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Background
Central-line associated bloodstream infections (CLABSI) are serious infections that
have significant morbidity and mortality. Our institution tracks CLABSIs in all settings.
Between February 2021 to March 2021, surveillance by our Infection Prevention and
Control Department identified five Portacath (PAC) CLABSIs with methicillin susceptible
Staphylococcus aureus (MSSA) in pediatric oncology patients. This was a significant
increase from our baseline of 3 MSSA PAC CLABSI in the 12 months prior, initiating
an outbreak investigation.
Methods
A line list was created and identified two epidemiologic links: all PAC were placed
in interventional radiology (IR), and primary points of access were ambulatory oncology
clinics. There was no common product used. Four of the five infections had identical
antimicrobial susceptibility profiles. Pulsed-field Gel Electrophoresis (PFGE) was
performed to discriminate between isolates. Observations in IR for line placement
were performed with attention to skin preparation. Ambulatory oncology observations
were performed to review skin preparation for PAC access and hand hygiene practices.
We confirmed with the PAC manufacturer there were no recalls of the PAC lot numbers.
Results
All 5 isolates were unrelated by PFGE and, therefore excluded a true outbreak. Observations
in IR revealed variabilities in skin preparation and recommendations were made to
standardize practices to align with those in our operating rooms. Although no variations
in practice were noted in ambulatory oncology this was used as an opportunity to re-educate
staff on the attention to detail for PAC access.
Conclusions
Outbreak identification by traditional epidemiologic methods are complemented with
technology such as PFGE to identify conclusive links between patients and can demonstrate
when an apparent outbreak is not due to a single pathogen. Obtaining PFGE data supported
broad-based interventions including observations of practice at the time of line insertion
and access, as well as reeducation to providers performing these roles, to reduce
CLABSI in our institution.
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Copyright
© 2022 Published by Elsevier Inc.
