Enhanced central venous catheter bundle for pediatric parenteral-dependent intestinal failure

Background: Central line-associated bloodstream infections (CLABSI) are a very common cause of healthcare-associated infections (HAI). CLABSIs will not only increase mortality and morbidity but also increases length of stay (LOS) and financial burden to ICU patients. Infection control practices play a major role in preventing CLABSI. Research indicates that quality improvement initiatives have helped in reducing CLABSI rates. CLABSI rates have been successfully reduced in ICU settings however, there is still significant variability in practice due to poor adherence to evidence-based CLABSI maintenance bundle components. However, nurses frequently struggle to follow evidence-based preventive practices, thus it is necessary to understand better the behavioral influences on implementing CLABSI prevention measures. Additionally, it has been emphasized that implementation studies must consider or quantify the potential impact on CLABSI rates. Before taking up the study, we have noticed increase in CLABSI rates for 1month Period, for which the Retrospective data was collected and analyzed to understand the gaps to implement CLABSI maintenance bundle components. Therefore, this study helped us identifying gaps in maintenance bundle and observed infections rates before and after study Aim: To evaluate the effect of central line (CL) bundle compliance on central line-associated bloodstream infections (CLABSIs) To evaluate the knowledge and practices of physicians and nurses working in all ICUs and wards regarding the components of central line maintenance bundles (ref table I) Design: Used a retro prospective study, to reduce the CLABSI rates and to increase awareness on maintenance bundle components in intensive care units (ICU) and wards. we have initiated a structured training program to all nurses and doctors. Two tools were prepared. one is to assess the knowledge of nurses and doctors working in ICUs and wards on CLABSI. The second tool consists of components related to central line maintenance bundle to evaluate the effectiveness in reducing incidence of CLABSI. A total 489 Registered nurses and 10 intensivists and 15 ward doctors were included in the current study. Phase I was the pre-interventional period during this period audits were conducted, we observed lacunae in implementing CLABSI Maintenance bundle. Phase II was the intervention period lasting for 2 month, during this period, the entire nursing staff and doctors working in ICUs and Wards underwent a continuous teaching and training. Phase III was the post-intervention period- In this period questionnaire was given in September and again in December. This was to check for the impact of training on knowledge and awareness level which will further lead better implementation of the practices. Observed CLABSI rate reduced from17.2. to 6.8 per 1000 central line days. Result: Knowledge assessment- Comparison data between June 2021 and September 2021 mean knowledge score significantly higher in September (9.1) than June (6.4) .similarly, December (9.9) score significantly higher than June and September to determine the difference between the mean of various observations in the pre and post intervention period with 95% confidence interval, the difference in the knowledge level and CLABSI rate in the pre and post intervention period was found significant(p<0.001) .During this 6 months period(July 2021 to December 2021) there were a total of 1120 patients on central lines, for all the patients line care was observed after implementation of structured training programme. The rate of CLABSI significantly declined from 17.2 per 1000 catheter days to 6.8 per 1000 catheter days. Conclusion: This study clearly indicated that the educational interventions in structured formats are imperative when imparting trainings in Infection control practices and should be implemented frequently to bridge the gap between knowledge and practice. With the dynamics of infection control and the challenges faced in its implementation continuing this type of trainings will ensure all use evidence-based interventions. Recommendations: Continues Training program should be carried out for nurses and doctors related to implementation of CLABSI Bundle. Keywords: CLABSI, Catheter hub care, Hand hygiene, Training, Maintenance bundle, Teaching, Implementing, Structured program.

The Efficacy of Passive Valve Antimicrobial Swab Caps Against Existing Clabsi Prevention Bundle in an Adult Hematology Inpatient Population: A Quality Improvement Initiative

A quality improvement initiative to reduce central line-associated bloodstream infection rates in the polytrauma intensive care unit of a tertiary care trauma hospital in India.

