Intraluminal infection of central venous catheters, used for long-term treatment, can result in central line-associated bloodstream infection (CLABSI). These infections can be challenging to prevent and treat due to formation of biofilms within catheter lumens, which shield bacteria from the human immune response and conventional antimicrobial therapies. Preventing bacterial colonization of catheter hubs is a strategy to prevent CLABSI. To address this, we developed a nonantibiotic, animal-ready electrochemical catheter hub (e-catheter hub), operated by a wearable, battery-powered micropotentiostat (MP), that internally generates tunable hypochlorous acid (HOCl) for preventing intraluminal infection. The design evaluated three different electrode materials-titanium, platinum, and gold-for HOCl generation and biocidal activity, using working and counter electrodes of the same materials and a silver/silver chloride-plated wire as a quasi-reference electrode. e-catheter hubs operated by MPs at 1.5 V_Ag/AgCl for 3 h generated HOCl, reducing Acinetobacter baumannii ATCC-17978 below the detection limit (average reduction of 4.40 ± 0.05 log₁₀ CFU/mL). The efficacy of e-catheter hubs operated by MPs in generating HOCl and achieving biocidal activity is comparable to that of a commercial potentiostat. This study represents the first step in developing a localized, nonantibiotic strategy to mitigate CLABSI risk.

Objective: To provide evidence of the cost savings of a quality improvement (QI) initiative preventing healthcare-associated infections (HAIs) in critical care settings.

Design: A micro-costing study focused on financial data related to a nationwide multicentric project preventing central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infection (CAUTI).

Setting: Brazilian public healthcare system.

Participants: Adult, paediatric and neonatal intensive care units (ICUs) participating in the QI initiative.

Intervention: This collaborative QI project implemented a multifaceted strategy to enhance infection-control measures. Participating ICUs reported the number of patients with and without HAIs and information on each HAI's aggregate average cost (AC), which was analysed following the Brazilian Ministry of Health's micro-costing guidelines. The 1-year preintervention period evidenced an aggregated AC in adult, paediatric and neonatal ICUs, respectively, of Intl$21 763.5 (95% CI 20 683.6 to 22 843.0), Intl$34 062.4 (95% CI 25 819.6 to 42 304.9) and Intl$32 903.2 (95% CI 29 203.6 to 36 602.4) for CLABSI; Intl$25 202.5 (95% CI 24 276.6 to 26 127.8), Intl$44 753.6 and Intl$17 238.4 for VAP and Intl$19 166.3 (95% CI 17 676.2 to 20 656.1) and Intl$55 873.3 (95% CI 43 563.1 to 68 183.1) for CAUTI (not included neonatal ICUs).

Primary outcome: The cost savings were estimated using the HAIs prevented-expenses avoided-during the QI intervention period from September 2021 to December 2023. The HAIs prevented were estimated using the difference between observed and predicted infections based on the aggregated preintervention baseline.

Results: Of the 188 participating ICUs, 31 voluntarily completed and provided the requested financial data with 100% accuracy. Considering the prevented 7342 HAIs for adult, paediatric and neonatal ICUs, respectively: 1647, 86 and 205 CLABSI; 3775, 114 and 118 VAP; and 1377 and 20 CAUTI, we estimated a saving of Intl$175.3 million (95% CI 153.2 to 180.9 million) to the Brazilian unified health system and a resultant estimated return on investment (ROI) of 890%.

Conclusion: This QI collaborative is a value-based initiative preventing HAIs in adult, paediatric and neonatal ICUs in South American settings. The substantial cost savings and a remarkable ROI underscore the economic viability of investing in comprehensive QI infection prevention strategies.

Objective: This study aimed to describe the rate of Healthcare-Associated Infections (HAIs) in hospitals in the last decade (2014-2023), Türkiye.

Materials and methods: The study was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statements. The keywords were "Türkiye", "healthcare-associated infections" (HAIs), "surgical site infections" (SSIs), "central line-catheter-associated bloodstream infections" (CLABSIs), "catheter-associated urinary tract infections" (CAUTI) and "ventilator-associated pneumonia" (VAP). We included all original articles reflecting the HAI rate of all adult patients in hospitals in Türkiye for at least one year of duration between January 01, 2014 and December 31, 2023.

