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1.
《Journal of the Association for Vascular Access》2014,19(3):159-164
BackgroundIn response to Medicare reimbursement changes related to central line-associated blood stream infection (CLABSI) effective January 2011, a long-term acute care hospital implemented quality improvement measures to reduce these health care-associated infections. Improvements included alcohol-impregnated port protectors, chlorhexidine gluconate barrier dressings, and didactic/hands on training for care and maintenance. During 2010 the peripherally inserted central line (PICC) team at a neighboring Magnet hospital was asked to partner and develop strategies to further decrease CLABSI.MethodsThe PICC team evaluated the effects of an antimicrobial PICC device in an effort to further reduce the incidence of CLABSI. Upon initiation of the evaluation phase, a database was created to track infection/thrombus rate, insertion-related complications, dwell time, diagnosis, tip location, infusate, vein used, and catheter size. Data collection and reporting was managed by the PICC team.ResultsAcross a 2-year period (July 2011-July 2013), 100 devices were inserted with a total of 1,705 line days without any reported CLABSI. The majority of patients received a 4.5F single lumen device (59%). Dwell time ranged from 1 to 57 days with an average of 17 days. To date, no CLABSIs related to this device have been reported at the long-term acute care hospital.ConclusionsBased on 100 insertions yielding no infections this new product appears to improve patient safety and quality of care. Relative to these results sole use of this product has become their institutional standard for long-term intravenous needs. 相似文献
2.
《Clinical microbiology and infection》2022,28(6):825-831
ObjectivesOur study aimed to compare the effect of daily bathing with chlorhexidine, octenidine, or water and soap (routine care = control) on central line (CL)–associated bloodstream infection (CLABSI) rates in intensive care units (ICUs).MethodsA multicentre cluster-randomized controlled trial was done with a 12-month intervention period from February 1, 2017 to January 31, 2018 (octenidine and routine care group) or from June 1, 2017 to May 31, 2018 (chlorhexidine group). Wards were randomly assigned to one of two decolonization regimes or routine care (control). Intervention included daily bathing with 2% chlorhexidine-impregnated cloths or 0.08% octenidine wash mitts for 12 months, whereas the control group used water and soap (routine care). The primary outcome was incidence density of CLABSI per 1000 CL days. Poisson regression and generalized estimating equation models were applied.ResultsA total of 72 ICUs with 76 815 patients (22 897 patients in the chlorhexidine group, 25 127 in the octenidine group, and 28 791 in the routine care group) were included. Incidence densities were 0.90 CLABSI per 1000 CL days (95% CI 0.67–1.19) in the chlorhexidine group, 1.47 (95% CI 1.17–1.81) in the octenidine group, and 1.17 (95% CI 0.93–1.45) in the routine care group. Adjusted incidence rate ratios of CLABSI were 0.69 (95% CI 0.37–1.22, p = 0.28) in the chlorhexidine group and 1.22 (95% CI 0.54–2.75, p = 0.65) in the octenidine group (compared with routine care).DiscussionAntiseptic bathing with 2% chlorhexidine-impregnated cloths and 0.08% octenidine wash mitts lacks a significant preventive effect on CLABSI rates in ICUs. However, our trial has a high likelihood of being underpowered because CLABSI rates in the routine care group were approximately 40% lower than initially assumed. 相似文献
3.
