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1.
J Nurs Care Qual ; 37(3): 275-281, 2022.
Article in English | MEDLINE | ID: covidwho-1922418

ABSTRACT

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) are an ongoing concern in health care, resulting in increased mortality, morbidity, length of stay, and additional costs to hospitals. LOCAL PROBLEM: Despite intermittent improvements in CLABSI rates within our facility, long-term sustainment has been challenging. METHODS: This was a quality improvement project including a collaborative rounding approach supported by specialty nursing roles. INTERVENTIONS: In addition to implementing a variety of evidence-based interventions, the rounding team performed audits to assess performance and created focused education tools to address the identified opportunities within each individual unit. RESULTS: High levels of engagement as evidenced by increased audit completion resulted in CLABSI reductions. However, 2 peaks in CLABSI rates were associated with higher volumes of coronavirus disease (COVID-19) hospitalizations and decreased audits. CONCLUSIONS: Despite challenges correlated with COVID-19, a collaborative rounding team promotes and enhances awareness of prevention methods and a culture of safety.


Subject(s)
COVID-19 , Catheter-Related Infections , Catheterization, Central Venous , Cross Infection , COVID-19/prevention & control , Catheter-Related Infections/prevention & control , Catheterization, Central Venous/adverse effects , Cross Infection/prevention & control , Hospitals , Humans , Infection Control/methods , Quality Improvement
3.
Antimicrob Resist Infect Control ; 11(1): 67, 2022 05 07.
Article in English | MEDLINE | ID: covidwho-1833352

ABSTRACT

BACKGROUND: The COVID-19 pandemic may have had a substantial impact on the incidence of device-associated healthcare-associated infections (HAI), in particular in intensive care units (ICU). A significant increase of HAI was reported by US hospitals when comparing incidence rates from 2019 and 2020. The objective of this study was to investigate the development of the most relevant device-associated HAI in German ICUs during the year 2020 as compared to 2019. METHODS: We utilized the data of the ICU component of the German National Reference Center for Surveillance of Nosocomial Infections (KISS = Krankenhaus-Infektions-Surveillance-System) for the period 2019-2020. We focused on central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), ventilator-associated lower respiratory infections (VALRTI) and bloodstream infections associated with the use of Extracorporeal-Life-Support-Systems (ECLSABSI). Device use was defined as the number device days per 100 patient days; device-associated infection rates as the number of device-associated infections per 1000 device days. To compare the pooled means between the years and quarters we calculated rate ratios of device-associated infection rates with 95% confidence intervals by Poisson regression models. RESULTS: The number of participating ICUs in the surveillance system decreased from 982 in 2019 to 921 in 2020 (6.2%). Device utilization rates increased significantly for central lines and ventilator use. VALRTI rates and CAUTI rates decreased in 2020 compared with 2019, however, no increase was shown for CLABSI or ECLSABSI. This result was also confirmed when the corresponding quarters per year were analyzed. CONCLUSIONS: The lack of an increase in device-associated healthcare associated infections (HAI) in German ICUs may be due to the lower overall incidence of COVID-19 cases in Germany in 2020 compared with US, to a very high availability of ICU beds per 100,000 inhabitants compared with many other countries, and a change in the ICU patient mix due to numerous elective procedures that were postponed during the first two waves. The primary reason seems to be that only 7% of all ICU patients in Germany in 2020 were COVID-19 patients.


Subject(s)
COVID-19 , Catheter-Related Infections , Cross Infection , Pneumonia, Ventilator-Associated , Sepsis , Urinary Tract Infections , COVID-19/epidemiology , Catheter-Related Infections/epidemiology , Cross Infection/epidemiology , Female , Humans , Intensive Care Units , Male , Pandemics , Pneumonia, Ventilator-Associated/epidemiology , Prospective Studies , Sepsis/epidemiology , Urinary Tract Infections/epidemiology
4.
Intensive Crit Care Nurs ; 70: 103227, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1828574

ABSTRACT

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.


