CATHETER ASSOCIATED BLOOD STREAM INFECTION (CABSI) SURVEILLANCE November 2012 Infection Control Unit...
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Transcript of CATHETER ASSOCIATED BLOOD STREAM INFECTION (CABSI) SURVEILLANCE November 2012 Infection Control Unit...
MANUALCATHETER ASSOCIATED BLOOD
STREAM INFECTION (CABSI) SURVEILLANCE
November 2012
Infection Control UnitQuality in Medical Care Section
Medical Development DivisionMinistry of Health
INTRODUCTIONRegardless of the numerous reports on the
adverse impact associated with the use of catheters as a vascular access for haemodialysis (HD), Central Venous Catheters (CVCs) remains as an important tool in the delivery of adequate dialysis.
In incident HD patients, CVCs provide an instant access to the circulation.
In chronic or prevalent HD patients, CVCs are useful as a bridging gap for patients who have problems with poor maturation of their native fistula and while awaiting fistula maturation.
INTRODUCTION - ContThe use of CVCs is associated with a high
morbidity, mortality and increased health care costs due to infectious complications.
The risk of infection in CVCs is 5-10 fold higher than dialyzing with a native fistula or graft(1).
Vascular access related infection and other complications frequently result in prolonged hospitalization and account for more than one third of the cost of ESRD management.
The reported mortality rate ranges between 12 to 25.9%
INTRODUCTION - ContDespite numerous attempts to encourage the use of
fistula, the usage of CVCs in the USA remains high with nearly 65% of patients using CVCs at the first outpatient HD treatment (1)
The 19th Report of Malaysian Dialysis and Transplant Registry showed that the prevalence rate of End Stage Renal Disease has increased from 368 per million population in 2002 to 900 per million population in 2011.
The usage of CVC in prevalent or chronic HD patients has also increased from 3% to 8.1% during the same period.
This is an underestimation as the predominant usage of CVCs for HD is in the incident patients.
INTRODUCTION - ContThe growing numbers of patients who require
haemodialysis combined with the increasing number of patients who are unable to use native vascular access other than a CVC stress the need to monitor the rate of CABSI and the importance of strategies to prevent it.
OBJECTIVES Generalto assess the rate of CABSI in CVC for HD in MOH hospitals with the aim to reduce morbidity and mortality related to CABSI
OBJECTIVES - Cont
Specific: To determine the incidence rate of CABSI in CVC
for HD in selected MOH hospitals to identify risk factors that predispose patient to
CABSI in CVC for HDto compare the rate of CABSI among the selected
hospitalsto determine the average catheter days before
infectionto determine rate of CVC removal due to infection
METHODOLOGYPopulation under surveillance
All patients who has a CVC for HD inserted and receiving haemodialysis or extracorporeal therapy in Ministry of Health facilities.
Case Definition All patients who are currently receiving haemodialysis receiving haemodialysis or extracorporeal therapy via CVC in Ministry of Health facilities with CABSI.
CABSI is defined as: clinical signs and symptoms of infection
(fever, chills and/or hypotension) ANDa positive peripheral blood culture ANDno other apparent source of infection.
Exclusion Criteria
Patient defaulted treatment more than 72hours from the last haemodialysis treatment
Patient from private haemodialysis facility with evidence of current infection during presentation
CVC inserted outside MOH facilities
End of Catheter Days
The end of catheter days can be determined through one of the following:
Date of discharge (Discharge date from HD facilities plus 72hours; to allow cases that developed CABSI within the specified period)
Date of Catheter removalDate of Death
DATA COLLECTION All patients who have a CVC inserted for HD
will be identified by a designated personnel . Upon insertion of CVC for HD , CABSI
Coordinator (Staff Nurse or Medical Assistant) should fill up :
Surveillance Form For Catheter Associated Blood Stream Infection In Ministry Of Health Haemodialysis Facility CABSI/MOH/2012/1 (Appendix I )
DATA COLLECTION - Cont fill up item A, B, C (1 to 4) - Upon CVC
insertion
fill up item C (5 to 6) - Upon removal of catheter or discharge (discharge from haemodialysis facility or died)
If patient developed infection, proceed to item D and fill up Surveillance Form For Catheter Associated Blood Stream Infection In Ministry Of Health Haemodialysis Facility CABSI/MOH/2012/2 as in Appendix II
DATA COLLECTION - ContData to be collected and analyzed by the CABSI
Coordinator on monthly basis. CABSI Database (Appendix III to VIII)
provided by the MOH will be used as a tool in analysis. It will generate results automatically.
