What are the CLABSI risk factors in an adult intensive care unit?

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To evaluate the incidence, risk factors and associated mortality of central line-associated bloodstream infection (CLABSI) in an adult intensive care unit (ICU) in India” Mishra et al (2016).

Abstract:

OBJECTIVE: To evaluate the incidence, risk factors and associated mortality of central line-associated bloodstream infection (CLABSI) in an adult intensive care unit (ICU) in India.

DESIGN: This prospective observational study was conducted over a period of 16 months at a tertiary care referral medical center.

SETTING: We conducted this study over a period of 16 months at a tertiary care referral medical center.

PARTICIPANTS: All patients with a central venous catheter (CVC) for >48 h admitted to the ICU were enrolled.

INTERVENTION AND MAIN OUTCOME MEASURES: Patient characteristics included were underlying disease, sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation (APACHE II) scores and outcome. Statistical analysis of risk factors for their association with mortality was also done.

RESULTS: There were 3235 inpatient-days and 2698 catheter-days. About 46 cases of CLABSI were diagnosed during the study period. The overall rate of CLABSI was 17.04 per 1000 catheter-days and 14.21 per 1000 inpatient-days. The median duration of hospitalization was 23.5 days while the median number of days that a CVC was in place was 17.5. The median APACHE II and SOFA scores were 17 and 10, respectively. Klebsiella pneumoniae was the most common organism (n = 22/55, 40%). Immunosuppressed state and duration of central line more than 10 days were significant factors for developing CLABSI. SOFA and APACHE II scores showed a tendency towards significance for mortality.

CONCLUSIONS: Our results underscore the need for strict institutional infection control measures. Regular training module for doctors and nurses for catheter insertion and maintenance with a checklist on nurses’ chart for site inspection and alerts in all shifts are some measures planned at our center.

Reference:

Mishra, S.B., Misra, R., Azim, A., Baronia, A.K., Prasad, K.N., Dhole, T.N., Gurjar, M., Singh, R.K. and Poddar, B. (2016) Incidence, risk factors and associated mortality of central line-associated bloodstream infections at an intensive care unit in northern India. International Journal for Quality in Health Care. December 8th. [Epub ahead of print].

DOI: 10.1093/intqhc/mzw144

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