Results: In total, 1171 reports, including the keywords, were retrieved, and duplications were removed. After filtering according to the title and abstract, eight original articles were selected. The quality of four reports published in peer-reviewed journals was rated as high, and the four as moderate. The rate of invasive device-associated HAIs in intensive care units (ICUs) was 4.19 (CLABSI: 1.97, CAUTI: 1.94, VAP: 6.49) and 1.88 in inpatient wards. No article was published that reflected the overall surgical site infection rate of a hospital.

Conclusion: We detected that in the last 10 years (2014-2023) in Türkiye, invasive device-associated HAI rates were 1.88% in inpatient wards and 4.19% in ICU. More comprehensive studies should be conducted on HAI rates, frequently detected HAI agents, and resistance rates. Health centers should prioritize the issue, and intervention and prevention studies should be priority research topics.

Introduction: Healthcare-associated infections (HAIs) pose a significant concern for patient safety, impacting one in 31 hospitalized patients in the United States. Traditional infection prevention strategies emphasize clinical and procedural factors. However, emerging evidence highlights the critical role of social determinants of health (SDOH). Factors such as race, ethnicity, socioeconomic status, insurance coverage, language barriers, disability, and other social disadvantages contribute to HAI disparities. Despite this increasing recognition, limited research has systematically examined these relationships. In response, the Association for Professionals in Infection Prevention and Epidemiology (APIC) established a Health Equity Committee to evaluate the impact of SDOH on HAIs and advance meaningful action.

Methods: A literature review was conducted to synthesize findings on the intersection of HAIs and SDOH. A comprehensive search strategy identified 16 relevant studies published between January 2014 and March 2024, focusing on catheter-associated urinary tract infections (CAUTI), central line-associated bloodstream infections (CLABSI), Clostridioides difficile infections (CDI), and surgical site infections (SSI).

Results: The findings revealed significant disparities in infection rates, readmission risks, and access to preventive measures. Black, Hispanic, and Asian patients experienced higher CLABSI and CAUTI rates, particularly in pediatric populations. CDI disproportionately affected individuals from disadvantaged neighborhoods and those insured through Medicare and Medicaid. SSI risks were higher among racial and ethnic minorities, especially in underserved areas with limited healthcare access. Additionally, hospitals serving socially vulnerable populations reported worse standardized infection ratios (SIRs) for HAIs yet were not consistently recognized in reimbursement penalties, highlighting systemic challenges in quality measurement.

Conclusion: To reduce HAI disparities, healthcare systems must adopt multifaceted approaches that include enhanced data collection, health equity-focused infection prevention strategies, and policy reforms that address SDOH-driven risks. Prioritizing longitudinal studies and systematic analyses will be essential in advancing equitable healthcare and improving patient outcomes across diverse populations.

Objectives: To evaluate the impact of a mobile-app-based central line-associated bloodstream infection (CLABSI) prevention program in oncology clinic patients with peripherally inserted central catheters (PICCs).

Design: Pre-post prospective cohort study with baseline (July 2015-December 2016), phase-in (January 2017-April 2017), and intervention (May 2017-November 2018). Generalized linear mixed models compared intervention with baseline frequency of localized inflammation/infection and dressing peeling. Cox proportional hazards models compared days-to-removal of lines with localized inflammation/infection. Chi-square test compared bacteremia rates before and after intervention.

Setting: Oncology clinic at a large medical center.

Patients: Oncology clinic adult patients with PICCs.

Intervention: CLABSI prevention program consisting of an actionable scoring system for identifying insertion site infection/inflammation coupled with a mobile-app enabling photo-assessments and automated physician alerting for remote response.

