Infections in Critically Ill Children

Health care–associated infections (HAI) directly influence the survival of children in pediatric intensive care units (PICU), the most common being central line–associated bloodstream infection (CLABSI) 25–30%, followed by ventilator-associated pneumonia (VAP) 20–25%, and others such as catheter-associated urinary tract infection (CAUTI) 15%, surgical site infection (SSI) 11%. HAIs complicate the course of the disease, especially the critical one, thereby increasing the mortality, morbidity, length of hospital stay, and cost. The incidence of HAI in Western countries is 6.1–15.1% and in India, it is 10.5 to 19.5%. The advances in healthcare practices have reduced the incidence of HAIs in the recent years which is possible due to strict asepsis, hand hygiene practices, surveillance of infections, antibiotic stewardship, and adherence to bundled care. The burden of drug resistance and emerging infections are increasing with limited antibiotics in hand, is still a dreadful threat. The most common manifestation of HAIs is fever in PICU, hence the appropriate targeted search to identify the cause of fever should be done. Proper isolation practices, judicious handling of devices, regular microbiologic audit, local spectrum of organisms, identification of barriers in compliance of hand hygiene practices, appropriate education and training, all put together in an efficient and sustained system improves patient outcome.

Risk factors for peripherally inserted central catheterization-associated bloodstream infection in neonates / 中国当代儿科杂志

OBJECTIVES@#To study the features of catheter-related bloodstream infection (CRBSI) or central line-associated bloodstream infection (CLABSI) after peripherally inserted central catheterization (PICC) in neonates admitted to the neonatal intensive care unit (NICU) and the risk factors for CRBSI or CLABSI.@*METHODS@#A retrospective analysis was performed on the medical data of the neonates who were treated and required PICC in the NICU of the Children's Hospital, Zhejiang University School of Medicine from June 1, 2018 to May 1, 2020. The catheterization-related data were collected, including placement time, insertion site, removal time, and antimicrobial lock of PICC. The multivariate logistic regression model was used to investigate the risk factors for CRBSI or CLABSI in the neonates.@*RESULTS@#A total of 446 neonates were enrolled, with a mean gestational age of (30.8±4.0) weeks, a mean birth weight of (1 580±810) g, a median age of 9 days, and a median duration of PICC of 18 days. The incidence rates of CLABSI and CRBSI were 5.6 and 1.46 per 1 000 catheter days, respectively. Common pathogens for CLABSI caused by PICC included Staphylococcus epidermidis (n=19) and Klebsiella pneumoniae (n=11), and those for CRBSI caused by PICC included Klebsiella pneumoniae (n=6). The risk of CLABSI caused by PICC increased significantly with prolonged durations of PICC and antibiotic use, and the PICC-related infection probability at head and neck was significantly lower than that in the upper and low limbs (P<0.05), while the above conditions were more obvious in neonates with a birth weight of <1 500 g. The risk of CRBSI caused by PICC decreased with the increase in gestational age (P<0.05).@*CONCLUSIONS@#CRBSI and CLABSI remain serious issues in NICU nosocomial infection. The identification of the risk factors for CRBSI and CLABSI provides a basis for improving the quality of clinical care and management.

Sustained reduction of healthcare-associated infections after the introduction of a bundle for prevention of ventilator-associated pneumonia in medical-surgical intensive care units

Abstract Background Infection control interventions can be erroneously interpreted if outcomes are assessed in short periods. Also, statistical methods usually applied to compare outcomes before and after interventions are not appropriate for analyzing time series. Aims To analyze the impact of a bundle directed at reducing the incidence of ventilator-associated pneumonia (VAP) and other device-associated infections in two medical-surgical intensive care units (ICU) in Brazil. Methods Our study had a quasi-experimental design. Interrupted time series analyses (ITS) was performed assessing monthly rates of overall healthcare-associated infections (HCAI), VAP, laboratory-confirmed central line associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI), from January 2007 through June 2019. Moreover, multivariate ITS was adjusted for seasonality in Poisson regression models. An intervention based on a bundle for VAP prevention was introduced in August 2010. Findings The intervention was followed by sustained reduction in overall HCAI, VAP and CLABSI in both ICU. Continuous post-intervention trends towards reduction were detected for overall HCAI and VAP. Conclusion Interventions aimed at preventing one specific site of infection may have sustained impact on other HCAI, which can be documented using time series analyses.

