Carole Leone

Catheter-associated bloodstream infections in general medical patients outside the intensive care unit: A surveillance study

OBJECTIVE To determine the incidence of central venous catheter (CVC)-associated bloodstream infection (CA-BSI) among patients admitted to general medical wards outside the intensive care unit (ICU). DESIGN Prospective cohort study performed over a 13-month period, from April 1, 2002, through April 30, 2003. SETTING Four selected general medical wards at Barnes-Jewish Hospital, a 1,250-bed teaching hospital in Saint Louis, Missouri. PATIENTS; All patients admitted to 4 general medical wards. RESULTS A total of 7,337 catheter-days were observed during 33,174 patient-days. The device utilization ratio (defined as the number of catheter-days divided by the number of patient-days) was 0.22 overall and was similar among the 4 wards (0.21, 0.25, 0.19, and 0.24). Forty-two episodes of CA-BSI were identified (rate, 5.7 infections per 1,000 catheter-days). Twenty-four (57%) of the 42 cases of CA-BSI were caused by gram-positive bacteria: 10 isolates (24%) were coagulase-negative staphylococci, 10 (24%) were Enterococcus species, and 3 (7%) were Staphylococcus aureus. Gram-negative bacteria caused 7 infections (17%). Five CA-BSIs (12%) were caused by Candida albicans, and 5 infections (12%) had a polymicrobial etiology. Thirty-five patients (83%) with CA-BSI had nontunneled CVCs in place. CONCLUSIONS Non-ICU medical wards in the study hospital had device utilization rates that were considerably lower than those of medical ICUs, but CA-BSI rates were similar to CA-BSI rates in medical ICUs in the United States. Studies of catheter utilization and on CVC insertion and care should be performed on medical wards. CA-BSI prevention strategies that have been used in ICUs should be studied on medical wards.

Advancing the competency of infection preventionists.

The Association of Professionals in Infection Control and Epidemiology (APIC) has identified advancing infection prevention competency as a core goal in their Strategic Plan 2020. To achieve this goal, APIC has published a self-assessment tool to help infection preventionists identify where they are on a predefined scale. This project trialed APICs self-assessment tool along with an internally developed objective assessment. The objective was to determine if the tools help identify areas for improvement to advance overall group competency at BJC HealthCare, a large Midwestern health care system with nearly 30 infection preventionists.

Development of a standardized process improvement protocol to address elevated health care-associated infection rates on an incented quality scorecard.

This practice forum report details a standardized improvement process that was created both to improve patient outcomes related to various hospital-acquired infections and to address leadership concerns related to incented quality metrics. A 3-year retrospective review identified common issues to guide future interventions and confirmed that this methodology reduced the rate of recurrent infections across the health care system. Process tool samples are provided.

Inter-rater Reliability of Infection Preventionists’ Colon Surgical Site Infection Determination Utilizing a User Assisted Electronic Surveillance System

ISSUE: Our 28 bed Hematology Oncology (Heme-Onc) unit has had an unacceptably high central line assosciated bloodstream infection (CLABSI) rate. This patient population with various hematologic malignancies, including stem cell transplants, is at high risk for neutropenia, mucositis and graft-versus-host disease. Despite aggressive prevention efforts with implementation of multiple evidence-based CLABSI interventions over a 3 year period, no significant reduction in the CLABSI rate was achieved. PROJECT: Applying the new January 2013 National Healthcare Safety Network (NHSN) mucosal barrier injury laboratoryconfirmed bloodstream infection (MBI-LCBSI) definition, we identified that 80% of the CLABSIs on our Heme-Onc unit met the MBI-LCBSI definition for the first quarter of 2013. To determine if this finding was new, all CLABSIs from 2012 on this Heme-Onc unit were retrospectively reviewed applying the 2013 NSHN MBILCBI definition. Tracking of the CLABSI rate excluding the MBI-LCBSIs continued in 2013. Chi square tests were performed to determine if the overall CLABSI rate was significantly different than the CLABSI rate excluding MBI-LCBIs for both 2012 and 2013. RESULTS: The overall CLABSI rate in 2012 was 4.07 BSI/1,000 device days. 67.6% of the CLABSIs in 2012met the definition for MBI-LCBSI. The CLABSI rate, excluding MBI-LCBSIs, was 1.32 BSI/1,000 device days. For the first eleven months of 2013, the overall CLABSI rate was 3.6 BSI/1,000 device days. 77.8 % of the CLABSIs met the MBI-LCBSI definition in 2013. The CLABSI rate, excluding the MBI-LCBIs, was 0.8 BSI/1,000 device days. There was a significant difference between the rates in 2012, (c2 (1) 1⁄4 11.72, p < .01) as well as in 2013, (c2 (1) 1⁄4 13.33, p < .01).