Compliance with evidence-based guidelines for the prevention of central line–associated bloodstream infections in a Belgian home care setting: An observational study

2019 ◽  
Vol 47 (6) ◽  
pp. 723-725
Author(s):  
Ester Steffens ◽  
Isabel Spriet ◽  
Johan Van Eldere ◽  
Annette Schuermans
Keyword(s):  
Observational Study ◽  
Home Care ◽  
Care Setting ◽  
Bloodstream Infections ◽  
Central Line ◽  
Evidence Based ◽  
Evidence Based Guidelines

scholarly journals Prevention of central line-associated bloodstream infections: a survey of ICU nurses’ knowledge and practice in China

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Xiuwen Chi ◽  
Juan Guo ◽  
Xiaofeng Niu ◽  
Ru He ◽  
Lijuan Wu ◽  
...  
Keyword(s):  
Insertion Site ◽  
Bloodstream Infections ◽  
Guangdong Province ◽  
Central Line ◽  
Evidence Based ◽  
Department Of Health ◽  
Control And Prevention ◽  
Knowledge And Practice ◽  
Evidence Based Guidelines ◽  
Nurses Knowledge

Abstract Background Central line-associated bloodstream infections (CLABSI) are largely preventable when evidence-based guidelines are followed. However, it is not clear how well these guidelines are followed in intensive care units (ICUs) in China. This study aimed to evaluate Chinese ICU nurses’ knowledge and practice of evidence-based guidelines for prevention of CLABSIs issued by the Centers for Disease Control and Prevention, US and the Department of Health UK. Method Nurses completed online questionnaires regarding their knowledge and practice of evidence-based guidelines for the prevention of CLABSIs from June to July 2019. The questionnaire consisted of 11 questions, and a score of 1 was given for a correct answer (total score = 0–11). Results A total of 835 ICU nurses from at least 104 hospitals completed the questionnaires, and 777 were from hospitals in Guangdong Province. The mean score of 11 questions related to evidence-based guidelines for preventing CLABSIs was 4.02. Individual total scores were significantly associated with sex, length of time as an ICU nurse, educational level, professional title, establishment, hospital grade, and incidence of CLABSIs at the participant’s ICU. Importantly, only 43% of nurses reported always using maximum barrier precautions, 14% of nurses reported never using 2% chlorhexidine gluconate for antisepsis at the insertion site, only 40% reported prompt removal of the catheter when it was no longer necessary, and 33% reported frequently and routinely changing catheters even if there was no suspicion of a CLABSI. Conclusion Chinese ICU nurses in Guangdong Province lack of knowledge and practice of evidence-based guidelines for the prevention of CLABSIs. National health administrations should adopt policies to train ICU nurses to prevent CLABSIs.

scholarly journals Results of the CHlorhexidine Gluconate Bathing implementation intervention to improve evidence-based nursing practices for prevention of central line associated bloodstream infections Study (CHanGing BathS): a stepped wedge cluster randomized trial

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Staci S. Reynolds ◽  
Patricia Woltz ◽  
Edward Keating ◽  
Janice Neff ◽  
Jennifer Elliott ◽  
...  
Keyword(s):  
Implementation Strategies ◽  
Bloodstream Infections ◽  
Central Line ◽  
Audit And Feedback ◽  
Educational Outreach ◽  
Evidence Based ◽  
Intervention Effect ◽  
Cluster Randomized ◽  
Outreach Visits ◽  
Educational Outreach Visits

Abstract Background Central line-associated bloodstream infections (CLABSIs) result in approximately 28,000 deaths and approximately $2.3 billion in added costs to the U.S. healthcare system each year, and yet, many of these infections are preventable. At two large health systems in the southeast United States, CLABSIs continue to be an area of opportunity. Despite strong evidence for interventions to prevent CLABSI and reduce associated patient harm, such as use of chlorhexidine gluconate (CHG) bathing, the adoption of these interventions in practice is poor. The primary objective of this study was to assess the effect of a tailored, multifaceted implementation program on nursing staff’s compliance with the CHG bathing process and electronic health record (EHR) documentation in critically ill patients. The secondary objectives were to examine the (1) moderating effect of unit characteristics and cultural context, (2) intervention effect on nursing staff’s knowledge and perceptions of CHG bathing, and (3) intervention effect on CLABSI rates. Methods A stepped wedged cluster-randomized design was used with units clustered into 4 sequences; each sequence consecutively began the intervention over the course of 4 months. The Grol and Wensing Model of Implementation helped guide selection of the implementation strategies, which included educational outreach visits and audit and feedback. Compliance with the appropriate CHG bathing process and daily CHG bathing documentation were assessed. Outcomes were assessed 12 months after the intervention to assess for sustainability. Results Among the 14 clinical units participating, 8 were in a university hospital setting and 6 were in community hospital settings. CHG bathing process compliance and nursing staff’s knowledge and perceptions of CHG bathing significantly improved after the intervention (p = .009, p = .002, and p = .01, respectively). CHG bathing documentation compliance and CLABSI rates did not significantly improve; however, there was a clinically significant 27.4% decrease in CLABSI rates. Conclusions Using educational outreach visits and audit and feedback implementation strategies can improve adoption of evidence-based CHG bathing practices. Trial registration ClinicalTrials.gov, NCT03898115, Registered 28 March 2019.