Results: We completed 5,343 assessments of 569 PICCs in 401 patients (baseline: 2,924 assessments, 300 PICCs, 216 patients; intervention: 2,419 assessments, 269 PICCs, 185 patients). The intervention was associated with a 92% lower likelihood of having a dressing with peeling (OR 0.08, 95%CI 0.04-0.17, P < 0.001), 53% lower local inflammation/infection (OR 0.47, 95%CI 0.27-0.84, P < 0.011), and 24% (non-significant) lower CLABSI rates (P = .63). Physician mobile-app alerting and response enabled 80% lower risk of lines remaining in place after inflammation/infection was identified (HR 0.20, 95%CI:0.14-0.30, P < 0.001) and 85% faster removal of infected lines from mean (SD) 11.1 (9.7) to 1.7 (2.4) days.

Conclusions: A mobile-app-based CLABSI prevention program decreased frequency of inflamed/infected central line insertion sites and increased speed of removal when inflammation/infection was found.

Central line associated bloodstream infection (CLABSI) is the most severe complication of indwelling intravascular catheters and one of the most common causes of intensive care unit (ICU)- or hospital-acquired infections. Once CLABSI occurs, it significantly increases the risk of mortality, long of hospital stay, and healthcare economic burden. In recent years, multiple large-scale clinical studies on the diagnosis, treatment, and prevention of CLABSI have been completed, providing evidence-based medical support for related practices. Additionally, evolving global trends in antibiotic resistance epidemiology and the development of novel antimicrobial agents necessitate adjustments in clinical management strategies. Based on these developments, the Chinese Society of Critical Care Medicine has updated and revised the Guideline on the Prevention and Treatment of Intravascular Catheter-Related Infections (2007). This guideline was developed following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system for evidence quality assessment. Guided by clinical questions, the working group initiated the process by defining key clinical issues, conducting literature searches, screening studies, performing meta-analyses, and synthesizing evidence-based findings to draft preliminary recommendations. These recommendations underwent iterative revisions through expert panel reviews, remote and in-person meetings, and two rounds of voting by the Standing Committee of the Chinese Society of Critical Care Medicine before finalization. The guideline comprises 52 recommendations, focusing on adult patients with central venous catheters in ICU. Key areas addressed include: selection of catheter insertion sites and techniques, catheter type and design, catheter management, prevention, diagnosis, and treatment of CLABSI. The guideline aims to provide ICU healthcare professionals with best practices for central line management, ensuring standardized clinical protocols for adult CLABSI.

Background: China's aging population and increasing demand for critical care pose significant challenges to ICU quality improvement (QI). This study evaluates the impact of a 12-year multicenter QI initiative on ICU performance and patient outcomes in the context of resource constraints.

Methods: A pre-post intervention study was conducted across 75 ICUs in Beijing from January 2011 to December 2022. Key interventions included the establishment of QI teams, infection prevention protocols, pain and sedation management, nutritional support, and early mobilization strategies based on the PDCA cycle, as well as regular training and feedback. Primary outcomes included ICU mortality, standardized mortality ratio (SMR) (ratio of observed to expected deaths, adjusted for risk), and healthcare-associated infections (HAIs), such as VAP, CLABSI, and CAUTI rates. Secondary outcomes included unplanned extubation rates, reintubation within 48 hours, and ICU readmission rates within 48 hours.

Results: Analysis of 425,534 patient records from 5396 reports revealed significant improvements. The proportion of ICU admissions among total inpatients increased from 4.1% in 2011 to 7.3% in 2022 (P < 0.001), and the proportion of patients with APACHE II scores ≥15 rose from 52.0% to 67.5% (P < 0.001). Compliance with 3-hour and 6-hour sepsis bundles increased (P < 0.001), and microbiological testing before antibiotic administration also improved (P < 0.001). Outcome indicators showed significant reductions in CRBSI and CAUTI rates (P < 0.001), ICU mortality (P < 0.001), and SMR (P < 0.001). VAP rates decreased from 6.29 to below 5.0 per 1000 ventilator days. ICU readmission rates and unplanned transfers slightly increased but remained low (P > 0.05).