BackgroundA central venous catheter (CVC) is an important medical device, but it could be preceding infection and the risk of central line-associated bloodstream infection (CLABSI). CLABSI is a common healthcare-associated infection but results in high cost and mortality; therefore, various efforts to reduce CLABSI have been attempted.MethodsThis is a retrospective, observational, quasi-experimental study in the intensive care unit (ICU) of a single tertiary care hospital. We reviewed and analysed the data of CLABSI rates and days from the insertion to the removal of the temporary CVC between January 2018 and June 2021 with transient periods over 9 months. Sequentially, all patients with the CVC in the ICU underwent the following interventions: maximal barrier precaution, automatic notification of catheter days and 2% chlorhexidine gluconate bathing. A segmented regression analysis of interrupted time series was conducted to compare the CLABSI rates before and after the introduction of multimodal interventions. During study periods, the impact of interventions on CLABSI was evaluated using multivariate logistic regression analyses.ResultsA total of 76,504 patient-days, 28,312 catheter days and 66 CLABSI cases were reviewed in ICU-hospitalised patients. As additional interventions, the CLABSI rate declined from 3.1 per 1000 CVC days to 1.2 per 1000 CVC days in post-interventions. In the pre-intervention and post-intervention periods, 4146 patents had one more short-term CVC. In the multivariate logistic regression analyses, multimodal intervention was one of determinants reducing CLABSI rates (odds ratio (OR), 0.52 [95% confidence interval {CI}, 0.28–0.94]). Indwelling time of CVC over 10 days was the risk factor for CLABSI rates (OR, 6.27 [95% CI, 3.36–12.48]). Of the three interventions, the automatic notification of catheter days was associated with decreased median monthly total CVC days and duration of CVC days per patient.ConclusionsMultidisciplinary and evidence-based interventions could lead to a decrease in the CLABSI rates. Moreover, the automatic notification of catheter days of the electronic medical healthcare system has shortened the time of indwelling CVC.

53 The Impact of an Ultrasound Guided-Central Venous Access Training Course on Central Line-Associated Blood Stream Infection Rate

BackgroundRecent publications suggest that central line-associated bloodstream infection (CLABSI) rates have increased in US hospitals during the COVID-19 pandemic. The objective of this study was to evaluate the impact of COVID-19 pandemic on CLABSIs.MethodsThis was a retrospective cross-sectional study comparing CLABSI rate per 1,000 central line (CL) days, blood culture (BC) utilization rate per 1,000 CL days, CL utilization rate per 1,000 patient days, Standardized Infection Ratio (SIR) and Standardized Utilization Ratio (SUR) in the pre-COVID-19 period from January 1, 2019 to December 31, 2019 to the COVID-19 period from April 1, 2020 to March 31, 2021 at an 877-bed tertiary care hospital in Detroit, Michigan. CLABSI, and BC and CL utilization rate were extracted from the electronic medical record (Epic™ Bugsy). SIR and SUR data were extracted from National Healthcare Safety Network (NHSN).ResultsThe average CLABSI rate per 1,000 CL days increased 24% from 1.66 to 2.06. Twenty percent of patients were hospitalized for COVID-19. The BC utilization rate per 1,000 CL days decreased from 0.43 to 0.32 with a 26% reduction. However, CL utilization increased by 28% from 0.25 to 0.32 (Figure 1). However, CLABSIs due to common commensals decreased from 13.8% to 10.9%. The SIR increased significantly from 1.055 to 1.795 (P-value 0.008), resulting in a 70% increase. The overall SUR also increased from 0.900 to 0.988 (P-value < 0.001). Figure 2 is a control chart of the CLABSI rate from July 2019 to April 2021.Figure 1. CLABSI, blood culture utilization and central line utilization rates pre-and during COVID-19 pandemicFigure 2. CLABSI control chart pre-and during COVID-19 pandemicConclusionDuring the COVID-19 pandemic, there was a significant increase in CL utilization, CLABSI rate, SIR and SUR likely due to higher acuity in COVID-19 patients despite a decrease in BC orders. DisclosuresAll Authors: No reported disclosures