Subject(s)
COVID-19 , Catheter-Related Infections , Cross Infection , Adult , Chlorhexidine , Cross Infection/diagnosis , Cross Infection/epidemiology , Cross Infection/prevention & control , Delivery of Health Care , Humans , Intensive Care Units , SARS-CoV-2
5.
J Pediatr Nurs ; 65: 29-32, 2022.
Article in English | MEDLINE | ID: covidwho-1796225

ABSTRACT

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.


Subject(s)
COVID-19 , Catheter-Related Infections , Catheterization, Central Venous , Central Venous Catheters , Catheter-Related Infections/epidemiology , Catheter-Related Infections/prevention & control , Central Venous Catheters/adverse effects , Child , Humans , Pandemics/prevention & control
6.
Am J Infect Control ; 50(7): 831-833, 2022 07.
Article in English | MEDLINE | ID: covidwho-1719185

ABSTRACT

While there are established and effective guidelines for prevention of hospital-acquired infections (HAIs), the impact of the COVID-19 pandemic on those implemented practices and policies have not been thoroughly investigated. This report examines the impact of COVID-19 on HAI rates at 2 hospitals within the same healthcare system. HAIs significantly increased during the COVID-19 pandemic which correlated with the use of overtime and agency nursing hours.


Subject(s)
COVID-19 , Catheter-Related Infections , Cross Infection , Catheter-Related Infections/prevention & control , Cross Infection/epidemiology , Cross Infection/prevention & control , Hospitals , Humans , Pandemics/prevention & control
7.
Clin J Am Soc Nephrol ; 17(3): 429-433, 2022 03.
Article in English | MEDLINE | ID: covidwho-1674203

ABSTRACT

Measures implemented to prevent transmission of severe acute respiratory syndrome coronavirus 2 in outpatient dialysis facilities may also help to prevent catheter-associated bloodstream infections in patients receiving hemodialysis. We used United States Renal Data System data to examine rates of antibiotic administration within dialysis facilities and rates of hospital admission for catheter-associated bloodstream infection from March 2018 through November 2020, and rates of hospitalization for sepsis, to address overall changes in hospitalization during the coronavirus disease 2019 (COVID-19) pandemic. Using logistic regression, we estimated year-over-year adjusted odds ratios of these events in 3-month intervals. During the first 6 months of the pandemic, rates of antibiotic administration were between 20% and 21% lower, and rates of hospitalization for catheter-associated bloodstream infection were between 17% and 24% lower than during corresponding periods in 2019, without significant changes in rates of hospitalization for sepsis. However, rates of catheter-associated events also decreased between 2018 and 2019, driven by reductions in facilities operated by a large dialysis provider. These data suggest that significant reductions in catheter-associated infections occurred during the pandemic, superimposed on nonpandemic-related reductions in some facilities before the pandemic. Even after the pandemic, it may be prudent to continue some COVID-19 mitigation measures to prevent catheter-associated bloodstream infections.


Subject(s)
COVID-19/prevention & control , Catheter-Related Infections/prevention & control , Catheterization, Central Venous/adverse effects , Catheters, Indwelling/adverse effects , Central Venous Catheters/adverse effects , Infection Control , Renal Dialysis/adverse effects , Aged , Anti-Bacterial Agents/therapeutic use , COVID-19/transmission , COVID-19/virology , Catheter-Related Infections/microbiology , Catheter-Related Infections/transmission , Catheterization, Central Venous/instrumentation , Female , Hospitalization , Humans , Male , Middle Aged , Protective Factors , Renal Dialysis/instrumentation , Risk Assessment , Risk Factors , Time Factors , United States
8.
Infect Dis Clin North Am ; 35(4): 841-856, 2021 12.
Article in English | MEDLINE | ID: covidwho-1506789

ABSTRACT

Despite a large volume of research in prevention, central line-associated bloodstream infections and catheter-related bloodstream infections continue to cause significant morbidity, mortality, and increased health care costs. Strategies in prevention, including decision about catheter placement, insertion bundles, adherence to standard of care guidelines, and technologic innovations, shown to decrease rates of catheter-related bloodstream infections and central line-associated bloodstream infections are described in this update. The coronavirus disease 2019 pandemic has resulted in increased health care-acquired infections, including central line-associated bloodstream infections.


