4 results
Identifying risk factors for pediatric central-line–associated bloodstream infections
- Paula Conrad, Julie Murphy, Pascale Audain, Michelle Connors, Christopher Hopkinson, Jenny Chan Yuen, Jennifer Ormsby
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue S2 / June 2023
- Published online by Cambridge University Press:
- 29 September 2023, p. s45
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Background: Pediatric patients often require central venous catheters (CVCs) for a variety of clinical indications, including medication administration, parenteral nutrition, and venous blood sampling. Patients with CVCs are at risk for central-line–associated bloodstream infections (CLABSI). These hospital-acquired infections are often preventable and may lead to increased morbidity and mortality. Clinicians at a 477-bed, freestanding pediatric academic hospital completed a quality improvement project to identify factors that place pediatric patients at increased risk for CLABSI and to outline strategies aimed at CLABSI reduction for our highest-risk patients. Methods: Project leaders completed a literature review to evaluate current research on the topic and then assembled a project team. The team completed a retrospective analysis and categorization of CLABSI cases and reviewed internal CLABSI root-cause analysis data. The group then completed a case–control analysis to identify risk factors in patients with CVCs who developed CLABSIs, compared to patients with CVCs who did not develop CLABSI. Following this analysis, the team created a CLABSI risk-factor tool for use by bedside nurses. This tool described patients with CLABSI risk factors and outlined best practices for CLABSI prevention. Results: Based upon literature review, root-cause analysis data, and retrospective CLABSI case review over the period from 2017 to 2021, an initial list of 9 potential CLABSI risk factors was compiled. A case–control analysis was performed comparing 97 CLABSI cases with 103 matched controls. Univariate, multivariate, and additional covariate analyses were employed to identify 3 factors placing pediatric patients at increased risk for CLABSI. These included (1) multiple enteral devices (ie, 2 or more devices, including gastrostomy tube, jejunostomy tube, gastrostomy or jejunostomy tube, ostomy, and peritoneal drain); (2) multiple CVC entries (ie, CVC used for medications and venous sampling); and (3) long-term CVC plus parenteral nutrition (CVC in place for >21 days and receiving parenteral nutrition and/or intralipids). Conclusions: Pediatric patients with central venous access are vulnerable to CLABSI, and certain patients may be at increased risk. Frontline clinicians may be able to identify these patients and adopt best practices to prevent infection. A tool for use by bedside nurses can be a useful adjunct to existing CLABSI prevention practices.
Disclosures: None
Investigating a cluster of pediatric oncology invasive fungal infections–Lessons learned
- Angelette Terk, Jennifer Ormsby, Paula Conrad, Catherine Svensson, David Barry, David Davis, Ana Vaughan Malloy, Tom Sandora
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 2 / Issue S1 / July 2022
- Published online by Cambridge University Press:
- 16 May 2022, p. s58
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Background: In spring 2021, the infection prevention and control department at a pediatric academic medical center identified 3 oncology patients with concern for invasive Rhizopus spp infections. An in-depth investigation was conducted, but a common source of the fungus was not identified. In August 2021, an additional oncology patient with concern for invasive Rhizopus spp was identified, resulting in an extended investigation for possible sources of fungus. Methods: A multidisciplinary work group was assembled. The CDC Targeted Environmental Investigation Checklist for Outbreaks of Invasive Infections Caused by Environmental Fungi was used as a framework for conducting the investigation. Stakeholders were engaged throughout the process, including the hematology–oncology service, hospital leadership, environmental services, patient safety and quality, and facilities and engineering. The investigation included hospital incident command system (HICS) activation; visual inspection of patient rooms and common spaces; heating, ventilation, and air conditioning (HVAC) review; environmental sampling (surfaces, linen, and air); chart review; and process mapping. Results: By early October 2021, 2 environmental samples grew isolates (each at 1 CFU/m3) of the same species of Rhizopus as one of the affected patients. One sample was from a patient room, and the other from an outdoor garden space. No source of indoor amplification of Rhizopus was identified. The investigation revealed several opportunities for improvement: annual room maintenance schedules, use of gardens and outdoor spaces by at-risk patients, linen storage, construction and/or infection control risk assessment (ICRA) processes, and appliances used by families (eg, washing machines and refrigerators). Work streams were established to address each of these areas. Conclusions: No definite source was identified for the 4 invasive Rhizopus spp infections. This extensive investigation highlighted multiple opportunities for improvement; the changes implemented may prevent future invasive fungal infections in high-risk pediatric patients.