BackgroundHospital-acquired infections (HAIs) are the most frequent cause of nosocomial adverse effects in the United States. In 2009, the Department of Health and Human Services developed an action plan to eliminate HAIs which includes monitoring the rates of six nosocomial infections including central line-associated bloodstream infections (CLABSIs). The focus on these measures has resulted in a decreased incidence of nosocomial blood stream infections, but the measures are labor-intensive, subject to ceiling effects, and do not reflect the full burden of hospital-acquired blood stream infections. Given these limitations, hospital-onset blood stream infection (HOBSI), defined as the growth of a recognized bacterial or fungal pathogen from a blood culture specimen collected on or after the fourth day of hospital admission, has been proposed as an alternate measure of nosocomial blood-stream infections. In a prior study, HOBSI rate correlated with CLABSI rate making this a possible surrogate marker for CLABSI.CLABSI & HOBSI Correlation Analyses South Texas VHAMethodsThis was a prospective review of all blood cultures positive for non-commensal organisms on day 4 or later of admission for patients hospitalized at the Audie L. Murphy VA between January 1, 2022 and December 31, 2024. Trends in HOBSI rates per 1000 bed days of care and CLABSI rates per 1000 central line days were described quarterly throughout the study period. The relationship between HOBSI and CLABSI was evaluated using Pearson correlation.ResultsThere were 91 total HOBSI and 14 CLABSI during the period reviewed. There was a trend towards an increase in HOBSI rates and decreasing CLABSI rates, with significant variability over time resulting in low R2 values.There was a low, non-significant correlation between CLABSI and HOBSI rates (R=0.30; p=0.343).ConclusionHOBSI surveillance has been proposed as an alternate nosocomial blood-stream surveillance measure that would be easier to automate and would provide data on hospital-acquired blood stream infections beyond CLABSIs. In our study, there was not a significant correlation between HOBSI and CLABSI rates, but rates of both were low. Further research is needed into whether HOBSI surveillance should be adopted as part of our standard HAI surveillance measures.DisclosuresKelly R. Reveles, PharmD, PhD, AstraZeneca: Advisor/Consultant|Ferring Pharmaceuticals: Advisor/Consultant

Background: The current NHSN guideline states that positive results from both blood cultures and non–culture-based testing (NCT) methodologies are to be used for central-line–associated bloodstream infection (CLABSI) surveillance determination. A positive NCT result in the absence of blood cultures or negative blood cultures in patients who meet CLABSI criteria is to be reported to NHSN. However, the reporting criteria for NCT changed starting January 1, 2020: If NCT is positive and the blood culture is negative 2 days before or 1 day after, the NCT result is not reported. If the NCT is positive with no blood culture within the 3-day window period, the NCT result is reported in patients who meet CLABSI criteria. We estimated the impact of the new NCT criteria on CLABSI numbers and rates compared to the previous definition. Methods: At our facility, the T2Candida Panel (T2), an NCT, was implemented for clinical use for the detection of early candidemia and invasive candidiasis. The T2 is a rapid molecular test performed directly on blood samples to detect DNA of 5 Candida spp: C. albicans/C. tropicalis, C. glabrata/C. krusei, and C. parapsilosis. In this retrospective study performed at an 877-bed teaching hospital in Detroit, we reviewed the impact of discordant T2 results (positive T2 with negative blood cultures) on CLABSI rates from January 1, 2017, to September 30, 2019, based on the current definition, and we applied the revised criteria to estimate the new CLABSI numbers and rates for the same period. Results: Of 343 positive T2 results, 202 (58.9%) were discordant and qualified for CLABSI determination during the study period. Of these, 109 (54%) met CLABSI criteria based on the current definition and 11 (5%) met CLABSI criteria using the new definition (proportional P &lt; .001), resulting in an 89.9% reduction. The CLABSI rate per 1,000 central-line days, which includes discordant T2 results, based on the current and new NCT criteria, are listed in Table 1. Conclusions: In institutions that utilize NCT such as T2, application of the new 2020 NCT NHSN definition would significantly reduce the CLABSI number and have a significant impact on the CLABSI rates and standardized infection ratios (SIRs).Funding: NoneDisclosures: None

A3 for Central Line-Associated Blood Stream Infections

Multicenter study in Colombia: Impact of a multidimensional International Nosocomial Infection Control Consortium (INICC) approach on central line-associated bloodstream infection rates.

