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Epidemiological Patterns of Central Line-associated Blood Stream Infections Outside the Intensive Care Units at a Freestanding Pediatric Hospital
Poster Abstracts / American Journal of Infection Control 41 (2013) S25-S145
S109
Clinical Nurse, Johns Hopkins Bayview Medical Center; Meghan Bibeault BSN RN, Clinical Nurse, Johns Hopkins Bayview Medical Center; Heather Thornton BSN RN, Clinical Nurse, Johns Hopkins Bayview Medical Center; Heather Streckfus RN, Clinical Nurse, Johns Hopkins Bayview Medical Center; Jocelyn Howard BSN RN, Clinical Nurse, Johns Hopkins Bayview Medical Center; Cheryle Wintermeyer BSN RN, Clinical Nurse, Johns Hopkins Bayview Medical Center; Doris Heath BSN RN, Infection Control Coordinator, Johns Hopkins Bayview Medical Center ISSUE: Central line-associated bloodstream infections (CLABSI) kill between 30 and 60 thousand patients in the U.S. each year. These preventable infections also result in nearly 3 billion dollars in excess cost. To fight against this costly killer, our Medical Intensive Care Unit (MICU) joined a national patient safety collaborative, On the CUSP: Stop BSI. The program is designed to improve safety culture and learn from mistakes. The goal is to reduce the CLABSI rate to zero.
RESULTS: Achievements were realized in both hand hygiene compliance and CLABSI rates. Within the hospital, our unit went from being among the worst hand hygiene compliance rate (<70%) to being among the best (>92%). We have prevented CLABSI for more than one year. LESSON LEARNED: Although the MICU’s CLABSI rates and hand hygiene compliance have clearly improved, another less measurable indicator of success was evident midway through the project. In August of 2011, the MICU had reached >160 days CLABSI-free. The staff had celebrated at the “100 day” mark, and now were looking ahead and talking about how they would celebrate the “200 day” mark. Then, a new infection was reported. Rather than accepting the news as inevitable, the staff was devastated that this had occurred. A culture change had taken place. The “Culture of Safety” in the MICU continues to grow.
Presentation Number 9-401 Epidemiological Patterns of Central Line-associated Blood Stream Infections Outside the Intensive Care Units at a Freestanding Pediatric Hospital
PROJECT: To work toward this important goal, the MICU formed a CUSP team. The staff nurses on the team represent all shifts and a range of experience levels from novice to expert. The Patient Care Manager (PCM) supports CUSP work by allowing staff nurses time out of unit staffing. The PCM not only attends monthly meetings, but supports our work with time out of unit staffing. The Chief Quality/Patient Safety Officer, an Infection Control Coordinator, Medical Director, and an executive sponsor support the team. Within the CUSP framework, the MICU team promotes safety by engaging and educating staff, executing standardized practices, and evaluating these efforts continuously. New products and technology have played an important role in efforts to prevent CLABSI. In September, 2011, the MICU began Chlorhexidine (CHG) baths on every patient upon admission, and nightly with a.m. care.. In February, 2012, the MICU started a CHG-impregnated dressing trial. Because central line maintenance audits highlighted the need for a central line dressing better suited for the MICU’s most common insertion site, the internal jugular (IJ), the team secured a dressing alternative.
