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4 results

  • Impact of a Central-Line Insertion Site Assessment (CLISA) score on localized insertion site infection to prevent central-line–associated bloodstream infection (CLABSI)
  • Shruti K. Gohil, Jennifer Yim, Kathleen Quan, Maurice Espinoza, Deborah J. Thompson, Allen P. Kong, Bardia Bahadori, Tom Tjoa, Chris Paiji, Scott Rudkin, Syma Rashid, Suzie S. Hong, Linda Dickey, Mohamad N. Alsharif, William C. Wilson, Alpesh N. Amin, Justin Chang, Usme Khusbu, Susan S. Huang
  • Journal: Infection Control & Hospital Epidemiology / Volume 41 / Issue 1 / January 2020
  • Published online by Cambridge University Press: 08 November 2019, pp. 59-66
  • Print publication: January 2020
  • View abstract
    Objective:

    To assess the impact of a newly developed Central-Line Insertion Site Assessment (CLISA) score on the incidence of local inflammation or infection for CLABSI prevention.

    Design:

    A pre- and postintervention, quasi-experimental quality improvement study.

    Setting and participants:

    Adult inpatients with central venous catheters (CVCs) hospitalized in an intensive care unit or oncology ward at a large academic medical center.

    Methods:

    We evaluated CLISA score impact on insertion site inflammation and infection (CLISA score of 2 or 3) incidence in the baseline period (June 2014–January 2015) and the intervention period (April 2015–October 2017) using interrupted times series and generalized linear mixed-effects multivariable analyses. These were run separately for days-to-line removal from identification of a CLISA score of 2 or 3. CLISA score interrater reliability and photo quiz results were evaluated.

    Results:

    Among 6,957 CVCs assessed 40,846 times, percentage of lines with CLISA score of 2 or 3 in the baseline and intervention periods decreased by 78.2% (from 22.0% to 4.7%), with a significant immediate decrease in the time-series analysis (P < .001). According to the multivariable regression, the intervention was associated with lower percentage of lines with a CLISA score of 2 or 3, after adjusting for age, gender, CVC body location, and hospital unit (odds ratio, 0.15; 95% confidence interval, 0.06–0.34; P < .001). According to the multivariate regression, days to removal of lines with CLISA score of 2 or 3 was 3.19 days faster after the intervention (P < .001). Also, line dwell time decreased 37.1% from a mean of 14 days (standard deviation [SD], 10.6) to 8.8 days (SD, 9.0) (P < .001). Device utilization ratios decreased 9% from 0.64 (SD, 0.08) to 0.58 (SD, 0.06) (P = .039).

    Conclusions:

    The CLISA score creates a common language for assessing line infection risk and successfully promotes high compliance with best practices in timely line removal.

  • Conflicting Diagnosis of Dermal Sinus Tract and Tethered Cord
  • Chris J. Hong, Saleh A. Almenawer, Boleslaw Lach, Nina Stein, Benedicto Baronia, Sheila K. Singh
  • Journal: Canadian Journal of Neurological Sciences / Volume 40 / Issue 6 / November 2013
  • Published online by Cambridge University Press: 23 September 2014, pp. 889-891
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    Dermal sinus tracts (DSTs) are an uncommon form of occult spinal dysraphism that is attributed to incomplete neural tube closure during fetal development. Dermal sinus tracts are found along the midline neuroaxis from the nasion to the coccyx, but they most commonly appear in the lumbar region. Dermal sinus tracts are more commonly associated with other developmental abnormalities such as skin tags, naevi, spinal dermoid cysts, meningocoele, lipomas and spinal cord tethering, and can be complicated by cerebrospinal fluid drainage, shedding of keratin from the epithelialized tract, and infection such as meningitis.