Impact of intensified prevention measures on rates of hospital-acquired bloodstream infection in medical-surgical intensive care units, Israel, 2011 to 2019

Ben-David, Debby; Vaturi, Azza; Wulffhart, Liat; Temkin, Elizabeth; Solter, Ester; Carmeli, Yehuda; Schwaber, Mitchell J; ,

doi:10.2807/1560-7917.es.2023.28.25.2200688

Cited by 3 publications

(1 citation statement)

References 25 publications

(26 reference statements)

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“…In 2012, national guidelines for preventing central line–associated bloodstream infections (CLABSI) were disseminated throughout the hospital. Additionally, mandatory national surveillance for health care–associated BSI and CLABSI was initiated in the general and surgical ICUs, with biannual feedback on infection rates [ 11 ]. Between 2012 and 2019, CLABSI cases per 1000 line-days decreased from 7.5 to 2.6 in the general ICU and from 10.0 to 3.6 in the surgical ICU [ 12 ].…”

Section: Methodsmentioning

confidence: 99%

Tailoring Interventions for Control of Endemic Carbapenem-Resistant Acinetobacter baumannii: An Interrupted Time Series Analysis

Schechner,

Cohen,

Carmeli

2024

Open Forum Infectious Diseases

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Background We examined temporal trends in carbapenem-resistant Acinetobacter baumannii (CRAB) infections in one hospital with hyperendemic CRAB, and assessed the efficacy of varied infection control strategies in different ward types. Methods We retrospectively analyzed all CRAB clinical samples from 2006 to 2019, and categorized infections as hospital-onset (HO) or community-onset. We used interrupted time series analysis to assess the impact of interventions on the incidence of all HO-CRAB infections and bloodstream infections (BSI) at the hospital and ward-group levels. Results Over 14 years, 4,009 CRAB infections were identified (89.7% HO), with 813 CRAB BSI (93.2% HO). The incidence per 100,000 patient-days of CRAB infections peaked at 79.1 in 2008, and that of CRAB BSI peaked at 16.2 in 2010. These rates decreased by two-thirds by 2019. In the general ICU, hand hygiene and environmental cleaning interventions were followed by a significant reduction in the level of HO-CRAB infections, with an additional decrease in the slope after the introduction of active surveillance and 2% chlorhexidine bathing. In the surgical ICU and surgical department, a reduction in slope or level of CRAB infection was observed after moving ventilated patients to single rooms. In medical wards, a multi-modal intervention was followed by a reduction in the slope of HO-CRAB infections and BSI. In wards where CRAB infections were uncommon, the incidence of HO-CRAB infections decreased throughout the study period. Conclusion Ward-specific variables determine the success of interventions to reduce CRAB infections; therefore, interventions should be tailored to each setting.

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Section: Methodsmentioning

confidence: 99%

Tailoring Interventions for Control of Endemic Carbapenem-Resistant Acinetobacter baumannii: An Interrupted Time Series Analysis

Schechner,

Cohen,

Carmeli

2024

Open Forum Infectious Diseases

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Effect of Infusion Set Replacement Intervals on Central Line-Associated Bloodstream Infection in the Intensive Care Unit: Study Protocol of the INSPIRATION Study

Xu,

Hu,

Xiong

et al. 2024

Infect Dis Ther

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Introduction The replacement intervals for infusion sets may differ among healthcare institutions, which may have an impact on the occurrence of central line-associated bloodstream infections (CLABSI). Nevertheless, there exists a limited amount of high-quality evidence available to assist clinicians in determining the most suitable replacement intervals for infusion sets. Therefore, the objective of this trial is to compare the efficacy of 24-h and 96-h replacement intervals for infusion sets on CLABSI among critically ill adults who have central venous access devices. Methods This is a multicenter, parallel-group randomized controlled trial that will investigate the effect of infusion set replacement intervals on CLABSI in adult patients admitted to intensive care units (ICUs). The study will enroll 1240 participants who meet the inclusion criteria, which includes being 18 years or older, expected to stay in the ICU for longer than 96 h, and in need of central venous access. Participants will be randomly assigned to either a control group receiving a 96-h replacement interval or a treatment group receiving a 24-h replacement interval. Planned Outcome The primary outcome of this trial is the rate of CLABSI within 28 days after randomization. Conclusion This is the first randomized controlled trial to investigate the effects of infusion set replacement at 24-h and 96-h intervals on CLABSI in ICU patients. Trial Registration ClinicalTrials.gov identifier, NCT05359601. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-024-00953-y.

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The Natural History of Carbapenemase-Producing Enterobacterales: Progression From Carriage of Various Carbapenemases to Bloodstream Infection

Temkin,

Solter,

Lugassy

et al. 2024

Clinical Infectious Diseases

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Background Little is known about the risk of progression from carbapenemase-producing Enterobacterales (CPE) carriage to CPE bloodstream infection (BSI) outside of high-risk settings. We aimed to determine the incidence of CPE BSI among CPE carriers and to assess whether the incidence differed by carbapenemase, species, and setting. Methods We conducted a nationwide population-based retrospective cohort study using national databases. The cohort consisted of all patients in Israel with CPE detected by screening from 1/1/2020 to 10/10/2022. We calculated the cumulative incidence of CPE BSI within 1 year among CPE carriers. We used a competing-risks model with BSI as the outcome and death as the competing risk. Results The study included 6,828 CPE carriers. The cumulative incidence of CPE BSI was 2.4% (95% CI: 2.1%-2.8%). Compared to KPC, the subhazard of BSI was lower for NDM (aSHR: 0.72, 95% CI: 0.49-1.05) and OXA-48-like (aSHR: 0.60, 95% CI: 0.32-1.12) but these differences did not reach statistical significance. Compared to K. pneumoniae, the subhazard of BSI was lower for carriers of carbapenemase-producing E. coli (aSHR: 0.31, 95% CI: 0.20-0.47). The subhazard of BSI was higher among patients with CPE carriage first detected in intensive care units (aSHR: 2.42, 95% CI: 1.50-3.92) or oncology/hematology wards (aSHR: 3.77, 95% CI: 2.40-5.93) compared to medical wards. Conclusions The risk of CPE BSI among CPE carriers is lower than previously reported in studies that focused on high-risk patients and settings. The risk of BSI differs significantly by bacterial species and setting, but not by carbapenemase.

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Impact of intensified prevention measures on rates of hospital-acquired bloodstream infection in medical-surgical intensive care units, Israel, 2011 to 2019

Cited by 3 publications

References 25 publications

Tailoring Interventions for Control of Endemic Carbapenem-Resistant Acinetobacter baumannii: An Interrupted Time Series Analysis

Tailoring Interventions for Control of Endemic Carbapenem-Resistant Acinetobacter baumannii: An Interrupted Time Series Analysis

Effect of Infusion Set Replacement Intervals on Central Line-Associated Bloodstream Infection in the Intensive Care Unit: Study Protocol of the INSPIRATION Study

The Natural History of Carbapenemase-Producing Enterobacterales: Progression From Carriage of Various Carbapenemases to Bloodstream Infection

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