• Journal of Hospice and Palliative Care
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• v.13 no.1
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• pp.24-31
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• 2010

Purpose: A central venous catheterization (CVC) is frequently used for delivering anti-cancer chemotherapeutic agents, blood products, parenteral nutrition, and other intravenous therapy in patients with cancer. Major complications of CVC use are thrombosis, infection, and mechanical complications. The aim of this study was to evaluate the frequency of CVC complications and related factors. Methods: The records of cancer patients who received a CVC at our university hospital from March 2001 to October 2006 were retrospectively investigated. Chi square test was used to determine whether there was a related factor for thrombosis or infection, and Kaplan-Meier analysis for univariate analysis, or Cox-regression analysis for multivariate analysis was used for catheter life span. Results: Three hundred and ten CVCs (235 nontunneled, 75 tunneled) were inserted in 310 patients (157 males, 153 females). Among them, 104 had hematologic cancers and 206 had solid cancers. The mean age of the patients was 52 years (range, 19~82 years). CVC complications occurred in 60 cases (19%). CVC-related thrombosis occurred frequently in patients with infection (P=0.003), whereas diagnosis, catheter type, transfusion, and TPN history did not affect infection or thrombosis. The mean duration of the catheter was 102 days (range, 2~1,330 days), and the duration was prolonged in patients with tunneled catheters (P=0.000), or without transfusion through CVC (P=0.030). Conclusion: The major complications for long-term use of a CVC were infectionand thrombosis. Tunneled catheter was effective tool for long term use, especially in cases without transfusion through CVC. The studies on the prevention or treatment ofthrombosis and infection are, therefore, warranted by using CVC for an extended period of time.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.17 no.6
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• pp.113-120
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• 2016

The purpose of this study is to identify the knowledge of and adherence to the infection control guidelines for indwelling urinary catheters, central venous catheters and ventilators among intensive care nurses. The subjects were 175 intensive care nurses working in 2 upper general hospitals and 3 general hospitals. Data were collected from July 1 to July 31, 2013. The collected data were analyzed by descriptive statistics, t-test and ANOVA using SPSS 18.0 for Windows. The mean scores of the knowledge of the infection control guidelines on indwelling urinary catheters, central venous catheters and ventilators were 0.87, 0.82 and 0.82 points, respectively. The average scores for the adherence to the infection control guidelines for indwelling urinary catheters, central venous catheters and ventilators were 4.18, 4.04 and 4.07 points, respectively. Statistically significant correlations were found between the knowledge of and adherence to the infection control guidelines for indwelling urinary catheters (r=.72, p<.00), central venous catheters (r=.54, p<.001) and ventilators (r=.30, p<.001). The knowledge of and adherence to the infection control guidelines for indwelling urinary catheters differed significantly according to gender, educational status, total career, number of patients, type of hospital, and attendance of seminar. The knowledge of and adherence to the infection control guidelines for central venous catheters differed significantly according to educational status, total career, number of patients, type of hospital, and attendance of seminar. The knowledge level of the infection control guidelines for the ventilator differed significantly according to the total career. The results of this study indicate that education and training programs for improving the knowledge of adherence to the infection control guidelines should be developed.

• Tuberculosis and Respiratory Diseases
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• v.59 no.4
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• pp.389-396
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• 2005

Background : Central venous catheters(CVCs) area major source of nosocomial infection. Chlorhexidine-silver sulfadiazine coated catheters (CHSS) were developed to reduce the rate of CVC infection. However, the clinical effectiveness of CHSS in comparison wth non-coated catheter (NCC) remains to be evaluated. Methods : From January 2004 to December 2004 in medical intensive care unit (ICU) of Asan Medical Center, CVCs were inserted in 446 cases. We retrospectively analyzed characteristics of patients and catheterization,the catheter-related infection rate and colonization, microbiologic findings, and insertion sites (subclavian, jugular, femoral) according to the type of inserted CVCs (NCC: 187 cases, CHSS: 259 cases). Catheter related infection is defined as catheter related bacteremia and catheter related non-bacteremic sepsis. Results : 1) The mean age of the patients in each group was $62{\pm}16$ years, $63{\pm}15$ years (p=0.42), and sex ratio 94:50, 141:69 (p=0.9) in NCC and CHSS. Duration of ICU admission ($29{\pm}37$, $26{\pm}44$ p=0.42), duration of mechanical ventilation ($17{\pm}22$, $15{\pm}19$ p=0.17), and APACHE III score at the time of CVC insertion ($81{\pm}34$, $82{\pm}37$ p=0.61) were not different between both groups. 2) Mean duration of catheterization was 118 in NCC and 119 in CHSS (p=0.98). Number of catheter-days was 2176 days in NCC and 3035 days in CHSS. Catheter-related infection occurred in 9 (4.8%) cases receiving NCC and 4 cases (1.5%) receiving CHSS. Catheterrelated infection incidence per 1000 catheter-days was 4.1 and 1.3, respectively (p=0.04). CHSS was associated with a significant reduction of infection in jugular catheters regarding to insertion sites (p=0.01). 3) Microorganisms causing infection were Staphylococcus aureus (n=3), Candida (n=3), coagulase-negative Staphylococci (n=2), and Klebsiella (n=1) in NCC, and Candida species (n=2), coagulase-negative Staphylococci (n=2), Proteus (n=1) in CHSS. Conclusion : CHSS has significantly reduced the episodes of infection compared to NCC in jugular catheterization in medical ICU.

