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A Collaborative Journey to Reduce in Central Line Associated Blood Stream Infections in the Neonatal Intensive Care Unit
Poster Abstracts / American Journal of Infection Control 44 (2016) S28-S82
the-hub was uncommon (17%). Yet many facilities don’t use a cap as added protection. Many cap users only apply the cap to central lines. This overemphasis on central lines, also seen in other survey responses, reflects a similar focus in the literature and by federal agencies.
Continuum of Care 3-124 A Collaborative Journey to Reduce in Central Line Associated Blood Stream Infections in the Neonatal Intensive Care Unit Adebisi A. Adeyeye, DHA, RN, CIC, Infection Preventionist, Weiler Division, Montefiore Medical Center; Audrey Adams, RN, MPH, CIC, Director, Infection Prevention & Control, Montefiore Medical Center; Carmel Boland-Reardon, RN, CIC, Infection Preventionist, Montefiore Medical Center; Grace E. Robinson, RN, Infection Prevention & Control Preventionist, Montefiore Medical Center, Weiler Campus; Brenda Denneny, RN, BSN, MBA, Infection Preventionist, Monteiore Medical Center, Wakefield BACKGROUND: Increased survival of extremely low birth weight (ELBW) neonates is associated with prolonged hospitalization and high risk of health care associated infections (HAIs) in the Neonatal Intensive Care Unit (NICU) setting. Central line-associated blood stream infections (CLABSIs) account for the majority of HAIs in ELBW neonates. Prevention of HAIs is crucial to positive patient outcomes. Hospital A NICU is a 46 bed regional perinatal center in our three campus academic medical center. The CLABSI rate for 2013 was 3.20 per 1000 catheter days, significantly higher than the mean New York State CLABSI rate. METHODS: A collaborative group was formed, including Neonatologists, Staff RN, Infection Prevention and Infectious Diseases specialists. The focus was CLABSI prevention through standardization of established CVC insertion and maintenance protocols. A decision was made to include Hospital B, a 22 bed special care nursery and NICU. The following strategies were implemented: retrained staff, using learning modules; implemented the CLABSI bundle checklist; reinforced hand hygiene procedures with staff; implemented the use of 2% Chlorhexidine gluconate as the central lines skin prep, with exclusion criteria for age and weight and instituted weekly CLABSI review meetings. RESULTS: This collaborative effort resulted in a 38% reduction of the Hospital A NICU CLABSI rate in 2014, as compared to the 2013 rate. In addition, there was a 32% reduction in the 2014 Hospital B rate, as compared to the rate in 2013. CONCLUSIONS: Collaboration of the NICU team with Infection Prevention and compliance with the bundle checklist contributed to this successful CLABSI prevention project. Despite this achievement, ongoing efforts are required to further reduce CLABSI rates as we target zero in the NICU setting.
3-125 Comparison of Present on Admission and Healthcare-Associated Fungal Infections in a Pediatric Cancer Center in Ecuador Joanna Acebo, MD, Pediatric Infectious Diseases Physician, Hospital SOLCA-Núcleo de Quito; Miriam L. Gonzalez, MD, MS,
S37
International Epidemiology Coordinator, St. Jude Children’s Research Hospital; Erika Villaneuva, MD, Pediatric Oncologist, Hospital SOLCA- Quito; Isabel Jaramillo, MD, Pediatrician, Hospital SOLCA- Quito; José Eguiguren, MD, Pediatric Oncologist, Hospital SOLCA- Quito; Gisella Sánchez, MD, Pediatric Hemato-Oncologist, Hospital SOLCA- Quito; Carlos Vicuña, MD, Pediatric Oncology Surgeon, Hospital SOLCAQuito; Jenny Martinez, MD, Pediatrician, Hospital SOLCA- Quito; Blanca Mosquera, MS, Microbiologist, Hospital SOLCA- Quito; Maysam R. Homsi, MPH, Clinical Research Associate I, St. Jude Children’s Research Hospital; George Relyea, MA, MS, Research Assistant Professor, Division of Epidemiology, Biostatistics, Environmental Health, University of Memphis; Miguela A. Caniza, MD, Director, Infectious Diseases International Outreach, St. Jude Children’s Research Hospital BACKGROUND: Fungal infections (FIs) are a major cause of morbimortality in immunocompromised patients. To date, there is little information about its burden in pediatric oncology centers in lowto middle-income countries. We aimed to compare clinical features and outcomes of fungal infection present on admission (POA) and healthcare-associated infections (HAI) in children with hematologic and malignant diseases at a pediatric oncology center in Quito, Ecuador. METHODS: Included in this retrospective cohort study were all fungal infections documented in the pediatric cancer center’s prospective infection surveillance database between July 1, 2009 and December 14, 2015. Fungal infection events were classified on the basis of Centers for Disease Control and Prevention/National Healthcare Safety Network 2015 definitions. Associated clinical information was obtained from patients’ medical records. Demographics, clinical and laboratory characteristics, and outcomes of fungal infections were compared. RESULTS: Twenty-one fungal infection events in twenty patients were included. 