Clinical experience with a chlorhexidine-coated PICC: A prospective, multicenter, observational study

2021 ◽  
pp. 112972982110496
Author(s):  
Michael A Winkler ◽  
Timothy R Spencer ◽  
Nasir Siddiqi ◽  
Jessica E Wallace ◽  
John Z Gallien ◽  
...  
Keyword(s):  
High Risk ◽  
Observational Study ◽  
Bloodstream Infections ◽  
Risk Groups ◽  
Central Line ◽  
Primary Treatment ◽  
Teaching Hospitals ◽  
Multicenter Observational Study ◽  
Treatment Indications ◽  
Multicenter Prospective Observational Study

Introduction: This study evaluated a chlorhexidine-coated peripherally inserted central catheter (PICC) and the incidence of associated complications within both inpatient and outpatient populations. Methods: This IRB-approved, multicenter, prospective observational study was performed at three large teaching hospitals in the US. All adults who required a PICC for ⩾14 days were considered. Patients were monitored throughout entire catheter dwell. Duplex venous ultrasounds were performed before insertion, after 10 to 14 days of dwell time, and upon removal. Data was collected from the hospital, outpatient clinic, and patient PICC diary records. Results: A total of 103 patients, 56% male, with mean BMI 29 ± 8.8, were enrolled. The majority (79%) of patients were from high-risk groups—cancer, infectious diseases, transplant, and trauma. Primary treatment indications were antibiotics (66.99%) and chemotherapy (25.24%). Double lumen PICCs (59.2%) were favored clinically, as was basilic vein placement (71.84%). Mean catheter dwell was 47.01 ± 25.82 days. Three (3, 2.9%) central line-associated bloodstream infections (CLABSI) were reported. Four patients (4.6%) reported symptomatic catheter-related thrombosis (CRT), confirmed with ultrasound. Three patients (3.4%) had ultrasound-confirmed fibroblastic sleeve (FS). Eight patients (9.2%) who entered the study with pre-existing superficial thrombosis, had complete resolution at the time of catheter removal. The incidence of CLABSI was 0.82/1000 days. The combined CRT and FS rate was 6.9%. Conclusion: Based upon the observational findings of this study, chlorhexidine-coated PICC technology may be considered for use in patient populations who are at moderate to high-risk for catheter-related complications in both inpatient and outpatient settings.

scholarly journals 584. Use of Multi-Disciplinary Prevention Rounds to Reduce Central Line-Associated Bloodstream Infections in a Neonatal Intensive Care Unit

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S275-S276
Author(s):  
Matthew Linam ◽  
Jessica Wright ◽  
Kum Kim ◽  
Cara Van Treek ◽  
Patrick Spafford
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Central Venous Line ◽  
Patient Specific ◽  
Successful Implementation ◽  
Evidence Based ◽  
Clabsi Rate

Abstract Background Despite successful implementation of evidence-based prevention bundles, central line-associated bloodstream infections (CLABSIs) continue to occur in neonatal intensive care units (NICUs). We hypothesized that multi-disciplinary prevention rounds may be able to further reduce CLABSIs. Methods We implemented bedside rounds in a 39-bed tertiary NICU in November 2018 with the focus of reducing CLABSIs. Standardized rounds for all patients with a central venous line (CVL) occurred 2–3 times/week on weekdays during either the day or evening shifts. Rounds included NICU nursing leadership, the Hospital Epidemiologist and the patient’s nurse. Questions focused on the CVL maintenance bundle, reducing line access, and patient-specific CLABSI risk factors. Best practices were reinforced and solutions for identified risk factors were developed. Recommendations were communicated to the physician, as appropriate. Prevention rounds data were collected. Nurses and providers in the NICU were surveyed about their perceptions of the rounds. CLABSIs were identified by Infection Prevention using standard definitions. Results The average daily NICU census was 35.6, with an average of 14 patients with CVLs/day. The average duration of rounds was 45 minutes. Recommendations to physicians, such as changing medications from intravenous to oral or line removal, were accepted 85% of the time. 74.5% of nurses and 87.5% of providers thought that prevention rounds had at least some impact on CLABSI prevention. Nurse and provider responses to the perceived impact of CLABSI prevention rounds are in Tables 1 and 2, respectively. In the 12 months prior to starting prevention rounds, the CLABSI rate was 1.53 /1000 line days and the CLABSI rate for the 6 months after starting rounds was 0.99/1,000 line days, a 65% decrease. Conclusion CLABSI prevention rounds helped reinforce evidence-based prevention practices, identified patient-specific risk factors and improved physician-nurse communication. CLABSIs in NICU were reduced. Disclosures All authors: No reported disclosures.