• Journal of Korean Biological Nursing Science
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• v.18 no.4
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• pp.257-263
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• 2016

Background: This study purposed to examine how the incidence of the central line-associated bloodstream infection (CLABSI) in a operating room (OR) is affected by bundle application on central line insertion (CLI) practice. Methods: The study design was a pretest-posttest experimental trial. The subjects were 83 patients before the bundle application on CLI and 70 patients after. Results: The compliance(%) of bundle on CLI of among those who observed all of the five items increased from 7.2% before the intervention to 72.9% after. By items, compliance with the maximal barrier precaution was 100% for the use of a mask and cap before and after the intervention, but increased from 73.5% before the intervention to 88.6% after for the hand hygiene, from 73.5% to 88.6% for the use of a sterile gown, and from 9.6% to 75.7% for the use of a sterile large drape covering the whole body. CLABSI did not happen on CLI either before or after the application of the bundle intervention. Conclusion: Bundle application increased compliance with the use of a sterile gown and the use of a sterile large drape. However, its effect in the prevention of CLABSI was not clear probably due to the short period of intervention in a single hospital.

• Pediatric Infection and Vaccine
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• v.28 no.3
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• pp.133-143
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• 2021

Purpose: This study aimed to determine the incidence of central line-associated bloodstream infection (CLABSI) in the neonatal intensive care unit (NICU), evaluate the patients' clinical characteristics, and identify the etiologic agents for guidance in prevention and treatment. Methods: A retrospective chart review study of infants classified as having CLABSI was conducted at the NICU of Seoul National University Bundang Hospital from January 2016 to December 2020. Results: Of the 45 infants, 53 had CLABSIs within a follow-up period of 18,622 catheter days. The incidence of CLABSIs was 2.85 per 1,000 catheter days. The most common catheter type was a peripherally inserted central catheter (n=47, 81%). A total of 57 pathogens were isolated, of which 57.9% (n=33) were Gram-positive bacteria, 36.8% (n=21) were Gram-negative bacteria, and 5.3% (n=3) were Candida spp. The most common pathogens were Staphylococcus aureus (n=12, 21%) and coagulase-negative staphylococci (n=12, 21%), followed by Klebsiella aerogenes (n=8, 14%). The median duration of bacteremia was 2 days, and 19 episodes showed bacteremia for 3 days or more. The mortality rate of infants within 14 days of CLABSI was 13.3% (n=6). Conclusions: This study analyzed the incidence of CLABSI and the distribution of pathogens in the NICU. Continuous monitoring of CLABSI based on active surveillance serves as guidance for empiric antibiotic use and also serves as a tool to assess the necessity for implementation of prevention strategies and their impact.

• Journal of Korean Academy of Nursing
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• v.50 no.4
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• pp.541-553
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• 2020

Purpose: In spite of the recent application of a general infection control method, central line-associated infections is still relatively high in Korea. Central line bundle with Chlorhexidine gluconate (CHG) tegaderm dressing was reported to be effective in reducing catheter colonization and central line-associated bloodstream infections (CLABSI). Therefore, this study aimed to examine the incidences of catheter colonization occurrence and CLABSI while using Tegaderm vs. CHG Tegaderm dressings. Methods: We used a descriptive design. 400 patients who had central venous catheters were selected from four hospitals in the Korean National Healthcare-associated Infections Surveillance System. Of all subjects, 200 used Tegaderm™ (Tegaderm group), and the remaining 200 used CHG Tegaderm (CHG Tegaderm group) dressing at the catheter insertion site. Data were analyzed using the χ² test or Fisher's exact test, t-test, and logistic regression analysis using SPSS WIN 21.0. Results: In the Tegaderm and CHG Tegaderm groups, CLABSI incidences were 5.89 and 1.79 per 1,000 catheter-days, catheter colonization incidences were 3.93 and 1.43 per 1,000 catheter-days, and central line bundle compliance rates were 26.0% and 49.0%, respectively. Catheter colonization risk factors were 'reinsertion after failure' and 'Tegaderm dressing' at the central line insertion site. CLABSI risk factors were 'incomplete performance of 7 central line bundle items' and 'Tegaderm dressing' at the central line insertion site. Conclusion: A further prospective study is needed to examine the effects of central line bundle with CHG Tegaderm dressing, avoiding central line reinsertion after failure, and improving the bundle compliance in reducing catheter colonization and CLABSI.

