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Hi Aspasia,
Great question. Biofilm can grow in the fibrin clot/sheath at the tip of the catheter, on the outer surface of the catheter or inside the lumens which in the early stages may just be a single lumen. Needless connectors can also become colonised. The recommendation to culture every lumen is based on Guembe (CID, 2010) who looked at 171 episodes of catheter related bloodstream infection – they found that 37% of infections would have been missed if only a single lumen was sampled. Similar findings from a smaller study by Robinson (J Ped Haem/Onc, 2002) in a paediatric haem-onc population where 32% of 41 episodes would have been missed.
Concern has been raised about the volume of blood required and risk of iatrogenic anaemia. Herrera-Guerra (Am J Infection Control, 2015) proposed a pooled culture technique where blood was taken from each lumen and used to inoculate a single blood culture bottle in comparison to traditional culture of each lumen. Also this was effective, I cannot see that it has been taken up elsewhere. I think this deserves consideration. Another thought I had is to only collect a single aerobic bottle from each lumen, knowing that almost all line pathogens do not need the specialised anaerobic environment – I don’t think this has been studied – has anyone seen this data?
For now, guidelines recommend a set of blood cultures from each lumen in addition to a peripheral set whenever catheter associated bloodstream infection is considered possible. An important aspect to note is that needless connectors should be replaced prior to sampling.
Kind regards,
EdDr Edward Raby
Medical Director of IPC
South Metropolitan Health Service, WA—–Original Message—–
From: ACIPC Infexion Connexion On Behalf Of Michael Wishart
Sent: Wednesday, 26 October 2022 6:40 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] 3 lumen Picc line Blood cultureCAUTION External Communication: This email originated from outside of the organisation. Do not click links or open attachments unless you recognise the sender and know the content is safe.Hi Aspasia
Blood cultures drawn through central device lumens can be very informative in regard to potential sources of infection. If you have positive growth in lumen collected blood cultures, and negative peripheral blood cultures, this can help determine the need for treatment, including the need to remove or replace lines. Blood cultures from lumens that return positive growth more rapidly than peripheral collections can also help guide appropriate treatment and potentially indicate a source.
Cheers
MichaelMichael Wishart | Infection Control Coordinator, CICP-E
St Vincents Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032 M +61 448 954 282 | T +61 7 3326 3068 | F +61 7 3607 2226 E michael.wishart@svha.org.au | W https://urldefense.com/v3/__https://www.svphn.org.au__;!!Lav448XFWxY!8bLSSTavpwUE7zNOmuvjTlE3Ke3_chKFmFOtyFtKq8bq_MfWT4rV42xPtRTEE9_xpRFnWn3CQ4JS6LIgzfq1I-dLebxB7O8JFvY$
St Vincents Private Hospital Brisbane | 411 Main Street KANGAROO POINT QLD 4169 M +61 448 954 282 | T +61 7 3240 1208 | F +61 7 3240 1166 E michael.wishart@svha.org.au | W https://urldefense.com/v3/__https://www.svphb.org.au__;!!Lav448XFWxY!8bLSSTavpwUE7zNOmuvjTlE3Ke3_chKFmFOtyFtKq8bq_MfWT4rV42xPtRTEE9_xpRFnWn3CQ4JS6LIgzfq1I-dLebxBGJtjmGs$
—–Original Message—–
From: ACIPC Infexion Connexion On Behalf Of Aspasia Kordanouli
Sent: Tuesday, 25 October 2022 3:56 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: [ACIPC_Infexion_Connexion] 3 lumen Picc line Blood cultureHi all,
Febrile neutropenia patient that has 3 lumen Picc- line insitu, what is the rationale of taking blood cultures of EACH lumen please?as per eviQ on management febrile neutropenia, 1 set blood cultures (aerobic and anaerobic bottles) from each lumen of central venous access device (CVAD) (if in situ)
What about the blood loss?
Aspasia Kordanouli
Infection Control NurseCalvary North Adelaide Hospital
89 Strangways Terrace North Adelaide SA 5006E: Aspasia.Kordanouli@calvarycare.org.au
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Hi Aspasia,
Great question. Biofilm can grow in the fibrin clot/sheath at the tip of the catheter, on the outer surface of the catheter or inside the lumens which in the early stages may just be a single lumen. Needless connectors can also become colonised. The recommendation to culture every lumen is based on Guembe (CID, 2010) who looked at 171 episodes of catheter related bloodstream infection – they found that 37% of infections would have been missed if only a single lumen was sampled. Similar findings from a smaller study by Robinson (J Ped Haem/Onc, 2002) in a paediatric haem-onc population where 32% of 41 episodes would have been missed.
Concern has been raised about the volume of blood required and risk of iatrogenic anaemia. Herrera-Guerra (Am J Infection Control, 2015) proposed a pooled culture technique where blood was taken from each lumen and used to inoculate a single blood culture bottle in comparison to traditional culture of each lumen. Also this was effective, I cannot see that it has been taken up elsewhere. I think this deserves consideration. Another thought I had is to only collect a single aerobic bottle from each lumen, knowing that almost all line pathogens do not need the specialised anaerobic environment – I don’t think this has been studied – has anyone seen this data?
