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PHC 231
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Introduction
A central line-associated bloodstream infection (CLABSI) is a serious infection that occurs when germs (usually bacteria or viruses) enter the bloodstream through the central line
1)Epidemiology
CLABSIs lead to prolonged hospital stays and increase health care costs and mortality. An estimated 250,000 bloodstream infections occur annually, and most are related to the presence of intravascular devices. In the United States, the CLABSI rate in intensive care units (ICU) is estimated to be 0.8 per 1000 central line days. International Nosocomial Infection Control Consortium (INICC) surveillance data from January 2010 through December 2015 (703 intensive care units in 50 countries) reported a CLABSI rate of 4.1 per 1000 central line days. Many central lines are found outside the ICUs. In one study, 55% of ICU patients and 24% of non-ICU patients had central lines. However, as more patients are located outside of the ICU, 70% of hospitalized patients with central venous catheters were outside the ICU. CLABSI rates outside ICUs are assumed to be similar tolike those within ICUs.[5].
Microbology
Organisms isolated from blood cultures among subjects with community-onset CLABSI or hospital-onset CLABSI were classified as Gram-positive bacteria, Gram-negative bacteria, or yeast.
Based on the National Healthcare Safety Network (NHSN) data from January 2006 to October 2007 the order of selected pathogens associated with causing CLABSI are as follows. Gram-positive organisms (staphylococci, 34.1%; enterococci, 16%; and Staphylococcus aureus, 9.9%) are the most common, followed by gram negatives (Klebsiella, 5.8%; Enterobacter, 3.9%; Pseudomonas, 3.1%; E.coli, 2.7%; Acinetobacter 2.2%), Candida species (11.8%).
Pseudomonas is commonly seen in association
with neutropenia, severe illness, or known prior colonization.
Candida is associated with the following risk
factors: femoral catheterization, TPN, prolonged administration of
broad-spectrum antibiotics, hematologic malignancy, or solid organ
or hematopoietic stem cell transplantation.
Certain bacteria such as staphylococci, Pseudomonas and
Candida produce extracellular polysaccharide [slime
(biofilm)] which favor increased virulence, adherence to catheter
surface and resistance to antimicrobial therapy
Describe Agent
Host factors
Host factors that increase the risk of CLABSI are chronic illnesses (hemodialysis, malignancy, gastrointestinal tract disorders, pulmonary hypertension), immune compromised states (bone marrow transplant, end-stage renal disease, diabetes mellitus), malnutrition, total parenteral nutrition (TPN), extremes of age, loss of skin integrity (burns), prolonged hospitalization before line insertion catheter type, catheter location (femoral line has the highest, followed by internal jugular, then subclavian), conditions of insertion (emergent versus elective, use of full barrier precautions versus limited), catheter site care, and skill of the catheter inserter.
Environmental Factors
An outbreak occurred at a Japanese Tertiary Care Center, was caused by 2 different clones of M. mucogenicum as well as M. canariasense. M. mucogenicum. The outbreak resulted from contaminated hospital equipment and contaminated tap water.
Another study Between July 2011 and April 2012, 16 RGM isolates were identified among 15 hematopoietic cell transplant patients, compared with none in the preceding year. After environmental samples were initially grown on media for heterotrophic counts and further speciated, RGM species were identified in the hospital water supply.
Also, Contaminated intravenous materials or hospital equipment may lead to CLABSI.
Spread of infection
There are many ways that contamination can occur of the central line and cause a central line-related infection. These include:
Central venous catheters disrupt the integrity of the skin, making infection with bacteria or fungi possible. A central line–associated bloodstream infection (CLABSI) may spread to the bloodstream and cause hemodynamic changes and organ dysfunction, possibly leading to death.
Prevention Guidelines During Insertion
Recent data reveal no difference in the infection rate based on the insertion catheter site. The following are some key components of a prevention program, abstracted from an extensive list provided by the CDC and IDSA.[8][9][6]
Prevention Guidelines During Maintenance
What can patients do to help prevent CLABSI?
4) Identify a population and develop a hypothesis about possible causes in a testable format with standard statistical notation (the null and the alternative)
5) Explain how you would choose controls to test this hypothesis?
a.) CLABI rate is 0.8 per 1000 central-line days, According to INICC the CLABI rates goes to 4.1 central-line days
Microbiological aspect-
Organism | Percentage Infection |
Staphylococcus aureus | 22.0 |
Coagulase-negative staphylococcus | 37.0 |
Yeasts | 9.3 |
Enteric Gram-negative bacilli | 12.4 |
Enterococci and streptococci | 4.9 |
Pseudomonas | 5.5 |
Other | 8.9 |
b.) Agent - Staphylococcus Aureus, Coagulase negative Staphylococcus,Yeast , Streptococci
Host- Chronic illness (malignancy, hemodialysis, gastrointestinal tract disorders), immune compromised states (bone marrow transplant, end-stage renal disease, diabetes mellitus), malnutrition, prolonged hospitalization before line insertion, catheter type, catheter size, catheter site care, etc.
Environment- Contamination of the insertion, the patient's skin flora, contamination of the components of IV sets, poor patient hygiene, impaired skin integrity, prolonged duration of the catheter, etc.
c.) The spread of the Infection occurs directly from central Catheter line to Heart and then it Can reach to any organ as the Heart Pumps Blood to all the Organs of Body and it can cause bacteremia and sepsis.
Prevention and Control of this Bacteremia is by Prophylactic and Empericial Microbial Therapy and Removal Of Catheter if the Infection persists is the Best Way out For Treatment.
Please Use your keyboard (Don't use handwriting) Thank you.. PHC 231 I need new and unique...
Please help Please write some comment of the post below The scholarly article that I chose is “Nosocomial infections in the ICU” by Stuart Edwardson and Chris Cairns. The article is about what are the major common infections that patients get during hospital staying period and the prevention methods. The major ones are ventilator-associated pneumonia (VAP), central line associated blood stream infection (CLABSI), urinary catheter related infection (CA-UTI), and surgical site infection. Due to all of these are invasive device...
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