Central line-associated bloodstream infections in cancer patients: An experience from a tertiary care cancer centre

Introduction: Central venous catheters (CVCs) implanted in patients with malignancies may often be associated with local or central line-associated bloodstream infections (CLABSI), which are a major source of morbidity and rarely mortality, making such patients' care difficult and complicated. Materials and Methods: This retrospective study is a single-centre's experience including both paediatric and adult patients with malignancy, who had a CVC inserted and were receiving care at cancer centre of our hospital over a period between January 2017 and June 2018. Results: In the period from January 2017 to June 2018, 73 confirmed cases of CLABSIs among cancer patients were included in this study. The rate of CLABSIs was estimated as 2.1 episodes/1000 CVC days. Out of 73 CLABSI cases, Gram-negative bacilli were the predominant causative agents of CLABSI constituting 72.6% (n = 53/73) of isolated organisms, 21.9% (n = 16/73) of infections were caused by Gram-positive cocci while polymicrobial infections accounted for 5.4% (n = 4/73) of these cases. Conclusion: Over the last 20 years, an epidemiologic shift has occurred among CLABSI in cancer patients. These findings should be considered with the development of interventions that will prevent Gram-negative CLABSI after CVC insertion. To our knowledge, this is the first study reporting data on the incidence of CLABSIs in cancer patients at tertiary care hospital from North Indian hospital.

Analysis of clinical characteristics of pediatric patients with central line-associated bloodstream infection in pediatric intensive care unit:a single-center retrospective study / 中国小儿急救医学

Objective To analyze the clinical characteristics and change in the infection rate of pedi-atric patients with hospital-acquired central line-associated bloodstream infection ( CLABSI) in PICU, and identify the deficiencies in management,and learn from the experience of developed countries in preventing and controlling CLABSI. Methods The cases of CLABSI diagnosed in the PICU of Beijing Children′s Hos-pital from July 2014 to September 2017 were selected,the clinical information of the pediatric patients was collected,and the infection rate,the in-hospital mortality,and other indicators of CLABSI were calculated to clarify the clinical characteristics and infection status to improve the current practice standard. Results A total of 13 cases of CLABSI had femoral vein catheters. Among them,hematological tumors were the most common(4/13). The infection rate increased from 0. 4 cases/1 000 catheter days in 2014 to 2. 5 cases/1 000 catheter days in 2017,while the catheter utilization rate increased from 24. 5% to 26. 6%,children infected with Gram-negative bacteria were the most common(7/13) and the in-hospital mortality was 23. 1%. Con-clusion In recent years,the number of CLABSI cases has increased. The " maximum sterile barrier" meas-ures should be supplemented to the current practice standards,the warning signs for catheter days should be added,and the necessity of indwelling catheter should be evaluated daily to reduce the rate of infection.

The axillary vein puncture can reduce the incidence of central venous catheter-related bloodstream infection / 中华急诊医学杂志

Objective@#To compare the effects of various interventions on the incidence of central line-associated bloodstream infection (CLABSI) .@*Methods@#The clinical data of 218 patients with central venous catheterization were retrospectively analyzed. Infected patients were treated as CLABSI group and non-infected patients as control group.@*Results@#Of the 218 patients, 24 patients were developed CLABSI. There was no significant difference in sex, age, primary infection status and puncture site between CLABSI group and control group. Univariate analysis showed that axillary vein puncture could significantly reduce the incidence of CLABSI (P=0.028), and the infection rate of axillary vein puncture per 1000 days under B-ultrasound was significantly reduced by 0.93‰. The average indwelling days of deep venous catheter in patients with pulse puncture were significantly longer than those in other groups (47.32 days vs 19.90 days). The average indwelling days in patients with axillary vein puncture positioned by B ultrasound were longer than those in patients with other parts of vein puncture positioned by B ultrasound (P < 0.05). Logistic multiple regression analysis showed that the main risk factors for CLABSI were anatomically located puncture (P = 0.031) and non-axillary venous catheterization (P = 0.068).@*Conclusions@#Choosing axillary vein as the position of deep venous catheterization and using ultrasound-guided central venous puncture can reduce the incidence of CLABSI and prolong the average catheterization time.

