• Korean Journal of Adult Nursing
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• v.22 no.3
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• pp.229-238
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• 2010

Purpose: The purpose of this study was to examine the effect of maximal sterile barrier precaution on the central venous catheter-related infection and subsequent cost savings. Methods: Study subjects were 462 hospitalized patients with central venous, catheter of more than 48 hours duration. Data collection period was from April 2008 to February 2009 at a tertiary university hospital in Seoul. Subjects were randomly assigned to either the treatment or the usual care group. Patients in the treatment group (n=209) were treated by staff using maximal sterile barrier precautions and the comparison group(n=253) received traditional care. Results: Central venous catheter-days was2,821 in treatment group and 3,515 in comparison group. The incidence density of central venous catheter-related infection was 2.1 times higher in the comparison group (8.2 per 1,000 catheter-days) compared with the treatment group (3.9 per 1,000 catheter-days). The incidence density of central venous catheter-related bloodstream infection was 4.54 times higher than in the comparison group (3.2 per 1,000 catheter-days) compared with the treatment group (0.7 per 1,000 catheter-days). The attributable cost of central venous catheter-related infection in the treatment group was 10,174,197 won and that of the comparison group was 22,224,554 won. Attributable cost by area was also significantly lower compared with that of the comparisons. Conclusion: The maximal sterile barrier precaution during central venous catheter insertion was an effective intervention to reduce central venous catheter-related infection rate and provides a significant cost savings.

• Advances in pediatric surgery
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• v.16 no.1
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• pp.25-31
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• 2010

Hickman catheters are tunneled central venous catheters used for long-term venous access in children with malignancies. The appropriate management for various kinds of catheter related complications has become a major issue. We retrospectively analyzed the clinical, demographic, and surgical characteristics in 154 pediatric hemato-oncology patients who underwent Hickman catheter insertion between January 2005 and December 2009. There were 92 boys and 62 girls. The mean age at surgery was $7.6{\pm}5.1$ years old. The mean operation time was $67.4{\pm}21.3$ minutes and C-arm fluoroscopy was used in 47(30.5 %). The causes of Hickman catheter removal were termination of use in 82 (57.3 %), catheter related bloodstream infection in 44(30.8 %), mechanical malfunction in 11(7.7 %), and accidents in 6(4.2 %). Univariate and multivariate analysis for associated factors with catheter related bloodstream infection showed that there were no statistically significant associated factors with catheter related infection complications. All cases except two showed clinical improvement with catheter removal and relevant antibiotics treatment. The mean catheter maintenance period in patients of catheter removal without complications was $214.9{\pm}140.2$ days. And, The mean catheter maintenance period in patients of late catheter related bloodstream infection was $198.0{\pm}116.0$ days. These data suggest that it is important to remove Hickman catheter as soon as possible after the termination of use. When symptoms and signs of complications were noticed, prompt diagnostic approach and management can lead to clinical improvements.

• Microbiology and Biotechnology Letters
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• v.47 no.2
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• pp.173-182
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• 2019

The use of double lumen catheters as a means of hemodialysis access is commonly accompanied with the use of gentamicin as an antibiotic lock. Other antibiotics and anticoagulants are often added to increase the efficacy of gentamicin in order to reduce catheter-related infection and to prevent biofilm formation. This review aimed to evaluate the following: 1) the use of gentamicin in eliminating catheter-related infection and reducing biofilm formation in hemodialysis catheters, 2) the efficacy of additional antibiotics in combination with gentamicin, and 3) the effect of additional anticoagulants to complement the efficacy of gentamicin as the main prophylactic antibiotic lock. We sorted through data from 242 PubMed and ScienceDirect studies, which were then short-listed to 33 studies. Next, they were grouped, extracted, and analyzed qualitatively to fulfil the objectives of this review. Consequently, the use of a gentamicin-lock solution was shown to reduce the incidence of bacteremia; however, it was not strong enough to inhibit the growth of infectious microbes and formation of biofilms. Several bacteria, such as Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, and Klebsiella pneumoniae, have been reported as infectious agents. Combination with other antibiotics also provided no effect in reducing bacterial growth and biofilm formation in catheters. Furthermore, the additional anticoagulants (trisodium citrate and EDTA) were reported to be effective in enhancing the efficacy of gentamicin in avoiding catheter-related infection, bacterial growth, and biofilm formation; thus, the use of gentamicin can be rationalized.

• Infection and chemotherapy
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• v.50 no.4
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• pp.362-366
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• 2018

Millerozyma farinosa (formerly Pichia farinosa) is halotolerant yeast mainly found in food and ubiquitous in the environment. It was a rare yeast pathogen, but it has recently emerged as a cause of fungemia in immunocompromised patients. Optimal therapy for invasive fungal infection by this pathogen remains unclear. We report a case of catheter related blood stream infection caused by M. farinosa in a 71-year-old patient who recovered successfully after removal of the central venous catheter and treatment with micafungin.