Central line-associated bloodstream infections (CLABSIs) are considered a significant cause of mortality in hospitalized patients; however, the incidence of CLABSIs in limited-resource countries has not been explored analytically. Likewise, the appropriate interventions to prevent, control, and reduce CLABSIs have yet to be analyzed thoroughly. This review demonstrates that the CLABSI rate ranged from 1.6 to 44.6 cases per 1000 central line days in adult and pediatric intensive care units (ICUs) and from 2.6 to 60.0 cases per 1000 central line days in neonatal ICUs and is associated with significant extra mortality, with an odds ratio ranging from 2.8 to 9.5. The results of 6 sequential prospective interventional studies showed that hand hygiene and educational programs were related to a significant reduction in CLABSI rates. CLABSI rates in limited-resource countries are higher than US National Healthcare Safety Network benchmark rates and have a significant impact on mortality. Studies showing successful interventions for a reduction in CLABSIs are few. Subsequently, it can be inferred that additional epidemiological studies need to be conducted to achieve an appreciation of the effects of CLABSIs and to develop more-definitive approaches for CLABSI prevention in the form of practical, low-cost, low-technology measures that are feasible to implement in limited-resource countries.

Central line-associated bloodstream infections (CLABSI) are associated with significant morbidity, mortality and costs. Multimodal intervention programs are effective in bringing down the rates of CLABSI, but they are difficult to sustain. In an attempt to improve sustainability, we implemented two multimodal intervention programs focusing on high-yield measures and assessed their effect on monthly CLABSI rates over a period of 42 months. The CLABSI rates were tracked on a monthly basis in a 300-bed Indian Corporate hospital and an analysis of the various contributing variables was done. The first intervention programin July 2009 put into practice the central line bundle. The second program went beyond the bundle and introduced high-yield measures like dedicated central line team and trolley, involved the senior management and promoted the ‘Scrub the Hub’ campaign while rectifying deficiencies observed in the first intervention program. The rates of CLABSI were statistically analysed in both the pre- and post-intervention periods. The CLABSI rates varied between 0 to 9.8 infections per 1000 catheter days in the 42 months period, the mean being 2.9. The difference in mean CLABSI rates before and after the first intervention program was not significant (5.2 versus 4.4 infections per 1000 catheter days ( P > 0.05)). However, the next intervention programsaw a significant decrease in the mean rates of CLABSI in the subsequent 24 months (0.7 infections per 1000 catheter days ( P < 0.05)). An overall 86.3% reduction in CLABSI rates in the entire study period was observed. Repeated multimodal intervention programs with a focus on high-yield measures resulted in a sustained reduction in CLABSI rates (86.3%).

Decreasing Rate of CLABSI in a Long Term Acute Care Hospital

Evaluation of Hospital-onset Bloodstream Infections in Comparison to Central Line-associated Bloodstream Infections at an Acute, Tertiary Care Hospital

Background:Infants in neonatal units are susceptible to numerous potential iatrogenic risks. One key concern is central line-associated blood stream infection (CLABSI). To ensure patient safety and reduce the incidence of CLABSI toward zero, numerous evidence-based clinical interventions and product innovations have been implemented. Nevertheless, sustaining zero CLABSI for sustained periods remains challenging.Aim:The purpose of this study was to evaluate the impact on CLABSI rates of introducing a preassembled closed intravenous (IV) administration set in a neonatal intensive care unit (NICU).Methods:This was a retrospective observational analysis of routinely collected anonymized IV therapy infection data in a NICU. The study period was from January 2019 through June 2020.Results:Nine-hundred eighty five patients with a Epicutaneo-Caval Catheter (ECC) were included (456 legacy IV set, 529 closed IV set). Patient demographics were comparable between the two groups. ECC dwell time was the only IV characteristic associated (p = 0.04) with CLABSI. Mann-Whitney U-test demonstrated significant differences between the two sets for CLABSI complication events (p = 0.031). Prior to using the closed IV administration sets (January 2019–September 2019) the mean monthly CLABSI rate was 2.87 (/1000 device days). This figure declined to 0.22 (/1000 device days) afterwards (October 2019–June 2020). Zero CLABSIs were observed during January to June 2020.Conclusions:Utilization of a pre-assembled closed IV administration set was associated with a reduction in CLABSI rates. The study results suggest that using a pre-assembled closed IV set concurrently with evidence-based central line infection control interventions can help attain extended periods of zero CLABSI.