Conclusion: The study highlights the importance of addressing structural, process, and outcome indicators for effective ICU management. Continued monitoring and targeted interventions for high-risk ICUs are essential to sustaining quality improvements.

Background: Central venous lines (CVLs) and arterial lines (ALs) are commonly used for patients in the intensive care units (ICUs) to facilitate the administration of medications and haemodynamic monitoring. In an ICU in Queensland, Australia (AU), saline (sodium chloride 0.9%) flush bags used for these lines were routinely changed every 24 h following organizational policy that all intravenous fluid bags are to be changed within a 24-h period.

Aim: This quality improvement (QI) project aimed to evaluate current practice guided by the Plan-Do-Study-Act (PDSA) model of QI and implementation science. Benchmarking practices with other ICUs was conducted.

Study design: A narrative literature review focused on evaluating the safe interval for changing flush solutions every 24 h was performed using EBSCO Medline, CINAHL, Cochrane Library, Embase and Google Scholar databases for citations up to November 2022. Bloodstream infection rates attributed to CVLs and/or ALs were monitored. Economic analysis was performed. End-user feedback was sought. A change of practice was implemented for a 1-year study period (March 2023 - March 2024) to extend dwell times of flushing solutions for CVLs and ALs from every 24 h to every 96 h.

Results: One-year post-implementation, no bloodstream infections were linked to CVLs or ALs. A simplified economic analysis was performed based on costs of 0.9% sodium chloride 500-mL fluid bags, which revealed that changing the fluid bags once every 96 h resulted in a per patient saving of AU$3.21 for any individual AL or CVL and up to AU$6.42 per patient where both an AL and CVL are in situ, based on fluid bag cost at AU$1.07 per bag. This saving excludes potential savings from reduced nursing time, infection-related costs and recycling costs.

Conclusion: A sustainable practice change based on evidence was implemented in the local ICU. The use of the PDSA model of the QI process and the principles of implementation science strengthened the buy-in and implementation of the project.

Relevance to clinical practice: This practice change was examined through lenses of evidence-based practice, environmental sustainability (minimizing environmental footprint by limiting plastic bag usage), patient safety, cost minimization, and reduced nursing workload.

Introduction: Central line-associated bloodstream infections (CLABSIs) represent a major source of morbidity and mortality, particularly in developing countries. Central venous catheters (CVCs) are an essential part of managing critically ill patients. This study seeks to describe the epidemiology of central line-associated bloodstream infections CLABSI among ICU patients in Palestine and to identify the specific organism involved.

Methods: This retrospective descriptive study included 323 ICU patients with 490 central venous catheters. The electronic medical records were reviewed to identify patients with CLABSIs hospitalized from January 2018 through December 2021. Comparative analysis was conducted to assess associations between various variables and the incidence of CLABSI.

Result: A total of 19 CLABSI episodes in 323 patients yielded an incidence of CLABSI of approximately 5.9%, with a rate of 8.91 per 1,000 device days. CLABSI patients had significantly more CVC utilization ratio and insertions compared to non-CLABSI patients. No significant differences were observed in age, gender, or overall mortality. The most predominant bacteria was Acinetobacter baumannii (21%).

Conclusion: This study highlights the importance of minimizing CVC use and limiting the number of insertions to reduce CLABSI risk. Effective management strategies should focus on reducing CVC duration and frequency.

Background and objective: Central Line-Associated Bloodstream Infection (CLABSI) remains a leading cause of death among critically ill patients. Implementing preventive measures and adhering to best practices is a crucial action to proactively prevent its occurrence. This project aimed to reduce the overall CLABSIs rate in adult medical/surgical Intensive Care Units (ICUs) of hospitals under the Ministry of Defense Health Services (MODHS) in Saudi Arabia. The baseline CLABSI rate was 2 cases per 1000 catheter days during the first quarter of 2020, while the target was to achieve a rate equal to or lower than 0.8 as reported by the American National Healthcare Safety Network (NHSN) in 2013.