76% had a HAI (0.39 infections per 1,000 patient days). The most common major site of HAIs was bloodstream infections (n = 11) of which 82% (n = 9) meet the mucosal barrier injury criteria. Skin and soft tissues was the most common site of POA infections. The most frequently isolated fungal agents were yeast (98%) and Candida non-albicans were isolated in 13 patients. There was no significant difference between POA and HAI in most demographics and clinical outcomes (Table 1). The only significant difference was the presence of neutropenia during the infection window (P = .03). Fungal infection-related mortality was 20% (4/ 21) and no difference was found between POA and HAIs (P = .950). CONCLUSIONS: The burden of fungal infections was predominantly due to yeasts and mostly HAI. Although there was no significant difference in clinical outcomes between POA and HAIs, we found that neutropenia was an important factor for HAI. Further studies with a larger sample size may render significant differences in clinical outcomes.
3-126 Decreasing Clostridium Difficile Utilizing Infection Prevention Methods Outside the Walls of the Hospital Leslie S. Kelt, BS, MT, CIC, CPHQ, Head, Department of Infection Prevention, St. Tammany Parish Hospital BACKGROUND: Clostridium difficile still continues to be major cause of patient mortality and morbidity. Even with infection
APIC 43rd Annual Educational Conference & International Meeting | Charlotte, NC | June 11-13, 2016
the-hub was uncommon (17%). Yet many facilities don’t use a cap as added protection. Many cap users only apply the cap to central lines. This overemphasis on central lines, also seen in other survey responses, reflects a similar focus in the literature and by federal agencies.
Continuum of Care 3-124 A Collaborative Journey to Reduce in Central Line Associated Blood Stream Infections in the Neonatal Intensive Care Unit Adebisi A. Adeyeye, DHA, RN, CIC, Infection Preventionist, Weiler Division, Montefiore Medical Center; Audrey Adams, RN, MPH, CIC, Director, Infection Prevention & Control, Montefiore Medical Center; Carmel Boland-Reardon, RN, CIC, Infection Preventionist, Montefiore Medical Center; Grace E. Robinson, RN, Infection Prevention & Control Preventionist, Montefiore Medical Center, Weiler Campus; Brenda Denneny, RN, BSN, MBA, Infection Preventionist, Monteiore Medical Center, Wakefield BACKGROUND: Increased survival of extremely low birth weight (ELBW) neonates is associated with prolonged hospitalization and high risk of health care associated infections (HAIs) in the Neonatal Intensive Care Unit (NICU) setting. Central line-associated blood stream infections (CLABSIs) account for the majority of HAIs in ELBW neonates. Prevention of HAIs is crucial to positive patient outcomes. Hospital A NICU is a 46 bed regional perinatal center in our three campus academic medical center. The CLABSI rate for 2013 was 3.20 per 1000 catheter days, significantly higher than the mean New York State CLABSI rate. METHODS: A collaborative group was formed, including Neonatologists, Staff RN, Infection Prevention and Infectious Diseases specialists. The focus was CLABSI prevention through standardization of established CVC insertion and maintenance protocols. A decision was made to include Hospital B, a 22 bed special care nursery and NICU. The following strategies were implemented: retrained staff, using learning modules; implemented the CLABSI bundle checklist; reinforced hand hygiene procedures with staff; implemented the use of 2% Chlorhexidine gluconate as the central lines skin prep, with exclusion criteria for age and weight and instituted weekly CLABSI review meetings. RESULTS: This collaborative effort resulted in a 38% reduction of the Hospital A NICU CLABSI rate in 2014, as compared to the 2013 rate. In addition, there was a 32% reduction in the 2014 Hospital B rate, as compared to the rate in 2013. CONCLUSIONS: Collaboration of the NICU team with Infection Prevention and compliance with the bundle checklist contributed to this successful CLABSI prevention project. Despite this achievement, ongoing efforts are required to further reduce CLABSI rates as we target zero in the NICU setting.