《Journal of the Association for Vascular Access》2014,19(2):87-93
BackgroundAlthough few facilities focus on it, bloodstream infection (BSI) risk from peripheral intravenous catheters (PIVs) may exceed central line-related risk. Over a 6-year period, Methodist Hospitals substantially reduced BSIs in patients with central lines but not in patients with PIVs. A practice audit revealed deficiencies in manual disinfection of intravenous connectors, thereby increasing BSI risk. Methodist thus sought an engineered approach to hub disinfection that would compensate for variations in scrubbing technique.MethodsOur institution involved bedside nurses in choosing new hub disinfection technology. They selected 2 devices to trial: a disinfection cap that passively disinfects hubs with isopropyl alcohol and a device that friction-scrubs with isopropyl alcohol. After trying both, nurses selected the cap for use in the facility's 3 intensive care units. After no BSIs occurred during a 3-month span, we implemented the cap throughout the hospital for use on central venous catheters; peripherally inserted central catheters; and peripheral lines, including tubing and Y-sites.ResultsComparing the postintervention period (December 2011-August 2013) to the preintervention span (September 2009-May 2011), the BSI rate dropped 43% for PIVs, 50% for central lines, and 45% overall (PIVs + central lines). The central line and overall results are statistically significant. The PIV BSI rate drop is attributable to cap use alone because the cap was the only new intervention during the postimplementation period. The other infection reductions appear to be at least partly due to cap use.ConclusionsOur institution achieved substantial BSI reductions, some statistically significant, by applying a disinfection cap to both PIVs and central lines. 相似文献
4.
《Indian journal of medical microbiology》2019,37(4):521-526
Background: There is a need to generate accurate data on temporal trends in incidence rates, aetiology and antimicrobial susceptibility of central line-associated bloodstream infections (CLABSIs) in the Indian setting. Aim: To study the incidence, aetiology and antimicrobial susceptibility of CLABSI in adult, paediatric and neonatal intensive care units (NICUs) in a tertiary care private hospital in Mumbai, India. Materials and Methods:This is a prospective observational study conducted at the adult, paediatric and NICUs of tertiary care private hospital from 2011 to 2018. CLABSI was defined as per the Centers for Disease Control criteria. Surveillance of CLABSI in the intensive care units (ICUs) was conducted using a form adapted from the International Nosocomial Infection Control Consortium surveillance system. The incidence rates of CLABSI (per 1000 central line days), crude mortality, aetiology and antimicrobial susceptibility were calculated and reported. Results: Six hundred and eighty-six episodes of CLABSI were recorded, and the overall incidence of CLABSI was 5/1000 catheter days, 4.1 in the adult ICU, 5 in the paediatric ICU and 9 in the newborn ICU. Crude mortality in patients with CLABSI in the adult, paediatric and NICUs was 45%, 30% and 7%, respectively. Of the 752 isolates, 80% were Gram negative, 10% Gram positive and 10% yeast. The prevalence of extended-spectrum beta-lactamase producers was 80%, and rates of carbapenem resistance were on an average 50%. Conclusions: The CLABSI rates at a well-equipped tertiary care hospital are still significantly higher than the USA benchmarks. Alarming rates of drug resistance in Gram-negative pathogens were seen. 相似文献
5.
Tracie Savage Darci E. Hodge Kary Pickard Pam Myers Kristen Powell Jonathan M. Cayce 《Journal of the Association for Vascular Access》2018,23(1):30-41
Purpose
Hospitals devote significant resources developing protocols to minimize the incidence of central line-associated bloodstream infections (CLABSIs), a source of increased patient morbidity and health care costs; however, few of these protocols, especially centralized protocols, are reported in the literature. This study characterizes the development and effectiveness of a pediatric hospital's centralized CLABSI prevention bundle.Design and Methods
The study was designed as a retrospective interrupted time series to quantify the effectiveness of the prevention bundle that was developed and implemented by nursing leadership in infection control, and both the neonatal and pediatric intensive care units between 2006 and 2014. The study period was subdivided into pre-, peri-, post-, and second peri-intervention periods based on the implementation status of the bundle. Segmented linear regression was used to model and compare the CLABSI rates for each intervention period overall as well as the 5 individual hospital units.Results
The hospital's modeled CLABSI rate during the preintervention period was 3.80 out of 1000 line days and was significantly reduced to 0.45 (P?<0.001). Clear decreases in unit CLABSI rates were observed and all units were below corresponding National Healthcare Safety Network CLABSI rates after the study.Conclusions
The centralized CLABSI prevention bundle reduced and sustained low CLABSI rates overall and within each hospital unit demonstrating the success of the bundle.Practice Implications
A centralized CLABSI prevention bundle can universalize central line care, simplify infection control, and improve quality of care to help sustain low CLABSI rates throughout the hospital. 相似文献6.
