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

BMC Infectious Diseases

Pascual Sesma-Sánchez⁶  Ana Isabel Mariño-Callejo³  Patricia Ordoñez-Barrosa⁵  Ana Cantón-Blanco²  María Virginia Lorenzo-García¹  Laura Vilariño-Maneiro⁶  Hortensia Álvarez-Díaz³  José Francisco García-Rodríguez⁴ 

[1] Preventive Medicine Ward, Health Area of Ferrol, SERGAS, La Coruña, Spain;Endocrinology Ward, Health Area of Ferrol, SERGAS, La Coruña, Spain;Infectious Diseases Unit, Internal Medicine Ward, Health Area of Ferrol, SERGAS, La Coruña, Spain;C/ San Amaro 10-12, 6° Derecha, 15403, Ferrol, La Coruña, Spain;Microbiology Ward, Health Area of Ferrol, SERGAS, La Coruña, Spain;Internal Medicine Ward, Health Area of Ferrol, SERGAS, La Coruña, Spain

关键词: Infection control;    Bloodstreams;    Catheter;   

Others  :  1145728
DOI  :  10.1186/1471-2334-13-445

 received in 2012-10-29, accepted in 2013-09-20,  发布年份 2013

【 摘 要 】

Background

Outside 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.

Methods

From 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.

Results

Prevalence 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).

Conclusion

The rate of CVC-ABSIs increased outside-ICU, and the implementation of multifaceted infection control programme decreased their clinical impact.

【 授权许可】

   
2013 García-Rodríguez et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Centers for Disease Control and Prevention (CDC): Vital signs: central line- associated blood stream infections–United States, 2001, 2008, and 2009. MMWR Morb Mortal Wkly Rep 2011, 60:243-248.
• [2]O’Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA: Guidelines for the prevention of intravascular catheter- related infections. Centers for disease control and prevention. MMWR Recomm Rep 2002, 51(RR-10):1-29.
• [3]Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, Sexton B, Hyzy R, Welsh R, Roth G, Bander J, Kepros J, Goeschel C: An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006, 355:2725-2732.
• [4]Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ: Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol 2011, 32:101-114.
• [5]Marschall J: Catheter-associated bloodstream infections: looking outside of the ICU. Am J Infect Control 2008, 36:S172.e5-8.
• [6]Climo M, Diekema D, Warren DK, Herwaldt LA, Perl TM, Peterson L, Plaskett T, Price C, Sepkowitz K, Solomon S, Tokars J, Fraser VJ, Wong E: Prevalence of the use of central venous access devides within and out-side of the intensive care unit: results of a survey among hospitals in the prevention epicenter of the Centers for Disease Control and Prevention. Infect Control Hosp Epidemiol 2003, 24:942-945.
• [7]Kallen AJ, Patel PR, O’Grady NP: Preventing catheter-related bloodstream infections outside the intensive care unit: expanding prevention to new settings. Clin Infect Dis 2010, 5:335-341.
• [8]McCabe W, Jackson G: Gram-negative bacteremia, I: etiology and ecology. Arch Intern Med 1962, 110:847-853.
• [9]Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM: CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988, 16:128-140.
• [10]Reducción de bacteriemias relacionadas con catéteres en los servicios de medicina intensiva mediante una intervención multifactorial. Informe del estudio. Madrid: Ministerio de Sanidad y Consumo; 2009. [http://www.seguridaddelpaciente.es/contenidos/castellano/2009/BRC_informe_estudio_piloto.pdf?phpMyAdmin=mvRY-xVABNPM34i7Fnm%2C23Wrlq5 webcite]
• [11]Klevens RM, Tokars JI, Edwards J, Horan T: National nosocomial infections surveillance system. Sampling for collection of central line-day denominators in surveillance of healthcare-associated bloodstream infections. Infect Control Hosp Epidemiol 2006, 27(4):338-342.
• [12]Gozu A, Clay C, Younus F: Hospital-wide reduction in central line- associated bloodstream infections: a tale of two small community hospitals. Infect Control Hosp Epidemiol 2011, 32:619-622.
• [13]Trick WE, Miranda J, Evans AT, Charles-Damte M, Reilly BM, Clarke P: Prospective cohort study of central venous catheters among internal medicine ward patients. Am J Infect Control 2006, 34:636-641.
• [14]Suljagić V, Cobeljić M, Janković S, Mirović V, Marković-Denić L, Romić P, Mikić D: Nosocomial bloodstream infections in IU and non-ICU patients. Am J Infect Control 2005, 33:333-340.
• [15]Dudeck MA, Horan TC, Peterson KD, Allen-Bridson K, Morrell GC, Pollock DA, Edwards JR: National Healthcare Safety Network (NHSN) report, data summary for 2009, device-associated module. Am J Infect Control 2011, 39:349-367.
• [16]Vonberg RP, Behnke M, Geffers C, Sohr D, Rüden H, Dettenkofer M, Gastmeier P: Device-associated infection rates for non–intensive care unit patients. Infect Control Hosp Epidemiol 2006, 27:357-361.
• [17]Fearonce G, Faraklas I, Saffle JR, Cochran A: Peripherally inserted central venous catheters and central venous catheters in burn patients: a comparative review. J Burn Care Res 2010, 31(1):31-35.
• [18]Madhukumar P, Loh GY, Maung ZT, Chua FS, Chen JJ: Incidence of non- tunnelled central venous catheter-related infections in oncologic patients receiving chemotherapy in an outpatient setting. Singapore Med J 2012, 53(8):513-516.
• [19]Rodríguez JF, Trobo AR, García MV, Martínez MJ, Millán CP, Vázquez MC, Rodríguez JF, Pérez-Mendaña JM: The effect of performance feedback on wound infection rate in abdominal hysterectomy. Am J Infect Control 2006, 34(4):182-187.
• [20]Zingg W, Sax H, Inan C, Cartier V, Diby M, Clergue F, Pittet D, Walder B: Hospital-wide surveillance of catheter-related bloodstream infection: from the expected to the unexpected. J Hosp Infect 2009, 73:41-46.
• [21]Tiwari MM, Hermsen ED, Charlton ME, Anderson JR, Rupp ME: Inappropriate intravascular device use: a prospective study. J Hosp Infect 2011, 78:128-132.
• [22]Tejedor SC, Tong D, Stein J, Payne C, Dressler D, Xue W, Steinberg JP: Temporary central venous catheter utilization patterns in a large tertiary carecenter: tracking the “idle central venous catheter”. Infect Control Hosp Epidemiol 2012, 33(1):50-57.
• [23]Pittiruti M, Hamilton H, Biffi R, MacFie J, Pertkiewicz M, ESPEN: ESPEN Guidelines on Parenteral Nutrition: central venous catheters (access, care, diagnosis and therapy of complications). Clin Nutr 2009, 28(4):365-377.