3-125 Comparison of Present on Admission and Healthcare-Associated Fungal Infections in a Pediatric Cancer Center in Ecuador Joanna Acebo, MD, Pediatric Infectious Diseases Physician, Hospital SOLCA-Núcleo de Quito; Miriam L. Gonzalez, MD, MS,
S37
International Epidemiology Coordinator, St. Jude Children’s Research Hospital; Erika Villaneuva, MD, Pediatric Oncologist, Hospital SOLCA- Quito; Isabel Jaramillo, MD, Pediatrician, Hospital SOLCA- Quito; José Eguiguren, MD, Pediatric Oncologist, Hospital SOLCA- Quito; Gisella Sánchez, MD, Pediatric Hemato-Oncologist, Hospital SOLCA- Quito; Carlos Vicuña, MD, Pediatric Oncology Surgeon, Hospital SOLCAQuito; Jenny Martinez, MD, Pediatrician, Hospital SOLCA- Quito; Blanca Mosquera, MS, Microbiologist, Hospital SOLCA- Quito; Maysam R. Homsi, MPH, Clinical Research Associate I, St. Jude Children’s Research Hospital; George Relyea, MA, MS, Research Assistant Professor, Division of Epidemiology, Biostatistics, Environmental Health, University of Memphis; Miguela A. Caniza, MD, Director, Infectious Diseases International Outreach, St. Jude Children’s Research Hospital BACKGROUND: Fungal infections (FIs) are a major cause of morbimortality in immunocompromised patients. To date, there is little information about its burden in pediatric oncology centers in lowto middle-income countries. We aimed to compare clinical features and outcomes of fungal infection present on admission (POA) and healthcare-associated infections (HAI) in children with hematologic and malignant diseases at a pediatric oncology center in Quito, Ecuador. METHODS: Included in this retrospective cohort study were all fungal infections documented in the pediatric cancer center’s prospective infection surveillance database between July 1, 2009 and December 14, 2015. Fungal infection events were classified on the basis of Centers for Disease Control and Prevention/National Healthcare Safety Network 2015 definitions. Associated clinical information was obtained from patients’ medical records. Demographics, clinical and laboratory characteristics, and outcomes of fungal infections were compared. RESULTS: Twenty-one fungal infection events in twenty patients were included. 76% had a HAI (0.39 infections per 1,000 patient days). The most common major site of HAIs was bloodstream infections (n = 11) of which 82% (n = 9) meet the mucosal barrier injury criteria. Skin and soft tissues was the most common site of POA infections. The most frequently isolated fungal agents were yeast (98%) and Candida non-albicans were isolated in 13 patients. There was no significant difference between POA and HAI in most demographics and clinical outcomes (Table 1). The only significant difference was the presence of neutropenia during the infection window (P = .03). Fungal infection-related mortality was 20% (4/ 21) and no difference was found between POA and HAIs (P = .950). CONCLUSIONS: The burden of fungal infections was predominantly due to yeasts and mostly HAI. Although there was no significant difference in clinical outcomes between POA and HAIs, we found that neutropenia was an important factor for HAI. Further studies with a larger sample size may render significant differences in clinical outcomes.
3-126 Decreasing Clostridium Difficile Utilizing Infection Prevention Methods Outside the Walls of the Hospital Leslie S. Kelt, BS, MT, CIC, CPHQ, Head, Department of Infection Prevention, St. Tammany Parish Hospital BACKGROUND: Clostridium difficile still continues to be major cause of patient mortality and morbidity. Even with infection
APIC 43rd Annual Educational Conference & International Meeting | Charlotte, NC | June 11-13, 2016