An initiative to reduce blood stream infections (BSI) in patients on ECMO

Abstract

Introduction

Blood Stream Infections (BSI) occur in 3-35% of patients on ECMO (Extracorporeal membrane Oxygenation). With the increased use of ECMO since the COVID-19 pandemic, the magnitude of this problem has increased. There are no clear established practice guidelines for BSI prevention on ECMO.

Methods

Single center retrospective study. Data collected for adult and pediatric ECMO patients between the ages of 0-82 years between January 2017 – December 2023. Outcomes from patients before and after we implemented our ECMO-specific BSI prevention bundle in February 2021. This bundle includes two person ECMO cannula and central line dressing changes, daily chlorhexidine (CHG) bathing of the entire tubing of the ECMO circuit, including the hubs and connectors and avoiding prophylactic antibiotic use.

Results

142 admissions for ECMO and ECPR during the study period were evaluated. 110 admissions were finally included for data analysis after 32 met exclusion criteria. 47 patients included from the preintervention and 63 in the post-intervention periods. The difference in BSI per admission between the preintervention and postintervention groups was statistically significant (p = .0003). The mean BSI rate was 0.468 in the preintervention group and 0.0159 in the post intervention group. Mortality showed a trend towards statistical significance (p = .082). There were no statistical differences in age, sex of the patient, body mass index (BMI), CRRT/AKI use/incidence, type of ECMO (VV or VA), presence of COVID-19 infection, and duration of ECMO.

Conclusions

The introduction of an ECMO-specific BSI reduction bundle resulted in a greater than 10-fold reduction in BSI. There was a trend towards statistically significant improvement in mortality between the two groups. We believe that this intervention is implementable at other hospitals.