Subject(s)
Bacteremia/prevention & control , Catheter-Related Infections/prevention & control , Catheterization, Central Venous/adverse effects , Bacteremia/epidemiology , Bacteremia/etiology , COVID-19/epidemiology , Catheter-Related Infections/epidemiology , Catheter-Related Infections/etiology , Catheterization, Central Venous/standards , Clinical Decision-Making , Cross Infection/epidemiology , Cross Infection/etiology , Humans , Patient Care Bundles/standards , Practice Guidelines as Topic , SARS-CoV-2
9.
J Hosp Infect ; 119: 149-154, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1458761

ABSTRACT

BACKGROUND: The incidence of nosocomial infections including ventilator-associated pneumonia and bacteraemia has been described during the COVID-19 pandemic. However, information regarding the impact of COVID-19 on the incidence of catheter-related bloodstream infections (CR-BSIs) is very limited. AIM: To evaluate the impact of the COVID-19 pandemic in the evolution of CR-BSIs in a large hospital. METHODS: This was a retrospective study comparing the incidence, aetiology and outcome of CR-BSIs during the months of March to May 2019 (pre-pandemic) and 2020 (during the pandemic). FINDINGS: The number of patients with one or more CR-BSIs in 2019 and 2020 were 23 and 58, respectively (1.89 vs 5.53/1000 admissions); P<0.001. Median time from catheter implantation to demonstration of CR-BSI was 27.5 days (range 11.75-126.00 days) in the 2019 cases and 16.0 days (range 11.00-23.50 days) in the 2020 population (P=0.032). CONCLUSIONS: A dramatic increase of CR-BSIs was found during the COVID-19 pandemic. Reinforcement of classic and new preventive measures is necessary.


Subject(s)
Bacteremia , COVID-19 , Catheter-Related Infections , Cross Infection , Bacteremia/epidemiology , Bacteremia/prevention & control , Catheter-Related Infections/epidemiology , Catheters , Cross Infection/epidemiology , Cross Infection/prevention & control , Humans , Pandemics , Retrospective Studies , SARS-CoV-2
10.
Infect Control Hosp Epidemiol ; 43(1): 12-25, 2022 01.
Article in English | MEDLINE | ID: covidwho-1392703

ABSTRACT

OBJECTIVES: To determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on healthcare-associated infection (HAI) incidence in US hospitals, national- and state-level standardized infection ratios (SIRs) were calculated for each quarter in 2020 and compared to those from 2019. METHODS: Central-line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), select surgical site infections, and Clostridioides difficile and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia laboratory-identified events reported to the National Healthcare Safety Network for 2019 and 2020 by acute-care hospitals were analyzed. SIRs were calculated for each HAI and quarter by dividing the number of reported infections by the number of predicted infections, calculated using 2015 national baseline data. Percentage changes between 2019 and 2020 SIRs were calculated. Supporting analyses, such as an assessment of device utilization in 2020 compared to 2019, were also performed. RESULTS: Significant increases in the national SIRs for CLABSI, CAUTI, VAE, and MRSA bacteremia were observed in 2020. Changes in the SIR varied by quarter and state. The largest increase was observed for CLABSI, and significant increases in VAE incidence and ventilator utilization were seen across all 4 quarters of 2020. CONCLUSIONS: This report provides a national view of the increases in HAI incidence in 2020. These data highlight the need to return to conventional infection prevention and control practices and build resiliency in these programs to withstand future pandemics.


