Catheter‐related blood stream infection (CRBSI) in TPN patients

Criona M. Walshe (Department of Intensive Care Medicine at the Mater Misericordiae University Hospital, Dublin, Ireland)
Kevin S. Boner (Department of Intensive Care Medicine at the Mater Misericordiae University Hospital, Dublin, Ireland)
Jane Bourke (Department of Intensive Care Medicine at the Mater Misericordiae University Hospital, Dublin, Ireland)
Rosemary Hone (Department of Clinical Microbiology at the Mater Misericordiae University Hospital, Dublin, Ireland)
Maureen Lynch (Department of Clinical Microbiology at the Mater Misericordiae University Hospital, Dublin, Ireland)
Liam Delaney (Geary Institute, University College Dublin, Ireland)
Dermot Phelan (Department of Intensive Care Medicine at the Mater Misericordiae University Hospital, Dublin, Ireland)

Clinical Governance: An International Journal

ISSN: 1477-7274

Publication date: 19 October 2010

Abstract

Purpose

Catheter related blood stream infection (CRBSI) remains an important complication of central venous catheters(CVCs). Educational programmes have been associated with CRBSI reduction but evidence in total parenteral nutrition (TPN) patients is limited, despite an increased risk of CRBSI. The effect of educational processes were evaluated and the value of different methods of expression of CRBSI incidence were assessed.

Design/methodology/approach

Study was performed in a 525‐bed tertiary university hospital over 12 years. A multidisciplinary TPN committee was created to examine CRBSI episodes and a parallel education programme was set up and maintained. Prospectively collected data were analysed from 1,392 patients in whom 2,565 CVCs were used over 15,397 CVC days. CRBSI incidence was expressed as CRBSI episodes per 1,000 CVC days, percentage patients or percentage CVCs infected.

Findings

CRBSI incidence fell from 33 to 7 episodes per 1,000 CVC days (p<0.01). Percentage of infected CVCs fell from 17 per cent to 5 per cent(p <0.05) and proportion of patients affected fell from 27 per cent to 7 per cent(p <0.01). The corresponding slopes of the lines expressing fall in CRBSI rate were −1.3‐0.63 and −1.4 respectively.

Research limitations/implications

A sustained educational programme was associated with a significant fall in CRBSI in TPN patients. An incidence of 5‐7 episodes per 1,000 CVC days, a figure comparable with non‐TPN CVCs, was achievable.

Practical implications

Each method of expression of CRBSI incidence proved valid in this setting and contributed to the educational programme.

Originality/value

The value of this study is that it demonstrates how implementing and sustaining an education programme can achieve reduced rates of infection. No published study utilising all methods of expressing CRBSI incidence could be found.

Keywords

Citation

Walshe, C., Boner, K., Bourke, J., Hone, R., Lynch, M., Delaney, L. and Phelan, D. (2010), "Catheter‐related blood stream infection (CRBSI) in TPN patients", Clinical Governance: An International Journal, Vol. 15 No. 4, pp. 292-301. https://doi.org/10.1108/14777271011084064

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Publisher

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Emerald Group Publishing Limited

Copyright © 2010, Emerald Group Publishing Limited

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