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Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Background: Hospital acquired catheter related blood stream infection (HA-CRBSI) data are available for adult and pediatric intensive care unit (ICU) patients. Scant data demonstrate that rates of HA-CRBSI in adult patients outside the ICU are similar. No data are available regarding the incidence of HA-CRBSI in pediatric patients outside the ICU.
Objective: Determine the incidence and epidemiology of HA-BSI in pediatric patients outside the ICU.
Methods: Children’sMemorial Hermann Hospital has a 96 bed general pediatric unit. BSI surveillance occurred in the unit from 4/08-10/09. National Healthcare Safety Network definitions were used to identify HA-CRBSI. All patients with a central venous catheter (CVC) were monitored for development of HA-CRBSI. From 5/09-10/09, line day data was available and HA-CRBSI rates were calculated for this time period. Characteristics of infected patients and organisms causing infection were abstracted.
Results: 26 HA-CRBSI were identified in 19 patients. The mean HA-CRBSI rate was 5/1000 line days with a monthly range of 2.1-6.8 per 1,000 line days. 17 patients had one HA-CRBSI each; 1 patient had 6 HA-CRBSI over several hospitalizations and 1 patient had 3 infections. 3/26 HA-CRBSIs were polymicrobial. The organisms isolated included gram negative rods (11), Candida species (6), coagulase negative Staphylococcus (3), Staphylococcus aureus (3) and other gram positive organisms (3). The mean time to bloodstream infection from line insertion was 14.2 days, (range: 1–55 days). Then mean age of patients with CRBSI was 29 months, (range: 2 – 173 months). 68% (13/19) of infected patients were male. Mean hospital length of stay was 51.5 days, (range: 6 – 115 days). 85% (22/26) of the CVCs were necessary for chronic access; with the primary use for parenteral nutrition. 61.5% (16/26) of the infections occurred in Hickman-Broviac catheters (Internal Jugular = 3, Chest = 3, Femoral = 4, Subclavian = 6). 15.4% (4/26) of the infections occurred in port-a-cath systems placed in the chest and 23.1% (6/26) occurred in percutaneous central venous lines (PCVL) placed in the extremities. 69% (18/26) of the CVCs were pulled as a result of the infection. The underlying diagnoses of patients with HA-CRBSI were: short gut (5), immune deficiency (3), congenital disorder (3), cardiac anomalies (2), organ transplant (2), and other (1 meningitis, 1 trauma, 1 second degree burn, and 1 chronic lung disease).
Conclusions: HA-CRBSI occur in pediatric patients outside the ICU at rates similar to pediatric ICU patients. The majority of pediatric patients outside the ICU who develop a HA-CRBSI have chronic underlying illness and are dependent on chronic central venous access. Interventions known to decrease CRBSI such as CVC maintenance bundles should be expanded to pediatric patients outside the ICU.
Objective: Determine the incidence and epidemiology of HA-BSI in pediatric patients outside the ICU.
Methods: Children’s
Results: 26 HA-CRBSI were identified in 19 patients. The mean HA-CRBSI rate was 5/1000 line days with a monthly range of 2.1-6.8 per 1,000 line days. 17 patients had one HA-CRBSI each; 1 patient had 6 HA-CRBSI over several hospitalizations and 1 patient had 3 infections. 3/26 HA-CRBSIs were polymicrobial. The organisms isolated included gram negative rods (11), Candida species (6), coagulase negative Staphylococcus (3), Staphylococcus aureus (3) and other gram positive organisms (3). The mean time to bloodstream infection from line insertion was 14.2 days, (range: 1–55 days). Then mean age of patients with CRBSI was 29 months, (range: 2 – 173 months). 68% (13/19) of infected patients were male. Mean hospital length of stay was 51.5 days, (range: 6 – 115 days). 85% (22/26) of the CVCs were necessary for chronic access; with the primary use for parenteral nutrition. 61.5% (16/26) of the infections occurred in Hickman-Broviac catheters (Internal Jugular = 3, Chest = 3, Femoral = 4, Subclavian = 6). 15.4% (4/26) of the infections occurred in port-a-cath systems placed in the chest and 23.1% (6/26) occurred in percutaneous central venous lines (PCVL) placed in the extremities. 69% (18/26) of the CVCs were pulled as a result of the infection. The underlying diagnoses of patients with HA-CRBSI were: short gut (5), immune deficiency (3), congenital disorder (3), cardiac anomalies (2), organ transplant (2), and other (1 meningitis, 1 trauma, 1 second degree burn, and 1 chronic lung disease).
Conclusions: HA-CRBSI occur in pediatric patients outside the ICU at rates similar to pediatric ICU patients. The majority of pediatric patients outside the ICU who develop a HA-CRBSI have chronic underlying illness and are dependent on chronic central venous access. Interventions known to decrease CRBSI such as CVC maintenance bundles should be expanded to pediatric patients outside the ICU.