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Decline in hospital onset Candida bloodstream infections is associated with better IV catheter care

March 31 2016

Efforts to eliminate healthcare associated infections have successfully reduced Staphyloccoccus aureus bloodstream infections (BSI) but for Candida spp it is less clear. Some recent studies indicate falling rates of Candida BSIs in both adults and neonates (1,2), but the reason  has been unclear. Kabbani investigated this in a US hospital for veterans, searching for specific interventions associated with changes in incidence of Candida BSIs. The epidemiology of Candida BSIs were compared with hospital onset S. aureus BSI.

Infection rates between October 1999 and September 2013 were calculated for inpatients at the Atlanta Veterans Affairs Medical Center. Over 14 years, 311 Candida BSIs were found, of which 254 were considered hospital-onset infections. For the majority of the study period, the rate per 1000 veterans remained stable, until 2011, at which point, the rate began to decline significantly, driven by a decrease in hospital-onset infections (from 0.39 in 2011, to 0.07 in 2013). 

 

Over the period studied, several health care interventions were put into action. In 1999 an ongoing hand hygiene campaign started, which was intermittently refreshed; in 2002, the use of antiseptic-coated central venous catheters was introduced; in 2007, the methicillin-resistant S. aureus (MRSA) directive was implemented, including nasal screening, isolation of positives and emphasis on a culture of decreasing nosocomial MRSA transmission; chlorhexidine bathing began in 2010, while chlorhexidine dressing use for central venous catheters began in 2011. Finally, alcohol cap use was implemented in 2013.

The earlier interventions of hand hygiene and antiseptic coating on catheter lines did not have an effect on the rate of Candida blood stream infections.

A true decline in Candida BSIs between 2012-13 followed interventions which focused on catheter care specifically with the implementation of chlorhexidine bathing and improved central line maintenance using chlorhexidine dressing. Though a causal relationship between these factors cannot be confirmed, previous research suggests a link between the use of chlorhexidine bathing and dressings and the reduction of hospital-acquired infections (3, 4). 

Original Article

References

(1). Cleveland et al. 2015

(2). Fisher et al. 2014

(3) Climo et al. 2013

(4). Safdar et al. 2014