Becker's Clinical Quality & Infection Control

57 INFECTION PREVENTION & ANTIBIOTIC RESISTANCE Central Line Care Maintenance Bundle Improves Catheter Dressing Care, Study Finds By Shannon Barnet C hanging the dressing on a patient's catheter is a crucial infection prevention method that can be improved by implementing a multifaceted catheter care maintenance bundle, accord- ing to a recent study published in March the journal Infection Control & Hospital Epidemiology. Authors of the study conducted a 12-month, before-and-aer trial at a 1,250-bed teaching hospital. e study examined a bundle that included educational programs for nurses, updated hospital policies, visual aids, a competency assessment, process monitoring, regular progress reports and consolidation of catheter maintenance supplies. All total, the researchers collected data for more than 25,500 catheter days, including 43 central line-associated bloodstream infec- tions, and more than 4,000 catheter dressing observations. ey found the CLABSI incidence den- sity decreased 2.5 percent per month on intervention floors. Even more telling, the bundle was associated with significant im- provements in catheter dressing compliance. Compliance increased from 78.8 percent to 87.9 percent on intervention wards, more than on control wards, where compliance increased from 84.9 percent to 90.9 percent. Ultimately, the authors concluded that while the program improved catheter dressing care, more research is necessary to create CLABSI prevention strategies in non-inten- sive care unit patients. n MRSA Antibiotic Susceptibility Changing in Pediatric Patients, Study Finds By Brian Zimmerman T he proportion of Staphylococcus aureus infections in children due to methicillin-resistant strains has decreased, according to a study in Pediatrics and covered by HealthDay. Researchers from the San Antonio Military Medical Center examined S. aureus strains from 39,207 kids who had been hospitalized within the U.S. Military Health System between 2005 and 2014, looking at susceptibility of the isolates. The researchers then assessed clinical and demographic characteristics to evaluate for trends in antibiotic resistance. The results indicated S. aureus became more susceptible to erythromy- cin, gentamicin and oxacillin during the 10-year time period. There was measurable decrease in susceptibility to clindamycin, ciprofloxacin and trimethoprim-sulfamethoxazole. "Similar to recent trends in adults, the proportion of pediatric S. aureus in- fections secondary to methicillin-resistant S. aureus appear to be decreas- ing, as is variability in U.S. geographical resistance rates," the authors wrote. "Increasing clindamycin resistance among methicillin-susceptible S. aureus should raise caution in the use of empirical clindamycin as pre- sumed S. aureus infection." n Research Says Skin Tests to Predict Allergies to Antibiotics are Ineffective By Shannon Barnet A new study from the Research Institute of the McGill University Health Centre in Montreal has found skin tests used to predict allergies to amoxicillin are ineffective. The research team leading the study examined 818 children who present- ed with a rash due to suspected amoxicillin allergy from March 2012 to April 2015. All of the children then received a provocation or challenge test, or PC test, which involves gradually introducing a suspected allergen to the patient. The researchers found 94.1 percent of the children were tolerant to the graded PC for amoxicillin. Of all the participants, only 17 had an immedi- ate positive reaction to amoxicillin, and only one within this group had a positive skin test. Ultimately, they found that similar to many antibiotics, skin tests can have a high false-negative rate. Thirty-one had non-immedi- ate reactions developing more than one hour after challenge. "Our study suggests that skin tests are essentially useless as diagnostic tests, and that we should go directly to the graded provocation test that is highly sensitive and specific," said Moshe Ben-Shoshan, MD. "This is a game changer in the way physicians assess amoxicillin allergy in children given the fact that skin tests are still the recommended screening method in hospitals." n

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