Tjin Koy MT(ASCP), MPH, CIC, Infection Preventionist, Texas Children’s Hospital, Houston, TX; Amy Hankins MSN, RN, CPN, Infection Preventionist, Texas Children’s Hospital; Jeffrey Starke MD, Medical Director of Infection Control, Texas Children’s Hospital BACKGROUND/OBJECTIVES: While varied literature exists regarding the rates of central-line associated blood steam infections (CLABSI) in intensive care units (ICUs) in pediatric facilities, data describing the occurrence of CLABSI outside the intensive care units is limited. Objectives: To describe the incidence and clinical characteristics of confirmed CLABSI cases seen outside the intensive care units at Texas Children’s Hospital (TCH). METHODS: Children with confirmed CLABSI cases outside intensive care units at TCH between November 1, 2011 to October 31, 2012 were identified through a microbiology database. Medical records were reviewed to collect information regarding demographics, organisms isolated and co-morbidities. RESULTS: Forty-five patients with CLABSI were identified utilizing Centers for Disease Control and Prevention (CDC) definitions. Denominators for this study were collected by automated electronic
APIC 40th Annual Conference j Ft Lauderdale, FL j June 8-10, 2013
S110
Poster Abstracts / American Journal of Infection Control 41 (2013) S25-S145
method. Rates of CLABSI in this study were 1.4 infections per 1,000 catheter-days. Peripherally inserted central catheter (PICC) was the majority of the infected lines (64%) followed by tunneled catheter (36%). The ages ranged from 0 month to 21 years old (mean ¼ 6 years). The percentage of males was higher (64%) than females (36%). Whites comprised 38% of cases, followed by Hispanics (35%), African-Americans (18%), and Others (9%). Forty-three out of 45 cases (95%) had an underlying co-morbidity associated with CLABSI. Malignancy was the leading co-morbidity (47%), followed by gastrointestinal (24%), cardiac disease (13%), kidney disease (2%), genetic disorder (7%) and pulmonary (7%). Five patients (11%) died during the study period. Multiple varieties of organisms were isolated in this study. Enterobacter/Klebsiella species are the majority of the organisms isolated (25%), followed by Coagulase-Negative Staphylococcus (19%), Candida species (15%), Staphylococcus aureus (9%), Streptococcus viridans (8%), Escherichia coli (6%), Pseudomonas aeruginosa (6%), Serratia species (6%), and other organisms (2%). CONCLUSIONS: The rates of CLABSI outside the intensive care units at TCH during this study period were slightly higher than the rates of CLABSI in the intensive care units. Most work aimed in reducing CLABSI at TCH had been focused in ICUs. Based on the data above, the prevention efforts should be expanded outside the intensive care units.
physicians (30%) (p<0.001). The required effort to perform hand hygiene considered to be high or very high among more than 90% of responders. Nurses and physicians highly perceived the effectiveness of being a good example for colleagues in improving hand hygiene, 98% and 82% respectively, while about 50% of both of them perceived the effectiveness of inviting patients to remind healthcare workers to perform hand hygiene (p<0.001). Physicians were the least in knowing that non-clean healthcare workers’ hands are the main rout of germs cross transmission (35.7%; p<0.001). About 86% of nurses know the minimal time needed for alcohol-based handrub to kill germs on the hands, versus 37.5% of physicians (p<0.001).
Presentation Number 9-402 Physicians: The Forgotten Healthcare Professional Group in Hand Hygiene Education Khawater Bahkali MD, DFE, Hospital Epidemiologist, King Khalid University Hospital; Sarah Alsubaie MD, Assistant Professor & Consultant Pediatric Infectious Diseases, College of Medicine, King Saud University; Shaffi Ahamed, Assistant Professor and Consultant Statistician, Family and community medicine, King Saud University; Najwa Nasser, Infection Control Coordinator, Msc, King Khalid University Hospital; Mohammed Mofleh, Director of Nursing Department, King Khalid University Hospital; Omar Hassan, Nurse Education, King Khalid University Hospital; Maha Qabeel, Microbiologist, King Khalid University Hospital ISSUE: Despite all efforts to educate and spread the culture of hand hygiene, there is still variation in the practice of hand hygiene among various healthcare professional categories and in the different healthcare areas. While hand hygiene usually depicted as the simplest way to prevent infection, some healthcare workers perceive that it needs high effort. This fact made understanding the perception and knowledge background imperative. PROJECT: A self administered questionnaire of healthcare workers’ knowledge and perception of hand hygiene was distributed at an 850-bed teaching hospital in Saudi Arabia. Three professional groups and 9 healthcare departments were included. The questionnaire was derived from two questionnaires included in the World Health Organization’ tools to implement the “multimodal hand hygiene improving strategy”. This derived questionnaire addressed the exposure to training on hand hygiene, and included 4 items on perception and 5 items on knowledge. Descriptive statistics were calculated and bivariate relationships were evaluated between the professional categories, departmental affiliation, and previous training; and perception and knowledge, using appropriate tests of significance. RESULTS: A total of 1118 healthcare workers responded; 100% response rate among nurses, 70% among technicians and therapist, and 50% among physicians. The rate of receiving hand hygiene training was the highest among nurses (98%) and the lowest among
LESSON LEARNED: Majority of healthcare workers perceived that performing hand hygiene requires high effort. As nurses always targeted by continuous hand hygiene training and education; their knowledge was the best in comparison to technicians, therapist, and physicians. Physicians need to be targeted with more hand hygiene education and training. Incorporating hand hygiene training into orientation program for medical students and training physicians has become imperative.