Three-year prospective, observational study of central line–associated bloodstream infections in a 600-bed Japanese acute care hospital

2015 ◽  
Vol 43 (5) ◽  
pp. 494-498 ◽  
Author(s):  
Yasuko Matsui ◽  
Michitsugu Shimatani ◽  
Kenta Kuzuhara ◽  
Yoshiko Miyazaki ◽  
Tomoko Horiuchi ◽  
...  
Keyword(s):  
Observational Study ◽  
Acute Care ◽  
Prospective Observational Study ◽  
Acute Care Hospital ◽  
Bloodstream Infections ◽  
Central Line ◽  
Care Hospital

scholarly journals Bundle approach used to achieve zero central line-associated bloodstream infections in an adult coronary intensive care unit

2021 ◽  
Vol 10 (1) ◽  
pp. e001200
Author(s):  
Poonam Gupta ◽  
Mincy Thomas ◽  
Ashfaq Patel ◽  
Reeba George ◽  
Leena Mathews ◽  
...  
Keyword(s):  
Intensive Care ◽  
Single Case ◽  
Bloodstream Infections ◽  
Central Line ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
Mortality And Morbidity ◽  
Healthcare Improvement ◽  
Critical Patients ◽  
Clabsi Rate

BackgroundCentral venous catheterisation is commonly used in critical patients in intensive care units (ICU). It may cause complications and attribute to increase mortality and morbidity. At coronary ICU (CICU) of cardiac hospital, central line-associated bloodstream infection (CLABSI) rate was 2.82/1000 central line days in 2015 and 3.11/1000 central line days in 2016. Working in collaboration with Institute for Healthcare Improvement (IHI), we implemented evidence-based practices in the form of bundles in with the aim of eliminating CLABSI in CICU.MethodsIn collaboration with IHI, we worked on this initiative as multidisciplinary team and tested several changes. CLABSI prevention bundles were tested and implemented, single kit for line insertion, simulation-based training for line insertions, standardised and real-time bundle monitoring by direct observations are key interventions tested. We used model for improvement and changes were tested using small Plan-Do-Study-Act cycles. Surveillance methods and CLABSI definition used according to National Healthcare Safety Network.ResultsThe CLABSI rate per 1000 patient-days dropped from 3.1 per 1000 device-days to 0.4 per 1000 device-days. We achieved 757 days free of CLABSI in the unit till December 2018 when a single case happened. After that we achieved 602 free days till July 2020 and still counting.ConclusionsImplementation of evidence-based CLABSI prevention bundle and process monitoring by direct observation led to significant and subsequently sustained improvement in reducing CLABSI rate in adult CICU.

scholarly journals Evidence Based Suggestions for the Return to Elective Urology Surgery Following the COVID-19 Pandemic

2020 ◽  
Author(s):  
Sarkhell Radha ◽  
Irrum Afzal ◽  
Stella Vig
Keyword(s):  
Intensive Care ◽  
Orthopaedic Surgery ◽  
Care Setting ◽  
Surgical Care ◽  
Outpatient Clinics ◽  
Evidence Based ◽  
Intensive Care Setting ◽  
Elective Surgical Procedures ◽  
The World ◽  
Evidence Based Guidelines

The COVID-19 pandemic has presented the world with increased challenges. The response to this pandemic has led to a sudden disruption of routine medical and elective surgical care. Most hospitals across the globe have had to change the way outpatient clinics are carried out and postpone non-urgent elective surgical procedures. NHS England ceased all elective general surgeries to train and re-deploy their staff to support the increased pressures from COVID-19 in an intensive care setting. However, with a decline of reported cases and deaths, the return to undertaking non-urgent elective services is imminent. In May 2020, Radha and Afzal published the first evidence-based guidelines for the resumption of elective orthopaedic services titled “Evidence based suggestions for the return to elective orthopaedic surgery following the COVID-19 Pandemic”. The pathway presented is adapted from the “Evidence based suggestions for the return to elective orthopaedic surgery following the COVID-19 Pandemic” and could potentially be used as a model for other surgical specialities. We present a three-phased return back to urological services. Safe resumption of elective care is possible but needs to be carefully planned.

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