Patrick Chaftari1, Anne-Marie Chaftari2, Javier Adachi3, Ray Hachem3, Sammy Raad3, Elizabeth Natividad4, Nora Oliver3, Bena Ellickalputhenpura3, Ying Jiang3, Jeffrey Tarrand5, Issam Raad3. 1. Department of Emergency Medicine, University of Texas MD Anderson Cancer Center, Houston, TX. 2. Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: achaftar@mdanderson.org. 3. Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX. 4. Department of Infusion Therapy, University of Texas MD Anderson Cancer Center, Houston, TX. 5. Laboratory Medicine Administration, University of Texas MD Anderson Cancer Center, Houston, TX.
Abstract
BACKGROUND: Identifying a central venous catheter (CVC) as the source of bacteremia requires drawing simultaneous blood cultures (BCs) from the CVC and peripheral site and correct labeling of the BC source. In our emergency center (EC), 52% of BCs collected from febrile cancer patients lacked source information, making the diagnosis and management of catheter-related bloodstream infections (CRBSIs) challenging. METHODS: Between January 2015 and June 2015, we conducted a quality improvement project in our EC aiming to increase the occurrence of simultaneous BC drawing with accurate source labeling by 10%. RESULTS: Staff education and monitoring increased average BC source labeling from a baseline of 48% to a much better rate of 70%. Label introduction led to increased source labeling to 94% by June 2015. This project had a significant influence in patients with a CVC and a positive BC because the physician is now able to determine whether the CVC is the source of the bacteremia in 88% of cases compared with 36% at baseline (P = .0003). CONCLUSIONS: Education without an active intervention is usually not enough. Simple solutions such as label introduction can have significant influence on patient safety and care. Accurate diagnosis may guide clinicians at the bedside to appropriately manage CVCs in the setting of bacteremia, remove a CVC when indicated, and prevent unnecessary CVC removal with its potential safety and cost-effectiveness implications.
BACKGROUND: Identifying a central venous catheter (CVC) as the source of bacteremia requires drawing simultaneous blood cultures (BCs) from the CVC and peripheral site and correct labeling of the BC source. In our emergency center (EC), 52% of BCs collected from febrile cancerpatients lacked source information, making the diagnosis and management of catheter-related bloodstream infections (CRBSIs) challenging. METHODS: Between January 2015 and June 2015, we conducted a quality improvement project in our EC aiming to increase the occurrence of simultaneous BC drawing with accurate source labeling by 10%. RESULTS: Staff education and monitoring increased average BC source labeling from a baseline of 48% to a much better rate of 70%. Label introduction led to increased source labeling to 94% by June 2015. This project had a significant influence in patients with a CVC and a positive BC because the physician is now able to determine whether the CVC is the source of the bacteremia in 88% of cases compared with 36% at baseline (P = .0003). CONCLUSIONS: Education without an active intervention is usually not enough. Simple solutions such as label introduction can have significant influence on patient safety and care. Accurate diagnosis may guide clinicians at the bedside to appropriately manage CVCs in the setting of bacteremia, remove a CVC when indicated, and prevent unnecessary CVC removal with its potential safety and cost-effectiveness implications.
Authors: Boris Böll; Enrico Schalk; Dieter Buchheidt; Justin Hasenkamp; Michael Kiehl; Til Ramon Kiderlen; Matthias Kochanek; Michael Koldehoff; Philippe Kostrewa; Annika Y Claßen; Sibylle C Mellinghoff; Bernd Metzner; Olaf Penack; Markus Ruhnke; Maria J G T Vehreschild; Florian Weissinger; Hans-Heinrich Wolf; Meinolf Karthaus; Marcus Hentrich Journal: Ann Hematol Date: 2020-09-30 Impact factor: 3.673
Authors: Colum P Dunne; Phelim Ryan; Roisin Connolly; Suzanne S Dunne; Mohammed A Kaballo; James Powell; Bernie Woulfe; Nuala H O'Connell; Rajnish K Gupta Journal: Infect Prev Pract Date: 2020-02-01