Article

Team-based prevention of catheter-related infections

New England Journal of Medicine (Impact Factor: 54.42). 01/2007; 355(26):2781-3. DOI: 10.1056/NEJMe068230
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Available from: Michael B Edmond, Aug 07, 2015
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    • "There have been a range of strategies to prevent or reduce intravenous catheter related complications . These include: optimising patency through continuous infusion or intermittent flushes with either normal saline, heparin, antibiotic and/or ethanol locks (Goode et al., 1991; Peterson and Kirchhoff, 1991; Randolph et al., 1998); less frequent catheter and infusion set changes (Bregenzer et al., 1998; Cornely et al., 2002; Homer and Holmes, 1998; Rickard et al., 2012; White, 2001); placement of in-line filters (Chee and Tan, 2002; Roberts et al., 1994); and designated intravenous therapy teams (da Silva et al., 2010; Wenzel and Edmond, 2006). Despite these interventions, catheter failure before the end of treatment is all too common. "
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    ABSTRACT: Up to 85% of hospital in-patients will require some form of vascular access device to deliver essential fluids, drug therapy, nutrition and blood products, or facilitate sampling. The failure rate of these devices is unacceptably high, with 20-69% of peripheral intravenous catheters and 15-66% of central venous catheters failing due to occlusion, depending on the device, setting and population. A range of strategies have been developed to maintain device patency, including intermittent flushing. However, there is limited evidence informing flushing practice and little is known about the current flushing practices. The aim of the study was to improve our understanding of current flushing practices for vascular access devices through a survey of practice. A cross-sectional survey of nurses and midwives working in the State of Queensland, Australia was conducted using a 25-item electronic survey that was distributed via the local union membership database. A total of 1178 surveys were completed and analysed, with n=1068 reporting peripheral device flushing and n=584 reporting central device flushing. The majority of respondents were registered nurses (55%) caring for adult patients (63%). A large proportion of respondents (72% for peripheral, 742/1028; 80% for central, 451/566) were aware of their facility's policy for vascular access device flushing. Most nurses reported using sodium chloride 0.9% for flushing both peripheral (96%, 987/1028) and central devices (75%, 423/566). Some concentration of heparin saline was used by 25% of those flushing central devices. A 10-mL syringe was used by most respondents for flushing; however, 24% of respondents used smaller syringes in the peripheral device group. Use of prefilled syringes (either commercially prepared sterile or prefilled in the workplace) was limited to 10% and 11% respectively for each group. The frequency of flushing varied widely, with the most common response being pro re nata (23% peripheral and 21% central), or 6 hourly (23% peripheral and 22% central). Approximately half of respondents stated that there was no medical order or documentation for either peripheral or central device flushing. Flushing practices for vascular access device flushing appear to vary widely. Specific areas of practice that warrant further investigation include questions about the efficacy of heparin for central device flushing, increasing adherence to the recommended 10mL diameter syringe use, increased use of prefilled flush syringes, identifying and standardising optimal volumes and frequency of flushing, and improving documentation of flush orders and administration. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
    International journal of nursing studies 07/2015; DOI:10.1016/j.ijnurstu.2015.07.001 · 2.25 Impact Factor
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    • "There have been a range of strategies to prevent or reduce intravenous catheter related complications . These include: optimising patency through continuous infusion or intermittent flushes with either normal saline, heparin, antibiotic and/or ethanol locks (Goode et al., 1991; Peterson and Kirchhoff, 1991; Randolph et al., 1998); less frequent catheter and infusion set changes (Bregenzer et al., 1998; Cornely et al., 2002; Homer and Holmes, 1998; Rickard et al., 2012; White, 2001); placement of in-line filters (Chee and Tan, 2002; Roberts et al., 1994); and designated intravenous therapy teams (da Silva et al., 2010; Wenzel and Edmond, 2006). Despite these interventions, catheter failure before the end of treatment is all too common. "
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    ABSTRACT: Peripheral venous catheters (PVCs) are the simplest and most frequently used method for drug, fluid, and blood product administration in the hospital setting. It is estimated that up to 90% of patients in acute care hospitals require a PVC; however, PVCs are associated with inherent complications, which can be mechanical or infectious. There have been a range of strategies to prevent or reduce PVC-related complications that include optimizing patency through the use of flushing. Little is known about the current status of flushing practice. This observational study quantified preparation and administration time and identified adherence to principles of Aseptic Non-Touch Technique and organizational protocol on PVC flushing by using both manually prepared and prefilled syringes.
    Journal of infusion nursing: the official publication of the Infusion Nurses Society 01/2014; 37(2):96-101. DOI:10.1097/NAN.0000000000000024
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    • "Central venous lines are used extensively in intensive care units (ICUs) but may occasionally result in central line associated bloodstream infections (CLABSIs). In the United States, about 48,600 CLABSIs occur in ICUs each year [1]. These infections impose a significant economic burden, with additional estimated costs ranging from US $4,000 to US $36,000 per episode [2] [3] [4]. "
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    ABSTRACT: Objectives: Central line associated bloodstream infections (CLABSIs) impose a significant economic burden for patients admitted to the intensive care unit for adults (AICU). The objectives of the study were to evaluate the excess length of stay and extra costs attributable to CLABSIs diagnosed in the AICU. Methods: Cases were selected as patients admitted to AICU from 2006 through 2009, who developed a CLABSI episode. These were matched (1:1) with appropriate controls. Matching criteria were selected to exclude other factors that could influence cost and care practices. The length of stay and resources used between AICU admission and discharge and until hospital discharge or death were measured. Incremental costs and lengths of stay were calculated for each pair of patients. Results: Thirty cases and 30 controls were included in the study. A CLABSI episode resulted Introduction Central venous lines are used extensively in intensive care units (ICUs) but may occasionally result in central line associated bloodstream infections (CLABSIs). In the United States, about 48,600 CLABSIs occur in ICUs each year [1]. These infections impose a significant economic burden, with additional estimated costs ranging from US $4,000 to US $36,000 per episode [2–4]. Critically ill patients with primary bloodstream infections are hospitalized for an average of 6.5 to 22 days longer than are patients without bloodstream infection [2–4]. Data from Latin America and other developing countries participating in the International Nosocomial Infection Control Consortium show that CLABSI rates in these countries are three to five times higher than rates in the United States [5]. Preventing CLABSI may improve patient care while reducing hospital stays, costs, and possibly also mortality. Central venous line bundles are fairly simple to perform with reproducible results. However, the implementation of these interventions requires a considerable investment in resources and manpower. Hospital Israelita Albert Einstein (HIAE) has implemented pre- ventive measures in two phases, March 2005 to March 2007 phase in an additional 10.5 days in the AICU and 9.1 days after AICU discharge, totaling an additional 19.6 days. The incremental cost associated with a CLABSI episode was US $65,993 in the AICU and US $23,893 after AICU discharge, totaling an incremental cost of US $89,886. Conclusions: By avoiding CLABSI events, cost offsets would be expected for payers with revenue losses to providers. An approach of sharing the gains resulting from preventive measures could be used to incentivize providers to maintain those invest- ments, benefiting patients who will have a reduced risk of CLABSI development. Keywords: bloodstream infection, cost, intensive care unit. Copyright & 2012, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.
    12/2012; DOI:10.1016/j.vhri.2012.10.002
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