The axillary vein puncture can reduce the incidence of central venous catheter-related bloodstream infection / 中华急诊医学杂志

Objective To compare the effects of various interventions on the incidence of central line-associated bloodstream infection (CLABSI).Methods The clinical data of 218 patients with central venous catheterization were retrospectively analyzed.Infected patients were treated as CLABSI group and non-infected patients as control group.Results Of the 218 patients,24 patients were developed CLABSI.There was no significant difference in sex,age,primary infection status and puncture site between CLABSI group and control group.Univariate analysis showed that axillary vein puncture could significantly reduce the incidence of CLABSI (P=0.028),and the infection rate of axillary vein puncture per 1000 days under B-ultrasound was significantly reduced by 0.93‰.The average indwelling days of deep venous catheter in patients with pulse puncture were significantly longer than those in other groups (47.32 days vs 19.90 days).The average indwelling days in patients with axillary vein puncture positioned by B ultrasound were longer than those in patients with other parts of vein puncture positioned by B ultrasound (P ＜ 0.05).Logistic multiple regression analysis showed that the main risk factors for CLABSI were anatomically located puncture (P =0.031) and non-axillary venous catheterization (P =0.068).Conclusions Choosing axillary vein as the position of deep venous catheterization and using ultrasound-guided central venous puncture can reduce the incidence of CLABSI and prolong the average catheterization time.

Establishment and validation of risk prediction scoring model of central line-associated bloodstream infection in elderly patients / 中国感染控制杂志

Objective To establish the risk prediction scoring model of central line-associated bloodstream infection (CLABSI) in elderly patients, provide basis for screening high-risk population, and effectively prevent and control bloodstream infection (BSI) in elderly patients.Methods According to the inclusion and exclusion criteria, data of elderly patients who underwent central catheterization during hospitalization from January 1, 2015 to December 31, 2017 were collected, patients were randomly divided into modeling group and verification group according to the ratio of 7∶3 (random seed was 20180708), risk factors of data of modeling group were distinguished, logistic regression model was constructed. The corresponding score of each risk factor was assigned according to β value, infection risk scoring model was established, prediction accuracy of model was evaluated by receiver operating characteristic (ROC) curve; according to the established infection risk scoring model, cases in validation group were scored, prediction accuracy of model was evaluated by ROC curve. Decision curve was constructed using R software.Results Logistic regression analysis showed that the number of operation≥3 times, length of stay in intensive care unit (ICU) ≥2 days, duration of indwelling central venous catheterization≥7 days, and use of antimicrobial agents were independent risk factors for CLABSI in elderly patients; the corresponding points in risk prediction scoring model were 3, 4, 4, and 9 respectively, and the score of 13-17 points were high-risk population of CLABSI; the area of ROC curve (AUC) was 0.74 in the modeling group; ROC curve was plotted based on the risk score of patients in validation group, AUC was 0.70. The decision curve showed that the net benefit of the risk scoring model was higher in the high risk thershold of 0.01-0.05.Conclusion The established risk prediction scoring model has good discriminant validity and application value, and can be used in the identification of susceptible high risk population of CLABSI in elderly patients, so as to achieve early prevention and control.

