Complications Associated with Peripherally Inserted Central Catheters (PICC) in People Undergoing Autologous Hematopoietic Stem Cell Transplantation (HSCT) in Home Hospitalization.

INTRODUCTION: The SARS-CoV-2 pandemic generated the need to keep immunosuppressed patients away from hospital institutions for as long as possible. This in turn stimulated the implementation of a home hospitalization model for autologous hematopoietic stem-cell transplantation (HSCT). PURPOSE: To analyze whether there are significant differences in post-transplantation complications related to catheters observed in patients treated in the home-transplant care modality compared to patients treated in the hospital. METHODOLOGY: Observational, analytical, longitudinal, and retrospective study of cases and controls. A convenience sample was chosen, in which the cases comprised 20 patients included in the home HSCT care model. For each patient, it was considered suitable to propose two controls among those who received autologous transplantation in the last five years with a baseline demographic and pathological profile similar to the case for whom they were control. RESULTS: The home patients achieved an average of 22.4 ± 2.6 days of evolution with an average of 16.4 ± 2.08 days post-transplant, compared to the hospital process with an average of 21.21 ± 4.18 days of evolution and 15.51 ± 3.96 days post-transplant (evolution days p = 0.022; post-transplant days p = 0.002). A higher percentage of use of parenteral nutrition (p = 0.036) and transfusions (p = 0.003) was observed during the post-transplant phase in the hospital. The rest of the therapeutic measures did not show significant differences. When analyzing the frequency of adverse effects in the post-transplant phase, a significant increase in neutropenic fever (OR = 8.55) and positive blood cultures (OR = 6.65) was observed in hospital patients. Any other significant differences in other variables related to PICC were found (presence and days of neutropenic fever, catheter infection, complications, pathogens, admission to the ICU, or death). Concerning local complications (pain, DVT, Medical adhesive-related Skin Injury, and erythema), there was more erythema in the hospital (p = 0.056). CONCLUSIONS: The results obtained indicate that regarding the appearance of complications associated with PICCs in home hospitalization HSCT patients, there are no significant differences compared to hospitalization, so that home care can be a safe context for people with these lines.

Healthcare-associated infections in adult intensive care unit patients: Changes in epidemiology, diagnosis, prevention and contributions of new technologies.

Patients in intensive care units (ICUs) are at high risk for healthcare-acquired infections (HAI) due to the high prevalence of invasive procedures and devices, induced immunosuppression, comorbidity, frailty and increased age. Over the past decade we have seen a successful reduction in the incidence of HAI related to invasive procedures and devices. However, the rate of ICU-acquired infections remains high. Within this context, the ongoing emergence of new pathogens, further complicates treatment and threatens patient outcomes. Additionally, the SARS-CoV-2 (COVID-19) pandemic highlighted the challenge that an emerging pathogen provides in adapting prevention measures regarding both the risk of exposure to caregivers and the need to maintain quality of care. ICU nurses hold a special place in the prevention and management of HAI as they are involved in basic hygienic care, steering and implementing quality improvement initiatives, correct microbiological sampling, and aspects antibiotic stewardship. The emergence of more sensitive microbiological techniques and our increased knowledge about interactions between critically ill patients and their microbiota are leading us to rethink how we define HAIs and best strategies to diagnose, treat and prevent these infections in the ICU. This multidisciplinary expert review, focused on the ICU setting, will summarise the recent epidemiology of ICU-HAI, discuss the place of modern microbiological techniques in their diagnosis, review operational and epidemiological definitions and redefine the place of several controversial preventive measures including antimicrobial-impregnated medical devices, chlorhexidine-impregnated washcloths, catheter dressings and chlorhexidine-based mouthwashes. Finally, general guidance is suggested that may reduce HAI incidence and especially outbreaks in ICUs.

The downstream effects of the COVID-19 pandemic: The supply chain failure, a wicked problem.

The failure of the global supply chain became rapidly apparent at the beginning of the COVID-19 pandemic when healthcare organizations were left without supplies needed to care for patients. The supply chain failure is one downstream effect of the pandemic and indirectly impacts patient morbidity and mortality. This column presents a case study of one staff nurse's experience working in a pediatric intensive care unit at a rural children's hospital two years into the pandemic and the toll the global supply chain failure continues to take on patients and healthcare professionals. Central Line Blood Stream Infections (CLABSIs) are used to showcase the severity of the supply chain failure at the point of care. Standardized central line insertion and care bundles have proven to be effective in reducing the incidence of CLABSI; however, they are dependent on the availability of materials and supplies. Health care providers face a "wicked problem" in preventing CLABSIs. The failure of the global supply chain must be examined by healthcare organizations, manufacturers, and government officials so that new systems can be put into place, so we are prepared for a public health emergency.

Analysis of Bloodstream Infections and Their Antibiotic Sensitivity Pattern (Pre-and Post-COVID Lockdown in an Indian Cancer Hospital): A Record-Based Retrospective Cohort Study

Objectives: In cancer centers, various factors influence the type of organism causing bloodstream infection (BSI). Our premise includes the indirect benefits of hand hygiene of healthcare personnel, masking, and distancing practices during lockdown/post-lockdown period on the type of BSI among cancer patients and their antibiotic sensitivity patterns. Methods: The retrospective cohort study was conducted from November 2020 to July 2021, among cancer patients admitted to Healthcare Global cancer center. Blood culture reports of patients presenting with symptoms of BSI were retrieved and analyzed in the Department of Preventive Oncology, Healthcare Global. Our data were stratified from pre-lockdown (November 2019 to March 24, 2020) and lockdown/post-lockdown (March 25, 2020, to Jul 2020) periods. Results: The proportion of culture positives during the pre-lockdown (Nov 2019 to March 24, 2020) and post-lockdown period (March 25, 2020, to July 2020) are 21.7% and 21.1%, respectively. However, this small difference did not show a significant association with the difference in hand hygiene during the two periods (<80% and ≥80%). In our study, Escherichia coli (23.8%), Staphylococcus epidermidis (10.9 %), and Klebsiella pneumoniae (17.8%) were the most common BSI during the pre-lockdown period. A similar analysis during the post-lockdown period shows a higher prevalence of E. coli (20.7%), Staphylococcus haemolyticus (12.1%), and K. pneumoniae (15.5%). In our study, the isolates showed a greater proportion of resistance (>50%) to Gentamicin, Ciprofloxacin, Tigecycline, and Cephalosporin group of drugs. Conclusion: During COVID times, some of the preventive interventions which were implemented for reducing the transmission of SARS-CoV-2 could contribute to the reduction of BSI in the hospital setting. For the management of BSI, it is imperative to initiate appropriate antimicrobial treatment at an early stage. It is imperative for customizing the antimicrobial stewardship strategies as per the geographic location. © 2022 by Eurasian Journal of Medicine and Oncology.

COVID-19 AND CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTION: A SINGLE TERTIARY CENTER EXPERIENCE

B Introduction/Hypothesis: b An increase in the rates of central line-associated bloodstream infections (CLABSI) during the COVID-19 pandemic has been previously described. Descriptive statistics were used to explore the relationship between COVID-19 positive (COVID+) CLABSI infections and COVID-19 negative (COVID-) CLABSI infections. The purpose of this investigation was to examine the data from institutional CLABSI infections and identify risk factors for CLABSI development in the presence of COVID-19. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)