TY - JOUR
T1 - Improvement in the diagnosis of catheter-related bloodstream infections in a tertiary cancer center
AU - Chaftari, Patrick
AU - Chaftari, Anne Marie
AU - Adachi, Javier
AU - Hachem, Ray
AU - Raad, Sammy
AU - Natividad, Elizabeth
AU - Oliver, Nora
AU - Ellickalputhenpura, Bena
AU - Jiang, Ying
AU - Tarrand, Jeffrey
AU - Raad, Issam
N1 - Publisher Copyright:
© 2017
PY - 2017/3/1
Y1 - 2017/3/1
N2 - 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.
AB - 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.
KW - Blood cultures
KW - Cancer patients
KW - Central venous catheter
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U2 - 10.1016/j.ajic.2016.12.009
DO - 10.1016/j.ajic.2016.12.009
M3 - Article
C2 - 28254252
AN - SCOPUS:85014103757
SN - 0196-6553
VL - 45
SP - e34-e39
JO - American Journal of Infection Control
JF - American Journal of Infection Control
IS - 3
ER -