Multivariate study on central line-associated bloodstream infection in patients undergoing hematopoietic stem cell transplantation / 中国感染控制杂志

Objective To investigate the incidence of central line-associated bloodstream infection (CLABSI) in patients with hematopoietic stem cell transplantation (HSCT), explore risk factors for the occurrence of CLABSI.Methods Basic information of patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) who underwent HSCT in a hematology department from November 1, 2016 to October 31, 2017 was collected, incidences of original CLABSI (OCLABSI) and modified CLABSI (MCLABSI) were calculated, related risk factors were analyzed by multivariate Cox regression.Results A total of 218 patients with AML and MDS who underwent HSCT were enrolled, 19 of whom had OCLABSI and 10 had MCLABSI.Twenty-one strains of pathogens were isolated from 19 patients with OCLABSI, including 9 gram-positive bacteria, 11 gram-negative bacteria, 1 fungus;9 strains were multidrug-resistant organisms.The main risk factors for OCLABSI included the female (HR=0.088;95％CI:0.017-0.440;P=0.003), age (HR=1.560;95％CI:1.066-2.530;P=0.034), bone marrow cell transplantation only (HR=4.408;95％CI:1.860-22.593;P=0.043), ATG/CSA/MMF/MTXG for preventing graft-versus-host disease (GVHD) (HR=0.101;95％CI:0.015-0.686;P=0.019), and MTX for preventing GVHD (HR=0.097;95％CI:0.011-0.816;P=0.032).Conclusion Definition of MCLABSI can provide more accurate monitoring on deep central venous catheter-related bloodstream infection.Incidence of CLABSI in HSCT patients can be reduced by early detection of high-risk population according to high-risk factors, strict adherence to the prevention and control measures of bloodstream infection, and implementation of immune recombination after enhanced transplantation.

Changing panorama for surveillance of device-associated healthcare infections: Challenges faced in implementation of current guidelines

Healthcare-associated infections (HAI) are preventable in up to 30% of patients with evidence-based infection prevention and control (IPC) activities. IPC activities require effective surveillance to generate data for the HAI rates, defining priority areas, identifying processes amenable for improvement and institute interventions to improve patient's safety. However, uniform, accurate and standardised surveillance methodology using objective definitions can only generate meaningful data for effective execution of IPC activities. The highly exhaustive, complex and ever-evolving infection surveillance methodology pose a challenge for effective data capture, analysis and interpretation by ground level personnel. The present review addresses the gaps in knowledge and day-to-day challenges in surveillance faced by infection control team for effective implementation of IPC activities.

Multidisciplinary Intestinal Rehabilitation for Short Bowel Syndrome in Adults: Results in a Korean Intestinal Rehabilitation Team

PURPOSE: Intense multidisciplinary team effort is required for the intestinal rehabilitation of patients afflicted with the short bowel syndrome (SBS). These include enteral and parenteral nutrition (PN) support, monitoring of complications related to treatment, and considering further medical or surgical options for intestinal adaptation. METHODS: In the Intestinal Rehabilitation Team (IRT) at the Samsung Medical Center, we have experienced 20 cases of adult SBS requiring multidisciplinary intestinal rehabilitation. This study is a retrospective review of the collected medical records. RESULTS: Of the 20 subjects treated, 12 patients were male and 8 patients were female. At the time of referral to the IRT, the mean age was 51.5 years, and the mean body weight was 50.1 kg, which was 90% of the usual body weight. The diseases or operative managements preceding massive bowel resection were malignancy in 11 cases, cardiac surgery in 2 cases, trauma in 2 cases and one case, each of tuberculosis, corrosive esophagitis, atrial fibrillation, simultaneous pancreas and kidney transplantation, and perforated appendicitis. Of these, there were 14 survivals and 6 mortalities. The fatalities were attributed to progression of disease, intestinal failure-associated liver disease, and sepsis (unrelated to intestinal failure) (2 cases each). Among the 14 surviving patients, 8 patients have been weaned off PN, whereas 6 are still dependent on PN (mean PN dependence 36%). CONCLUSION: This paper reports the results of multidisciplinary intestinal rehabilitation of adult short bowel patients treated at the Samsung Medical Center. Further studies are required to improve survival and enteral tolerance of these patients.

