Literature Update - December, 2005
Compiled by Claire Boardman, VICNISS Senior Infection Control Consultant, and Phil Russo, VICNISS Deputy Director
Reduction in Central Line-Associated Bloodstream Infections (CLABSI) Among Patients in Intensive Care Units (ICUs)
Pennsylvania, April 2001--March 2005
MMWR: October 14, 2005 / 54(40);1013-1016
C Muto, MD, Univ of Pittsburgh Medical Center Presbyterian Hospital reports a 68% reduction in CLABSI rates following the
implementation of several interventions;
- promotion of targeted, evidence-based catheter insertion practices (i.e., use of maximum sterile barrier precautions
during insertion, use of chlorhexidine for skin disinfection before catheter insertion, avoidance of the femoral insertion
site, use of recommended insertion-site dressing care practices, and removal of catheters when no longer indicated);
- promotion of an educational module about CLABSIs and strategies for their prevention;
- promotion of standardised tools for recording adherence to recommended catheter insertion practices;
- promotion of a standardised list of contents for catheter insertion kits that includes all supplies required to adhere
to recommended insertion practices; and
- measurement of CLABSI rates and distribution of data to participating hospitals in confidential quarterly reports,
allowing comparison of individual unit-specific rates with pooled mean rates from other participating ICUs in the region
and pooled mean rates from all other US hospitals participating in the National Nosocomial Infection Surveillance (NNIS)
system, stratified by type of ICU.
Data was collected from 69 ICUs in Southwestern Pennsylvania from April 2001 to March 2005. The overall CLABSI rate
reduced 4.31 to 1.36 per 1000 central line days. CLABSI rates in medical/surgical; ICUs decreased from 3.64 to 1.18 per
1000 central line days.
Surgical Site Infection Rates following Cardiac Surgery: The impact of a 6-year infection control program
Am J Infect Control 2005;33:450-4
Finklestien and colleagues report on a prospective cohort study of patients undergoing cardiac operations to evaluate the
impact of an infection control program on surgical site infections (SSIs) complicating cardiac operations. Interventions included
prospective surveillance, povidone-iodine scrub showers, depilation before surgery, administration of preoperative antibiotic
prophylaxis in the operating room, and post discharge follow-up. When cardiac bypass graft surgery (CABGS) SSI rates were
stratified by NNIS risk index, the infection rate was 9.9 and 17.5 per 100 procedures for Risk Category 1 and 2 respectively.
Rates of superficial and deep incisional SSIs remained unchanged over the study period. The rates of all organ/space infections,
mediastinitis, reduced significantly.
The authors acknowledge the high rates when compared to NNIS, and suggest this may indicate either a failure of their program,
or the possibility that their program is more efficient at detecting SSIs.
Hospital-Acquired Pneumonia: A review of the risk factors for hospital-acquired pneumonia, diagnostic
testing, and treatment strategies
Medscape Pulmonary Medicine 9(2) 2005 available from: http://mp.medscape.com/cgi-bin1/DM/y/evSB0FY3w30D2Q0G4sq0ES
If you have been contributing to the ventilator-associated pneumonia (VAP) VICNISS dataset you may be interested in this
article that discusses the epidemiology of VAPs and guidelines for prevention including an algorithm that demonstrates
risk factors, diagnostic testing and treatment strategies for management of VAP. The paper concludes that although
there is a high crude mortality rate often exceeding 50% and attributable mortality rates average half that figure,
there is still a number of modifiable factors that may prevent the development of hospital-acquired pneumonia, such
as semirecumbent positioning (particularly for patients being enterally fed), handwashing, and the minimisation of
invasive oropharyngeal devices such as endotracheal tubes and nasogastric tubes.
Genetic Relatedness of Staphylococcus Epidermidis from Infected Infants and Staff in the
Neonatal Intensive Care Unit (NICU)
For those of you who have a NICU and are undertaking surveillance for laboratory-confirmed bloodstream infections (LC-BSIs)
you may be interested in this article in AJIC 2005;33:341-7 that suggests that NICU infants often become colonised and infected
by the same bacterial strains that are isolated from nurses, and that normal hand hygiene alone may not be enough to prevent
the spread of bacteria from healthcare workers to infants or between different infants.