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

La Martinique – French West Indies

great island A teaching hospitalA carribbean E.C.M.O. center

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

High cost – ineffectiveness of catheter-related bloodstream infections

[Blot. CID. 2005]

spontaneous generation could not occur”

Louis Pasteur - 1857

Epidemiology of CRBI01-02-03/ 2013

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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

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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

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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]

Selection of catheterisation site

Maintain aseptic technique for the insertion

Note skin aspect

Education, Training and Staffing

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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

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taux incidence PAVM

taux incidence BLC

taux incidence IU

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Programme surveillance et prévention des IN Réanima tion polyvalente

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Better practices, better results !

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