Question

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PHC 231

1.   Discuss Central Line-Associated Bloodstream Infection (CLABI)
"or" Ventilator-Associated Pneumonia (VAP) outbreak in long-term acute care hospital
settings. Address the following in your report:
a)   Characterize the epidemiology and microbiology
b)   Describe the agent, and identify the host and the environment that is favorable
for the infection.
c)   Discuss how the infections spread and the types of prevention and
control measures
d)   Identify a population and develop a hypothesis about possible causes
in a testable format with standard statistical notation (the null and the alternative)
e)   Explain how you would choose controls to test this hypothesis?

Answer 1

A central line associated bloodstream infection (CLABSI) occurs when bacteria or other germs enter the patient's central line and then enter into their bloodstream. These infections are serious but can often be successfully treated. Health care workers, patients and families can play an active role in CLABSI prevention.

A.

Introduction: Extensive literature exists on the incidence, risk factors and impact of Central Line-Associated Bloodstream Infections (CLABSI) in the general ICU, but is lacking for the Cardiac Intensive Care Unit (CICU).

Hypothesis: We describe the epidemiology and microbiology of CLABSI in patients admitted to a CICU.

Methods: We retrospectively reviewed all critically-ill cardiac patients who met the definition for CLABSI while admitted at a Quaternary CICU between May-10 to Feb-18. Data on CLABSI rate per 1000 line days was only available since Jan 13. CLABSI data were collected prospectively by the Infectious Diseases Nurse Specialist. Patient demographics and clinical data were retrospectively collected using a predefined collection tool.

Results: Out of approximately 21,070 individual CICU admissions within the study period, 46 patients met criteria for CLABSI with an average of 1.4 CLABSI per 1000 line days. The mean age was 67±11 years, 59% male with an observed in-hospital mortality of 39%. Most patients who developed CLABSI sustained a cardiac arrest (34%), cardiogenic shock (28%) or acute decompensated heart failure (24%). Line burden prior to CLABSI was estimated as a median of 2 (2-3 Q1-3) lines per patient. Most central lines were venous (86%) with jugular access predominance (76.5%) over femoral (22.5%). Inotropic, vasopressor and mechanical circulatory support was commonly encountered in this population. (Figure 1) Gram-positive cocci (64%) were the most common organism detected in blood cultures, but gram-negative bacilli represented a significant proportion (26%) of the implicated microbiology.

Conclusion: A definition of CLABSI is met in the CICU mainly in the setting of cardiac arrest, cardiogenic shock and/or decompensated heart failure. The emergent placement of lines in hemodynamically unstable patients and the potential for gut translocation in this population may play a potential role and deserves further exploration.

B. A central line-associated bloodstream infection (CLABSI) is a serious infection that occurs when germs (usually bacteria or viruses) enter the bloodstream through the central line.Uncomplicated CLABSI caused by organisms other than Staphylococcus aureus, Pseudomonas aeruginosa, Bacillus spp, Micrococcus species, Propionibacteria, fungi, or mycobacteria.

3.

Prevention Guidelines During Insertion

Hand hygiene by washing hands with soap and water or with alcohol-based gels or foams. Gloves do not obviate the need for hand hygiene. Strict aseptic technique by using maximal sterile barrier precautions, including a full-body drape when inserting central venous catheters.