For now, guidelines recommend a set of blood cultures from each lumen in addition to a peripheral set whenever catheter associated bloodstream infection is considered possible. An important aspect to note is that needless connectors should be replaced prior to sampling.
Kind regards,
Ed—–Original Message—–
From: ACIPC Infexion Connexion On Behalf Of Michael Wishart
Sent: Wednesday, 26 October 2022 6:40 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] 3 lumen Picc line Blood cultureCAUTION External Communication: This email originated from outside of the organisation. Do not click links or open attachments unless you recognise the sender and know the content is safe.Hi Aspasia
Blood cultures drawn through central device lumens can be very informative in regard to potential sources of infection. If you have positive growth in lumen collected blood cultures, and negative peripheral blood cultures, this can help determine the need for treatment, including the need to remove or replace lines. Blood cultures from lumens that return positive growth more rapidly than peripheral collections can also help guide appropriate treatment and potentially indicate a source.
Cheers
MichaelMichael Wishart | Infection Control Coordinator, CICP-E
St Vincents Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032 M +61 448 954 282 | T +61 7 3326 3068 | F +61 7 3607 2226 E michael.wishart@svha.org.au | W https://urldefense.com/v3/__https://www.svphn.org.au__;!!Lav448XFWxY!8bLSSTavpwUE7zNOmuvjTlE3Ke3_chKFmFOtyFtKq8bq_MfWT4rV42xPtRTEE9_xpRFnWn3CQ4JS6LIgzfq1I-dLebxB7O8JFvY$
St Vincents Private Hospital Brisbane | 411 Main Street KANGAROO POINT QLD 4169 M +61 448 954 282 | T +61 7 3240 1208 | F +61 7 3240 1166 E michael.wishart@svha.org.au | W https://urldefense.com/v3/__https://www.svphb.org.au__;!!Lav448XFWxY!8bLSSTavpwUE7zNOmuvjTlE3Ke3_chKFmFOtyFtKq8bq_MfWT4rV42xPtRTEE9_xpRFnWn3CQ4JS6LIgzfq1I-dLebxBGJtjmGs$
—–Original Message—–
From: ACIPC Infexion Connexion On Behalf Of Aspasia Kordanouli
Sent: Tuesday, 25 October 2022 3:56 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: [ACIPC_Infexion_Connexion] 3 lumen Picc line Blood cultureHi all,
Febrile neutropenia patient that has 3 lumen Picc- line insitu, what is the rationale of taking blood cultures of EACH lumen please?as per eviQ on management febrile neutropenia, 1 set blood cultures (aerobic and anaerobic bottles) from each lumen of central venous access device (CVAD) (if in situ)
What about the blood loss?
Aspasia Kordanouli
Infection Control NurseCalvary North Adelaide Hospital
89 Strangways Terrace North Adelaide SA 5006E: Aspasia.Kordanouli@calvarycare.org.au
https://urldefense.com/v3/__http://www.calvarynorthadelaide.org.au__;!!LUsMDrd6!mzAOsp0GAmG-vWMDsVxHCjEJ-Q3ri5dt7CyWcr9htC9LPxkeAcf910hj0mlArWZSEn-2C4jmNl9x78QxtPffQfYJXRDWDSLppASVO8CG$MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
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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.
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Reposting this… Keen to hear if anyone has an opinion or experience of implementing PFR use for source control. I don’t think there’s a right answer.
Thanks
Ed________________________________
CAUTION External Communication: This email originated from outside of the organisation. Do not click links or open attachments unless you recognise the sender and know the content is safe.
Hello IPC community,
Are you recommending PFRs for source control in your facilities?
We are considering use for
1. COVID positive patients coming into outpatient areas for infusions/assessment
2. All visitors to very high risk areas, eg bone marrow transplant unit, as we reduce stringency of RAT screening and have increasing levels of non-COVID respiratory illness in communityThe available literature seems to provide evidence of only marginal theoretical benefit which needs to be balanced against the cost and confusion of applying this targeted strategy.
Summarised in this systematic review 2022 https://doi.org/10.1007/s00420-021-01775-y which in discussion says: The results of the present review indicate that the use of a surgical mask by the source of the aerosol reaches a higher level of protection than the use of the N95 respirator by the receiver (Diaz and Smaldone 2010; Mansour and Smaldone 2013; Patel et al 2016). These data suggest that traditional surgical masks are useful in preventing the transmission of respiratory diseases when applied at the source of the infected aerosol, significantly reducing the exposure of pathogens, functioning as an inhalation barrier; however, in regard to respiratory protection equipment, there are still doubts about which is the best type to be used for this purpose (Patel et al. 2016 ). In an environment of 27 m3 occupied by five people, although the N95 respirator promotes greater filtration, surgical masks seemed to be more effective in reducing the release of bioaerosol, a difference mainly due to the adjustment and sealing of the mask to the face of the source (Xu et al. 2017).
This is primarily based on the Patel/Smaldone 2016 paper http://dx.doi.org/10.1080/15459624.2015.1043050 which reports findings from an in vitro model that perhaps underrepresents the efficiency and seal achieved in the majority of people with the current generation of soft shell PFRs.
Keen to hear your approach/experience.
Kind regards,
EdDr Ed Raby
Medical Director Infection Prevention and Control
South Metropolitan Health Service, WA
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.
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