scholarly journals Preventing Catheter-Associated Bloodstream Infections: A Survey of Policies for Insertion and Care of Central Venous Catheters From Hospitals in the Prevention Epicenter Program

2006 ◽  
Vol 27 (1) ◽  
pp. 8-13 ◽  
Author(s):  
David K. Warren ◽  
Deborah S. Yokoe ◽  
Michael W. Climo ◽  
Loreen A. Herwaldt ◽  
Gary A. Noskin ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Nurse Managers ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
The United States ◽  
Evidence Based ◽  
Central Venous ◽  
Single Location ◽  
Evidence Based Guidelines

Objective.To determine the extent to which evidence-based practices for the prevention of central venous catheter (CVC)-associated bloodstream infections are incorporated into the policies and practices of academic intensive care units (ICUs) in the United States and to determine variations in the policies on CVC insertion, use, and care.Design.A 9-page written survey of practices and policies for nontunneled CVC insertion and care.Setting.ICUs in 10 academic tertiary-care hospitals.Participants.ICU medical directors and nurse managers.Results.Twenty-five ICUs were surveyed (1-6 ICUs per hospital). In 80% of the units, 5 separate groups of clinicians inserted 24%-50% of all nontunneled CVCs. In 56% of the units, placement of more than two-thirds of nontunneled CVCs was performed in a single location in the hospital. Twenty units (80%) had written policies for CVC insertion. Twenty-eight percent of units had a policy requiring maximal sterile-barrier precautions when CVCs were placed, and 52% of the units had formal educational programs with regard to CVC insertion. Eighty percent of the units had a policy requiring staff to perform hand hygiene before inserting CVCs, but only 36% and 60% of the units required hand hygiene before accessing a CVC and treating the exit site, respectively.Conclusion.ICU policy regarding the insertion and care of CVCs varies considerably from hospital to hospital. ICUs may be able to improve patient outcome if evidence-based guidelines for CVC insertion and care are implemented.

scholarly journals Care of Peripheral Venous Catheter Sites: Advantages of Transparent Film Dressings Over Tape and Gauze

2014 ◽  
Vol 19 (4) ◽  
pp. 256-261 ◽  
Author(s):  
Stéphanie F. Bernatchez
Keyword(s):  
Bloodstream Infections ◽  
Venous Catheter ◽  
The United States ◽  
Central Venous ◽  
Term Care ◽  
Peripheral Venous Catheter ◽  
Care Facilities ◽  
Review Current ◽  
Peripheral Venous Line

AbstractPeripheral intravenous (PIV) catheters are the most commonly used catheters in hospitals, with up to 70% of patients requiring a peripheral venous line during their hospital stay. This represents 200 million PIV catheters used per year in acute-care hospitals in the United States alone. These medical devices are also used in other health care settings, such as long-term care facilities and nursing homes, and common indications include the administration of medications, nutrients, and fluids. These catheters require proper maintenance and care to avoid complications such as phlebitis, infiltration, occlusion, local infection, and bloodstream infection. Recently it has been suggested that PIV catheter use may lead to a higher rate of complications than previously thought. This is important because some studies have claimed that the rate of bloodstream infections due to PIV catheters is actually comparable to the rates observed with central venous catheters, rather than much lower as previously thought. Moreover, catheter-related infections are now seen as largely preventable. Our goal was to review the current literature and provide an overview of the various approaches used to manage PIV catheter sites as well as review current recommendations.

Prevention of Central Venous Catheter–Related Bloodstream Infections Using Non-Technologic Strategies

2004 ◽  
Vol 25 (8) ◽  
pp. 675-677 ◽  
Author(s):  
Silvia Acosta Gnass ◽  
Luisa Barboza ◽  
Dafne Bilicich ◽  
Pablo Angeloro ◽  
Walter Treiyer ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Infectious Complications ◽  
Central Venous ◽  
Methicillin Resistant ◽  
Sterile Drape ◽  
Improvement Programs ◽  
A Prospective Study ◽  
Quality Improvement Programs