• Journal of Microbiology and Biotechnology
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• v.25 no.10
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• pp.1728-1733
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• 2015

This study was done to establish a mouse model for catheter-related biofilm infection suitable to bioluminescence imaging (BLI). Biofilm formation of Pseudomonas aeruginosa (P. aeruginosa) Xen5 grown on catheter disks in vitro and in an implanted mouse model was real-time monitored during a 7-day study period using BLI. The numbers of integrated brightness (IB) and viable bacterial count (VBC) in the biofilm disks in vitro were highest at 24 h after inoculation; the IB of biofilm in vivo was increased until 24 h after implantation. A statistical correlation was observed between IB and VBC in vitro by linear regression analysis. The actual VBC value in vivo can be estimated accurately by IB without sacrifice. In addition, we monitored the change in white blood cells (WBCs) during infection. The number of WBCs on day 7 was significantly higher in the infection group than in the control group. This study indicates that BLI is a simple, fast, and sensitive method to measure catheter biofilm infection in mice.

• Journal of Korean Academy of Nursing Administration
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• v.18 no.2
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• pp.244-250
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• 2012

Purpose: The purpose of this study was to investigate the effect of a short message service intervention on adherence to maximal barrier precautions (MBP) and catheter-related blood stream infections. Method: The data were collected from March to September, 2008, at an 826-bed university-affiliated hospital in Daejeon. The study participants were 24 physicians who were inserting central catheters and 133 patients (control group 78 and intervention group 55) with central catheter insertions. The researcher sent the message (adherence to MBP and optimal recommendations) to each internal medicine doctor using the short message service (SMS) for cellular phones. Messages were sent monthly for 3 months. Data were analyzed by chi-square test and t-test using SPSS 12.0 windows program. Result: Adherence to maximal barrier precautions was significantly increased from 44.9% to 69.1% (p=.006) after the SMS intervention. But changes in the rate of CRBSI (catheter related blood stream infection) between the intervention group (1.89) and the control group (4.45) were not significant (p=.323). Conclusions: The results indicate that the SMS intervention is effective in increasing the adherence to maximal barrier precautions and the SMS intervention can be recommended for utilization in infection control nursing practice.

• Journal of Korean Academy of Nursing
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• v.24 no.3
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• pp.345-363
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• 1994

This study attempted to identify important problems of the factors related to the indwelling catheter with closed drainage and to enhance recognization of Urinary Tract Infection management to protect patients with indwelling catheter from UTI. We selected the 58 patients with indwelling catheter with closed drainage from md-surg. intensive care units, and general neurological and neurosurgical ward, in one hospital in Pusan, Korea from May 30 to October 15, 1993. Patients were examined by urinary analysis before inserting catheter and then by urine cultures three times. The obtained data was analized using an SPSS /PC$^{+}$ The statistical analyses employed here was the frequency, percentage and x$^2$-tests. 1. Analyses for Indwelling Catheter induced UTI and infection rates were found to be presented in patients related to the factors of being on antibiotic drugs (x$^2$=14.105, p=.000) and the duration of the indwelling catheter(x$^2$=58.0, p=.000), both of which were found to affect the UTI. 2. UTI rates according to the duration of the in-dwelling catheter were high 8.6％ for the 2nd day, 27.6 for the 4th day, and 36.2% for the 7th day, and as the duration for the indwelling catheter was longer, UTI rates were higher. 3. The UTI rates according to the duration of the indwelling catheter related re factors, on the 7th day, were high-52.0% for women, 37.0% for more than 50 years in ages, 30.0% for patients under sur-gery, 33.3% for altered mental states outsides the alert, 76.7% for patients not given antibiotic drugs, 36.4% for less than 3500cc of fluids intakes, it was found that these affected to increase the UTI. 4. Causative organisms of UTI were found ; E.Coli appears the most than all other isolated organisms in women and Klebsiella and Pseudomonas in men. For antibiotic susceptibility of causative organisms, all causative organisms were found to be susceptible to Sul -cefoperazone, Trim-prim, and unasyn and Pseudomonas mostly net susceptible.e.