《Journal of the Association for Vascular Access》2014,19(3):172-179
BackgroundFederal agencies such as the Centers for Disease Control and Prevention have mandated reduction of hospital-acquired infections and recommended the use of antimicrobial catheters in clinical settings where central line-associated bloodstream infection (CLABSI) rates have remained high. The Infusion Nurses Society also recommends antimicrobial catheters for specific patient populations. At a California hospital, evidence-based infection prevention strategies for CLABSI prevention had been in effect for several years, but the CLABSI rate remained at an unacceptable level. For this reason, the effect of an antimicrobial peripherally inserted central catheter (PICC) on the incidence of CLABSI was studied.MethodsA quasiexperimental design was used with concurrent data collection on patients in an intervention group who received an antimicrobial PICC. Retrospective data were collected for patients in a nonintervention group who received nonantimicrobial PICCs the previous year.ResultsThe 257 patients in the nonintervention group experienced 8 CLABSIs with an infection rate of 4.18/1,000 line days. The 260 subjects in the intervention group experienced 1 CLABSI with an infection rate of 0.47/1,000 line days. The decrease in the number of infections per 1,000 line days for the intervention group was statistically significant.ConclusionsThe use of an antimicrobial PICC in conjunction with current infection prevention practices resulted in a statistically significant decrease in infection rate, which supports the recommendation for continued use of antimicrobial catheters. Treatment cost savings, which overcame the higher initial cost for the devices, were found to be an additional benefit of using antimicrobial catheters. 相似文献
7.
《Clinical microbiology and infection》2019,21(6):705-710
ObjectivesTo investigate whether daily bathing with a soap-like solution of 4% chlorhexidine (CHG) followed by water rinsing (CHGwr) would decrease the incidence of hospital-acquired infections (HAI) in intensive care settings.MethodsRandomized, controlled trial; infectious diseases specialists were blinded to the intervention status. All patients admitted to the Intensive Care Unit (ICU) and to the Post-operative Cardiosurgical Intensive Care Unit (PC-ICU) of the University Hospital of Perugia were enrolled and randomized to the intervention arm (daily bathing with 4% CHGwr) or to the control arm (daily bathing with standard soap). The incidence rate of acquisition of HAI was compared between the two arms as primary outcome. We also evaluated the incidence of bloodstream infections (BSI), central-line-associated BSI (CLABSI), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (CAUTI), and 4% CHGwr safety.ResultsIn all, 449 individuals were enrolled, 226 in treatment arm and 223 in control arm. Thirty-four individuals of the 226 (15%) and 57 (25.6%) suffered from at least an HAI in the intervention and control arms, respectively (p 0.008); 23.2 and 40.9 infections/1000 patient-days were detected in the intervention arm and control arm, respectively (p 0.037). The incidence of all bloodstream infections (BSI plus CABSI) was significantly reduced in the intervention arm (9.2 versus 22.6 infections/1000 patient-days, p 0.027); no differences were observed in the mortality between the two arms.ConclusionsDaily bathing with 4% CHGwr significantly reduced HAI incidence in intensive care settings.ClinicalTrial.gov registrationNCT03639363. 相似文献
8.