AbstractObjective:To evaluate the incidence of nosocomial bacteremias related to the use of non-impregnated central venous catheters (CVCs) when only non-technologic strategies were used to prevent them.Design:This was a prospective study of infectious complications of CVCs placed in intensive care unit (ICU) patients from April 1997 to December 2001.Setting:The medical–surgical ICU of a tertiary-care, university-affiliated hospital in Argentina.Methods:We studied all patients admitted to the ICU using non-impregnated CVCs. Maximal sterile barrier precautions (ie, use of cap, mask, sterile gown, sterile gloves, and large sterile drape), strict handwashing, preparation of the patients' skin with antiseptic solutions, insertion and management of catheters by trained personnel, and continuing quality improvement programs aimed at appropriate insertion and maintenance of catheters were employed.Results:During the study period, 2,525 patients were admitted to the ICU. Eight hundred sixty-eight patients had 1,037 CVCs inserted. The number of CVC-related bloodstream infections (BSIs), acquired in the ICU, was 2.7 per 1,000 CVC-days (13 nosocomial CVC-related BSIs during 4,770 days of CVC use). Microorganisms isolated included methicillin-susceptible Staphylococcus aureus (n = 6), methicillin-resistant S. aureus (n = 2), coagulase-negative methicillin-resistant Staphylococcus (n = 2), Escherichia coli (n = 1), Klebsiella pneumoniae (n = 1), and Enterobacter cloacae (n = 1).Conclusions:A low rate of catheter-related BSI was achieved without antimicrobial-impregnated catheters. The incidence of CVC-associated bacteremias corresponded to the 10th to 20th percentile range of the National Nosocomial Infections Surveillance System hospitals for the same type of ICU.

Prevention of Central Venous Catheter-Associated Bloodstream Infections in Pediatric Intensive Care Units A Performance Improvement Collaborative

2009 ◽  
Vol 30 (7) ◽  
pp. 645-651 ◽  
Author(s):  
Howard E. Jeffries ◽  
Wilbert Mason ◽  
Melanie Brewer ◽  
Katie L. Oakes ◽  
Esther I. Mufioz ◽  
...  
Keyword(s):  
Intensive Care ◽  
Central Venous Catheter ◽  
Pediatric Intensive Care ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Evidence Based ◽  
Central Venous ◽  
Improvement Project ◽  
Team Members ◽  
Prevention Interventions

Objective.The goal of this effort was to reduce central venous catheter (CVC)-associated bloodstream infections (BSIs) in pediatric intensive care unit (ICU) patients by means of a multicenter evidence-based intervention.Methods.An observational study was conducted in 26 freestanding children's hospitals with pediatric or cardiac ICUs that joined a Child Health Corporation of America collaborative. CVC-associated BSI protocols were implemented using a collaborative process that included catheter insertion and maintenance bundles, daily review of CVC necessity, and daily goals. The primary goal was either a 50% reduction in the CVC-associated BSI rate or a rate of 1.5 CVC-associated BSIs per 1,000 CVC-days in each ICU at the end of a 9-month improvement period. A 12-month sustain period followed the initial improvement period, with the primary goal of maintaining the improvements achieved.Results.The collaborative median CVC-associated BSI rate decreased from 6.3 CVC-associated BSIs per 1,000 CVC-days at the start of the collaborative to 4.3 CVC-associated BSIs per 1,000 CVC-days at the end of the collaborative. Sixty-five percent of all participants documented a decrease in their CVC-associated BSI rate. Sixty-nine CVC-associated BSIs were prevented across all teams, with an estimated cost avoidance of $2.9 million. Hospitals were able to sustain their improvements during a 12-month sustain period and prevent another 198 infections.Conclusions.We conclude that our collaborative quality improvement project demonstrated that significant reduction in CVC-associated BSI rates and related costs can be realized by means of evidence-based prevention interventions, enhanced communication among caregivers, standardization of CVC insertion and maintenance processes, enhanced measurement, and empowerment of team members to enforce adherence to best practices.

The Role of Biofilm in Central Venous Catheter Related Bloodstream Infections: Evidence-based Nursing and Review of the Literature

2020 ◽  
Vol 15 (1) ◽  
pp. 22-27 ◽  
Author(s):  
Nicola Ielapi ◽  
Emanuela Nicoletti ◽  
Carmela Lorè ◽  
Giorgio Guasticchi ◽  
Tiziana Avenoso ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Infectious Complications ◽  
Evidence Based ◽  
Central Venous ◽  
Device Management ◽  
Bibliographic Search ◽  
Materials Used ◽  
Evidence Based Nursing