• Neonatal Medicine
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• v.17 no.1
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• pp.84-93
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• 2010

Purpose : This study was performed to estimate the incidence of nosocomial sepsis and to identify the most relevant risk factors for nosocomial sepsis in high-risk very low birth weight (VLBW) infants. Methods : A retrospective review of 341 VLBW infants, admitted to the Neonatal Intensive Care Unit of the Eulji University Hospital (Daejeon & Seoul) between January 2002 and June 2009, who survived more than 72 hours was performed. The incidence, causative organisms, risk factors and prognosis of nosocomial sepsis in VLBW infants were analyzed. Results : The incidence of nosocomial sepsis was 16.1% and the onset date of nosocomial sepsis was 21.5$\pm$15.9 days (mean$\pm$SD) after delivery. Staphylococcus aureus (21.3%) was the most common organism in the patients with nosocomial sepsis in VLBW infants. The multiple logistic regression analysis showed that, gestational age [odds ratio (OR), 0.87; 95% CI, 0.83-0.91], umbilical artery catheter use for more than 5 days (OR, 2.2; 95% CI, 1.15-4.46), umbilical venous catheter use for more than 5 days (OR, 2.1; 95% CI, 1.11-4.16), peripheral arterial line use (OR, 2.1; 95% CI, 1.14-4.04) and intravenous intralipids (OR, 4.3;95% CI, 1.13-14.32) were identified as risk factors. Conclusion : The limited usage of intravascular catheter related procedures and the short providence of intravenous nutrition may decrease the incidence of nosocomial sepsis in VLBW infants.

• Korean Journal of Adult Nursing
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• v.24 no.5
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• pp.546-555
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• 2012

Purpose: The objective of this study was to examine the relationships between nurses' knowledge and performance for the prevention of intravascular catheter-related infections (ICRI) according to the strength of recommendations in evidence based guidelines (EBG). Methods: The total participants were 144 nurses working for medical surgical unit and intensive care unit. Data were collected from July 12 to July 30, 2010 and analyzed by one way ANOVA and Pearson's correlation analysis. Results: The knowledge and performance mean scores were $0.80{\pm}0.17$ and $3.04{\pm}0.31$ for peripheral venous catheter (PVC) management, and $0.83{\pm}0.17$ and $3.00{\pm}0.30$ for central venous catheter (CVC) management respectively. The items of category IA had the highest knowledge score (F=44.70, p<.001) and the items of category II had the highest performance score (F=47.09, p<.001) in PVC management, while the items of category IA had the highest knowledge (F=20.04, p<.001) and performance scores (F=18.20, p<.001) in CVC management. Knowledge and performance scores were significantly correlated in CVC management (r=.24, p=.004), but not in PVC management (r=.03, p=.753). Conclusion: EBG for the prevention of ICRI was not fully implemented in clinical settings. These findings emphasize that clinical professions need to develope strategies to enhance nursing practices with evidence based guideline.

• 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.

• Clinical and Experimental Pediatrics
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• v.50 no.7
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• pp.636-642
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• 2007

Purpose : Fluconazole prophylaxis for very low birth weight (VLBW) infants has been shown to reduce invasive fungal infection and its mortality. This study aims to evaluate the effect of fluconazole prophylaxis in VLBW infants on the incidence and mortality of fungal infection. Methods : VLBW infants with endotracheal intubation and central vascular access admitted to the Neonatal Intensive Care Unit (NICU) at Chonnam University Hospital were enrolled. Twenty eight infants of 7-month baseline period from January to July 2005 ('non-fluconazole group') were compared with 29 infants of a 7-month fluconazole period from January to July 2006 ('fluconazole group'). Results : Gestational age, birth weight, sex, mode of delivery, frequency of twin pregnancy, chorioamnionitis, antenatal steroid and rupture of membranes were similar between the fluconazole and non-fluconazole groups. The rate of extremely low birth weight (ELBW) infants, frequency and duration of prophylactic antibiotics, total parenteral nutrition and umbilical catheters, duration of intralipid, mechanical ventilation and nasal continuous positive airway pressure (CPAP) were also not significant. However, frequency of percutaneous central venous catheterization (PCVC) and intralipid administration, and duration of PCVC were significant between the two groups. The overall incidence and mortality of fungal infection were not different between the two groups. Although the Malassezia infection was increased in the fluconazole group (P<0.05), candida was significantly decreased compared to the non-fluconazole group (P<0.05). Conclusion : Fluconazole prophylaxis in high risk VLBW infants decreased the candida infection significantly. Antifungal prophylaxis is recommended in terms of cost effectiveness, but further study is needed to clarify the reason for the increase of Malassezia infection.