Subject(s)
COVID-19 , Catheter-Related Infections , Cross Infection , Methicillin-Resistant Staphylococcus aureus , Pneumonia, Ventilator-Associated , Catheter-Related Infections/epidemiology , Cross Infection/epidemiology , Cross Infection/prevention & control , Delivery of Health Care , Humans , Pneumonia, Ventilator-Associated/epidemiology , Pneumonia, Ventilator-Associated/prevention & control , SARS-CoV-2
12.
BMC Infect Dis ; 21(1): 534, 2021 Jun 07.
Article in English | MEDLINE | ID: covidwho-1257922

ABSTRACT

BACKGROUND: Prone positioning (PP) is a standard of care for patients with moderate-severe acute respiratory distress syndrome (ARDS). While adverse events associated with PP are well-documented in the literature, research examining the effect of PP on the risk of infectious complications of intravascular catheters is lacking. METHOD: All consecutive ARDS patients treated with PP were recruited retrospectively over a two-year period and formed the exposed group. Intensive care unit (ICU) patients during the same period without ARDS for whom PP was not conducted but who had an equivalent disease severity were matched 1:1 to the exposed group based on age, sex, centre, length of ICU stay and SAPS II (unexposed group). Infection-related catheter complications were defined by a composite criterion, including catheter tip colonization or intravascular catheter-related infection. RESULTS: A total of 101 exposed patients were included in the study. Most had direct ARDS (pneumonia). The median [Q1-Q3] PP session number was 2 [1-4]. These patients were matched with 101 unexposed patients. The mortality rates of the exposed and unexposed groups were 31 and 30%, respectively. The incidence of the composite criterion was 14.2/1000 in the exposed group compared with 8.2/1000 days in the control group (p = 0.09). Multivariate analysis identified PP as a factor related to catheter colonization or infection (p = 0.04). CONCLUSION: Our data suggest that PP is associated with a higher risk of CVC infectious complications.


Subject(s)
Catheter-Related Infections/etiology , Patient Positioning/adverse effects , Respiratory Distress Syndrome/complications , Aged , Critical Care , Female , Humans , Incidence , Intensive Care Units , Male , Middle Aged , Prone Position , Respiratory Distress Syndrome/therapy , Retrospective Studies , Severity of Illness Index
13.
Int Urol Nephrol ; 54(1): 193-199, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1270535

ABSTRACT

PURPOSE: Hemodialysis patients with COVID-19 are at increased risk of death. We aimed to describe the characteristics of a cohort of Brazilian hemodialysis patients with COVID-19 and assess their mortality rate and risk factors for death. METHODS: Retrospective cohort study of 741 Brazilian hemodialysis patients with confirmed COVID-19 from Feb-Dec/2020, of 52 dialysis centers of the country. We analyzed comorbid conditions, sociodemographic factors, and dialysis-related parameters. To detect risk factors for mortality in hemodialysis patients, we performed multivariable Cox proportional hazard regression analysis. Survival was analyzed by Kaplan-Meier. RESULTS: From 9877 hemodialysis patients, 741 were diagnosed with COVID-19. Mean age was 57 ± 16 years, 61% were male, and 51% white. The most frequent symptoms were fever (54.1%), cough (50.9%), and dyspnea (37.2%); 14.2% were asymptomatic. There were 139 deaths (18.8%), with 66% within the disease's first 15 days. 333 patients (44.9%) required hospitalization, and 211 (28.5%) were admitted to an intensive care unit. The cumulative probability of survival at 90 days of diagnosis was 79% (95% CI 76-82%). In the fully adjusted multivariate model, the risk factors significantly associated with death were diabetes mellitus (HR 1.52, 95% CI 1.05-2.19, P = 0.026), use of a central venous catheter (CVC) (HR 1.79, 95% CI 1.22-2.64, P = 0.003), age (HR 1.03, 95% CI 1.01-1.04, P < 0.001), and origin from the North vs. Southeast region (HR 2.60, 95% CI 1.01-6.68, P = 0.047). CONCLUSIONS: Hemodialysis patients using a CVC as the vascular access, aside from diabetic and elderly ones, should be closely monitored due to their high risk of death in the course of the COVID-19.


