-five CLABSIs were observed in 193 patients with 284 tunneled CVCs. Overall, CVCs in
children with gastrointestinal disorders and in children 2 to 5 years of age showed the
highest incidence rates of 6.06 and 5.85 CLABSIs per 1,000 catheter days, respectively,
during the first 90 days after placement. Gastrointestinal disease (HR, 3.89; 95% CI, 2.19-
6.90; P < .001) and age 2 to 5 years (HR, 2.48; 95% CI, 1.45-4.22; P = .001) were identified
as independent risk factors for CLABSI. In children without gastrointestinal disease,
tunneled CVCs showed an increasing risk of CLABSI after a dwell time of 90 days.

Conclusions
The need for tunneled CVCs requires the evaluation of targeted CLABSI prevention
measures, especially in young children with underlying gastrointestinal disease.

www. Openpublic health journals .com

Amira m. malek, Mohamed f. allam ( dec 2018)

The study aimed to measure the incidence, risk factors and most frequent causative organisms of
central line-associated bloodstream infections (CLA-BSI) in the Medical/Coronary and Surgical Intensive
Care Units (ICUs) at a private hospital.

Methods:
This prospective study included 499 patients and was conducted between April 2014 and September
2014 in the Medical/Coronary ICU and Surgical ICU of a private hospital in Cairo, Egypt.

Results:
Approximately 44% of all the patients admitted to the ICUs underwent Central Venous Catheter (CVC)
insertion. The overall incidence density rate of CLA-BSI was 6 cases per 1000 central line-days. The
central line utilization rate was 0.94 per 1000 patient-days. The mortality rate among cases with CLA-
BSI was 16.8% (95% CI: 13.6% – 20.4%) during the study period. Risk factors for CLA-BSI were
detected by univariate analysis and included associated co-morbidities such as heart failure, APACHE II
scores of >15, an ICU stay of 5 days or more, duration of CVC placement, subclavian insertion of CVCs,
and mechanical ventilation. Additionally, logistic regression analysis identified a long ICU stay of 5
days or more, mechanical ventilation and the presence of heart failure as the only significant
predictors. Gram-negative bacteria, especially Enterobacter (36.8%: 95% CI: 16.3%–
61.6%), Pseudomonas aeruginosa (21.1%: 95% CI: 16.0% - 45.5%) were the predominant organisms
detected in CLA-BSI cases.
Conclusion:
CLA-BSI is an important cause of mortality in ICU patients. The infection rate is considerably higher
than that in recent studies from developed counties, but it is still lower than the rates reported in
comparable published studies in Egypt. Strict adherence to the standard infection prevention practices
for critically ill patients is highly recommended.

www. Academic.oup.com> articles

S.B. mishra, m. gurjar at. Al ( dec 2016)

To evaluate the incidence, risk factors and associated mortality of central line-associated

bloodstream infection (CLABSI) in an adult intensive care unit (ICU) in India.

Design
This prospective observational study was conducted over a period of 16 months at a tertiary

care referral medical center.

Setting
We conducted this study over a period of 16 months at a tertiary care referral medical

center.
Participants
All patients with a central venous catheter (CVC) for >48 h admitted to the ICU were

enrolled.
Intervention and main outcome measures
Patient characteristics included were underlying disease, sequential organ failure

assessment (SOFA), acute physiology and chronic health evaluation (APACHE II) scores and

outcome. Statistical analysis of risk factors for their association with mortality was also done.
Results
There were 3235 inpatient-days and 2698 catheter-days. About 46 cases of CLABSI were

diagnosed during the study period. The overall rate of CLABSI was 17.04 per 1000 catheter-

days and 14.21 per 1000 inpatient-days. The median duration of hospitalization was 23.5

days while the median number of days that a CVC was in place was 17.5. The median

APACHE II and SOFA scores were 17 and 10, respectively. Klebsiella pneumoniae was the

most common organism (n = 22/55, 40%). Immunosuppressed state and duration of central

line more than 10 days were significant factors for developing CLABSI. SOFA and APACHE II

scores showed a tendency towards significance for mortality.

Conclusions
Our results underscore the need for strict institutional infection control measures. Regular

training module for doctors and nurses for catheter insertion and maintenance with a

checklist on nurses’ chart for site inspection and alerts in all shifts are some measures

planned at our center.

www.jpeds.com>articles

Julie emberley, prakash s. shah( mar 2019)

To determine if the reported reduction in hospital-acquired infections is due to
reduced central line-associated blood stream infections (CLABSI) or non-
CLABSIs.
Study design
A retrospective cohort study design was used to describe the change in
organism pattern and incidence of hospital-acquired infections (CLABSIs and
non-CLABSIs) in neonates <33 weeks of gestation admitted to tertiary
neonatal intensive care units in the Canadian Neonatal Network between
January 1, 2010, and December 31, 2016. Hospital-acquired infection was
diagnosed when a pathogenic organism was isolated from blood or
cerebrospinal fluid in a neonate with suspected sepsis. CLABSI was
diagnosed when a central venous catheter was present at the time or
removed in the 2 days before a hospital-acquired infection diagnosis.
Cochran-Armitage and Mann-Kendall trend tests and linear regression models
were used for statistical analyses.
Results
Of 28 144 eligible neonates from 30 Canadian Neonatal Network neonatal
intensive care units, 3306 (11.7%) developed hospital-acquired infections.
There was a significant decrease in the rate of hospital-acquired infections
(14.2% in 2010 and 9.2% in 2016; P < .01), and the rate of both CLABSIs and
non-CLABSIs ( P < .01) over the study period concomitant with a significant
decrease in the duration of central line use ( P = .01). The rates of meningitis
also decreased during the study period (1.2% in 2010 and 0.9% in
2016; P < .01). Infections owing to gram-positive cocci significantly decreased,
but infections owing to gram-negative organisms remained unchanged.
Conclusion
Although there was a significant decrease in CLABSIs and non-CLABSIs,
hospital-acquired infections in preterm neonates remained high. Infections
owing to gram-negative organisms remained unchanged and are a target for
future preventative efforts.