• Clinical and Experimental Pediatrics
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• v.54 no.9
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• pp.363-367
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• 2011

Central venous catheters (CVCs) are regularly used in intensive care units, and catheter-related bloodstream infection (CRBSI) remains a leading cause of healthcare-associated infections, particularly in preterm infants. Increased survival rate of extremely-low-birth-weight infants can be partly attributed to routine practice of CVC placement. The most common types of CVCs used in neonatal intensive care units (NICUs) include umbilical venous catheters, peripherally inserted central catheters, and tunneled catheters. CRBSI is defined as a laboratory-confirmed bloodstream infection (BSI) with either a positive catheter tip culture or a positive blood culture drawn from the CVC. BSIs most frequently result from pathogens such as gram-positive cocci, coagulase-negative staphylococci, and sometimes gram-negative organisms. CRBSIs are usually associated with several risk factors, including prolonged catheter placement, femoral access, low birth weight, and young gestational age. Most NICUs have a strategy for catheter insertion and maintenance designed to decrease CRBSIs. Specific interventions slightly differ between NICUs, particularly with regard to the types of disinfectants used for hand hygiene and appropriate skin care for the infant. In conclusion, infection rates can be reduced by the application of strict protocols for the placement and maintenance of CVCs and the education of NICU physicians and nurses.

• Quality Improvement in Health Care
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• v.2 no.2
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• pp.156-171
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• 1996

Background: Nosocomial infection control is one of important means to assure the quality of medical care in the hospital, however, it has been neglected by most of the hospital personnels. Of nosocomial infections, urinary tract infection is the highest incidence, which is related to the indwelling catheter. It is, therefore, necessary to pay primary attention to the patients with the indwelling catheter in intensive care unit in order to control nosocomial Infection and to improve the quality of medical care in the hospital. Methods : The subjects of this study were patients with indwelling catheter who were admitted to the ICU of Pusan Paik Hospital from March 1994 to May 1995. The author calculated UTI rate among the subjects through the cultivation of the urine, identified the related factors of the UTI through brain storming of study team and head nurses working at ICU, and analized the effectiveness of the proposed approaches through comparing the infection rates of before and after activities. Results : The major activities carried out by the study team were to conduct in-service education programs for the staffs working at ICU about the importance of the nosocomial infection control in QA, and nursing intervention to reduce the UTI rate among the patients with indwelling catether. 1. The major nursing interventions that the study team had implemented were as follows ; 1) Drainage system was changed from partial open system to completely closed system. 2) Bladder irrigation which was routinely practised in all patients stopped among the noninfected patients. 3) Bladder irrigation set was changed to the disposable one. 4) Catheter was inserted under the anesthesia for patients to be operated. 5) Male patient receiving wrapped with gauze after perineal care was not wrapped. 6) Clamp which had not been before was newly attached to drainage tube. 7) Urine bag which had been packed into a lot of pieces was done into each piece. 8) The interval of change of indwelling catheter had regularly been four weeks, however it was used continously until it worked well. 9) Catheter was attached well at the defined site. 10) Paper towel was used instead of cotton towel. 11) Mats at the entrance were removed and cleansing of wards was enhanced. 2. The UTI rate by month was 34.4% in maximum and 9.8% in minimum during the period of this study, however it had gradually decreased. After 6 months from initiating infection control activities, the trend of rates was relatively stable. It was identified that UTI rate was different by season 12.5% in winter and 27.2% in summer. 3. Utilization rate of indwelling catheter was maintained at under 50%, but it was increased above 57% from April 1995. 4. The number of bladder irrigation sets used per day was 33.3 sets in maximum and 2.8 sets in minimum. The number used per day were also remarkably deceased. Conclusion : It was found that a program to control UTI could contribute to nosocomial infection control, and it was, in turn, a mean to assure the quality of medical care in the hospital. The nursing interventions which this study team had implemented were effective in the reduce of UTI rates.

• Biomedical Science Letters
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• v.10 no.3
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• pp.245-251
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• 2004

Microbial infection provokes one of the most serious complications to the patients with indwelling catheters. Ciprofloxacin (CFX) was added into the catheter materials (polyurethane or silicone) during the manufacturing process to avoid the microbial infection. Efficacy of the catheters containing CFX was investigated by using the in vitro zone of growth inhibition test method. The catheters made of polyurethane or silicone exhibited a strong antimicrobial activity against the major catheter-related microorganisms (S. aureus, S. epidermidis, P. aeruginosa and E. coli), when CFX was incorporated into the catheters. Fetal bovine serum (FBS) did not affected antimicrobial activities of the polyurethane catheters with CFX loading of 0.5 and 1.0％ (W/W) against S. aureus and S. epidermidis. However, the polyurethane catheters with 1.0％ (W/W) of CFX loading showed a significantly (P<0.05) reduced antimicrobial activity against E. coli when the catheters were exposed to FBS. Silicone catheters with 1.0 and 1.5％ (W/W) of CFX loading demonstrated effective antimicrobial activity against S. epidermidis for at least 2 weeks. These results suggest that the use of catheters containing ciprofloxacin could be effective in preventing catheter-related infections.