Background
Intervention studies to prevent catheter-related infections
Methods and Design
Objectives
Study design and setting
Appropriate use of catheters
Urinary catheter | Peripheral intravenous catheter | Central intravenous catheter |
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Acute urinary retention or bladder outlet obstruction (≥150 cc) | Delivery of peripherally compatible infusate (IV fluids and medications), at least once in 24 h | Delivery of non-peripherally compatible infusate (e.g., irritants or vesicants), regardless of proposed duration of use |
Accurate measurements of urinary output in critically ill patients required for treatment | Transfusion of blood and blood products | PICC : delivery of peripherally compatible infusate, with a duration of use which will likely confine ≥ 6 daysb
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Volume measurements of urine output aim for diagnostics (24 h urine), which cannot be assessed by other collection strategies | Injection of contrast fluids | Invasive hemodynamic monitoring or requirement to obtain central venous access in critically ill patients -Nontunneled CVC : duration of use will likely confine < 15 days -PICC : duration of use will likely confine ≥ 15 days |
Assist in healing of open sacral or perineal wounds in patients with urinary incontinence | Intravenous access for cardiac dysrhythmia | PICC : Delivery of cyclical or episodic chemotherapy that can be administered through a peripheral vein, provided that the proposed duration of such treatment is ≥3 months |
Continuous bladder irrigation for hematuria | PIVC : duration of use will likely confine ≤ 5 days | Frequent phlebotomy (every 8 h), provided that the proposed duration of such use is ≥6 days |
Patient requires prolonged immobilization | Midline : duration of use will likely confine ≤ 14 daysa
| PICC : Intermittent infusions or infrequent phlebotomy in patients with poor/difficult peripheral venous access, provided that the proposed duration of such use is ≥ 6 days |
Palliative care for terminally ill if needed | PICC: For infusions or palliative treatment during end-of-life care | |
Pre- or postoperative according (local) protocol | Tunneled catheter or port : preferred if proposed duration is ≥ 31 day |
Definition of catheter-related infections
Catheter-related infection | Definition |
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Healthcare-associated infection (HAI) | Infection where the date of event occurs on or after the 3rd calendar day of admission to an inpatient location, where calendar day 1 is the day of admission |
Laboratory-confirmed bloodstream infection (LCBI) | Criterion 1: Patient has a recognized pathogen identified from one or more blood specimens by a culture or non-culture based microbiologic testing method which is performed for purposes of clinical diagnosis or treatment AND organism(s) identified in blood is not related to an infection at another site Criterion 2: Patient has at least one of the following signs or symptoms: fever >38.0 °C, chills, or hypotension AND organism(s) identified from blood is not related to an infection at another site AND the same common commensal (i.e., diphtheroids [Corynebacterium spp. not C. diphtheriae], Bacillus spp. [not B. anthracis], Propionibacterium spp., coagulase-negative staphylococci [including S. epidermidis], viridans group streptococci, Aerococcus spp., and Micrococcus spp.) is identified from two or more blood specimens drawn on separate occasions |
Central line | An intravascular catheter that terminates at or close to the heart or in one of the great vessels (aorta, pulmonary artery, superior vena cava, inferior vena cava, brachiocephalic veins, internal jugular veins, subclavian veins, external iliac veins, common iliac veins, femoral veins) which is used for infusion, withdrawal of blood, or hemodynamic monitoring |
Central line-associated BSI (CLABSI) | A LCBI where the central line was in place for >2 calendar days on the date of event, with day of device placement being Day 1, AND the central line was also in place on the date of event or the day before |
Arterial or venous infection (VASC) | It must meet at least one of the following criteria: 1. Patient has organisms from extracted arteries or veins identified by a culture or non-culture based microbiologic testing method which is performed for purposes of clinical diagnosis or treatment. 2. Patient has evidence of arterial or venous infection on gross anatomic or histopathologic exam. 3. Patient has at least one of the following signs or symptoms: fever (>38.0 °C), pain, erythema, or heat at involved vascular site AND more than 15 colonies cultured from intravascular cannula tip using semiquantitative culture method. 4. Patient has purulent drainage at involved vascular site. |
Urinary tract infection (UTI) | Patient has at least one of the following signs or symptoms: fever >38.0 °C, suprapubic tenderness, costovertebral angle pain or tenderness, urinary urgency, urinary frequency, dysuriaa AND urine culture with no more than two species of organisms identified, at least one of which is a bacterium of ≥105 CFU/ml |
Indwelling catheter (Foley catheter) | A drainage tube that is inserted into the urinary bladder through the urethra, is left in place, and is connected to a drainage bag. |
Catheter-associated UTI (CAUTI) | A UTI where an indwelling urinary catheter was in place for >2 calendar days on the date of event, with day of device placement being Day 1, AND an indwelling urinary catheter was in place on the date of event or the day before |
Catheter-related infection | Definition |
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Probable laboratory-confirmed bloodstream infection (LCBI) | Patient has at least one of the following signs or symptoms: fever >38.0 °C, chills, or hypotension AND organism(s) identified from (peripheral) blood or catheter segment is not related to an infection at another site AND defervescence within 48 h of catheter removal or initiation of appropriate antibiotic therapy |
Probable central line-associated BSI (CLABSI) | A probable LCBI where the central line was in place for >2 calendar days on the date of event, with day of device placement being Day 1, AND the central line was also in place on the date of event or the day before |
Phlebitis | Local pain, warmth, tenderness, erythema, and a palpable cord along the vein OR by positive sonographic examination in conjunction with erythema and edema of the extremity |
Probable urinary tract infection (UTI) | Patient has at least two of the following signs or symptoms: fever >38.0 °C, suprapubic tenderness, costovertebral angle pain or tenderness, urinary urgency, urinary frequency, dysuriaa AND positive nitrite or leukocyte esterase dipstick test OR pyuria (>10 leukocytes/mm3) OR organism(s) seen in gram straining in not centrifuged urine OR two sequential urine culture (≥102 CFU/ml) with the same uropathogens (gram negative bacteria or S. saprophyticus) OR urine culture with one species of organism identified (≤105 CFU/ml) in a patient treated with appropriate antibiotic therapy OR the diagnose ‘urinary tract infection’ by doctor OR doctor starts appropriate antibiotic therapy |
Probable catheter-associated UTI (CAUTI) | A probable UTI where an indwelling urinary catheter was in place on the date of event or the 7 days before |
Patient selection
Primary and secondary endpoints
Assessments
De-implementation strategy
Interventions of de-implementation strategy |
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List of appropriate indications |
Local ‘champion’ |
Kick-off meeting, including competitive feedback report of baseline data |
Education meeting for healthcare workers |
Education materials (e.g., posters, pocket cards) |
Patient education materials |
Optional interventions based on baseline data and local conditions per hospital |