Upon completion, CABSI Coordinator has to fill up Reporting Form of Catheter Associated Blood Stream Infection in MOH Haemodialysis Facility CABSI/MOH/2012/3 as in Appendix IX according to the results generated from the CABSI Database.
DATA COLLECTION - ContCompleted CABSI/MOH/2012/3 form to be
verified by the respective Hospital Nephrologists. CABSI/MOH/2012/1 and CABSI/MOH/2012/2
forms to be kept at respective hospital. A completed and verified CABSI/MOH/2012/3
form to be submitted to the National Secretariat by 10th of every 2 subsequent month.
Further reporting and analysis will be performed by the National Secretariat.
DATA ANALYSIS AND REPORTINGThe Catheter Days will be used as
denominators to calculate the incidence rate of CRBSI in each hospital.
Following data will be collected:Monthly catheter daysCumulative catheter days
CABSI RATE
Monthly CABSI Rate = No. of CABSI for X Month x 1000
Total Catheter Days for X Month
Cumulative CABSI Rate =Total No. of CABSI for Cumulative Month x 1000
Total Catheter Days for Cumulative Month
Rate for CVC Removal Due to Infection = No. of CVC Removed Due To CABSI x 100 No. of Patient with CVC
a) Monthlyb) Cumulatively
DATA ANALYSIS AND REPORTING - Cont
All hospitals should send the aggregated data (Reporting Form of Catheter Associated Blood Stream Infection in MOH Haemodialysis Facility CABSI/MOH/2012/3 ) on monthly basis to the National Secretariat.
The data will be analyzed and result will be disseminated every 6-monthly.
A yearly report will be published and disseminated to all the states.
APPENDIX VIII
Fill up CABSI/MOH/2012/1
form (Appendix I)
Fill up CABSI/MOH/20
12/2 form (Appendix II)
Data compilation
Calculate the monthly and cumulative
denominator (catheter days) at the end of the
month
Development of Infection
YESNO
PROCESS FLOW CHART FOR CABSI SURVEILLANCE MANAGEMENT
Patient receiving haemodialysis or extracorporeal therapy in MOH
facility with existing catheter [OLD CASE]
Patient in the facility with newly inserted catheter
[NEW CASE]
Completed CABSI/MOH/2012/3 form
(Appendix III) to be verified by Nephrologist
Fill up CABSI/MOH/2012/3 form (Appendix IX)
Verified CABSI/MOH/2012/3 form to be sent to Infection Control Unit,
MOH
Data management
REFERENCEUnited States Renal Data System 2011 Annual Data Report:
Chapter 2. Clinical Indicators and Preventive Care. USRDS website: www.usrds.org
Burr R et al. The cost of vascular access infections: three years experience from a single outpatient dialysis center. Hemodialysis International 2003;7: 73 -104
Liu JW et al. Nosocomial blood-stream infections in patients with ESRD; excess length of stay, extra cost and attributed mortality. Hosp Infect 2002; 50: 224-7
19th Report Of The Malaysian Dialysis & Transplant Registry 2011. Ed Lim YN, Ong LM, Goh BL. Available on the MSN website: http://www.msn.org.my.nrr
Deborah Tomlinson et all. Defining Bloodstream Infections Related to Central Venous Catheters in Patients With Cancer: A Systematic Review. Available on http://cid.oxfordjournals.org/
An APIC Guide 2000 . Guide to the Elimination of Catheter-Related Bloodstream Infections
THANK YOU