Etiology and Susceptibility of Central line-associated bloodstream infections (CLABSI) in Cancer patients: Regular Pointwise audit of Central Line Insertion Practices (CLIP)

Dr. Hitender Gautam1, Dr. Abdul Hakim Choudhary2, Ms.  Asanai Agnes3, Ms.  Priyanka Singh3, Dr.  Bimal Kumar Das4, Dr. Arti Kapil4

1Hospital Infection Control Officer, Dr. BRAIRCH (Cancer Centre) & Department of Microbiology, All India Institute Of Medical Sciences, AIIMS, New Delhi, India 2Department of Hospital Administration, All India Institute of Medical Sciences, AIIMS, New Delhi, India
3Infection Control Nurse, Dr. BRAIRCH (Cancer Centre), All India Institute Of Medical Sciences, AIIMS, New Delhi, India
4Department of Microbiology, All India Institute of Medical Sciences, AIIMS, New Delhi, India

 

Introduction:

Central Venous Catheters considered source of Central-line-associated-bloodstream-infections (CLABSI). Malignancy carries Odds-Ratio of 1.35 for HAIs. Mostly gram‑positive cocci (GPC) are aetiological agents of CLABSI. In U.S. and developing countries, prevalence range from 1.8 to 7.6/1,000 and 4.2 to 14.4/1,000 catheter-days respectively. In Cancer-Units, CLABSI-rate were 5.2 & 5.86/1,000 central-line days from Brazil and Canada respectively. CDC emphasise Central-Line-Insertion-Practices (CLIP) for controlling CLABSI.

Methods:

CLABSI surveillance study (CDC/NHSN) from tertiary-care cancer-centre, Dr. BRAIRCH, AIIMS-New Delhi-India. Data from January 2017 to June 2018. Retrospective review of 73 cases of confirmed CLABSI. CDC’s-CLIP educational activity potentiated with continuous audit of CLIP

Results:

62,230 patient-days and 13,039 central-line days. Mean CLABSI rate 5.6/1,000 central-line-days. Only CLIP education is not sufficient, needs to be potentiated with continuous audit. Among 73 CLABSI cases, Gram-negative rods (GNR) were 72.6% and GPCs 21.9% while 4 polymicrobial infections. Among GNR, 43% Klebsiella pneumoniae (86.5%-ESBL, 75% Carbapenem-resistant), 30% Acinetobacter baumanii (63.3% Carbapenem-resistance) and 9% Escherichia coli (55.5%-ESBL).  Among GPC, 50% were Enterococcus spp. {37.5% Vancomycin-Resistant (VRE)}. Out of 18 CLIP points, compliance with, sterile barrier-precaution, hand-hygiene, Bundle-supplies, scrub the hub & checklist to clinician was highly variable, requires continuous audits check.

Conclusion:

CLABSI rate of our Cancer-centre is 5.6 in accordance with other developing-countries. GNR are predominant pathogens in our centre in contrast to western literature. Klebsiella spp. being predominant (86.5%-ESBL and 75% Carbapenem-resistant) and also high prevalence of VRE. Point wise periodic audit of all points of CLIP-activity is utmost requirement with targeted improvement in variable performing points.


Biography:

He is working as Assistant Professor in the Department from June 2014 and currently working in the bacteriology and serology section. He also looks after the Hospital Infection Control activities at Dr. B.R.A Institute-Rotary Cancer Hospital (IRCH), AIIMS, New Delhi. He is an editorial board member of Journal of Clinical and Medical Case Reports and Austin Tuberculosis: Research & Treatment. Currently, he is an invited Co-Guide for PhD in Medicine by Research Medical Microbiology program at Texila American University.

 

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