Central line-associated bloodstream infection prevention.

Curr Opin Infect Dis. 2012 Aug;25(4):412-22

Authors: Miller SE, Maragakis LL

Abstract

PURPOSE OF REVIEW: This review summarizes recent literature regarding the prevention of central line-associated bloodstream infection (CLABSI).

RECENT FINDINGS: CLABSI rates in United States ICUs reported to the National Healthcare Safety Network (NHSN) have decreased dramatically in recent years. This has been achieved largely through a multifaceted approach and a focus on evidence-based best practices for central line insertion. More recent studies suggest an added benefit from implementation of evidence-based best practices for central line maintenance. Recent investigations also focus on CLABSI prevention among pediatric patients and in the non-ICU setting, in which a significant proportion of central line-days and CLABSI occur. A recent meta-analysis supports the practice of daily chlorhexidine gluconate (CHG) bathing in the ICU population for CLABSI prevention. Investigation continues regarding the most effective way to implement and sustain CLABSI prevention practices, including ways to best address and improve the culture of safety in healthcare.

SUMMARY: Recent literature on CLABSI prevention shows that a multifaceted approach to improving central line insertion and maintenance practices results in decreased CLABSI rates in both the ICU and non-ICU settings. More data are needed to develop appropriate benchmarks and prevention strategies specific to the non-ICU setting, in which a significant proportion of central line-days and CLABSI occur.

PMID: 22766647 [PubMed - in process]

Community acquired respiratory and gastrointestinal viral infections: challenges in the immunocompromised host.

Curr Opin Infect Dis. 2012 Aug;25(4):423-30

Authors: Kaltsas A, Sepkowitz K

Abstract

PURPOSE OF REVIEW: Newer molecular diagnostic techniques have advanced the field of clinical microbiology and infectious diseases, particularly with respect to characterizing the role that community acquired viruses play in the clinical course and outcomes of the immunocompromised host. This review will examine recent studies describing the impact of adenovirus, rhinovirus, hepatitis E and norovirus in the course of solid organ and stem cell transplant recipients, as well as their epidemiology and implications for infection prevention and control.

RECENT FINDINGS: Adenovirus transmission is poorly understood; recent studies increasingly point to reactivation of latent infection in the immunocompromised host. Rhinovirus shedding can persist for weeks after acute viral infection, complicating hospital infection control policies. Hepatitis E is increasingly recognized as a potential pathogen in the stem cell and solid organ transplant population, and should be considered in the work-up for unexplained liver function test abnormalities. Similar to rhinovirus, norovirus shedding from the gastrointestinal tract may persist for months in the immunocompromised host; infected patients are at a higher risk for transmitting norovirus compared with infected healthcare workers.

SUMMARY: Additional studies are needed, particularly with respect to transmission, for these community acquired viral infections, which often have devastating consequences in the immunocompromised patient population.

PMID: 22766648 [PubMed - in process]