Methods: The initiative was carried out across 15 hospitals under the purview of MODHS. Data on CLABSI incidents were collected from the ICUs dedicated to adult medical and surgical care. The project utilized the Institute for Healthcare Improvement collaborative model to achieve breakthrough improvement in a short-term learning system that facilitated the collaboration of participating hospitals in the pursuit of enhancements in CLABSI rates. The project involved 3 cycles, each consisting of a learning session followed by an action period.

Results: The data revealed a continuous improvement in the overall CLABSI rate within MODHS hospitals, progressing positively for 4 consecutive quarters and attaining a value of 0.3 during the third quarter of 2021. This signifies an impressive 85% reduction from the initial baseline of 2, and the rate remains below the project benchmark of 0.8.

Conclusion: The project successfully employed collaborative learning cycles, fostering effective knowledge-sharing among teams and promoting active engagement. This approach proved instrumental in achieving learning objectives, identifying gaps, and determining appropriate courses of action. Key factors for the project's success included standardizing the change package, conducting regular training sessions, encouraging open discussions, and sharing experiences.

Background: Despite significant prevention efforts, the incidence of central line-associated bloodstream infection (CLABSI) in intensive care units (ICUs) is rising at an alarming rate. CLABSI contributes to increased morbidity, mortality, prolonged hospital stays and elevated healthcare costs. This study aimed to determine the incidence rate of CLABSI, compliance with the central venous catheter (CVC) care bundle and risk factors associated with CLABSI among ICU patients. Method: This prospective observational study was conducted in one university hospital and two public hospitals in Malaysia between October 2022 to January 2023. Adult ICU patients (aged > 18 years) with CVC and admitted to the ICU for more than 48 h were included in this study. Data collected included patient demographics, clinical diagnosis, CVC details, compliance with CVC care bundle and microbiological results. All data analyses were performed using SPSS version 23. Results: A total of 862 patients with 997 CVCs met the inclusion criteria, contributing to 4330 central line (CL) days and 18 CLABSI cases. The overall incidence rate of CLABSI was 4.16 per 1000 CL days. The average of overall compliance with CVC care bundle components was 65%. The predominant causative microorganisms isolated from CLABSI episodes were Gram-negative bacteria (78.3%), followed by Gram-positive bacteria (17.4%) and Candida spp. (2.0%). Multivariate analysis identified prolonged ICU stay (adjusted odds ratio (AOR): 1.994; 95% confidence interval (CI): 1.092-3.009), undergoing surgery (AOR: 2.02, 95% CI: 1.468-5.830) and having had multiple catheters (AOR: 3.167, 95% CI: 1.519-9.313) as significant risk factors for CLABSI. Conclusions: The findings underscore the importance of robust surveillance, embedded infection-control and -prevention initiatives, and strict adherence to the CVC care bundle to prevent CLABSI in ICUs. Targeted interventions addressing identified risk factors are crucial to improve patient outcomes and reduce healthcare costs.

Background: Central line-associated blood stream infections (CLABSIs) can contribute to significant morbidity and mortality. The aim of this improvement project was to decrease CLABSIs by creating an Outpatient Pediatric Central Line Education Bundle and standardizing the education and supplies needed for pediatric patients and families to safely be discharged home with an accessed central line.

Methods: The Plan Do Study Act method of quality improvement was used for this project. Patient and family interviews were conducted, and the Family and Youth Advisory councils were consulted. Assessment surveys utilizing a 5-point Likert scale were given to patients before and after the implementation to evaluate the effectiveness of the intervention.

Results: Following the implementation zero community CLABSIs have been reported.

Discussion: This collaborative project provides the necessary education and resources to manage and streamline central line care in the home and may help prevent complications such as CLABSI.

Background: The effect of different concentrations of heparin-locking solution for central venous catheters (CVC) in hemodialysis patients is varied. Regarding the optimal concentration of heparin-locking solution, there is no definitive consensus based on evidence.

Objective: To investigate the efficacy and safety of different concentrations of heparin for CVC locking in hemodialysis patients.