Neonatal umbilical venous catheters-related infections / 中国小儿急救医学

The umbilical vein catheterization is one of the most common interventions in neonates.Central line-associated bloodstream infections is a frequent complication of umbilical vein catheterization.It may lead to increased morbidity and mortality by 7% to 11%.At present, published literature on umbilical vein catheter-related bloodstream infections is limited in China.Our better knowledge of its epidemiology, risk factors and preventive measures could help to improve clinical practice and guide future research.

Two-Year Hospital-Wide Surveillance of Central Line-Associated Bloodstream Infections in a Korean Hospital

BACKGROUND: Surveillance and interventions of central line-associated bloodstream infections (CLABSIs) had mainly been targeted in intensive care units (ICUs). Central lines are increasingly used outside ICUs. Therefore, we performed a hospital-wide survey of CLABSIs to evaluate the current status and develop strategies to reduce CLBASI rates. METHODS: All hospitalized patients with central venous catheters (CVCs) were screened for CLABSIs from January 2014 through December 2015 at a 1,328 bed tertiary care teaching hospital in Korea using an electronic data-collecting system. Clinical information including type of CVC was collected. CLABSI rates were calculated using the definitions of the National Health and Safety Network after excluding mucosal barrier injury laboratory-confirmed bloodstream infection (BSI). RESULTS: A total of 154 CLABSIs were identified, of which 72 (46.8%) occurred in general wards and 82 (53.2%) in ICUs (0.81 and 2.71 per 1,000 catheter days), respectively. Non-tunneled CVCs were most common (68.6%) among 70 CLABSI events diagnosed within one week of their maintenance. On the other hand, tunneled CVCs and peripherally inserted central catheters (PICCs) were more common (60.5%) among 114 CLABSI events diagnosed more than a week after maintenance. Whereas the majority (72.2%) of CLABSIs in ICUs were associated with non-tunneled CVCs, tunneled CVCs (38.9%) and PICCs (36.8%) were more common in general wards. CONCLUSION: CLABSIs are less common in general wards than in ICUs, but they are more often associated with long-term indwelling catheters. Therefore, interventions to prevent CLABSIs should be tailored according to the type of ward and type of catheter.

Effect of Central Line Bundle Compliance on Central Line-Associated Bloodstream Infections

PURPOSE: The present study aimed to evaluate the effect of central line (CL) bundle compliance on central line-associated bloodstream infections (CLABSIs) in different departments of the same hospital, including the intensive care unit (ICU) and other departments. MATERIALS AND METHODS: The four components of the CL bundle were hand hygiene, use of maximal sterile barrier precautions, chlorhexidine use, and selection of an appropriate site for venous access. Compliance of the CL bundle and CLABSIs were measured for every department [emergency room (ER), ICU, general ward (GW), and operating room (OR)]. A total of 1672 patients were included over 3 years (August 2013 through July 2016). RESULTS: A total of 29 CLABSI episodes (1.73%) were identified, and only 53.7% of the patients completed CL bundles. The performance rates of all components of the CL bundle were 22.3%, 28.5%, 36.5%, and 84.6% for the ER, ICU, GW, and OR, respectively. The highest CLABSI rate was observed in patients of the ICU, for whom all components were not performed perfectly. Conversely, the lowest CLABSI rate was observed for patients of GWs, for whom all components were performed. Among individual components, femoral insertion site [relative risk (RR), 2.26; 95% confidence interval (CI), 1.09–4.68], not using a full body drape (RR, 3.55; 95% CI, 1.44–8.71), and not performing all CL bundle components (RR, 2.79; 95% CI, 1.19–6.54) were significant variables associated with CLABSIs. CONCLUSION: This study provides direct evidence that completing all CL bundle components perfectly is essential for preventing CLABSIs. Customized education should be provided, according to specific weaknesses of bundle performance.

