Related Experiment Videos
Surveillance methods for central venous access device-associated infections in Canadian pediatric hospitals
Insights
Canadian pediatric hospitals surveil central venous access device (CVAD) infections, but inconsistent definitions and limited resources hinder effective data collection and comparison. Standardizing practices is crucial for improving patient safety.
Area of Science:
- Medical Device Safety
- Infection Control
- Pediatric Healthcare
Background:
- Central venous access device (CVAD) infections are a common complication, affecting 3-48% of hospitalized patients.
- Regular surveillance of CVAD adverse events is recommended to mitigate risks.
- Developing standardized CVAD programs requires understanding current practices.
Purpose of the Study:
- To assess the current practices for surveillance of central venous access device (CVAD) infections in Canadian pediatric hospitals.
- To identify variations in data collection, definitions, and resources among these institutions.
Main Methods:
- A telephone survey was conducted with infection control practitioners or CVAD nurses at 15 university-affiliated Canadian pediatric hospitals.
- A standardized questionnaire was used to gather information on surveillance methods, definitions, and resources.
- Data analysis focused on identifying commonalities and discrepancies in CVAD infection surveillance.
Main Results:
- Fourteen hospitals (93%) conduct CVAD infection surveillance, with varying comprehensiveness.
- Significant variations exist in the definitions used for CVAD infections and the denominators for reporting rates.
- Most surveillance relies on paper-based records, and insufficient resources limit follow-up for outpatients.
Conclusions:
- Canadian pediatric hospitals acknowledge the importance of CVAD infection surveillance.
- Inconsistent definitions, denominators, and reporting methods prevent interhospital comparison of infection rates.
- Insufficient resources and a lack of standardized data collection impede the development of optimal CVAD programs.
Abstract:
The most common complication of central venous access device (CVAD) use is infection, which occurs in 3 to 48% of hospitalized patients. It is recommended that regular surveillance of adverse events with CVADs be conducted, expressed as a proportion of 1000 device days and reviewed and acted upon by the institution's infection control committee. In the process of developing a CVAD program the authors attempted to determine the standard of practice at other Canadian pediatric hospitals. A telephone survey of infection control practitioners (ICPS) or CVAD nurses in 15 university-affiliated Canadian pediatric hospitals was conducted using a standard questionnaire. Fourteen hospitals (93%) conduct surveillance for infections associated with CVADS. One program, a pilot project, follows mechanical complications of CVAD use. Eleven centres conduct comprehensive surveillance; in three, selected patients are followed. Only three programs have sufficient staff to follow out-patients. Definitions for CVAD infections varied widely. A positive blood culture from the catheter is sufficient for diagnosis in eight of the 14 centres (57%); the rest use Centers for Disease Control and Prevention (CDC) or modified CDC criteria. In the four centres where CVAD line days are collected on most or all patients, multiple personnel other than the ICP assist in data collection. Four hospitals report number of infections per 100 discharges, four report absolute number of infections and two use more than one denominator. Surveillance methods rely largely on paper-based chart and microbiology record review; no hospital had access to computerized patient data for direct data retrieval. Eight centres have CVAD committees for policy development, and all 15 have or are developing hospital-wide protocols for CVAD use. Canadian pediatric hospitals recognize the importance of CVAD infections, but it appears that insufficient resources are available to meet recommended data collection methods. Interhospital comparison of rates is not possible at present because of variation in definitions and denominators and in types of patients surveyed.