Methods: We searched PubMed, Embase, Web of science, the Cochrane Library and Clinical Trial Database (clinicaltrials.gov) from establishment of each database to September 19, 2024 for randomized control trials (RCTs), non-randomized control trials (NRCTs) and cohort study of heparin-locking solution for CVC in hemodialysis patients aged ≥ 18 years. Outcome data regarding catheter occlusion, hemodialysis blood flow, bleeding-related complications, catheter-related infection, and catheter retention time were extracted and pooled from selected studies. The quality of included RCTS, cohort studies, and NRCT were assessed using bias risk tools recommended in the Cochrane Handbook. A fixed-effect model was used to calculate pooled odds ratios or mean differences with 95% confidence intervals.

Results: Three RCTs, three cohort studies and one NRCT involving 946 hemodialysis patients were included. Heparin-locking solution of 1000 U/ml reduces the occurrence of bleeding related complications (OR = 0.20, 95%CI: 0.05-0.79, P = 0.02) compared to 5000 U/ml and 10000 U/ml. No significant difference was observed in hemodialysis blood flow (MD = -6.95, 95% CI: -14.41- 0.51, P = 0.07), catheter occlusion (OR = 0.89, 95% CI = 0.60-1.33, P = 0.58), catheter retention time (MD = -0.16, 95% CI: -1.98 - 1.67, P = 0.87), and catheter-related infection (OR = 0.60, 95%CI: 0.31-1.19, P = 0.14).

Conclusion: Our findings suggest that a heparin-locking solution at a concentration of 1000 U/ml for central venous catheters (CVC) in hemodialysis patients may reduce the incidence of bleeding-related complications, without impacting the rates of catheter occlusion, hemodialysis blood flow, catheter retention time, or catheter-related infections. However, due to the limited number of included studies, high-quality randomized controlled trials and cohort studies with long-term follow-up are warranted to further validate these results.

Aims and objectives: To investigate evidence-based practices and examine rates of adherence to bundles on maintenance of central venous catheters among intensive care unit nurses in 22 selected hospitals.

Background: Although there has been an overwhelming increase in the use of evidence-based practices to reduce Central Line-Associated Bloodstream Infections, also known as bundles, there continues to be a considerable gap between clinical practice and evidence.

Design: This study employs a multi-center cross-sectional design.

Methods: Registered nurses who worked in the ICUs of 22 selected hospitals were included. Evidence-based procedures were developed based on Central Line Bundles, which include an 11-area and 35-item checklist. Rates of adherence to bundles were calculated and analysed after reaching 22,000 central line days in 22 units. The study was reported using the STROBE checklist.

Results: The average adherence rate to evidence-based procedures for CVC maintenance among ICU nurses in the 22 units was 87.40%. The adherence rate of five areas of the evidence-based procedure based on the Central Line bundle was above 90%, including 'Selection of regulated skin disinfectants', 'Tube sealing', 'Tube flushing', 'Dressing and catheter fixation' and 'Sterilized skin and catheter'. The three lowest-achieving areas of bundles were 'Catheter and insertion site assessment,' 'Hand hygiene' and 'Sterilized catheter access hubs'. The lowest-achieving item of bundles is 'Assess during multidisciplinary patient care rounds with signature confirmation'. The adherence rates in hospitals where CLABSI occurred were all less than 90%.

Conclusion: ICU nurses' adherence to maintenance bundles for CVC is moderate, implying that boosting adherence rates is critical for improved results. As a result, comparable studies should be done in ICUs where the bundle has been deployed to assess and improve adherence rates through effective interventions. To minimise CLABSI in future practice, novel strategies must be developed and implemented via continued education and regular evaluation.

Trial registration: We registered the trial with the US Clinical Trials Registry (ID: NCT06085690, Name: Multicenter Clinical Translational Study of 'ICU-NO CRBSI' Based on Improvement Science, https://ichgcp.net/clinical-trials-registry/NCT06085690) IMPLICATIONS FOR PATIENT CARE: Nurse administrators and policymakers can develop strategies and interventions for improving the quality of CVC care toward evidence-based practice. Minimising the gaps between evidence and practice will reduce the incidence of CLABSI to enhance the survival of critically ill patients.

