ABSTRACT
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.
ABSTRACT
Purpose: Device-associated infections constitute the majority of health care-associated infections (HAIs) in ICUs. Trauma patients are predisposed to acquire such infections due to various trauma-related factors. The prevalence of HAIs is underreported from developing nations due to a lack of systematic surveillance. This study reports the impact of an intensive surveillance on the rates and outcome of device-associated infections in trauma patients from a developing country and compares the rates with a previous pilot observation. Materials and Methods: The study was conducted at a level-1 trauma centre of India. Surveillance for ventilator-associated pneumonia (VAP), central line-associated blood stream infections (CLA-BSIs) and catheter-associated urinary tract infections (CA-UTIs) was done based on centre for disease control-National Healthcare Safety Network (CDC-NHSN) defi nitions. The impact of an intensive surveillance, education and awareness drive on the rates of infections over the study period, and compliance to preventive bundles and hand hygiene was assessed. Results: A total of 15,462 ventilator days, 12,207 central line days and 17,740 urinary catheter days were recorded in the study population. The overall rates of VAP, CLA-BSI and CA-UTI were respectively 17, 7.2 and 15.5/1000 device days. There was a signifi cant correlation between device days and the propensity to develop infections. Infections were the cause of death in 36.6% of fatal trauma cases. A signifi cantly higher rate of VAP, CLA-BSI and CA-UTIs was noted in fatal cases. The compliance to ventilator bundle, central line bundle, bladder bundle and hand hygiene were 74.5%, 86%, 79.3% and 64.6%, respectively. A high rate of multi-drug-resistance was observed in all pathogens. A gross reduction in the rates of all infections was observed over time during the study due to implementation of a stringent surveillance system, feedbacks and education. The compliance to hand hygiene and preventive bundles also increased over time. Conclusion: The automated surveillance was easy and useful for data entry and analysis. Surveillance had a signifi cant impact on reduction of HAIs and mortality in trauma patients.
ABSTRACT
The objective of the study was to determine the effect of switching from an open (glass or semi-rigid plastic) infusion container to a closed, fully collapsible plastic infusion container (Viaflex®) on rate and time to onset of central lineassociated bloodstream infections (CLABSI). An open-label, prospective cohort, active healthcare-associated infection surveillance, sequential study was conducted in three intensive care units in Brazil. The CLABSI rate using open infusion containers was compared to the rate using a closed infusion container. Probability of acquiring CLABSI was assessed over time and compared between open and closed infusion container periods; three-day intervals were examined. A total of 1125 adult ICU patients were enrolled. CLABSI rate was significantly higher during the open compared with the closed infusion container period (6.5 versus 3.2 CLABSI/1000 CL days; RR=0.49, 95 percentCI=0.26- 0.95, p=0.031). During the closed infusion container period, the probability of acquiring a CLABSI remained relatively constant along the time of central line use (0.8 percent Days 2-4 to 0.7 percent Days 11-13) but increased in the open infusion container period (1.5 percent Days 2-4 to 2.3 percent Days 11-13). Combined across all time intervals, the chance of a patient acquiring a CLABSI was significantly lower (55 percent) in the closed infusion container period (Cox proportional hazard ratio 0.45, p= 0.019). CLABSIs can be reduced with the use of full barrier precautions, education, and performance feedback. Our results show that switching from an open to a closed infusion container may further reduce CLABSI rate as well as delay the onset of CLABSIs. Closed infusion containers significantly reduced CLABSI rate and the probability of acquiring CLABSI.