Chih-Cheng Lai Cong-Tat Cia Hsiu-Tzy Chiang Yung-Chung Kung Zhi-Yuan Shi Yin-Ching Chuang Chun-Ming Lee Wen-Chien Ko Po-Ren Hsueh 《Journal of microbiology, immunology, and infection》2018,51(5):666-671
Background/purpose
This study assessed the effect of the central line bundle on the rate of central line-associated bloodstream infections (CLABSI) in intensive care units (ICUs) in Taiwan.Methods
This national study was conducted in 27 ICUs with 404 beds total, including 15 medical ICUs, 11 surgical ICUs, and one mixed ICU. The study period was divided into two phases: a pre-intervention (between June 1, 2011 and October 31, 2011) and intervention phase (between December 1, 2011 and October 31, 2012). Outcome variables, including CLABSI rates (per 1000 catheter-days) and catheter utilization rates, were measured.Results
The overall rate of CLABSI significantly decreased by 12.2% (p < 0.001) from 5.74 per 1000 catheter-days in the pre-intervention phase to 5.04 per 1000 catheter-days in the intervention phase. The catheter utilization rate decreased by 1.1% from 55.3% in the pre-intervention phase to 54.2% in the intervention phase. The decline in CLABSI varied significantly among hospital and ICU levels, except surgical ICUs (p = 0.59).Conclusions
Implementing a multidimensional central-line bundle significantly reduced the rates of CLABSI by 12.2% in nearly all participating ICUs, except surgical ICUs. 相似文献9.
《Clinical microbiology and infection》2014,20(5):O318-O324
Previous work has suggested that central-line-associated bloodstream infection (CLABSI) is associated with increased costs and risk of mortality; however, no studies have looked at both total and variable costs, and information on outcomes outside of the intensive-care unit (ICU) is sparse. The aim of this study was to determine the excess in-hospital mortality and costs attributable to CLABSI in ICU and non-ICU patients. We conducted a retrospective cohort and cost-of-illness study from the hospital perspective of 398 patients at a tertiary-care academic medical centre from 1 January 2008 to 31 December 2010. All CLABSI patients and a simple random sample drawn from a list of all central lines inserted during the study period were included. Generalized linear models with log link and gamma distribution were used to model costs as a function of CLABSI and important covariates. Costs were adjusted to 2010 US dollars by use of the personal consumption expenditures for medical care index. We used multivariable logistic regression to identify independent predictors of in-hospital mortality. Among both ICU and non-ICU patients, adjusted variable costs for patients with CLABSI were c. $32 000 (2010 US dollars) higher on average than for patients without CLABSI. After we controlled for severity of illness and other healthcare-associated infections, CLABSI was associated with a 2.27-fold (95% CI 1.15–4.46) increased risk of mortality. Other healthcare-associated infections were also significantly associated with greater costs and mortality. Overall, CLABSI was associated with significantly higher adjusted in-hospital mortality and total and variable costs than those for patients without CLABSI. 相似文献
10.
11.
《Indian journal of medical microbiology》2020,38(1):24-32
Background: Acinetobacter baumannii has become a common pathogen causing hospital-acquired infections (HAIs). Although acquiring any nosocomial infection is associated with increased mortality, we do not know if the acquisition of Acinetobacter infection confers a worse prognosis as compared to non-Acinetobacter-related HAI. The aim of the current study is to compare the clinical outcomes of ventilator-associated pneumonia (VAP) and central line associated blood stream infections (CLABSIs) caused by A. baumannii with those caused by other bacterial pathogens. Materials and Methods: This prospective cohort study was conducted among critically ill adults admitted to a tertiary care hospital in South India from January 2013 to June 2014. We enrolled patients who developed new-onset fever ≥48 h after admission and fulfilled pre-specified criteria for VAP or CLABSI. The patients were followed up until the primary outcomes of death or hospital discharge. Results: During the study period, 4047 patients were admitted in the intensive care units, among which 129 eligible HAI events were analysed. Of these, 95 (73.6%) were VAP, 34 (26.4%) were CLABSI, 78 (60.4%) were A. baumannii-related HAI (AR-HAI) and 51 (39.6%) were non-A. baumannii-related HAI (NAR-HAI). Mortality among AR-HAI was 57.6% compared to 39.2% in NAR-HAI (P = 0.04) which on multivariate analysis did not achieve statistical significance, although the trend persisted (odds ratio [OR] = 4.2, 95% confidence interval [CI]: 0.95–18.4, P = 0.06). The acquisition of VAP due to A. baumannii was associated with poor ventilator outcomes even after adjusting for confounders (adjusted OR = 3.5, 95% CI: 1.07–11.6, P = 0.04). Conclusion: In our cohort of critically ill adults with VAP and CLABSI, AR-HAI was associated with poor ventilator outcomes and a trend towards higher mortality. These findings add to the evidence suggesting that A. baumannii is a dangerous pathogen, perhaps even more so than others. 相似文献
12.
