Download Improvement in the Diagnosis of Patients With Central Line

1048. Improvement in the Diagnosis of Patients With Central Line-Related
Bloodstream Infections by Proper Blood Culture Drawing and Labeling in
an Emergency Center
Anne-Marie Chaftari, MD1; Patrick Chaftari, MD2; Javier Adachi, MD, FIDSA3;
Ray Hachem, MD, FIDSA4; Sammy Raad, MS5; Elizabeth Natividad, BSN6;
Nora Oliver, BA7; Bena Elickalputhenpura, BA2; Jeffrey Tarrand, MD8; Issam Raad,
MD, FIDSA, FSHEA5; 1Infectious Diseases, Infection Control and Employee Health,
University of Texas MD Anderson Cancer Center, Infectious Diseases, Infection
Control and Employee Health, Houston, Texas; 2University of Texas MD Anderson
Cancer Center, Houston, Texas; 3Department of Infectious Diseases, Infection Control
and Employee Health, The University of Texas-MD Anderson Cancer Center,
Houston, Texas; 4University of Texas, MD Anderson Cancer Center, Houston, Texas;
5
Infectious Diseases, Infection Control and Employee Health, University of Texas MD
Anderson Cancer Center, Houston, Texas; 6Infusion Therapy, University of Texas MD
Anderson Cancer Center, Houston, Texas; 7MD Anderson Cancer Center, Houston,
Texas; 8Laboratory Medicine, University of Texas MD Anderson Cancer Center,
Houston, Texas
Session: 135. Clinical Infectious Diseases: Bacteremia and Endocarditis
Friday, October 28, 2016: 12:30 PM
Background. Accurately identifying the central venous catheter (CVC) as the
source of bacteremia requires drawing simultaneous blood cultures (BC) from CVC
and peripheral site and correct labeling of the source of the BC. In a busy emergency
center (EC), 52% of BC collected from febrile cancer patients lacked the documented
source information making the diagnosis and management of catheter-related bloodstream infections (CRBSI) challenging. We aimed to improve the diagnosis of CRBSI
in our febrile cancer patients who present to our EC.
Figure 2. Xbar chart of portion with source information by stage.
Methods. Between January 2015 and June 2015, we conducted a clinical safety and
effectiveness project aiming to increase the occurrence of simultaneous BC drawing
(one from the CVC and one from the peripheral site) with accurate labeling of site
in the EC department by 10%. We measured the number of BC draws with proper labeling compared to the number of EC patients requiring BC, and the number of simultaneous BC draws with proper labeling compared to the number of EC patients with
CVC requiring BC. We also evaluated the impact on the patients with positive blood
cultures.
Results. Staff education along with monitoring increased average percentage BC
source labeling from 48% to 70%. Implementation of a new label (Figure 1) along
with healthcare staff education led to an increase in source labeling to 94% by end
of June 2015, and this was sustained when reassessed in September 2015 (Figure 2).
This project had a significant impact in patients with CVC and positive BC where
the physician is now able to determine if the CVC is the source of the bacteremia in
62% of the cases compared to 22% at baseline (P = 0.0006).
Conclusion. Education without an active intervention is usually not enough. Simple solutions such as label introduction can have significant impact to patient safety
and care. Physicians can determine now if the CVC is the source of 62% of the bacteremia. Accurate diagnosis may guide the clinician at the bedside to appropriately manage the CVC in the setting of bacteremia, removing CVC when indicated and
preventing unnecessary CVC removal with its potential safety and cost-effectiveness
implications.
Disclosures. I. Raad, Merck: Grant Investigator, Grant recipient. Pfizer: Speaker’s
Bureau, Speaker honorarium. Allergan: Grant Investigator, Grant recipient
Figure 1. Blood culture label indicating specimen source.
Poster Abstracts
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OFID 2016:1 (Suppl 1)
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S201
Q263