Background: Biofilm is a fundamental component in the pathogenesis of infections related to the use of the central venous catheter (CVC,) which can represent an important health issue in everyday practice of nursing and medical staff. Objective: The objective of the following review is to analyze the components of biofilm and their role in catheter-related infection determinism in an evidencebased nursing perspective in such a way as to give health professionals useful suggestions in the prevention and management of these complications. Methods: The following databases were consulted for the bibliographic search: Medline, Scopus, Science Direct. Biofilm can be the cause of CVC extraction and can lead to serious haematogenic infectious complications that can increase the morbidity and mortality of affected patients. Results: Updated pathophysiologic knowledge of biofilm formation and appropriate diagnostic methodology are pivotal in understanding and detecting CVC-related infections. Lock therapy appears to be a useful, preventive, and therapeutic aid in the management of CVCrelated infections. New therapies attempting to stop bacterial adhesion on the materials used could represent new frontiers for the prevention of CVC-related infections. Conclusion: The correct evidence-based nursing methods, based on the use of guidelines, provides the opportunity to minimize the risks of infection through the implementation of a series of preventive measures both during the CVC positioning phase and in the subsequent phase, for example, during device management which is performed by medical and nursing staff.

Reducing Central Line-Associated Bloodstream Infection in Contaminated Central Venous Catheters: Case Studies of a Pediatric Contamination Guideline

2021 ◽  
Author(s):  
Tracy B. Chamblee ◽  
Lindsey J. Patton ◽  
Virginia B. Young ◽  
Jennifer Marusich ◽  
Cindy D. Bowens ◽  
...  
Keyword(s):  
Case Reports ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Healthcare Organizations ◽  
Central Venous ◽  
Mortality And Morbidity ◽  
Reduction Strategies ◽  
Contamination Events

Highlights Abstract Healthcare organizations have prioritized patient safety and quality improvement efforts to reduce central line-associated bloodstream infections (CLABSIs). Implementation of central venous catheter (CVC) insertion and maintenance bundles have significantly reduced infection rates. Nevertheless, CLABSIs continue to be a significant cause of mortality and morbidity in hospitals, and further efforts are necessary to improve CVC care practices. A hospital-wide committee at a tertiary care pediatric hospital identified gaps in our CVC maintenance practices resulting from CVC contamination events from a patient’s body fluids. A lack of published literature on the topic resulted in the need to create an institutional clinical practice guideline (CPG) to develop guidance to mitigate potential CLASBIs from CVC contamination. Utilization of the CVC CPG in all inpatient units and other reduction strategies resulted in a steady decline in our CLABSI rates, particularly in those related to CVC contamination events. Case reports illustrate the effectiveness of the CPG.

scholarly journals Complications Associated With Use of Long-Term Central Venous Catheters Among Commercially Insured Women With Breast Cancer

2015 ◽  
Vol 11 (6) ◽  
pp. 505-510 ◽  
Author(s):  
Allison Lipitz-Snyderman ◽  
Qinli Ma ◽  
Michael F. Pollack ◽  
John Barron ◽  
Elena B. Elkin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Central Venous Catheter ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Evidence Based ◽  
Central Venous ◽  
Evidence Based Guidelines

Long-term central venous catheter (CVC) use is associated with increased morbidity. Evidence-based guidelines tools may help decrease discretionary use of long-term CVCs resulting from provider- or institution-driven variations in practice.

Patient- and Device-Specific Risk Factors for Peripherally Inserted Central Venous Catheter—Related Bloodstream Infections

2013 ◽  
Vol 34 (2) ◽  
pp. 184-189 ◽  
Author(s):  
Makhawadee Pongruangporn ◽  
M. Cristina Ajenjo ◽  
Anthony J. Russo ◽  
Kathleen M. McMullen ◽  
Catherine Robinson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Venous Catheter ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Adult Patients ◽  
Chronic Obstructive ◽  
Central Venous ◽  
Obstructive Pulmonary Disease ◽  
Specific Risk