Shin-Huei Kuo Wei-Ru Lin Jun-You Lin Chung-Hao Huang Ya-Ting Jao Pei-Wen Yang Jong-Rung Tsai Wen-Hung Wang Yen-Hsu Chen Ching-Tzu Hung Po-Liang Lu 《Journal of microbiology, immunology, and infection》2018,51(3):401-410
Background/purpose
For high risk of central line-associated bloodstream infections (CLABSIs) in patients of intensive care units (ICUs) and scarcely epidemiology and therapeutic recommendations in Asia, we aimed to evaluate the annual change in epidemiology, antibiogram, and risk factors for 14-day mortality.Methods
A retrospective study of ICUs patients with CLABSIs at a medical center in Taiwan (2010–2016), where central line care bundle implemented since 2014, by reviewing clinical data, pathogens, and the antibiogram.Results
Gram-negative bacteria (59.3%) were main microorganisms of CLABSIs, and 9.0% of all GNB were MDROs. Acinetobacter spp., Enterobacter spp., and Stenotrophomonas maltophilia were the most frequently isolated. In multivariate analysis, malignancy, inadequate empirical antimicrobial therapy, inadequate definite antimicrobial therapy, and infection by fungi or multidrug-resistant organisms (MDROs) were associated with 14-day mortality (all p < 0.05). The CLABSI incidence rate decreased from 5.54 to 2.18 per 1000 catheter-day (from 2014 to 2015) with improved compliance to care bundle. Carbapenem and aminoglycoside were suitable empirical drugs in the hospital setting when GNB is predominant for CLABSI. Significant decreasing susceptibility of ampicillin/sulbactam in Enterobacter spp. (36.7%–0.0%), and ampicillin/sulbactam (12.5%–0.0%), ceftazidime (100.0%–52.9%), and tigecycline (87.5%–35.3%) in Serratia marcescens.Conclusion
We identified Gram-negative bacteria as leading pathogens of CLABSIs in a Taiwan medical center, and good compliance to care bundle is associated with reduced CLABSI incidence rate. Malignancy, infection by MDROs or fungi, inadequate empirical or definite antimicrobial therapy are significant factors for 14-day mortality. 相似文献13.
Wu-Pu Lin Yu-Ching Chang Un-In Wu Mei-Chuan Hung Pao-Yu Chuang Jann-Tay Wang Wang-Huei Sheng Yee-Chun Chen Shan-Chwen Chang 《Journal of microbiology, immunology, and infection》2018,51(5):644-651
Background
Central line (CL)-associated bloodstream infection (CLABSI) poses a major threat to patient safety and is associated with additional cost. This study investigated the sustained effect of multimodal interventions focusing on CL bundle improvement in the adult intensive care units (ICUs) of a teaching hospital in Taiwan.Methods
A before–after prospective study was conducted in 17 adult ICUs of a medical center in northern Taiwan from January 2009 to December 2013. Many interventions that aimed to facilitate CL bundle implementation were initiated in January 2011. The incidence rates of CLABSI and catheter-related bloodstream infection (CRBSI) were compared between the baseline and intervention periods. Catheter utilization ratios and microbiological characteristics were also analyzed.Results
The incidence rates of both CLABSI and CRBSI decreased significantly from the baseline to the intervention periods (from 9.27 to 7.66 per 1000 CL-days and from 1.51 to 0.89 per 1000 CL-days, respectively). The yearly incidence rate decreased by up to 31% (incidence rate ratio [IRR], 0.69; 95% confidence interval [CI], 0.59–0.81) for CLABSI and 59% (IRR, 0.41; 95% CI, 0.26–0.65) for CRBSI since the initiation of the interventions. The catheter utilization ratio also decreased from 0.71 to 0.63 (p < 0.001). Microbiological analysis showed that among all CLABSI isolates, the proportion of coagulase-negative staphylococci significantly decreased during the intervention period.Conclusion
Implementing multimodal interventions focusing on CL bundle improvement was effective in reducing the incidence rates of CLABSI and CRBSI in Taiwan's adult ICUs. 相似文献14.