Presentation Number 9-403 A Statewide Catheter-Associated Urinary Tract Infection Prevention Collaborative Tammy Jernigan MSN, ARNP, CIC, Senior Healthcare-Associated Infections Preventionist, Florida Department of Health, Bureau of Epidemiology; Chaz Rhone, HAI Infection Preventionist, Florida Department of Health; A.C. Burke MA, Healthcare Associated Infection Prevention Program Manager, Florida Department of Health BACKGROUND/OBJECTIVES: Since the prevalence of catheter associated urinary tract infections (CAUTIs) is so great in proportion to other healthcare-associated infections (HAIs), a collaborative was established with the overall mission of utilizing surveillance-guided, evidence-based prevention strategies to reduce HAIs within Florida’s acute care facilities. The mission translates into two terminal objectives: reducing CAUTI and reducing indwelling urinary catheter (IUC) device utilization ratio (DUR) by 25% from baseline or to 0. METHODS: Each acute care facility within the state of Florida was invited to join the CAUTI prevention collaborative. Sixteen facilities
APIC 40th Annual Conference j Ft Lauderdale, FL j June 8-10, 2013
S109
Clinical Nurse, Johns Hopkins Bayview Medical Center; Meghan Bibeault BSN RN, Clinical Nurse, Johns Hopkins Bayview Medical Center; Heather Thornton BSN RN, Clinical Nurse, Johns Hopkins Bayview Medical Center; Heather Streckfus RN, Clinical Nurse, Johns Hopkins Bayview Medical Center; Jocelyn Howard BSN RN, Clinical Nurse, Johns Hopkins Bayview Medical Center; Cheryle Wintermeyer BSN RN, Clinical Nurse, Johns Hopkins Bayview Medical Center; Doris Heath BSN RN, Infection Control Coordinator, Johns Hopkins Bayview Medical Center ISSUE: Central line-associated bloodstream infections (CLABSI) kill between 30 and 60 thousand patients in the U.S. each year. These preventable infections also result in nearly 3 billion dollars in excess cost. To fight against this costly killer, our Medical Intensive Care Unit (MICU) joined a national patient safety collaborative, On the CUSP: Stop BSI. The program is designed to improve safety culture and learn from mistakes. The goal is to reduce the CLABSI rate to zero.
RESULTS: Achievements were realized in both hand hygiene compliance and CLABSI rates. Within the hospital, our unit went from being among the worst hand hygiene compliance rate (<70%) to being among the best (>92%). We have prevented CLABSI for more than one year. LESSON LEARNED: Although the MICU’s CLABSI rates and hand hygiene compliance have clearly improved, another less measurable indicator of success was evident midway through the project. In August of 2011, the MICU had reached >160 days CLABSI-free. The staff had celebrated at the “100 day” mark, and now were looking ahead and talking about how they would celebrate the “200 day” mark. Then, a new infection was reported. Rather than accepting the news as inevitable, the staff was devastated that this had occurred. A culture change had taken place. The “Culture of Safety” in the MICU continues to grow.