Subject(s)
COVID-19/epidemiology , Catheter-Related Infections/etiology , Central Venous Catheters/adverse effects , Kidney Failure, Chronic/therapy , Renal Dialysis/adverse effects , Brazil/epidemiology , Catheter-Related Infections/epidemiology , Comorbidity , Female , Follow-Up Studies , Humans , Incidence , Kidney Failure, Chronic/epidemiology , Male , Middle Aged , Retrospective Studies , SARS-CoV-2 , Survival Rate/trends , Time Factors
14.
Am J Infect Control ; 49(6): 843-845, 2021 06.
Article in English | MEDLINE | ID: covidwho-1269214

ABSTRACT

Several catheter-associated urinary tract infection (CAUTI) prevention interventions were successfully implemented and evaluated on a surgical unit in a community-based hospital. Sustainability of CAUTI prevention efforts requires daily communication between multidisciplinary staff. In our hospital, daily report on CAUTI events and indwelling catheters at a hospital-wide, multidisciplinary safety huddle contributed to an enhanced focus on CAUTI-prevention strategies and unit-level reduction in device use days and CAUTI rates.


Subject(s)
Catheter-Related Infections , Cross Infection , Urinary Tract Infections , Adult , Catheter-Related Infections/epidemiology , Catheter-Related Infections/prevention & control , Catheters, Indwelling/adverse effects , Cross Infection/epidemiology , Cross Infection/prevention & control , Hospitals , Humans , Urinary Catheterization/adverse effects , Urinary Tract Infections/prevention & control
15.
Am J Infect Control ; 49(6): 764-768, 2021 06.
Article in English | MEDLINE | ID: covidwho-1269209

ABSTRACT

BACKGROUND: Until recently, there has been a lack of viable alternative to an indwelling urinary catheter for female patients that require precise urine output measurements. With the introduction of external female urinary catheters, we can now substitute this type of device for an indwelling urinary catheter in many patients, decreasing their risk of catheter-associated urinary tract infections. METHODS: In this retrospective study, we analyzed the impact of a hospital-wide implementation of an external female urinary catheter at a large academic medical center. The study included female patients, greater than 18 years of age. We compared a 12-month period before and after device implementation to assess the impact on indwelling urinary catheter utilization and catheter-associated urinary tract infections rate. RESULTS: Data included over 220,000 patient days, over 10,000 external urinary catheter days and 33,000 indwelling urinary catheter days. We found a statistically significant decrease in indwelling urinary catheter utilization following the implementation of the external female urinary catheter, but only in intensive care units. CONCLUSIONS: It is our recommendation that facilities first implement the device in ICUs as this level of care was where we observed the most significant impact.


Subject(s)
Catheter-Related Infections , Cross Infection , Urinary Tract Infections , Catheter-Related Infections/epidemiology , Catheter-Related Infections/prevention & control , Catheters, Indwelling/adverse effects , Female , Humans , Retrospective Studies , Urinary Catheterization/adverse effects , Urinary Catheters/adverse effects , Urinary Tract Infections/prevention & control
16.
Antimicrob Resist Infect Control ; 10(1): 87, 2021 06 04.
Article in English | MEDLINE | ID: covidwho-1259218

ABSTRACT

BACKGROUND: During the intensive care units' (ICUs) reorganization that was forced by the COVID-19 emergency, attention to traditional infection control measures may have been reduced. Nevertheless, evidence on the effect of the COVID-19 pandemic on healthcare-associated infections (HAIs) is still limited and mixed. In this study, we estimated the pandemic impact on HAI incidence and investigated the HAI type occurring in COVID-19 patients. METHODS: Patients admitted to the main ICU of the Umberto I teaching hospital of Rome from March 1st and April 4th 2020 were compared with patients hospitalized in 2019. We assessed the association of risk factors and time-to-first event through multivariable Fine and Grey's regression models, that consider the competitive risk of death on the development of HAI (Model 1) or device related-HAI (dr-HAI, Model 2) and provide estimates of the sub-distribution hazard ratio (SHR) and its associated confidence interval (CI). A subgroup analysis was performed on the 2020 cohort. RESULTS: Data from 104 patients were retrieved. Overall, 59 HAIs were recorded, 32 of which occurred in the COVID-19 group. Patients admitted in 2020 were found to be positively associated with both HAI and dr-HAI onset (SHR: 2.66, 95% CI 1.31-5.38, and SHR: 10.0, 95% CI 1.84-54.41, respectively). Despite being not confirmed at the multivariable analysis, a greater proportion of dr-HAIs seemed to occur in COVID-19 patients, especially ventilator-associated pneumonia, and catheter-related urinary tract infections. CONCLUSIONS: We observed an increase in the incidence of patients with HAIs, especially dr-HAIs, mainly sustained by COVID-19 patients. A greater susceptibility of these patients to device-related infections was hypothesized, but further studies are needed.