During a 3-year study period in a university teaching hospital, 417 nosocomial infections associated with Pseudomonas aeruginosa were documented in 321 patients. The overall rate of P. aeruginosa nosocomial infection was 5.3 cases per 1,000 patients. Residence on the surgery or medicine service, advanced patient age, and exposure to the burn, surgery, or medicine intensive care units correlated with higher rates of infection. The most common sites for P. aeruginosa infection were the lower respiratory tract, urinary tract, blood stream, and surgical wounds. Nosocomial P. aeruginosa lower respiratory tract and blood stream infections were significantly associated with exposure to certain intensive care units, whereas P. aeruginosa urinary tract infections more commonly occurred on the neurology and neurosurgery services. Results of live antigen serotyping showed that serotype 6 was most common, followed by serotypes 1 and 11. Serotype 6 correlated with resistance to carbenicillin, gentamicin, and tobramycin, and serotype 11 correlated with resistance to carbenicillin. Two-thirds of the isolates tested were sensitive to carbenicillin, gentamicin, and tobramycin, but 13.2% were resistant to all three of these drugs. P. aeruginosa isolates resistant to all three drugs were associated with urinary tract infections. 相似文献
15.
Comparative efficacy of alternative hand-washing agents in reducing nosocomial infections in intensive care units. 总被引:20,自引:0,他引:20
B N Doebbeling G L Stanley C T Sheetz M A Pfaller A K Houston L Annis N Li R P Wenzel 《The New England journal of medicine》1992,327(2):88-93
BACKGROUND. Effective hand-washing can prevent nosocomial infections, particularly in high-risk areas of the hospital. There are few clinical studies of the efficacy of specific hand-cleansing agents in preventing the transmission of pathogens from health care workers to patients. METHODS. For eight months, we conducted a prospective multiple-crossover trial involving 1894 adult patients in three intensive care units (ICUs). In a given month, the ICU used a hand-washing system involving either chlorhexidine, a broad-spectrum antimicrobial agent, or 60 percent isopropyl alcohol with the optional use of a nonmedicated soap; in alternate months the other system was used. Rates of nosocomial infection and hand-washing compliance were monitored prospectively. RESULTS. When chlorhexidine was used, there were 152 nosocomial infections, as compared with 202 when the combination of alcohol and soap was used (adjusted incidence-density ratio [IDR], 0.73; 95 percent confidence interval, 0.59 to 0.90). The largest reduction with chlorhexidine was in gastrointestinal infections (IDR, 0.19; 95 percent confidence interval, 0.05 to 0.64). When chlorhexidine was available, the rates of nosocomial infection declined in each of the ICUs, and health care workers washed their hands more often than when alcohol and soap were used (relative risk, 1.28; 95 percent confidence interval, 1.02 to 1.60). The total volume of alcohol and soap used was 46 percent that of chlorhexidine (P less than 0.001). CONCLUSIONS. A hand-disinfection system using an antimicrobial agent (chlorhexidine) reduces the rate of nosocomial infections more effectively than one using alcohol and soap. The improvement may be explained at least in part by better compliance with hand-washing instructions when chlorhexidine was used. 相似文献
16.
