The risk of central line-associated bloodstream infection with femoral venous catheters as compared to no-femoral venous catheters

S94

Abstracts of the 7th International Congress of the Asia Pacific Society of Infection Control, Taipei, Taiwan, March 26-29, 2015

Conclusions: Implementing UTI care bundle and executing infection control procedures, combining daily assessment of line necessity and prompt removal of unnecessary lines were indeed helpful in lowering the UTI related infections.

Conclusions: The participation of Central Line Care Quality Improvement Plan can motivate all medical personnel. Therefore, the bloodstream infection bundle care can be put into practice accurately by encouraging each other between the staff in a hospital and via on-site survey and auditing by infection control nurses.

PS 1-125 PS 1-127 CONSTRUCTION AND TEST OF THE EFFECTIVENESS OF "CENTRAL VENOUS CATHETER BUNDLE CARE" FOR THE PREVENTION OF CENTRAL VENOUS CATHETER-RELATED BLOODSTREAM INFECTION

THE EFFECT OF BUNDLE PLAN ON CENTRAL CATHETER-RELATED BLOODSTREAM INFECTIONS: A REGIONAL HOSPITAL EXPERIENCE

Kuei-Tzu Yang a, Li-Fen Huang b, Guo-xi Lin c. aTungs’ Taichung MetroHarbor Hospital Infection Control Committees, Taiwan; bProvidence University, Taiwan; cTungs’ Taichung MetroHarbor Hospital Infection Control Committees, Taiwan

Jui-Hei Chung a, Chung-Wei Chou a, Fu-Der Wang b,c, Yow-Ren Lin a, WenHuey Tsai a, Hsiao-Wen Chiang a, Biing-Shiun Hlung a. aTaipei Municipal Gan-Dau Hospital, Taiwan; bTaipei Veterans General Hospital, Taiwan; c National Yang-Ming University, Taiwan

Purpose: Bloodstream infectionis the second leading cause of community acquired infection in Regional Hospitals. TheCenters for Disease Control and prevention(CDC)publishedguidelinesonthe prevention ofbloodstream infectionsin 2011, which indicated thatBundle Care can effectively reducebloodstream infections. Methods: Thestudy wasconducted in a1, 319-bededteaching hospital.Existingdata analysismethods was used. The compliance of medical staff was external audited by observation of members from infection control team withassistance of computersystems. Results: From January 2013 to May 2014, a totalnumber of3,656 catheter was placed., After comparing the medical chart ID and date of infection, and exclusion of different isolates from one episode, the number catheter related blood stream infection during this period was 239 episodes. Owing to the variated numbers of catheters placed each month, to compare the distribution of infection rates. The result showed that the number of placed catheter increased, and the rate ofcatheter related blood stream infection went downward. Conclusions: The study indicated that, the overall numbers of blood stream infectiondid not decrease after implementation of CVC care bundle. But the infection rate of patient-catheter based data showed a downward trend.

Purpose: Invasive medical devices are necessary for clinical treatment, unfortunately it also becomes one of the major healthcare-associated infection risk factors. According to the annual surveillance data by Gan-dau hospital, central catheter-related bloodstream infections (CLABSI) rate in intensive care unit (ICU) was 5.92 & and 5.05 & during 2011 to 2012. Comparison with the Department of Disease Control, Ministry of Health and Welfare 2012 regional Hospital CLABSI data 1.9 &, Our data obviously higher and requires feather effort in reducing the infection rate . Methods: By participating in quality improvement Bundle plan on 2013, there were 5 key components strictly embedded and carried out: hand decontamination pre-insertion, full sterile barrier precautions, 2% chlorhexidine for skin antisepsis, avoiding use of femoral site and removing unnecessary catheters. The period of intervention are 2 years. Results: The major findings of this plan revealed two ways, one at ICU: the annual average catheter insertion period were 5.4 and 6.4 days, annual CLABSI rate were 0 (0/261) and 5.18& (1/193), hand hygiene compliance elevated from 74.7% to 89.5%; the other one was in general wards: annual CLABSI rate were 9.5& (2/211) and 0& (0/106), and the hand hygiene compliance improved 9.5%. Conclusion: Education, training and operation audit could strengthen healthcare personnel sterile procedure and practice exactly in clinical treatment, reduce CLABSI rate, enhance safety and quality of care and thus reduce medical costs.

