title: Improvement in the diagnosis of catheter-related bloodstream infections in a tertiary cancer center.
abstract: BACKGROUND
  Identifying a central venous catheter (CVC) as the source of bacteremia requires drawing simultaneous blood cultures (BCs) from the CVC and peripheral site and correct labeling of the BC source. In our emergency center (EC), 52% of BCs collected from febrile cancer patients lacked source information, making the diagnosis and management of catheter-related bloodstream infections (CRBSIs) challenging.
  
  
  METHODS
  Between January 2015 and June 2015, we conducted a quality improvement project in our EC aiming to increase the occurrence of simultaneous BC drawing with accurate source labeling by 10%.
  
  
  RESULTS
  Staff education and monitoring increased average BC source labeling from a baseline of 48% to a much better rate of 70%. Label introduction led to increased source labeling to 94% by June 2015. This project had a significant influence in patients with a CVC and a positive BC because the physician is now able to determine whether the CVC is the source of the bacteremia in 88% of cases compared with 36% at baseline (P = .0003).
  
  
  CONCLUSIONS
  Education without an active intervention is usually not enough. Simple solutions such as label introduction can have significant influence on patient safety and care. Accurate diagnosis may guide clinicians at the bedside to appropriately manage CVCs in the setting of bacteremia, remove a CVC when indicated, and prevent unnecessary CVC removal with its potential safety and cost-effectiveness implications.
authors.affiliation: Department of Emergency Medicine, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Patrick
authors.initials: P
authors.lastname: Chaftari
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: achaftar@mdanderson.org.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Chaftari
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Javier
authors.initials: J
authors.lastname: Adachi
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Ray
authors.initials: R
authors.lastname: Hachem
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Sammy
authors.initials: S
authors.lastname: Raad
authors.affiliation: Department of Infusion Therapy, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Natividad
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Nora
authors.initials: N
authors.lastname: Oliver
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Bena
authors.initials: B
authors.lastname: Ellickalputhenpura
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Ying
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Laboratory Medicine Administration, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Tarrand
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Issam
authors.initials: I
authors.lastname: Raad
mesh_terms: D016470:Bacteremia / Q000175:diagnosis*; D001431:Bacteriological Techniques / Q000379:methods*; D055499:Catheter-Related Infections / Q000175:diagnosis*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003955:Diagnostic Tests, Routine / Q000379:methods*; D019468:Disease Management; D006801:Humans; D009369:Neoplasms / Q000150:complications*; D013048:Specimen Handling / Q000379:methods*
keywords: Blood cultures; Cancer patients; Central venous catheter