Presentation Number 9-401 Epidemiological Patterns of Central Line-associated Blood Stream Infections Outside the Intensive Care Units at a Freestanding Pediatric Hospital
PROJECT: To work toward this important goal, the MICU formed a CUSP team. The staff nurses on the team represent all shifts and a range of experience levels from novice to expert. The Patient Care Manager (PCM) supports CUSP work by allowing staff nurses time out of unit staffing. The PCM not only attends monthly meetings, but supports our work with time out of unit staffing. The Chief Quality/Patient Safety Officer, an Infection Control Coordinator, Medical Director, and an executive sponsor support the team. Within the CUSP framework, the MICU team promotes safety by engaging and educating staff, executing standardized practices, and evaluating these efforts continuously. New products and technology have played an important role in efforts to prevent CLABSI. In September, 2011, the MICU began Chlorhexidine (CHG) baths on every patient upon admission, and nightly with a.m. care.. In February, 2012, the MICU started a CHG-impregnated dressing trial. Because central line maintenance audits highlighted the need for a central line dressing better suited for the MICU’s most common insertion site, the internal jugular (IJ), the team secured a dressing alternative.
Tjin Koy MT(ASCP), MPH, CIC, Infection Preventionist, Texas Children’s Hospital, Houston, TX; Amy Hankins MSN, RN, CPN, Infection Preventionist, Texas Children’s Hospital; Jeffrey Starke MD, Medical Director of Infection Control, Texas Children’s Hospital BACKGROUND/OBJECTIVES: While varied literature exists regarding the rates of central-line associated blood steam infections (CLABSI) in intensive care units (ICUs) in pediatric facilities, data describing the occurrence of CLABSI outside the intensive care units is limited. Objectives: To describe the incidence and clinical characteristics of confirmed CLABSI cases seen outside the intensive care units at Texas Children’s Hospital (TCH). METHODS: Children with confirmed CLABSI cases outside intensive care units at TCH between November 1, 2011 to October 31, 2012 were identified through a microbiology database. Medical records were reviewed to collect information regarding demographics, organisms isolated and co-morbidities. RESULTS: Forty-five patients with CLABSI were identified utilizing Centers for Disease Control and Prevention (CDC) definitions. Denominators for this study were collected by automated electronic
APIC 40th Annual Conference j Ft Lauderdale, FL j June 8-10, 2013
S110
Poster Abstracts / American Journal of Infection Control 41 (2013) S25-S145
method. Rates of CLABSI in this study were 1.4 infections per 1,000 catheter-days. Peripherally inserted central catheter (PICC) was the majority of the infected lines (64%) followed by tunneled catheter (36%). The ages ranged from 0 month to 21 years old (mean ¼ 6 years). The percentage of males was higher (64%) than females (36%). Whites comprised 38% of cases, followed by Hispanics (35%), African-Americans (18%), and Others (9%). Forty-three out of 45 cases (95%) had an underlying co-morbidity associated with CLABSI. Malignancy was the leading co-morbidity (47%), followed by gastrointestinal (24%), cardiac disease (13%), kidney disease (2%), genetic disorder (7%) and pulmonary (7%). Five patients (11%) died during the study period. Multiple varieties of organisms were isolated in this study. Enterobacter/Klebsiella species are the majority of the organisms isolated (25%), followed by Coagulase-Negative Staphylococcus (19%), Candida species (15%), Staphylococcus aureus (9%), Streptococcus viridans (8%), Escherichia coli (6%), Pseudomonas aeruginosa (6%), Serratia species (6%), and other organisms (2%). CONCLUSIONS: The rates of CLABSI outside the intensive care units at TCH during this study period were slightly higher than the rates of CLABSI in the intensive care units. Most work aimed in reducing CLABSI at TCH had been focused in ICUs. Based on the data above, the prevention efforts should be expanded outside the intensive care units.
physicians (30%) (p<0.001). The required effort to perform hand hygiene considered to be high or very high among more than 90% of responders. Nurses and physicians highly perceived the effectiveness of being a good example for colleagues in improving hand hygiene, 98% and 82% respectively, while about 50% of both of them perceived the effectiveness of inviting patients to remind healthcare workers to perform hand hygiene (p<0.001). Physicians were the least in knowing that non-clean healthcare workers’ hands are the main rout of germs cross transmission (35.7%; p<0.001). About 86% of nurses know the minimal time needed for alcohol-based handrub to kill germs on the hands, versus 37.5% of physicians (p<0.001).