Mary Duncan Patricia Warden Stéphanie F. Bernatchez Dan Morse 《Journal of the Association for Vascular Access》2018,23(1):15-22
Background
Peripheral intravenous catheters (PIVs) have been considered as having lower risk of infection than central lines. However, research is limited regarding numbers of primary bloodstream infections related to peripheral lines and prevention of peripheral line-associated bloodstream infections (PLABSI).Methods
Our aim was to create and monitor compliance with a new PIV maintenance bundle using disinfecting caps and tips and to assess whether this bundle would lead to a decrease in PLABSI rates. Weekly audits were conducted to measure compliance with both the new PIV bundle and our existing central line-associated bloodstream infection (CLABSI) bundle. We also audited the disconnection method used for intravenous line tubing (peripheral and central lines) before and during the study intervention period.Results
A compliance rate of close to 90% with the use of the disinfecting caps and tips was attained. Using a PLABSI bundle successfully decreased primary bloodstream infections due to PIVs (from 0.57 infections per 1000 patient-days preintervention to 0.11 infections per 1000 patient-days; p?<?0.001). We confirmed that improving care for PIVs would decrease primary bloodstream infections associated with these devices.Conclusions
Using a PIV maintenance bundle including disinfecting caps and tips can effectively lower the rate of primary bloodstream infections attributable to PIV lines. 相似文献17.
《Indian journal of medical microbiology》2021,39(1):15-18
BackgroundDevice-associated infections (DAIs) are an important cause of excessive stay and mortality in ICUs. Trauma patients are predisposed to acquire such infections due to various factors. The prevalence of HAIs is underreported from developing nations due to a lack of systematic surveillance. This study reports the rates and outcomes of DAIs at a dedicated Trauma Center in trauma patients and compares the rates with a previous pilot observation.MethodsThe study reports the finding of ongoing surveillance and the use of an indigenous software at a level-1 trauma center in India. Surveillance for ventilator-associated pneumonia, central line-associated bloodstream infections, and catheter-associated urinary tract infections was done based on standard definitions. The rates of HAIs and the profile of pathogens isolated from June 2010 to December 2018 were analyzed.ResultsA total of 7485 patients were included in the analysis, amounting to 68,715 patient days. The rates of VAP, CLABSI, and CA-UTI were respectively 12, 9.8 1st 8.5/1000 device days. There was a significant correlation between device days and the propensity to develop infections. Of the 1449 isolates recovered from cases of DAIs, Acinetobacter sp (28.2%) was the most common isolate, followed by Candida sp. A high rate of multi-resistance was observed.ConclusionAutomated surveillance was easy and useful for data entry and analysis. Surveillance data should be used for implementing preventive programs. 相似文献
18.
Hsing-Chen Tsai Meng-Tsen Tsai Wang-Huei Sheng Jann-Tay Wang Po-Nien Tsao Hung-Chieh Chou Chien-Yi Chen Luan-Yin Chang Chun-Yi Lu Li-Min Huang 《Journal of microbiology, immunology, and infection》2019,52(6):888-892
BackgroundDuring one week in September, one index case, followed by two cases of rotavirus gastroenteritis infection, was identified in a neonate intermediate care unit of a tertiary teaching children's hospital. An outbreak investigation was launched to clarify the possible infection source and to stop the spread of infection.MethodsCohort care and environmental disinfection were immediately implemented. We screened rotavirus in all the unit neonates' stool samples as well as environmental swab samples. The precautionary measures with regard to hand hygiene and contact isolation taken by healthcare providers and family members were re-examined.ResultsThe fourth case was identified 5 days after commencement of the outbreak investigation. There were total 39 contacts, including 6 neonates, 8 family members, and 25 healthcare providers. Nineteen stool samples collected from other neonates in the units revealed one positive case (the fourth case). However, one sample taken from the computer keyboard and mouse in the ward was also positive. The observation of hygiene precautions and the use of isolation gowns by healthcare workers were found to be inadequate. Following the intensification of infection control measures, no further cases of infection were reported.ConclusionsHand hygiene and an intensive isolation strategy remained the most critical precautions for preventing an outbreak of healthcare-associated viral gastroenteritis in the neonate care unit. 相似文献
19.