Prospective study on central line-associated bloodstream infection among critically ill children in 2012-2015 / 中国感染控制杂志

Objective To evaluate the incidence of central line-associated bloodstream infection(CLABSI) among critically ill children, and provide basis for making preventive and control measures.Methods Prospective surveillance was performed to monitor CLABSI among children (including neonates) with central lines in 7 children's intensive care units(ICUs) from January 2012 to December 2015.Results Of 37 712 hospitalized patients, the overall length of hospital stay were 268 531 days, the overall central line-day was 57 639, utilization rate of central line was 21.46%;126 patients had CLABSI, CLABSI rate per 1 000 central line-days was 2.19, there was no significant difference in the CLABSI rate among each year(P>0.05);CLABSI rate in the third quarter was higher than that in other quarters(all P<0.05,compared with the first quarter,RR[95%CI]=1.98[1.20, 3.29]);CLABSI rates were different among different types of ICUs, surgical neonatal ICU (SNICU)(6.12/1 000 central line-days) was higher than other types of ICUs (all P<0.05, compared with pediatric ICUs[PICUs], RR[95%CI]=3.02[1.51-6.04]).126 patients with CLABSI were isolated 139 strains of pathogenic bacteria, the main pathogens were Klebsiella pneumoniae (20.86%) and Staphylococcus epidermidis (15.83%).Conclusion Critically ill children in SNICU are high risk population of CLABSI infection, intensified intervention measures should be developed for the department , so as to reduce CLABSI effectively.

Tunnelled Peripherally Inserted Central Catherer- How We Do Them

In the current study, we report a new technique to place a tunnelled peripherally inserted central catheter (PICC) at the upper arm of patient under real-time ultrasound-guided venipuncture using disposal equipment provided within a standard PICC set. The tunnelling of the PICC required an extra time of 5 minutes but was well tolerated by all patients involved in the study. The tunnelled PICC was applied on 50 patients and the infection rate as well its catheter dwell time were compared to another 50 patients with conventional PICC. The rate of patients who developed infection decreased from 34% for conventional PICC to 16% in tunnelled PICC patients. The central line-associated blood stream infections rate was also decreased from 4.4 per 1000 catheter-days for conventional PICC to 1.3 per 1000 catheter-days for tunnelled PICC. The mean time to infection development for tunnelled PICC (24 days) was longer than those observed with conventional PICC (19 days). Tunnelled PICC has also increased the mean catheter dwell time from 27 days (for conventional PICC) to 47 days. Tunnelling a PICC has the potential to reduce the infection rate while increase the catheter dwell time.

Research of effect about two disinfectors on prevention for central line-associated blood stream infection in hemodialysis / 中国医学装备

Objective: To explore the clinical effect of two disinfectors on prevention for central line-associated blood stream infection (CLABSI) in hemodialysis. Methods: 168 patients received blood purification through central venous indwelling catheter were divided into control group (82 cases) and observation group (86 cases) as random table. The patients of control group were disinfected by using iodophor disinfectant on central venous catheter and skin around puncture, while the patients of observation group were disinfected by using medical chlorhexidine gluconate (2% chlorhexidine gluconate, 70% isopropanol and 28%injection) on the same positions. In different stages, before and after central venous indwelling catheter and 24 hours after central venous indwelling catheter, the colony count and incidence of CLABSI of patients between two groups were compared. Results: There was no significant difference between the two groups for colony count around puncture before central venous indwelling catheter (t=-1.478, P>0.05). The colony count of observation group was lower than that of control group after 24 hours of disinfection. According to the diagnosis standards of CLABSI, the incidence of CLABSI in observation group was significant lower than that in control group (x2=6.048, P<0.05). Conclusion: The disinfector of chlorhexidine gluconate can decrease the incidence of CLABSI in hemodialysis and its bacteriostatic time is longer than that of iodophor disinfectant. Therefore, this method is worthy for promotion in clinical practice.

Healthcare associated infections in Paediatric Intensive Care Unit of a tertiary care hospital in India: Hospital stay & extra costs.

