777. Implementation of Antimicrobial Impregnated Catheters to Reduce Central Line Associated Bloodstream Infections (CLABSI) in a Pediatric Setting

Abstract Background Antimicrobial impregnated catheters (AIC) are one strategy to prevent CLABSI with existing data for central lines required for short duration, however, the strength of evidence, particularly for children, is lacking. Recent 3-year CLABSI data at our institution show 60 (51%) infections occurred in central lines within 8 weeks of insertion, suggesting an opportunity for evaluation of an intervention targeting this time frame. We implemented AIC to evaluate their effectiveness in reducing CLABSI standardized infection ratio (SIR) in patients requiring central venous access for less than 8 weeks. We also monitored for complications (malfunction, line exchange, fungal infection). Methods A stepped wedge observational design was used to implement Minocycline + Rifampin impregnated catheters in a rolling fashion across the institution. Children > 3kg were eligible if admitted to a participating unit and required central venous access through a peripherally inserted central catheter (PICC), non-tunneled catheter, or tunneled non-cuffed femoral catheter for < 8 weeks. Units, prioritized based on CLABSI SIR, were added to the intervention monthly until AIC were used throughout the institution. A multidisciplinary team (infectious diseases and infection control experts, CLABSI leaders, unit-based physicians and nurses, proceduralists, supply chain) met weekly to facilitate implementation, assess for CLABSI and monitor for complications. Figure 1. Study design. This figure describes the stepped wedge study design where units were phased into the invention on a rolling monthly basis allowing for comparison between and within units. The shaded boxes represent time periods when units were using antimicrobial impregnated catheters and the white boxes represent time periods when units were using standard non-impregnated catheters. Results AIC were systematically implemented over a 7-month period. The institution’s CLABSI SIR decreased from 0.80 to 0.59 during this timeframe. There were no NHSH defined CLABSI in patients with an AIC during the intervention. Obstacles included shortage of catheters due to supply chain disruption, adjustment of technique for line insertion and cracked/broken lines. Infections and complications were reviewed by the multidisciplinary team and compared to historical rates with non-impregnated lines. This figure shows the institution’s rolling 12-month SIR during the intervention period. Conclusion CLABSI SIR decreased at our institution during the intervention period. While many efforts likely led to this reduction (optimizing maintenance bundle, unit based CLABSI initiatives), we believe the use of AIC contributed to this improvement. There were no pediatric-specific safety events identified during implementation. Disclosures Ravi Jhaveri, MD, AstraZeneca (Consultant)Dynavax (Consultant)Elsevier (Other Financial or Material Support, Editorial stipend as Co-EiC, Clinical Therapeutics)Hologic (Consultant)Seqirus (Consultant)


Reducing Central Line Associated Bloodstream Infections (CLABSI) in a High-Risk Cohort of Patients by Standardizing Skin Preparation Prior to Pulmonary Artery Catheter Insertion
Background. Central line associated bloodstream infections (CLABSI) are a recognized complication of all central venous access devices including pulmonary artery catheters (PAC). At our institution, PACs are utilized frequently, often for prolonged durations, for patients with advanced heart failure in the cardiac care unit (CCU) who are awaiting heart transplant. In early summer 2018, our hospital infection prevention (IP) department detected an uptick in CLABSI attributable to the CCU. After 9 months of zero CLABSI, two CLABSIs attributable to the CCU were identified during a 3 month period from November 2017-January 2018. Four additional CLABSIs were identified between May-July 2018 prompting an investigation by IP. Review of the 9 CLABSIs attributed to the CCU from May 2018 -June 2019 led IP to prioritize improving PAC insertion practices in our cardiac catheterization lab as a mean to reducing CLABSI (see table 1).
Methods. IP performed 5 observations of PAC insertion in the cath lab. During the observations of skin preparation, the prep time was performed correctly 40% of the time, correct application 60% of the time and dry time 60% of the time (see table 2 ,Figure1). Interventions included scheduling a training day for all cath lab staff with the skin prep vendor, performing competency check-offs, and identifying super-users to train future staff. Furthermore, skin antiseptic utilization according the manufacturer's instructions for use was implemented, the coverage area for the applicator was reviewed and a chart for reference was provided.The staff was provided with posters on correct skin prep technique as a visual cue in the procedure room.

Results.
Since the project was implemented in September 2019, there has been 1 CLABSI identified that was possibly related to a PAC inserted in the cath lab. During this time 3 CLABSIs were identified in the CCU but were felt to be unrelated to cath lab insertion.