Subject(s)
COVID-19/epidemiology , Cross Infection/epidemiology , Intensive Care Units/statistics & numerical data , Aged , Catheter-Related Infections/epidemiology , Critical Care , Delivery of Health Care , Female , Hospitalization , Hospitals, Teaching , Humans , Incidence , Infection Control , Male , Middle Aged , Pandemics , Pneumonia, Ventilator-Associated/epidemiology , Retrospective Studies , Risk Factors , SARS-CoV-2/isolation & purification
17.
BMJ Open ; 11(4): e042475, 2021 04 14.
Article in English | MEDLINE | ID: covidwho-1186290

ABSTRACT

INTRODUCTION: Peripherally inserted central catheters (PICCs) are vital for the delivery of medical therapies, but up to 30% of PICCs are associated with complications such as deep vein thrombosis or infection. The integration of antimicrobial and hydrophobic catheter materials, and pressure-activated valves, into polyurethane PICCs are innovations designed to prevent infective and/or thrombotic complications. METHODS AND ANALYSIS: A multicentre, parallel group, superiority randomised controlled trial with two experimental arms ((1) hydrophobic PICC (with pressure-activated valve); (2) chlorhexidine gluconate-impregnated PICC (with external clamp)) and one control group ((3) conventional polyurethane PICC (with external clamp)). Recruitment of 1098 adult and paediatric patients will take place over 2 years at three tertiary-referral hospitals in Queensland, Australia. Patients are eligible for inclusion if their PICC is to be inserted for medical treatment, with a vascular size sufficient to support a 4-Fr PICC or larger, and with informed consent. The primary outcome is PICC failure, a composite of thrombotic (venous thrombosis, breakage and occlusion) and infective complications (PICC-associated bloodstream infection and local infection). Secondary outcomes include: all-cause PICC complication; thrombotic complications; infective complications; adverse events (local or systemic reaction); PICC dwell time; patient/parent satisfaction; and healthcare costs. Differences between both intervention groups and the control group will be compared using Cox proportional hazards regression. Effect estimates will be presented as HRs with corresponding 95% CI. ETHICS AND DISSEMINATION: Ethical approval from Queensland Health (HREC/QCHQ/48682) and Griffith University (Ref. No. 2019/094). Results will be published. TRIAL REGISTRATION NUMBER: ACTRN12619000022167.


Subject(s)
Catheter-Related Infections , Catheterization, Central Venous , Catheterization, Peripheral , Central Venous Catheters , Adult , Australia , Catheter-Related Infections/prevention & control , Catheterization, Central Venous/adverse effects , Catheterization, Peripheral/adverse effects , Central Venous Catheters/adverse effects , Child , Humans , Multicenter Studies as Topic , Queensland , Randomized Controlled Trials as Topic , Risk Factors
18.
J Mycol Med ; 31(2): 101125, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1164245

ABSTRACT

Mucormycosis is an invasive fungal infection (IFI) due to several species of saprophytic fungi, occurring in patients with underlying co-morbidities (including organ transplantation). During the ongoing Coronavirus disease 2019 (COVID-19) pandemic, there have been increasing reports of bacterial and fungal co-infections occurring in COVID-19 patients, including COVID-19 associated pulmonary aspergillosis (CAPA). We describe a case of mucormycosis occurring after COVID-19, in an individual who received a recent heart transplant for severe heart failure. Two months after heart transplant, our patient developed upper respiratory and systemic symptoms and was diagnosed with COVID-19. He was managed with convalescent plasma therapy and supportive care. Approximately three months after COVID-19 diagnosis, he developed cutaneous mucormycosis at an old intravascular device site. He underwent extensive surgical interventions, combined with broad-spectrum antifungal therapy. Despite the aggressive therapeutic measures, he died after a prolonged hospital stay. In this case report, we also review the prior well-reported cases of mucormycosis occurring in COVID-19 patients and discuss potential mechanisms by which COVID-19 may predispose to IFIs. Similar to CAPA, mucormycosis with COVID-19 may need to be evaluated as an emerging disease association. Clinicians should be vigilant to evaluate for invasive fungal infections such as mucormycosis in patients with COVID-19 infection.


