270. From the Central Line to the Ventilator: Do Resident Physicians Know and Practice Mitigating Risk?
Session: Poster Abstract Session: HAI: Device Associated Infections
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • Fakih Lines-Vent poster ID week.pdf (7.1 MB)
  • Background: Central line-associated bloodstream infections (CLABSI) and ventilator-associated events (VAE) lead to serious morbidity and mortality. Resident physicians (RPs) play an important role in reducing the risk to patients.

    Methods: We administered a web-based survey to RPs of Medicine and Surgery training programs at 2 large teaching hospitals to evaluate knowledge and practice to reduce central line and ventilator risk. The questions addressed proper device placement and maintenance, and how to mitigate the risk.

    Results: 149 RPs completed the survey. The vast majority (94.8%) of RPs felt they know proper insertion technique of central line placement, but only 85.8% would use chlorhexidine-alcohol for site preparation. In addition, only 33.6% would use a checklist for catheter insertion. 97.7% of RPs were formally trained on central line placement, and 70% use ultrasound to give the insertion process in >90% of the time. 82.4% of RPs listed the internal jugular site as most common for insertion, and 55.7% thought it has the lowest risk for infection. RPs would seek another physician help after 2 attempts for insertion (38.2%), 3 attempts (38.2%), and 4 or more (14.5%). 77.1% of RPs reported daily evaluation of central line necessity >90% of the time. RPs were split on what constituted the highest risk for central lines (CLABSI: 52%; pneumothorax: 44.1%). On the other hand, only 68.5% reported being formally trained for preventing ventilator-associated pneumonia. They reported daily evaluation for ventilator necessity (78.2%), keeping head of bed >30 degrees (54%), and addressing early mobility (42.7%) in >90% of the time.

    Conclusion: RPs feel comfortable managing central lines and ventilators. However, their training may influence some of their practices, favoring the use of internal jugular lines. Opportunities exist to improve compliance with best practices.

    Mohamad G. Fakih, MD, MPH, FIDSA, FSHEA1, Ana C. Bardossy, MD2, Takiah Williams, BSN, RN3, Raymond Hilu, MD4, Katherine Reyes, MD, MPH5, Marcus Zervos, MD, FIDSA5, Debi Hopfner, RN, BSN3, Mina El-Kateb, MD6, Elango Edhayan, MD7, Susan Szpunar, PhD8, Steven Minnick, MD, MBA9 and Louis Saravolatz, MD, FIDSA10, (1)Infection Prevention and Control, St. John Hospital & Medical Center, Grosse Pointe Woods, MI, (2)Infectious Diseases, Henry Ford Health System, Detroit, MI, (3)Infection Prevention and Control, St John Hospital & Medical Center, Grosse Pointe Woods, MI, (4)Internal Medicine, St John Hospital and Medical Center, Grosse Pointe Woods, MI, (5)Division of Infectious Diseases, Henry Ford Hospital, Detroit, MI, (6)Internal Medicine, St John Hospital & Medical Center, Detroit, MI, (7)Surgery, St John Hospital and Medical Center, Detroit, MI, (8)Graduate Medical Education, St. John Hospital and Medical Center, Grosse Pointe Woods, MI, (9)Medical Education, St John Hospital and Medical Center, Grosse Pointe Woods, MI, (10)Internal Medicine, St. John Hospital and Medical Center, Grosse Pointe Woods, MI

    Disclosures:

    M. G. Fakih, None

    A. C. Bardossy, None

    T. Williams, None

    R. Hilu, None

    K. Reyes, None

    M. Zervos, None

    D. Hopfner, None

    M. El-Kateb, None

    E. Edhayan, None

    S. Szpunar, None

    S. Minnick, None

    L. Saravolatz, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.