Conclusion.
Since the project was implemented in September 2019, there has been 1 CLABSI identified that was possibly related to a PAC inserted in the cath lab. During this time 3 CLABSIs were identified in the CCU but were felt to be unrelated to cath lab insertion.
Disclosures. All Authors: No reported disclosures Background. Antimicrobial impregnated catheters (AIC) are one strategy to prevent CLABSI with existing data for central lines required for short duration, however, the strength of evidence, particularly for children, is lacking. Recent 3-year CLABSI data at our institution show 60 (51%) infections occurred in central lines within 8 weeks of insertion, suggesting an opportunity for evaluation of an intervention targeting this time frame. We implemented AIC to evaluate their effectiveness in reducing CLABSI standardized infection ratio (SIR) in patients requiring central venous access for less than 8 weeks. We also monitored for complications (malfunction, line exchange, fungal infection).

Implementation of Antimicrobial Impregnated Catheters to Reduce Central Line Associated Bloodstream Infections (CLABSI) in a Pediatric Setting
Methods. A stepped wedge observational design was used to implement Minocycline + Rifampin impregnated catheters in a rolling fashion across the institution. Children > 3kg were eligible if admitted to a participating unit and required central venous access through a peripherally inserted central catheter (PICC), non-tunneled catheter, or tunneled non-cuffed femoral catheter for < 8 weeks. Units, prioritized based on CLABSI SIR, were added to the intervention monthly until AIC were used throughout the institution. A multidisciplinary team (infectious diseases and infection control experts, CLABSI leaders, unit-based physicians and nurses, proceduralists, supply chain) met weekly to facilitate implementation, assess for CLABSI and monitor for complications. This figure describes the stepped wedge study design where units were phased into the invention on a rolling monthly basis allowing for comparison between and within units. The shaded boxes represent time periods when units were using antimicrobial impregnated catheters and the white boxes represent time periods when units were using standard non-impregnated catheters.
Results. AIC were systematically implemented over a 7-month period. The institution's CLABSI SIR decreased from 0.80 to 0.59 during this timeframe. There were no NHSH defined CLABSI in patients with an AIC during the intervention. Obstacles included shortage of catheters due to supply chain disruption, adjustment of technique for line insertion and cracked/broken lines. Infections and complications were reviewed by the multidisciplinary team and compared to historical rates with non-impregnated lines.
This figure shows the institution's rolling 12-month SIR during the intervention period.
Conclusion. CLABSI SIR decreased at our institution during the intervention period. While many efforts likely led to this reduction (optimizing maintenance bundle, unit based CLABSI initiatives), we believe the use of AIC contributed to this improvement. There were no pediatric-specific safety events identified during implementation.

Background. Bloodstream infection (BSI) -Central and Non-Central Line
Associated -and infections of the lower respiratory tract (RESP) -pneumonia and non pneumonia lower respiratory infections -are some of the main causes of unexpected death in Intensive Care Units (ICUs). Although the leading causes of these infections are already known, risk prediction models can be used to identify unexpected cases. This study aims to investigate whether or not it is possible to build multivariate models to predict BSI and RESP events.
Methods. Univariate and multivariate analysis using multiple logistic regression models were built to predict BSI and RESP events. ROC curve analysis was used to validate each model. Independent variables: 29 quantitative parameters and 131 categorical variables. BSI and RESP were identified using Brazilian Health Regulatory Agency protocols with data collected between January and November 2020 from a medical-surgical ICU in a Brazilian Hospital. Definitions: if an infection is 5% or less likely to occur according to the model used and it eventually occurs, it will be classified as "unexpected", or else, if an infection is 10% or less likely to occur, it will be classified as "probably unexpected". Otherwise, infections will be classified as "expected". Patients with a 30% or more risk for BSI or RESP will be classified as "high risk".
Results. A total of 1,171 patients were accessed: 70 patients with BSI (95% confidence interval [CI], 3.1%-5%), 66 patients with RESP (95% CI, 2.9%-4.7%), 235 deaths (95% CI, 11.8%-14.9%). Of the 160 potential risk factors evaluated, logistic models for BSI and RESP identified respectively five and seven predictors (Tables 1 and 2, and Figure 1). Patients admitted to the ICU with Covid-19 had a three fold BSI risk and five times more RESP risk than patients without this diagnosis.   Conclusion. The built models make possible the identification of the expected infections and the unexpected ones. Three main course of actions can be taken using these models and associated data: (1) Before the occurrence of BSI and RESP: to place high risk patients under more rigorous infection surveillance.
(2) After the occurrence of BSI or RESP: to investigate "unexpected" infections. (3) At discharge: to identify high risk patients with no infections for further studies.
Disclosures. All Authors: No reported disclosures