RESUMEN
Information on the impact of care bundles has been mainly acquired in adult intensive care units (ICUs). However, specific data for educational programs are scarce. Our objective was to analyze the impact of an educational program on the knowledge and prevention of catheter-related bloodstream infection (CRBSI) in two pediatric intensive care units (P-ICUs). A prospective study was carried out at a large teaching institution in Madrid, Spain. Healthcare workers' (HCWs) knowledge of guidelines for the prevention of CRBSI was assessed before and after the educational program using a questionnaire covering 12 issues. A 20-min program was offered to all HCWs on each ICU shift. The incidence density of CRBSI was assessed before, during, and after the educational program. A total of 174 questionnaires were completed by HCWs from both the neonatal ICU (N-ICU) and the P-ICU before the intervention and 54 were completed after the intervention (120 participants were not present during this period). The incidence density of CRBSI before, during, and after the intervention was 6.2, 5.2, and 9.3 in the N-ICU and 2.2, 3.1, and 2.9 in the P-ICU (p > 0.05). A single 20-min educational intervention on the prevention of CRBSI significantly improved HCWs' knowledge, but was not enough to reduce the incidence density of CRBSI.
Asunto(s)
Infecciones Relacionadas con Catéteres/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/educación , Unidades de Cuidado Intensivo Pediátrico/normas , Cuidado Intensivo Neonatal/normas , Bacterias/aislamiento & purificación , Bacterias/patogenicidad , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/prevención & control , Infecciones Relacionadas con Catéteres/sangre , Cateterismo Venoso Central/efectos adversos , Preescolar , Femenino , Hospitales de Enseñanza/métodos , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Guías de Práctica Clínica como Asunto , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , Factores de Riesgo , España , Estadísticas no Paramétricas , Encuestas y CuestionariosRESUMEN
In order to assess the value of vascular catheter tip culture in patients with negative blood cultures, all tip samples from hospitalised patients were prospectively randomised (1:1) to two different routines for processing catheters: culture of all tips (routine A) vs culture only of tips from patients with concomitant bacteraemia or fungaemia (routine B). Over a nine-month period, 426 catheters from 318 patients were randomly assigned to routine A and 429 catheters from 322 patients to routine B (n=40 [corrected] patients). We compared the outcome and costs from both groups. No statistically significant differences were found with respect to demographic data, mortality, hospital stay or antimicrobial use. In non-bacteraemic/fungaemic cases (N=517), days on antimicrobial therapy after catheter withdrawal were significantly higher in patients from group A [10.0 days (interquartile range, IQR): 6.0-14.0] vs 8.0 days (IQR: 4.7-12.2), P=0.03], as was the number of daily defined doses (DDDs) of antimicrobials [10.8 DDDs (IQR: 2.4-26.9) vs 7.5 DDDs (IQR: 1.5-20.0), P=0.03]. Median antimicrobial cost per treated patient was significantly higher in group A: 222.30 (IQR: 20.30-1,030.60) vs 109.10 (IQR: 10.90-653.20), P=0.05. If all vascular catheter tips were processed according to routine B, the microbiology laboratory workload would decrease by 77% for the total number of catheters processed. Microbiology laboratories should not routinely culture catheter tips in patients without bacteraemia or fungaemia.
Asunto(s)
Antibacterianos/uso terapéutico , Catéteres/microbiología , Infección Hospitalaria/prevención & control , Control de Infecciones/métodos , Técnicas Microbiológicas/métodos , Carga de Trabajo/estadística & datos numéricos , Adolescente , Adulto , Anciano , Antibacterianos/economía , Niño , Preescolar , Infección Hospitalaria/economía , Femenino , Humanos , Lactante , Control de Infecciones/economía , Masculino , Técnicas Microbiológicas/economía , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
Tsukamurellae are strictly aerobic Gram-positive rods that can be easily misidentified as Corynebacterium species, Rhodococcus species, Nocardia species, Mycobacterium species, or other Gram-positive aerobic rods. They have been uncommonly reported as a cause of different human infections, including bloodstream infections. We describe 2 new cases of catheter-related bloodstream infections (CR-BSI) caused by Tsukamurella species and review 12 similar cases reported in the literature. Conventional procedures have often misidentified Tsukamurella species as other aerobic Gram-positive rods. This misidentification could be avoided using genotyping. All cases ultimately required the withdrawal of the infected line. The literature provides no firm conclusions regarding ideal choice or duration of antimicrobial therapy for this infection. Tsukamurella species should be added to the list of agents able to produce CR-BSI. Genotypic methods such as PCR 16S rRNA can allow a reliable identification at the genus level of Tsukamurella strains faster than a combination of conventional phenotypic methods.