PS 1-126 IMPROVING ACCURACY OF IMPLEMENTING BLOODSTREAM INFECTION BUNDLE BY PROCESS REENGINEERING IN A NORTHERN REGIONAL HOSPITAL IN TAIWAN Meng-Tsen Tsai a, Ming-Feng Lin a,b, Hung-Jen Fan b, Chia-Sui Wu c, PenChing Chen c, Hisao-Ting Lin c. aInfection Control Center, National Taiwan University Hospital Chu-Tung Branch, Taiwan; bDepartment of Medicine, National Taiwan University Hospital Chu-Tung Branch, Taiwan; cDepartment of Nursing, National Taiwan University Hospital Chu-Tung Branch, Taiwan Purpose: Central line-associated bloodstream infection (CLABSI) is one of the common healthcare associated infections, which will lead to increased consumption of antibiotics and length of hospital stay, or even death if not properly treated. National Taiwan University Hospital Chu-Tung Branch has been enrolled in the Central Line Care Quality Improvement Plan of Centers for Disease Control, Taiwan since 2014 February. The accuracy of both central line care process and equipment accessibility was below 60% and that of hand hygiene was 63.3% in the first quarter auditing. The aim of this study was to improve accuracy of implementing bloodstream infection bundle by process reengineering Methods: A task force was organized on April 4, 2014. Then literature searching, on-site survey, auditing, and root cause analysis were performed. Four major faults, including poor compliance of hand hygiene, non-familiarity of care process, no standard procedure of central line care, and lack of a fixed place for equipment needed in central line insertion, were found. The strategies of process reengineering are as follows: 1. Emphasis of hand hygiene; 2. Education and rehearsal of care process; 3. Formulation of care guideline; 4. Changing the working box to working car. Results: After a campaign for improving care process was undertaken, the accuracy of both central line care process and equipment accessibility was raised to 100% and the accuracy of hand hygiene reached 96.6%.

PS 1-128 THE RISK OF CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTION WITH FEMORAL VENOUS CATHETERS AS COMPARED TO NO-FEMORAL VENOUS CATHETERS Shu-Ling Chen a, Ying-Ling Chen a, Hung-Jen Tang b. aInfection Control Committee, Chi Mei Medical Center, Taiwan, ROC; bDivision of Infectious Diseases, Department of Internal Medicine, Chi Mei Medical Center, Taiwan, ROC Purpose: Taiwan Centers for Disease Control (Taiwan CDC) has promoted the CVC bundle care project for two years. For this project, the five modular measures of the CVC bundle of central line-associated prevention include hand hygiene, maximal sterile barrier precautions, using alcohol-based 2% chlorhexidine gluconate disinfectants, avoiding femoral venous catheters, and removing catheter as soon as possible. Medical personnel have to follow the above five modular measures in the central catheter placement and in daily care. Avoiding femoral venous catheters is always a difficulty during the course of promotion. Dialysis patients often implanted two central catheters (CVC and dialysis CVC). One is on the femoral vein. Therefore, the purpose of this study is to identify the correlation between the femoral or no-femoral venous catheters and central line-associated bloodstream infection (CLABSI). Methods: 13 departments (7 ICUs and 6 wards) were invited to participate in this research. From January 2014 to October 2014 of 1264 CVCs, 805 (63.7%) had femoral venous catheters, 459 (36.3%) had no-femoral venous catheters. There were 105 CLABSIs. 79 (75.2%) had femoral venous catheters, 26 (24.8%) had a no-femoral venous catheter. Based on chi-square test, the event of CLABSI is statistically significant with the position of femoral venous catheters placement (PZ0.0102
Abstracts of the 7th International Congress of the Asia Pacific Society of Infection Control, Taipei, Taiwan, March 26-29, 2015 in the examples of these papers. The catheters were placed on patients 8.3 days on average in the model hospital in the southern part of Taiwan. Therefore, the risk of CLABSI is higher with femoral venous catheters compared to no-femoral venous catheters. Anyway, we could reduce the probability of CLABSI by removing catheter as soon as possible. We promote very strongly evidence on the study’s result and Taiwan CDC could take as a reference to the promotion of CVC bundle project.

PS 1-129 IMPLEMENTATION OF CVC BUNDLE CARE IN THE INTENSIVE CARE UNIT IN A REGIONAL TEACHING HOSPITAL Ya-Chi Huang a, Yuan-Hsin Chu a, Hsiao-Fang Cheng a, Yuen-Chun Hsu a, YiChing Huang b, Fang-Ching Liu b. aDepartment of Infection Control, Jen-Ai Hospital, Taiwan, ROC; bDivision of Infectious Disease, Jen-Ai Hospital, Taiwan, ROC Purpose: Intravascular catheters play a central role in the care of critically and chronically ill patients, but it’s also a main route of bloodstream infection in the hospital. July 2011, the central venous catheter (CVC) care bundles were executed in the intensive care unit (ICU) in a regional teaching hospital. Density of infection of catheter related bloodstream infection (CRBSI) were 1.298& in ICU on 2011. Methods: According to CVC bundle care guidelines from Centers for Disease Control (CDC), we did the measures including 5 parts: optimal catheter site selection, hand hygiene, Chlorhexidine skin antisepsis, maximal sterile barrier precautions and daily review of line necessity in March 2014. And we made the education classes of nurses and doctors involved in this program. Calculated the CRBSI rates were based on the definition of healthcare associated infection (HAI). Results: The CRBSI rates of ICU were 1.298 &, 1.445&, of 2011 and 2012, respectively. The mean compliance of executing CVC bundle placement from 2011 to 2013 was 60%, and daily care compliance was 85%. Along with the ongoing CVC bundle program in 2014, we held staff’s educations and training, revised procedures and arranged supplies settings. The CRBSI rates subsequently decreased to 0.930&. CVC bundle placement compliance and daily care compliance raised to 86.1% and 94.6%, respectively from Jan to Oct in 2014. Conclusions: By implementing the CVC bundle program not only reduced CRBSI rate, but also made us learn much from the process. However, health care workers have inadequate recognition of CVC bundles of only 70.56%. In addition to educating and training new recruits to elevate the recognitions of CVC bundles, hopefully, CVC bundles could be extended into clinical practice in the associated departments of the hospital.

