Non-interventional prospective multicenter study on the resistance pattern of Gram-negative bacteria isolated from blood from HSCT recipients, on behalf of IDWP

Introduction: In 2009 Infectious Diseases Working Party of EBMT with other international bodies introduced updated evidence based guidelines for placement and management of central venous catheters in patients undergoing hematopoietic stem cell transplantation. The central venous catheter infection prevention bundle consists of recommendations regarding hand hygiene, full barrier precautions, cleaning the insertion site with chlorhexidine, avoiding femoral sites for insertion, and removing unnecessary catheters. The aim of this study was to survey recommendations included in standard operating procedures (SOP) and current clinical practice regarding CLABSI prevention, infection monitoring and education on CVCs at hematologic and oncologic EBMT centers performing HSCT.  Materials (or patients) and methods: Setting and sample This cross sectional study was performed during January to June 2013 among European centers performing HSCT and being a member of EBMT. Among the 545 EBMT transplant centers worldwide 103 (19%) participated. The questionnaire A questionnaire concerning recommendations included in standard operating procedures (SOP) of the center for management of CVCs to prevent CLABSI (Part A) and current practice regarding management of CVCs (Part B) was specifically developed for this study by the authors. Results: CLABSI prevention bundle The recommended CLABSI prevention bundle consists of hand hygiene, full barrier precautions, cleaning the insertion site with chlorhexidine, avoiding femoral sites for insertion, and removing unnecessary catheters. In 33% of the centers  all parts of the bundle were included in SOP. This corresponded to 27% of centers that fully incorporated recommended CLABSI prevention bundle into current clinical practice. The most common unfulfilled parts of CLABSI prevention bandle were lack of complete full barrier precautions and lack of use of chlorhexidine in clinical practice. Full barrier precautions All five parameters of full barrier precaution (use of cap, mask, sterile gloves, sterile gown, full size body drape: 60 x 60 cm) were fulfilled in 57% of the centers SOP and 36% reported these procedures being used in clinical practice. The most common unfulfilled criteria for full barrier precautions was lack of use of full size body drapes during CVC insertion. In clinical practice 35% of the centers used a full size body drape, 48% used a larger drape and 17% used a smaller drape than 60 x 60 cm.  Discussion: This is the first report on the current practice on CLABSI prevention among the EBMT centers. Among the surveyed centers only minority report implementation of the full recommended practices. The most common recommendations missing in clinical practice are use of all full barrier precautions and use of chlorhexidine containing solutions. Also considerable variation exists regarding preferred site of the central line insertion and every day care. The results of the study show that prevention of CLABSI is still a challenge for many centers and there is a need for improvement. The further study is needed to assess if observed differences between the centers could influence HSCT outcome at the centers.