İlker Devrim Sevgi Topal Gökhan Ceylan Yeliz Oruç Gamze Gülfidan Yüce Ayhan Nuri Bayram Hasan Ağın 《Journal de Mycologie Médicale》2022,32(3):101277
ObjectiveCandida species are among the most prevalent microorganisms in pediatric critical care units that cause central line-associated bloodstream infections. The goal of this study was to assess the therapeutic benefit of central line bundle for the prevention of Candida species-related bloodstream infections in pediatric intensive care units.DesignThe study covered the period from January 1, 2009, to December 31, 2019. Pre-bundle and bundle phases were included in the research. The Clinical Microbiology Laboratory's records revealed episodes of Candida-related central line-associated bloodstream infections.SettingThe study was conducted in the Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital's PICU (which has 24 beds and admits 350 patients per year).PatientsThis study included pediatric patients in the pediatric intensive care unit with non-tunneled central venous catheters.InterventionsIn the pediatric intensive care unit, a central line bundle was started.ResultsA total of 236 Candida-related central line-associated bloodstream infections were discovered during the study period. Non-albicans Candida accounted for 83.5% (197) of the total, whereas C.albicans accounted for 16.5%(39). During the pre-bundle period, 137 Candida species were isolated from the patients, while 99 Candida species were isolated during the bundle period. Candida-related central line-associated bloodstream infections dropped from 13.68 to 5.93 per 1000 CL-days after the central line bundle was used (p < 0.001).ConclusionsAccording to our findings, the central line bundle greatly reduced central line-associated Candida species bloodstream infections. Central line bundles are an effective scientific solution for preventing Candida-related central line-associated bloodstream infections in hospitals with high Candida prevalence. 相似文献
20.
《Clinical microbiology and infection》2020,26(5):563-571
ObjectivesThe prevention of catheter-related bloodstream infection (CRBSI) has been an area of intense research, but the heterogeneity of endpoints used to define catheter infection makes the interpretation of randomized controlled trials (RCTs) problematic. The aim of this study was to determine the validity of different endpoints for central venous catheter infections.Data sources(a) Individual-catheter data were collected from 9428 catheters from four large RCTs; (b) study-level data from 70 RCTs were identified with a systematic search. Eligible studies were RCTs published between January 1987 and October 2018 investigating various interventions to reduce infections from short-term central venous catheters or short-term dialysis catheters. For each RCT the prevalence rates of CRBSI, quantitative catheter tip colonization, catheter-associated infection (CAI) and central line-associated bloodstream infection (CLABSI) were extracted for each randomized study arm.MethodsCRBSI was used as the gold-standard endpoint, for which colonization, CAI and CLABSI were evaluated as surrogate endpoints. Surrogate validity was assessed as (1) the individual partial coefficient of determination (individual-pR2) using individual catheter data; (2) the coefficient of determination (study-R2) from mixed-effect models regressing the therapeutic effect size of the surrogates on the effect size of CRBSI, using study-level data.ResultsColonization showed poor agreement with CRBSI at the individual-patient level (pR2 = 0.33 95% CI 0.28–0.38) and poor capture at the study level (R2 = 0.42, 95% CI 0.21–0.58). CAI showed good agreement with CRBSI at the individual-patient level (pR2 = 0.80, 95% CI 0.76–0.83) and moderate capture at the study level (R2 = 0.71, 95% CI 0.51–0.85). CLABSI showed poor agreement with CRBSI at the individual patient level (pR2 = 0.34, 95% CI 0.23–0.46) and poor capture at the study level (R2 = 0.28, 95% CI 0.07–0.76).ConclusionsCAI is a moderate to good surrogate endpoint for CRBSI. Colonization and CLABSI do not reliably reflect treatment effects on CRBSI and are consequently more suitable for surveillance than for clinical effectiveness research. 相似文献