PS 1-130 THE EFFECTIVENESS OF USING BUNDLE CARE TO REDUCE THE INCIDENCE OF CENTRAL LINE-ASSOCIATED BLOOD STREAM INFECTION IN A REGIONAL HOSPITAL Ya-Hui Lai a, Guo-heng Tsai a, Yu-Shi Liou b, Mei-Lin Shih c, Shiou-Shian Tsaig c, Ya-Ping Hung d, Huei-Ying Luo d, Chiau-Min Lin e, Yu-Chi Yang f. aInfection Control Office; bAdult Intensive Unit Care; c Surgical Care Ward; dInternal Medical Ward; eAnesthesia Department; f Hemodialysis Center Purpose: Hospitals are places where we would like to bring patients with medical services, treatments, and overall improvement of health conditions. However, iatrogenic infections caused by various types of invasive techniques or examinations may come along as the most undesirable outcomes.Both domestic and foreign research documents indicate that there is a correlation between iatrogenic bloodstream infection (BSI) and invasive vascular therapeutic devices. The BIS would result in increases of the cost as well as the duration of hospitalization, or even fatality.Bundle care, based on evidence-based medicine (EBM), has been proven to be the most effective measure in terms of tackling central Line-Associated bloodstream infection (CLBSI). Bundle care is a uniformly structured way applied to the process of patient care that “bundles” several single practices together. It shows positive outcomes on lowering the risk of CLBSI. Methods: The central line bundle has five key components. There are Hand hygiene, Maximal barrier precautions, Chlorhexidine skin antisepsis, Optimal

S95

catheter site selection, with subclavian vein as the preferred site for nontunneled catheters, and Daily review of line necessity, with prompt removal of unnecessary lines. In a range of process, we need to meet the advocacy team regularly, take part in the customized education and training, and establish a standardizing process. In a range of execution, we need to establish a standard technical certification, internal and external audits, technical guidance, creativity and competition advocacy propaganda materials.In a range of result, we plan to reduce the density of the central line associated blood stream infection and the usage of central line. Results: The density of the central line associated blood stream infection is from 2.2 0/00 to 2.4 0/00 after bringing to practice in March 2013. The implementation of this project is necessary as we can see in the Table 1.

Table 1

The usage rate of central line in unit ward.

Conclusions: The implementation rate of infection of CLBSI is different. But there is the same formula to calculate and to identify with the infection of CLBSI in hospitals. We’ll get the best quality of caring results from implementing bundle care components in hospitals.

PS 1-131 IMPLEMENTATION OF THE CATHETER ASSOCIATED URINARY TRACT INFECTION (CAUTI) BUNDLE WITH THE HELP OF INFECTION CONTROL LINK NURSES AND INFECTION CONTROL PRACTICE AUDITORS C. W. Y. Cheung a, Y. Y. Wong a, S. S. Lau a, P. T. Y. Ching a, K. H. LI a,b, W. H. Seto a,b,c. aInfection Control Team, Hong Kong Baptist Hospital, Hong Kong, China; bPathology, Hong Kong Baptist Hospital, Hong Kong, China; c WHO Collaborating Centre for Infection Control, Hospital Authority, Hong Kong, China Purpose: Catheter Associated Urinary Tract Infection (CAUTI) is accounts for the highest rate of healthcare associated infection (HAI). To reduce CAUTI and implement the best practice in the hospital, the CAUTI bundle was introduced. The process included training of the Infection Control Link Nurses (ICLN) to educate the front line staff and the infection control practice auditors (ICPA) to monitor the patient-care-practice. Methods: The ICPA were trained on the CAUTI bundle and the bundle compliance monitor techniques before the baseline data was collected in all wards in May 2014. After that the ICLN were trained on the CAUTI care bundle, they then cascaded the information to their subordinates including nurses and health care assistance by using the same set of training materials. After 3 months of the CAUTI bundle implementation, the survey was repeated to demonstrate the effect. Results: A survey of 17 wards was done pre and post of the implementation of the CAUTI bundle. Initially the prevalence rate of urinary catheter insertion was 8.9% (40 patients with urinary catheter) at the baseline which decreased to 8% (42 patients with urinary catheter) afterwards. This is much lower than the rate of 12%-25% reported in the literature. Correct indications for catheter insertion improved from 85% to 95%. The compliance with the bundle also improved from 58-98% to 63-100%. Conclusions: The CAUTI care bundle was implemented successfully with the following results. There was an improvement shown on the correct indications for catheter insertion. The compliance with best practice according to the CAUTI guidelines have improved in most areas. There were two areas for improvement: securing the catheter by proper taping and making sure that the drainage tubing was above the floor. The use of a special catheter anchoring device and periodic audit monitoring could help to sustain the best practice of the CAUTI bundle.