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Dear ACIPC Colleagues
I am looking for help regarding current practices of monitoring bloodstream infections in day patient oncology services. The service I am working with has no inpatient capacity. The majority of patients have long-term implantable devices and are most often neutropenic, suffering episodes of “febrile neutropenia”. The amount of time between their therapies varies making it impossible to apply the usual 48hrs since healthcare equals HA BSI logic. One could argue that without an implantable device the patient would have no risk of developing a BSI. Or you could equally argue that the majority of pts w/ neutropenia inevitably develop an episode of febrile neutropenia and discount the case arguing that if asepsis on line/port access and site care are perfect in the facility sepsis may be related to something happening while the pt is not receiving therapy. Although my counter argument is that our responsibility includes teaching the patient and family how to manage and care for the site/ port whilst in the domestic setting. This is very difficult for me epidemiologically, logistically and clinically to determine the importance and or need for BSI monitoring among this day-only population.
Would others please be willing to share:
1. how they approach BSI monitoring in non-inpatients;
2. their opinions on whether this should be done at all;
3. whether just monitoring S. aureus BSI would suffice for purposes of Accreditation; and
4. how they classify BSI in populations w/ febrile neutropenic patients
5. any other gems ie. protocols.The model I have used up to now has been based on CHRISP, QLD recommendations. I would be really grateful for other suggestions.
Regards and advanced thanks.
CathDr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.auMESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
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Hi Cath,
This is what I do here in our hospital in New Zealand.
We capture any blood stream infections associated with day patient oncology services if the blood culture comes through our hospital lab i.e. it was taken while attending the hospital or they were admitted because they were septic. If they have a CVC in situ then we assess them as to whether they meet the definition for a non-inpatient HABSI as below:They are subcategorised as either non-inpatient associated
OR
Inpatient associated (those that occur more than 48hrs after hospital admission or within 48hrs of discharge)Healthcare Associated event satisfies at least one of the following criteria:
– Acquired during hospitalisation and not present or incubating on admission
– Is a complication of the presence of an indwelling medical device (e.g. IV catheter, urinary catheter)
– Occurs within 30 days of a surgical procedure, where the bloodstream infection is related to the Surgical Site Infection
– An invasive instrumentation or incision related to the bloodstream infection was performed within 48hrs before onset of the infection. If the time interval was longer than 48hours, there must be compelling evidence that the infection was related to the invasive device or procedure; or
– Associated with neutropaenia (<1×109/l) contributed to by cytotoxic therapySo most of the cases that are attributed to the CVC and they have not been in wirthin the previous 48 hours we would class them as 'non-inpatient HABSI, source CVC' and they counted in our rates.
We also use the CDC 'Mucosal barrier injury laboratory-confirmed bloodstream infection' definiton for this patient population and have seen a reduction in attributing BSI in neutropaenic patients to their CVC as a result..Ruth Barratt RN, BSc, MAdvPrac (Hons)
Clinical NurseSpecialist Infection Prevention and Control
e: ruth.barratt@cdhb.health.nz
t: + 64 3 3640 083 or ext.80083
Level 5, Riverside Building
Christchurch Hospital | Private Bag 4710, Christchurch
Clean Hands Save Lives!—–Original Message—–
Dear ACIPC Colleagues
I am looking for help regarding current practices of monitoring bloodstream infections in day patient oncology services. The service I am working with has no inpatient capacity. The majority of patients have long-term implantable devices and are most often neutropenic, suffering episodes of "febrile neutropenia". The amount of time between their therapies varies making it impossible to apply the usual 48hrs since healthcare equals HA BSI logic. One could argue that without an implantable device the patient would have no risk of developing a BSI. Or you could equally argue that the majority of pts w/ neutropenia inevitably develop an episode of febrile neutropenia and discount the case arguing that if asepsis on line/port access and site care are perfect in the facility sepsis may be related to something happening while the pt is not receiving therapy. Although my counter argument is that our responsibility includes teaching the patient and family how to manage and care for the site/ port whilst in the domestic setting. This is very difficult for me epidemiologically, logistically and clinically to determine the importance and or need for BSI monitoring among this day-only population.
Would others please be willing to share:
1. how they approach BSI monitoring in non-inpatients; 2. their opinions on whether this should be done at all; 3. whether just monitoring S. aureus BSI would suffice for purposes of Accreditation; and 4. how they classify BSI in populations w/ febrile neutropenic patients 5. any other gems ie. protocols.The model I have used up to now has been based on CHRISP, QLD recommendations. I would be really grateful for other suggestions.
Regards and advanced thanks.
CathDr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.auMESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
You can unsubscribe from this list be sending 'signoff aicalist' (without the quotes) to listserv@aicalist.org.au
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
You can unsubscribe from this list be sending 'signoff aicalist' (without the quotes) to listserv@aicalist.org.au
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