Excellence in ECMO Outcomes: Getting Back to Basics

ABSTRACT

Between 4/2020 and 1/2021 we identified 7 VV ECMO patients (4 IJ, 3 fem/fem) with bloodstream infections due to Enterococcus faecalis. Time from cannulation to first positive blood culture ranged from 8 to 63 days. There was no geographic clustering apparent. A culture of the heater/ cooler water reservoir of an actively infected patient was sterile. Based on our preliminary analysis, we felt that there were likely multiple contributing factors leading to our spike in infections rather than one simple cause. We hypothesized that our nursing focus had shifted during the COVID-19 pandemic to a culture of minimizing spread of COVID-19 to our staff, with less focus on basic patient care and standard patient infection prevention. Knowing that E faecalis can be spread from the patient (it is a common enteric bacteria) to the environment and then back to lines, we began intensive reeducation and focus on basics of ICU patient care emphasizing (1) Basic hand hygiene/gloving, (2) General room sanitation including disinfecting surfaces daily, (2) Sterility during line and cannula dressing changes, (3) Weekly dressing changes as well as PRN blood or fluid under the dressing, and (5) Diarrhea containment. Since implementing these policies we have had no blood stream infections in our ECMO population. The importance of daily routine care is too easily forgotten. A strategy of teaching and emphasizing basics can produce large and sustained benefits.