Subject(s)
COVID-19/complications , Heart Transplantation , Invasive Fungal Infections/complications , Mucormycosis/complications , Postoperative Complications/etiology , Rhizopus/isolation & purification , Aged , Anti-Infective Agents/therapeutic use , Bacteremia/complications , Bacteremia/drug therapy , Bacteremia/microbiology , COVID-19/therapy , Catheter-Related Infections/drug therapy , Catheter-Related Infections/etiology , Coinfection/drug therapy , Coinfection/microbiology , Combined Modality Therapy , Contraindications, Drug , Debridement , Dermatomycoses/drug therapy , Dermatomycoses/etiology , Disease Susceptibility , Fatal Outcome , Heart Failure/surgery , Humans , Hydroxychloroquine/therapeutic use , Immunization, Passive , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Intra-Aortic Balloon Pumping/instrumentation , Invasive Fungal Infections/drug therapy , Male , Mucormycosis/drug therapy , Mucormycosis/microbiology , Negative-Pressure Wound Therapy , Opportunistic Infections/complications , Opportunistic Infections/drug therapy , Opportunistic Infections/microbiology , Postoperative Complications/drug therapy , Postoperative Complications/microbiology , Postoperative Complications/virology , Surgical Wound Infection/complications , Surgical Wound Infection/drug therapy , Surgical Wound Infection/microbiology , Surgical Wound Infection/surgery
19.
Infect Control Hosp Epidemiol ; 43(1): 26-31, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1146282

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has had a considerable impact on US hospitalizations, affecting processes and patient population. OBJECTIVE: To evaluate the impact of COVID-19 pandemic on central-line-associated bloodstream infections (CLABSIs) and catheter associated urinary tract infections (CAUTIs) in hospitals. METHODS: We performed a retrospective study of CLABSIs and CAUTIs in 78 US 12 months before COVID-19 and 6 months during COVID-19 pandemic. RESULTS: During the 2 study periods, there were 795,022 central-line days and 817,267 urinary catheter days. Compared to the period before the COVID-19 pandemic, CLABSI rates increased by 51.0% during the pandemic period from 0.56 to 0.85 per 1,000 line days (P < .001) and by 62.9% from 1.00 to 1.64 per 10,000 patient days (P < .001). Hospitals with monthly COVID-19 patients representing >10% of admissions had a National Health Safety Network (NHSN) device standardized infection ratio for CLABSI that was 2.38 times higher than hospitals with <5% prevalence during the pandemic period (P = .004). Coagulase-negative Staphylococcus CLABSIs increased by 130% from 0.07 to 0.17 events per 1,000 line days (P < .001), and Candida spp by 56.9% from 0.14 to 0.21 per 1,000 line days (P = .01). In contrast, no significant changes were identified for CAUTI (0.86 vs 0.77 per 1,000 catheter days; P = .19). CONCLUSIONS: The COVID-19 pandemic was associated with substantial increases in CLABSIs but not CAUTIs. Our findings underscore the importance of hardwiring processes for optimal line care and regular feedback on performance to maintain a safe environment.


Subject(s)
COVID-19 , Catheter-Related Infections , Cross Infection , Sepsis , Urinary Tract Infections , Catheter-Related Infections/epidemiology , Catheter-Related Infections/prevention & control , Cross Infection/epidemiology , Cross Infection/prevention & control , Humans , Intensive Care Units , Pandemics , Retrospective Studies , SARS-CoV-2 , Sepsis/epidemiology , Urinary Catheters , Urinary Tract Infections/epidemiology , Urinary Tract Infections/prevention & control
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