title: Dramatic increase of central venous catheter-related infections associated with a high turnover of the nursing team.
abstract: OBJECTIVE
  This retrospective study evaluated the impact of new organization during the moving to a new university pediatric hospital on the incidence of central catheter-related blood stream infections (CRBSIs) among children on long-term parenteral nutrition.
  
  
  METHODS
  The study ran from April 2007 to March 2014, starting a year prior to reorganisation of the department of pediatric Hepato-Gastroenterology and Nutrition associated to moving the children to a new hospital in April 2008, and continuing for 6 years following the move. During this time, data from all children hospitalized in this department who received parenteral nutrition (PN) for more than 15 days were analysed.
  
  
  RESULTS
  During this 7-years study, 183 children aged 4.6 ± 0.5 years received prolonged PN. Intestinal diseases were the main aetiologies (89%), primarily short bowel syndrome (18.4%), Hirschsprung disease and CIPO (13.5%) and inflammatory bowel disease (13.8%). The mean durations of hospitalization and of PN during hospitalization were, respectively, 70 ± 2.1 and 55.7 ± 3.6 days. During the study period, 151 CRBSIs occurred in 77 children (42% of all patients), i.e. 14.8 septic episodes/1000 PN days and 12.0 septic episodes/1000 CVC days. No patient died of a central venous catheter-related infection. However, following the move from the older hospital to the newer one, the rate of CRBSIs significantly doubled, from 3.9/1000 to 8.8/1000 CVC days (p = 0.02). During the following 4 years, the incidence of CRBSIs tended to increase between the 2nd and the 5th year after the move: 11.3 (p = NS); 21.4 (p = 0.01); 17.3 (p = NS), 20.3/1000 (p = NS) CVC days. We also observed that after evaluations by the Department of Infection Control, nurse training and stabilization of the nursing team, the incidence decreased significantly from 20.3 to 11.1/1000 CVC days during the 6th year after the move (p = 0.01).
  
  
  CONCLUSIONS
  Our results reveal the deleterious impact of the reorganization during the hospital moving on the CRBSI incidence rate, and the possible implication of inexperienced team of nurses.
authors.affiliation: Hospices Civils de Lyon, Faculté de pharmacie université Lyon1, Lyon, F-69008, France. Electronic address: e.mirabelchambaud@gmail.com.
authors.forename: Eléa
authors.initials: E
authors.lastname: Mirabel-Chambaud
authors.affiliation: Hospices Civils de Lyon, Faculté de pharmacie université Lyon1, Lyon, F-69008, France. Electronic address: michael.nguyenhuu@gmail.com.
authors.forename: Michael
authors.initials: M
authors.lastname: N'Guyen
authors.affiliation: Hospices Civils de Lyon, Department of Infection Control, Groupement Est, Bron, F-69677, France. Electronic address: marie.laure.@chu-lyon.fr.
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Valdeyron
authors.affiliation: Hospices Civils de Lyon, Faculté de pharmacie université Lyon1, Lyon, F-69008, France. Electronic address: thierry.quessada@chu-lyon.fr.
authors.forename: Thierry
authors.initials: T
authors.lastname: Quessada
authors.affiliation: Hospices Civils de Lyon, Faculté de pharmacie université Lyon1, Lyon, F-69008, France; Université Claude Bernard Lyon 1, Faculté de Médecine Lyon-Est, F-69003, Lyon, France; Université de Lyon, INSERM U1060, CarMeN Laboratory, Lyon, F-69008, France. Electronic address: joelle.goudable@chu-lyon.fr.
authors.forename: Joelle
authors.initials: J
authors.lastname: Goudable
authors.affiliation: Hospices Civils de Lyon, Hôpital Femme Mère Enfant de Lyon, Pediatric Hepato-Gastroenterology and Nutrition Department, Bron, F-69677, France. Electronic address: irene.loras-duclaux@chu-lyon.fr.
authors.forename: Irene
authors.initials: I
authors.lastname: Loras-Duclaux
authors.affiliation: Hospices Civils de Lyon, Hôpital Femme Mère Enfant de Lyon, Pediatric Hepato-Gastroenterology and Nutrition Department, Bron, F-69677, France. Electronic address: stephanie.marotte@chu-lyon.fr.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Marotte
authors.affiliation: Hospices Civils de Lyon, Hôpital Femme Mère Enfant de Lyon, Pediatric Hepato-Gastroenterology and Nutrition Department, Bron, F-69677, France. Electronic address: sophie.heissat@chu-lyon.fr.
authors.forename: Sophie
authors.initials: S
authors.lastname: Heissat
authors.affiliation: Hospices Civils de Lyon, Hôpital Femme Mère Enfant de Lyon, Pediatric Hepato-Gastroenterology and Nutrition Department, Bron, F-69677, France. Electronic address: lioara.restier@chu-lyon.fr.
authors.forename: Lioara
authors.initials: L
authors.lastname: Restier
authors.affiliation: Hospices Civils de Lyon, Hôpital Femme Mère Enfant de Lyon, Pediatric Hepato-Gastroenterology and Nutrition Department, Bron, F-69677, France; Université Claude Bernard Lyon 1, Faculté de Médecine Lyon-Est, F-69003, Lyon, France. Electronic address: alain.lachaux@chu-lyon.fr.
authors.forename: Alain
authors.initials: A
authors.lastname: Lachaux
authors.affiliation: Hospices Civils de Lyon, Hôpital Femme Mère Enfant de Lyon, Pediatric Hepato-Gastroenterology and Nutrition Department, Bron, F-69677, France; Université Claude Bernard Lyon 1, Faculté de Médecine Lyon-Est, F-69003, Lyon, France; Université de Lyon, INSERM U1060, CarMeN Laboratory, Lyon, F-69008, France. Electronic address: noel.peretti@chu-lyon.fr.
authors.forename: Noel
authors.initials: N
authors.lastname: Peretti
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000382:microbiology; D062905:Central Venous Catheters / Q000009:adverse effects* / Q000382:microbiology; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007410:Intestinal Diseases / Q000453:epidemiology* / Q000382:microbiology; D007902:Length of Stay; D008297:Male; D010288:Parenteral Nutrition / Q000009:adverse effects; D010563:Personnel Turnover; D012189:Retrospective Studies; D013210:Staphylococcus / Q000302:isolation & purification
keywords: CRBSI; Children; Nosocomial infection; Parenteral nutrition; Septicemia