Background & objectives: Healthcare associated infections (HAIs) increase the length of stay in the hospital and consequently costs as reported from studies done in developed countries. The current study was undertaken to evaluate the impact of HAIs on length of stay and costs of health care in children admitted to Paediatric Intensive Care Unit (PICU) of a tertiary care hospital in north India. Methods: This prospective study was done in the seven bedded PICU of a large multi-specialty tertiary care hospital in New Delhi, India. A total of 20 children with HAI (cases) and 35 children without HAI (controls), admitted to the PICU during the study period (January 2012 to June 2012), were matched for gender, age, and average severity of illness score. Each patient’s length of stay was obtained prospectively. Costs of healthcare were estimated according to traditional and time driven activity based costing methods approach. Results: The median extra length of PICU stay for children with HAI (cases), compared with children with no HAI (controls), was seven days (IQR 3-16). The mean total costs of patients with and without HAI were ` 2,04,787 (US$ 3,413) and ` 56,587 (US$ 943), respectively and the mean difference in the total cost between cases and controls was ` 1,48,200 (95% CI 55,716 to 2,40,685, P<0.01). Interpretation & conclusions: This study highlights the effect of HAI on costs for PICU patients, especially costs due to prolongation of hospital stay, and suggests the need to develop effective strategies for prevention of HAI to reduce costs of health care.

Device-associated healthcare-associated infection in intensive care unit of a university hospital in China:a descriptive study / 中国感染控制杂志

Objective To identify the occurrence and microorganism profile of device-associated healthcare-associa-ted infections (DA-HAIs)in the intensive care unit (ICU)of a university hospital in China.Methods From Janua-ry 1 to November 30,2015,patients admitted to the ICU of a university hospital in China for more than 48 hours were performed prospective descriptive study. DA-HAIs were defined according to the criteria of the Centers for Disease Control and Prevention (CDC)of U.S.,descriptive statistical analysis was performed.Results Of 254 pa-tients admitted to ICU,the overall incidence of DA-HAIs was 15.35% ,with 10.23 cases of DA-HAIs per 1 000 ICU-days;the incidence of ventilator-associated pneumonia (VAP ),catheter-associated urinary tract infection (CAUTI),and central line-associated bloodstream infection (CLABSI)were 7.05 per 1 000 ventilator-days,4.91 per 1 000 urinary catheter-days,and 3.22 per 1 000 central line-days,respectively. The main infection site was lower respiratory tract,accounting for 48. 27% ,followed by bloodstream system (27. 59% ),urinary tract (22.99% ),and gastrointestinal tract(1.15% ). The major isolated microorganism was Acinetobacterbaumannii (21 .52% ).Conclusion The surveillance system can identify the epidemiological status of DA-HAIs and make effec-tive control measures to ensure the healthcare safety.

Impact of Central Line Insertion Bundle on the Adherence of Bundle and Central Line-Associated Bloodstream Infections in the Operating Room

BACKGROUND: This study purposed to examine how the incidence of the central line-associated bloodstream infection (CLABSI) in a operating room (OR) is affected by bundle application on central line insertion (CLI) practice. METHODS: The study design was a pretest-posttest experimental trial. The subjects were 83 patients before the bundle application on CLI and 70 patients after. RESULTS: The compliance(%) of bundle on CLI of among those who observed all of the five items increased from 7.2% before the intervention to 72.9% after. By items, compliance with the maximal barrier precaution was 100% for the use of a mask and cap before and after the intervention, but increased from 73.5% before the intervention to 88.6% after for the hand hygiene, from 73.5% to 88.6% for the use of a sterile gown, and from 9.6% to 75.7% for the use of a sterile large drape covering the whole body. CLABSI did not happen on CLI either before or after the application of the bundle intervention. CONCLUSION: Bundle application increased compliance with the use of a sterile gown and the use of a sterile large drape. However, its effect in the prevention of CLABSI was not clear probably due to the short period of intervention in a single hospital.