Impact: In addressing the status of evidence-based practices among ICU nurses, this study enhances healthcare quality and outcomes.

Patient or public contribution: There was no patient or public contribution.

Background: Neonates in the NICU, particularly those born with very low birth weights, are at heightened risk for healthcare-associated infections (HAIs). Such infections can prolong hospitalization, increase medical costs, and potentially lead to adverse long-term outcomes. Recognizing evolving infection patterns and targeted prevention measures is essential to improving patient care.

Methods: We retrospectively collected data on neonates admitted to the NICU of our hospital between January 2019 and December 2023. Information regarding HAI incidence, site of infection, device utilization, pathogen distribution, and antibiotic use was extracted and statistically analyzed. Comparisons regarding infection rates and clinical variables were performed using chi-square or Fisher's exact tests for categorical variables and Wilcoxon rank-sum tests for continuous variables.

Results: Among 9786 neonates (70,509 patient-days), 86 HAI cases were identified (0.88%), corresponding to 1.22‰ infections per 1000 patient-days. Neonates with extremely low birth weight had significantly higher infection rates (13.04%) than other birth weight groups (p < 0.01). Bloodstream infections (35.87%) were the most common site, followed by respiratory and gastrointestinal infections (both 18.48%). Central line-associated bloodstream infection occurred at 0.75 infections per 1000 catheter-days, while ventilator-associated pneumonia decreased from 2.76‰ to 0.73‰ over the study period. Staphylococcus epidermidis was the predominant isolate among the pathogens identified. Neonates with HAIs had significantly longer antibiotic courses and higher rates of combination antibiotic therapy (p < 0.001).

Conclusions: Although the overall incidence of NICU HAIs declined from 2019 to 2023, infection patterns continued to evolve, particularly regarding bloodstream infections. Prevention strategies must focus on high-risk neonates, rigorous device management, punctual surveillance of pathogen resistance, and prudent antibiotic use to further reduce infection morbidity and mortality in the NICU setting.

Background: Chlorhexidine gluconate (CHG), an antimicrobial topical treatment, reduces central line-associated bloodstream infections (CLABSIs). However, many barriers exist to CHG use, limiting the benefits of this evidence-based intervention.

Objectives: This review aimed to identify effective CHG interventions to reduce CLABSIs in patients with cancer, particularly those undergoing bone marrow transplantations.

Methods: PubMed® and CINAHL® databases were searched for articles published in English between 2014 and 2024 that focused on adults (aged 18 years or older) and evaluated CHG use, barriers to CHG use, and interventions to reduce CLABSI rates.

Findings: This review identified the following three themes: the efficacy of CHG on reducing hospital-acquired infections, barriers to CHG use, and multilevel educational programs that improve rates of CHG use.

Introduction: Central line-associated bloodstream infections (CLABSI) are among the most common and preventable hospital-acquired infections in pediatric and neonatal intensive care units (PICU-NICU). CLABSI is a common etiology of late-onset sepsis and is associated with high morbidity and mortality. The aim of this study was to describe the incidence of CLABSI in PICUs and NICUs in our geographical setting.

Methods: Descriptive study conducted as part of the VINCat program, investigating the incidence of CLABSI in NICUs and PICUs at acute care hospitals in Catalonia from 2013 to 2022. The annual CLABSI incidence rate was calculated by multiplying the total detected cases in a year by 1000 and dividing by the total patient-days with central venous catheter (CVC).

Results: NICU: The overall incidence rate was 5.59 per 1000 patient-days. Peripherally inserted CVC was involved in 59.8% of catheter-related infection, and an overall median duration of 7 days from catheter insertion to the onset of infection. PICU: The overall incidence rate was 3.62 per 1000 patient-days. Jugular venous access (44.1%) was the most common location of infections, with a median of 12 days to CLABSI. Gram-positive bacteria, especially coagulase-negative Staphylococci, were the most prevalent in both units.