Objective.To determine the patient- and device-specific risk factors for hospital-acquired peripherally inserted central venous catheter–related bloodstream infections (PICC BSIs) in adult patients.Design.Nested case-control study.Setting.Barnes-Jewish Hospital, a 1,252-bed tertiary care teaching hospital.Patients.Adult patients with PICCs placed from January 1, 2006, through July 31, 2008.Methods.PICC BSI cases were identified using the National Healthcare Safety Network definition. Uninfected control patients with PICCs in place were randomly selected at a 3: 1 ratio. Patient- and device-related variables were examined using multivariate analysis.Results.The overall PICC BSI rate was 3.13 per 1,000 catheter-days. Independent risk factors for PICC BSIs included congestive heart failure (odds ratio [OR], 2.0 [95% confidence interval (CI), 1.26–3.17];P= .003), intra-abdominal perforation (OR, 5.66 [95% CI, 1.76–18.19];P= .004),Clostidium difficileinfection (OR, 2.25 [95% CI, 1.17–4.33];P= .02), recent chemotherapy (OR, 3.36 [95% CI, 1.15–9.78];P= .03), presence of tracheostomy (OR, 5.88 [95% CI, 2.99–11.55];P< .001), and type of catheter (OR for double lumen, 1.89 [95% CI, 1.15–3.10];P= .01; OR for triple lumen, 2.87 [95% CI, 1.39–5.92];P= .004). Underlying chronic obstructive pulmonary disease (OR, 0.48 [95% CI, 0.29–0.78];P= .03) and admission to surgical (OR, 0.43 [95% CI, 0.24–0.79];P= .006) or oncology and orthopedic (OR, 0.35 [95% CI, 0.13–0.99];P= .05) services were less likely to be associated with having a PICC BSI.Conclusions.We identified several novel factors related to PICC BSIs. These factors may inform preventive measures.

Clinical and financial implications of central venous catheters bloodstream infections in patients with multiple myeloma in the United States.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e20033-e20033
Author(s):  
Pool Tobar ◽  
Luis F. Gonzalez Mosquera ◽  
Diana D. Cardenas Maldonado ◽  
Bernard Moscoso ◽  
Alida I. Podrumar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multiple Myeloma ◽  
Weight Loss ◽  
Central Venous Catheter ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
The United States ◽  
Central Venous ◽  
Predictors Of Mortality ◽  
Poor Outcome

e20033 Background: Multiple Myeloma(MM) has an increased exposure to intravascular catheters due to the increased risk of severe infections and due to the route of treatment administration. Central Venous Catheter Bloodstream Infections(CVCBI) have significant mortality, imply a delay in treatment and increased cost as well. There is no prior report on the risk factors for poor outcome in MM patients that develop this complication. We aim to describe the predictors of mortality as well as the changes in cost that CVCBI implies. Methods: We retrieved adult patients with MM from the Nationwide Inpatient Sample database from 2016-2018. We used the ICD-10 codes to identify and compare patients who developed CVCBI with those that did not developed it. The main outcomes were hospital mortality and predictors of mortality. We computed the chi-squared test and the Mann-Whitney U-test. Mortality predictors are estimated using multivariate logistic regression and logistic fixed-effect methods to control for admission cohort and hospital time invariant characteristics. All analyses were performed using Stata Statistical Software version 14 (StataCorp, College Station, TX). Results: A total of 58,838 patients with MM were identified. The majority were white (63.5%), male (55.3%), with a median age of 70 (IQR 62-78). Most MM were not in remission (99.1%), followed by those in remission (1.3%) and relapse (0.3%). CVCBI was diagnosed in 264 (0.4%) of the MM patients. There was significantly higher mortality in the CVCBI group vs. the non-CVCBI group (8.7% vs. 5%; p < 0.01), longer LOS (10 vs. 5 days; p < 0.001), and higher median hospitalization cost (US$86,168 vs. US$43,511; p < 0.001). In the multivariable analysis, CVCBI was associated with higher mortality (OR: 1.69; CI 95%: 1.14-2.52; p < 0.001). Among patients with MM and CVCBI those that had achieved remission had a higher risk of death (OR: 2.87; CI 95%: 2.17-3.8; p < 0.001). Other variables associated with mortality were age > 65 (OR: 1.84; CI 95%: 1.59-2.15; p < 0.001), concomitant chronic heart failure (CHF) (OR: 1.46; CI 95%: 1.29-1.65; p < 0.001), chronic kidney disease (CKD) (OR: 1.43; CI 95%: 1.32-1.56; p < 0.001), and weight loss (OR: 2.31; CI 95%: 1.91-2.8; p < 0.001). When compared to medicare patients with higher mortality were more likely to be under medicaid(OR: 1.25; CI 95%: 1.02-1.55; p < 0.05) and private insurances(OR: 1.31; CI 95%: 1.15-1.49; p < 0.001). There was no significant association with sex, race/ethinicity or household income. Conclusions: In patients with Multiple Myeloma the development of Central Venous Catheter Bloodstream Infections was associated with a higher overall mortality, length of stay and cost of hospitalization. Age, CHF, CKD and weight loss were independent risk factors for poor outcome in this patient population. Further studies are required on developing strategies for the prevention of this complication.

Sign in / Sign up

Export Citation Format

Share Document