PMID- 23497591
OWN - NLM
STAT- MEDLINE
DCOM- 20150916
LR  - 20240506
IS  - 1466-609X (Electronic)
IS  - 1364-8535 (Print)
IS  - 1364-8535 (Linking)
VI  - 17
IP  - 2
DP  - 2013 Mar 4
TI  - Beyond the bundle--journey of a tertiary care medical intensive care unit to zero 
      central line-associated bloodstream infections.
PG  - R41
LID - 10.1186/cc12551 [doi]
AB  - INTRODUCTION: We set a goal to reduce the incidence rate of catheter-related 
      bloodstream infections to rate of <1 per 1,000 central line days in a two-year 
      period. METHODS: This is an observational cohort study with historical controls 
      in a 25-bed intensive care unit at a tertiary academic hospital. All patients 
      admitted to the unit from January 2008 to December 2011 (31,931 patient days) 
      were included. A multidisciplinary team consisting of hospital 
      epidemiologist/infectious diseases physician, infection preventionist, unit 
      physician and nursing leadership was convened. Interventions included: central 
      line insertion checklist, demonstration of competencies for line maintenance and 
      access, daily line necessity checklist, and quality rounds by nursing leadership, 
      heightened staff accountability, follow-up surveillance by epidemiology with 
      timely unit feedback and case reviews, and identification of noncompliance with 
      evidence-based guidelines. Molecular epidemiologic investigation of a cluster of 
      vancomycin-resistant Enterococcus faecium (VRE) was undertaken resulting in staff 
      education for proper acquisition of blood cultures, environmental decontamination 
      and daily chlorhexidine gluconate (CHG) bathing for patients. RESULTS: Center for 
      Disease Control/National Health Safety Network (CDC/NHSN) definition was used to 
      measure central line-associated bloodstream infection (CLA-BSI) rates during the 
      following time periods: baseline (January 2008 to December 2009), intervention 
      year (IY) 1 (January to December 2010), and IY 2 (January to December 2011). 
      Infection rates were as follows: baseline: 2.65 infections per 1,000 catheter 
      days; IY1: 1.97 per 1,000 catheter days; the incidence rate ratio (IRR) was 0.74 
      (95% CI=0.37 to 1.65, P=0.398); residual seven CLA-BSIs during IY1 were VRE 
      faecium blood cultures positive from central line alone in the setting of 
      findings explicable by noninfectious conditions. Following staff education, 
      environmental decontamination and CHG bathing (IY2): 0.53 per 1,000 catheter 
      days; the IRR was 0.20 (95% CI=0.06 to 0.65, P=0.008) with 80% reduction compared 
      to the baseline. Over the two-year intervention period, the overall rate 
      decreased by 53% to 1.24 per 1,000 catheter-days (IRR of 0.47 (95% CI=0.25 to 
      0.88, P=0.019) with zero CLA-BSI for a total of 15 months. CONCLUSIONS: Residual 
      CLA-BSIs, despite strict adherence to central line bundle, may be related to 
      blood culture contamination categorized as CLA-BSIs per CDC/NHSN definition. 
      Efforts to reduce residual CLA-BSIs require a strategic multidisciplinary team 
      approach focused on epidemiologic investigations of practitioner- or 
      unit-specific etiologies.
FAU - Exline, Matthew C
AU  - Exline MC
FAU - Ali, Naeem A
AU  - Ali NA
FAU - Zikri, Nancy
AU  - Zikri N
FAU - Mangino, Julie E
AU  - Mangino JE
FAU - Torrence, Kelly
AU  - Torrence K
FAU - Vermillion, Brenda
AU  - Vermillion B
FAU - St Clair, Jamie
AU  - St Clair J
FAU - Lustberg, Mark E
AU  - Lustberg ME
FAU - Pancholi, Preeti
AU  - Pancholi P
FAU - Sopirala, Madhuri M
AU  - Sopirala MM
LA  - eng
GR  - HL095772/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20130304
PL  - England
TA  - Crit Care
JT  - Critical care (London, England)
JID - 9801902
SB  - IM
CIN - Crit Care. 2013;17(3):139. PMID: 23659634
MH  - Catheter-Related Infections/*epidemiology/*prevention & control
MH  - Catheterization, Central Venous/standards/trends
MH  - Cohort Studies
MH  - Cross Infection/*epidemiology/*prevention & control
MH  - Female
MH  - Humans
MH  - Intensive Care Units/*standards/trends
MH  - Male
MH  - Tertiary Healthcare/*standards/trends
PMC - PMC3733431
EDAT- 2013/03/19 06:00
MHDA- 2015/09/17 06:00
PMCR- 2013/03/04
CRDT- 2013/03/19 06:00
PHST- 2012/09/20 00:00 [received]
PHST- 2013/02/22 00:00 [accepted]
PHST- 2013/03/19 06:00 [entrez]
PHST- 2013/03/19 06:00 [pubmed]
PHST- 2015/09/17 06:00 [medline]
PHST- 2013/03/04 00:00 [pmc-release]
AID - cc12551 [pii]
AID - 10.1186/cc12551 [doi]
PST - epublish
SO  - Crit Care. 2013 Mar 4;17(2):R41. doi: 10.1186/cc12551.