Presentation Number 9-402 Physicians: The Forgotten Healthcare Professional Group in Hand Hygiene Education Khawater Bahkali MD, DFE, Hospital Epidemiologist, King Khalid University Hospital; Sarah Alsubaie MD, Assistant Professor & Consultant Pediatric Infectious Diseases, College of Medicine, King Saud University; Shaffi Ahamed, Assistant Professor and Consultant Statistician, Family and community medicine, King Saud University; Najwa Nasser, Infection Control Coordinator, Msc, King Khalid University Hospital; Mohammed Mofleh, Director of Nursing Department, King Khalid University Hospital; Omar Hassan, Nurse Education, King Khalid University Hospital; Maha Qabeel, Microbiologist, King Khalid University Hospital ISSUE: Despite all efforts to educate and spread the culture of hand hygiene, there is still variation in the practice of hand hygiene among various healthcare professional categories and in the different healthcare areas. While hand hygiene usually depicted as the simplest way to prevent infection, some healthcare workers perceive that it needs high effort. This fact made understanding the perception and knowledge background imperative. PROJECT: A self administered questionnaire of healthcare workers’ knowledge and perception of hand hygiene was distributed at an 850-bed teaching hospital in Saudi Arabia. Three professional groups and 9 healthcare departments were included. The questionnaire was derived from two questionnaires included in the World Health Organization’ tools to implement the “multimodal hand hygiene improving strategy”. This derived questionnaire addressed the exposure to training on hand hygiene, and included 4 items on perception and 5 items on knowledge. Descriptive statistics were calculated and bivariate relationships were evaluated between the professional categories, departmental affiliation, and previous training; and perception and knowledge, using appropriate tests of significance. RESULTS: A total of 1118 healthcare workers responded; 100% response rate among nurses, 70% among technicians and therapist, and 50% among physicians. The rate of receiving hand hygiene training was the highest among nurses (98%) and the lowest among
LESSON LEARNED: Majority of healthcare workers perceived that performing hand hygiene requires high effort. As nurses always targeted by continuous hand hygiene training and education; their knowledge was the best in comparison to technicians, therapist, and physicians. Physicians need to be targeted with more hand hygiene education and training. Incorporating hand hygiene training into orientation program for medical students and training physicians has become imperative.
Presentation Number 9-403 A Statewide Catheter-Associated Urinary Tract Infection Prevention Collaborative Tammy Jernigan MSN, ARNP, CIC, Senior Healthcare-Associated Infections Preventionist, Florida Department of Health, Bureau of Epidemiology; Chaz Rhone, HAI Infection Preventionist, Florida Department of Health; A.C. Burke MA, Healthcare Associated Infection Prevention Program Manager, Florida Department of Health BACKGROUND/OBJECTIVES: Since the prevalence of catheter associated urinary tract infections (CAUTIs) is so great in proportion to other healthcare-associated infections (HAIs), a collaborative was established with the overall mission of utilizing surveillance-guided, evidence-based prevention strategies to reduce HAIs within Florida’s acute care facilities. The mission translates into two terminal objectives: reducing CAUTI and reducing indwelling urinary catheter (IUC) device utilization ratio (DUR) by 25% from baseline or to 0. METHODS: Each acute care facility within the state of Florida was invited to join the CAUTI prevention collaborative. Sixteen facilities
APIC 40th Annual Conference j Ft Lauderdale, FL j June 8-10, 2013