Conclusions: A standardized surveillance system based on the calculation of the incidence rate of CLABSI in PICUs and NICUs can broaden our understanding of this HAI and will guide the implementation of measures of infection control and prevention.

Background: The incidence of central line-associated bloodstream infection (CLABSI) in the ICU continues to rise. Despite existing CLABSI bundles to prevent infections, adherence remains suboptimal.

Objective: To identify and synthesize the evidence about strategies used to enhance nurses' adherence to CLABSI prevention bundles.

Methods: Five databases were searched: CINAHL, MEDLINE, PubMed, Cochrane Library, and SCOPUS. Eligible studies were those published between 2012-2024, and investigated the adherence to central line bundles and strategies to improve adherence in the ICU. Two reviewers independently screened, critically appraised, and extracted data using Joanna Briggs Institute tools. The review protocol was registered on PROSPERO (CRD42024513345).

Results: Seven studies met the inclusion criteria, including four quality improvement projects and three quasi-experimental studies. The studies ranged in quality from moderate to high, with scores between 68.75 %-88.88 %. These studies explored various strategies to enhance nurses' adherence to CLABSI prevention bundles. Strategies included education, leadership, and auditing/feedback mechanisms. Education was the primary strategy utilized and included simulation and online training. Active participation in decision making, transparency in sharing CLABSI outcome data, celebrating achievements, and electronic documentation were essential aspects of leadership support to promote adherence. Implementing these strategies led to significant improvements in nurses' adherence to bundle (<0.01).

Conclusion: Education, leadership, and audit mechanisms improve adherence to CLABSI bundles. Yet, the current evidence lacks randomized controlled trails that can establish effectiveness of these strategies. Future research should also investigate the long-term effect of these strategies on adherence, and the influence of organizational culture on CLABSI bundle adherence.

Background: Central line-associated bloodstream infection (CLABSI) is a preventable complication of central venous catheters (CVC) that can result in prolonged hospitalization, increased cost, and mortality.

Local problem: CLABSI rates in a solid organ transplant unit were above the National Database of Nursing Quality Indicators target.

Methods: Evidence-based CLABSI prevention interventions were implemented using the Plan-Do-Study-Act process.

Interventions: A stepwise approach was used to implement CVC maintenance bundle pole cards, chlorhexidine gluconate (CHG) bathing treatments, and Kamishibai card (K-card) door tag processes for all patients with CVCs.

Results: The unit achieved and sustained >90% compliance with both CHG bathing treatments and K-card door tag processes. The CLABSI rate decreased from 2.15 to 0.41, an 81% reduction.

Conclusions: CLABSI reduction in a transplant unit can be achieved through the systematic implementation of evidence-based practices.

Objective: Central line-associated bloodstream infections (CLABSIs) result in morbidity and mortality among hospitalized patients. Hospital interventions to reduce the incidence of CLABSI are often broadly applied to all patients with central venous access. Identifying central lines at high risk for CLABSI at time of insertion will allow for a more focused delivery of preventative interventions.

Design: This was an observational cohort study conducted at three hospitals including all patients who received central venous access. CLABSIs were identified using an institutional CLABSI database maintained by the hospital epidemiology team. Logistic regression (LASSO) and machine learning (random forest, XGboost) techniques were applied for the prediction of CLABSI occurrence, adjusting for selected patent and insertion-level characteristics.

Results: A total of 40,008 central venous catheters were included, of which 409 (1.02%) were associated with CLABSI. The random forest and the XGBoost models had the highest discrimination (Area Under the Received Operating Curve [AUC] 0.79) followed by LASSO (0.73). High illness severity, receipt of total parenteral nutrition, receipt of hemodialysis, pre-insertion hospital length-of-stay, and low albumin levels were all predictive of CLABSI occurrence. Precision for all models was poor owing to a high false-positive rate.

Discussion: CLABSI can be predicted based upon patient and insertion level factors in the electronic health record. In this study, random forest and gradient-boosted models had the highest AUC. Prediction cut-offs for the identification of CLABSI can be adjusted based upon the acceptable rate of false-positives for a given CLABSI preventative intervention.