Many people in hospitals die every year from catheter infections.
Improving catheter-related infections in the I.C.U. · Improving catheter-related infections in the...
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Transcript of Improving catheter-related infections in the I.C.U. · Improving catheter-related infections in the...
Improving catheter-related infections in the I.C.U.A FRENCH WEST INDIES EXPERIENCE
Dr. Benoît Rozé
Tropical and infectious diseases unit
Intensive care unit
https://upload.wikimedia.org/wikipedia/commons/thumb/a/af/CaribbeanIslands.png/790px-CaribbeanIslands.png
An incredible rate of catheter-related infections
� French national
surveillance system � Data from Martinique
[Pronovost. NEJM 2006]
2012 – French National Surveillance onCatheter-related bloodstream infection in ICU.
Réa CHU FDF = 4,05
Epidemiology of CRBI01-02-03/ 2013
0
2
4
6
8
10
12
14
Germes
Kp BLSE
Pseudomonas aeruginosa
Staphylococcus spp
SAMS
Acinetobacter baumani S
Candida
Proteus mirabilis
Kp sauvage
Enterococcus faecalis
ABRI
Pseudomonas totoR
Evolution de l'indicateur ICSHA
117,6
137,9
106,6
74,4
104,6
94,4
127,5
107,9
89,4
74,9
89,1
60,8
0,0
100,0
200,0
Janvier Février Mars Avril Mai Juin Juillet Août Septembre Octobre Novembre Décembre
CHU de fort de France
OBJECTIFà atteindre:
≥150%
SERVICE: RéanimationAnnée 2012
Réanimation
Classe A
Classe B
Classe C
Classe D
Classe
E
Anatomical sites of infected catheter
J2 J3 J4 J5 J6 J7 J8 J9
J10
J11
J12
J13
J14
J15
J16
J17
J18
J19
J20
Sous clavier
Jugulaire interne
Fémoral
� Weigh the risks and benefits of placing a central venous device (IA)
� Avoid using the femoral vein for central veinous access (IA)
� Evaluate the catheter insertion daily (II)
� Promptly remove any catheter that is no longer essential (IA)
� Replace the catheter within 48h when adherence to aseptic technique is not ensured (IB)
� Perform hand hygiene procedures
� Periodically assess knowledge of and adherence to guidelines for all personnel involved (IA)
In fact : the central-catheter protocol
� Weigh the risks and benefits : only 4 possibilities
� Prevent chemical irritation of the tissues (Thiopental, vancomycine)
� Catecholamine administration
� Prolonged parenteral nutrition
� Difficult peripheral intravenous access
� Selection of catheterisation site
� Maintain aseptic technique for the insertion and care of intravascularcatheters (IB)
� Replace femoral catheter within 48h
� Note skin aspect on clinical data sheet TID
� 4% chlorexidine bathing, once daily [Bleasdale. Arch Intern Med 2007]
Education, Training and Staffing
40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18oc
t-12
nov-
12
déc-
12
janv
-13
févr
-13
mar
s-13
avr-
13
mai
-13
Immersion IDE/ test outils/bactériot0 (observance/incidences) t0Formations paramédicale/médicaleSurveillance/prévention
R t0 R t1 R t2 R t3Bilan à 3 mois
%observance mesures prévention %observance mesures prévention
incidence/acquisitions BLSE incidence/acquisitions BLSE
conso AB conso AB
conso SHA conso SHA
taux incidence PAVM (t0 et REA RAISIN) %observance mesures prévention
taux incidence BLC (t0 et REA RAISIN) incidence/acquisitions BLSE
taux incidence IU (t0 et REA RAISIN) conso AB
conso SHA
%observance mesures prévention
incidence/acquisitions BLSE
conso AB
conso SHA
taux incidence PAVM
taux incidence BLC
taux incidence IU
t3
Programme surveillance et prévention des IN Réanima tion polyvalente
t1 t2Formation
Take home messages
� catheter-related bloodstream infections are expensive, prevalent
� intervention to reduce these infections is simple and inexpensive
� Coincident with our intervention, the median rate of infection decreased from 4.3 per 1000 catheter-days at baseline to 1.1 after the implementation of the intervention.
� sustainability of this benefit have to be evaluated
� this intervention could significantly reduce morbidity and the costs of care associated with catheter-related bloodstream infections