Funding: None
Disclosures: None
COVID-19 Contact Tracing in a Pediatric Hospital: Maximizing Effectiveness Through Specialized Team and Automated Tools
- Lindsay Weir, Jennifer Ormsby, Carin Bennett-Rizzo, Jonathan Bickel, Colleen Dansereau, Matthew Horman
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 1 / Issue S1 / July 2021
- Published online by Cambridge University Press:
- 29 July 2021, pp. s46-s47
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Background: In their interim infection prevention and control recommendations for the coronavirus disease 2019 (COVID-19) pandemic, the Centers for Disease Control and Prevention (CDC) recommend that healthcare facilities have a plan to identify, investigate, and trace potential COVID-19 exposures. In an academic hospital, the scale of such tracing is substantial, given that medically complex patients can have dozens of staff contacts across multiple locations during an encounter. Furthermore, the family-centered care model employed by pediatric institutions precludes visitor exclusion, further complicating tracing efforts. Despite this complexity, tracing accuracy and timeliness is of paramount importance for exposure management. To address these challenges, our institution developed a contact-tracing system that balanced expert participation with automated tracing tools. Methods: Our institution’s contact-tracing initiative includes positive patients, parents and/or visitors, and staff for the enterprise’s inpatient, procedural, and ambulatory locations at the main campus and 4 satellites. The team consists of 11 staff and is overseen by an infection preventionist. For positive patients and parents and/or visitors, potentially exposed staff are automatically identified via a report that extracts staff details for all encounters occurring during the patient’s infectious period. For positive staff, trained contact tracers call the staff member to determine whether mask and distancing practices could result in others meeting CDC exposure criteria. Any potentially exposed healthcare workers (HCWs) receive an e-mail that details exposure criteria and provides follow-up instructions. These HCWs are also entered into a secure, centralized tracking database that (1) allows infection prevention and occupational health staff to query and identify all epidemiologic links between traced patients, parents and/or visitors, and staff, and (2) initiates staff enrollment in a twice-daily symptom tracking system administered via REDCap. Potentially exposed patients and parents and/or visitors are contacted directly by a hospital representative. The contact tracing team, infection prevention staff, and occupational health staff meet daily to review positive staff cases in the last 24 hours. Results: To date, the team has traced ~1,300 patients, 15 parents and/or visitors, and 700 staff. Since the start of the pandemic, tracing and contact notification for all positive cases has been conducted within 24 hours. Through these proactive tracing efforts and other institutional infection prevention initiatives, the institution only experienced 1 staff cluster (N < 15) and <5 hospital-onset patient cases. Conclusions: Equipping a trained group of contact tracers with automated tracking tools can afford infection prevention and occupational health departments the ability to achieve and sustain timely and accurate contact tracing initiatives throughout a large-scale pandemic response.
Funding: No
Disclosures: None
Central venous catheter bundle adherence: Kamishibai card (K-card) rounding for central-line–associated bloodstream infection (CLABSI) prevention
- Jennifer A. Ormsby, Julie Cronin, Jane Carpenter, Dionne A. Graham, Gail Potter-Bynoe, Ana M. Vaughan, Lindsay Weir, Kathleen A. Flaherty, Celeste J. Chandonnet, Gregory P. Priebe, Thomas J. Sandora
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue 9 / September 2020
- Published online by Cambridge University Press:
- 04 June 2020, pp. 1058-1063
- Print publication:
- September 2020
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Objective:
To institute facility-wide Kamishibai card (K-card) rounding for central venous catheter (CVC) maintenance bundle education and adherence and to evaluate its impact on bundle reliability and central-line–associated bloodstream infection (CLABSI) rates.
Design:Quality improvement project.
Setting:Inpatient units at a large, academic freestanding children’s hospital.
Participants:Data for inpatients with a CVC in place for ≥1 day between November 1, 2017 and October 31, 2018 were included.
Intervention:A K-card was developed based on 7 core elements in our CVC maintenance bundle. During monthly audits, auditors used the K-cards to ask bedside nurses standardized questions and to conduct medical record documentation reviews in real time. Adherence to every bundle element was required for the audit to be considered “adherent.” We recorded bundle reliability prospectively, and we compared reliability and CLABSI rates at baseline and 1 year after the intervention.
Results:During the study period, 2,321 K-card audits were performed for 1,051 unique patients. Overall maintenance bundle reliability increased significantly from 43% at baseline to 78% at 12 months after implementation (P < .001). The hospital-wide CLABSI rate decreased from 1.35 during the 12-month baseline period to 1.17 during the 12-month intervention period, but the change was not statistically significant (incidence rate ratio [IRR], 0.87; 95% confidence interval [CI], 0.60–1.24; P = .41).
Conclusions:Hospital-wide CVC K-card rounding facilitated standardized data collection, discussion of reliability, and real-time feedback to nurses. Maintenance bundle reliability increased after implementation, accompanied by a nonsignificant decrease in the CLABSI rate.