Barriers to Diagnosis, Treatment and Prevention of Bloodstream Infections: Healthcare Mission Impossible

Bloodstream Infections (BSI) is defined as one or more positive blood cultures associated with symptoms of an infectious disease such as bronchitis, cold, and/or high blood pressure. BSI is usually divided into primary & secondary. Primary BSI appears without a specific location. Secondary BSI increases in the affected area, which can be identified as the cause of bacterial infection. Examples of Secondary BSI are urinary tract infections with subsequent bacterial infections.

In general, BSI can be divided into three major groups.

1. Natural immunity and permanent protection,
2. Patients with physical problems (impaired defenses mostly in youth, adults)
3. Patients with pathological disease or predisposing to infection

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Key Factors:

• BSI is usually administered by injection, such as an IV catheter.
• Preventing catheter-related BSIs is a top priority in combating disease.
• Vascular catheter-related BSIs is a common cause for bacterial infections.
• However, peripheral venous catheters less commonly cause BSI.

Well Known Facts and Figures:

• Each year, 278,000 BSI patients are reported in the United States.
• 87,000 of these are catheter-related BSIs that occur in ICUs.
• BSI increases hospital stay and long-term costs.
• The predicted mortality rate for BSI is 13 to 29%.
• Catheter -linked bloodstream infections account for 14% of infections.
• The most common isolated BSI organisms include coagulase-negative staphylococci (31%), Staphylococcus aureus— either methicillin sensitive or resistant (23%), enterococci (12%), Escherichia coli (7%), Klebsiella species (8%), and Candida species (3%).
• Independent risk factors for central line associated BSIs are:
  1. Continued hospitalization before catheterization.
  2. Prolonged time of catheterization.
  3. Large colonies of microorganisms at the site of insertion or catheter hub.
  4. Femoral catheterization in adults.
  5. Neutropenia
  6. Reduced nurse-to-subject ratio in the Intensive Care Unit.
  7. Total parenteral nutrition.

• Implement a mutually effective strategy to reduce catheter-related BSI to 77% during intensive care in the United States

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Safe Practice Suggestions:

• Education and training of healthcare workers.
• In-hospital disease management policy for intravascular device-related disease
• The location and use of central line include five key components:
• Maintain hand hygiene with use of appropriate alcohol based waterless hand or antibacterial soap and water with adequate rinsing.
• Take maximal barrier precautions like strict Hand hygiene; Wear a sterile surgical gown, mask, sterile coat, and gloves; and the use of sterile drapes.
• Prepare the skin with 2% chlorhexidine and 70% isopropyl
• Use of an optimal catheter site such as the subclavian area and avoidance of a femoral site.
• Review important central lines that should be disposed of as soon as possible.
• The spray mask must be disinfected before use and the station must be applied when not in use.
• Sanitize injection ports before use and stopcocks should be plugged when not in use.
• Use Teflon or polyurethane catheter instead of using polyvinyl chloride or polyethylene catheter.
• Change sterile gauze dressings every day with transparent dressing changes every 4 days.
• Putting chlorhexidine-impregnated sponges (Biopatch) at catheter sites is related with significant decrease in BSI rates.
• Daily cleaning of the implant with 2% chlorhexidine oxide lowers BSI levels.
• If the device has been used for more than 4-day, special antimicrobial-coated catheters should be considered.
• Substitute tubing used for blood products, lipid emulsions, and propofol infusions.
• Use sutureless securement devices.
• Use peripheral catheters as opposed to central venous catheters whenever possible, although peripheral catheters can also be associated with BSI.
• Tunneled central venous catheters should be specially employed for long term use (>6 days of catheterization).

Practices Currently Not Allowed:

• Don’t use topical antimicrobials at insertions sites except when with dialysis catheters
• Don’t use in-line filters for infection prevention.
• Don’t use antibacterial lock solutions routinely. Antimicrobial locks should only be used under special circumstances such as patients with history of multiple catheter related bloodstream infections despite adequate precautions
• Don’t use guidewire catheter exchanges to change out suspected infected catheters.
• Don’t routinely use anticoagulant therapy to reduce catheter-related infection risk.

British BioMedicine Clinical Trials (BBMCT)

Suggested Practice amid Lack of equipment:

The hand washing catheter insertion and care bundles described above can be used in small areas and may reduce the risk of catheter-associated bloodstream infections in South America, Asia, United States. Western and European countries. These measures not only reduce deadly diseases, but also save hospitals cost.

Closing Remarks

Bacterial infections are caused by contagious catheter-related bloodstream infections. These diseases increase the risk of illness and death, take longer hospital stay and require higher costs. Implementation of the above measures has been shown to reduce costs and improve the quality of health care. The biggest changes in the management of bacterial infections over the past 20 years have been the decrease in the overall activity of antibiotics and the lack of novel drug molecules. Bacteria has become resistant to most antibiotics. It is necessary to find new molecules to fight bacteria related infections, raise awareness, restrict use  of old antibiotics, and improve the spread of the disease resistance. BSI is a serious challenge for scientists, but it can be a daunting task if the medicine isn’t working properly.