Survey of Infection Control Practices in Hemodialysis Units: Preventing Vascular Access–Associated Bloodstream Infections

2014 ◽  
Vol 35 (7) ◽  
pp. 833-838 ◽  
Author(s):  
Pascale Trépanier ◽  
Caroline Quach ◽  
Milagros Gonzales ◽  
Élise Fortin ◽  
Mohammed Kaouache ◽  
...  
Keyword(s):  
Infection Control ◽  
Vascular Access ◽  
Practice Guidelines ◽  
Online Survey ◽  
Insertion Site ◽  
Bloodstream Infections ◽  
Control Measures ◽  
Face Validity ◽  
Surveillance Program ◽  
Skin Disinfection

ObjectiveDespite surveillance, the Quebec Healthcare-Associated Infections Surveillance Program saw no improvement in vascular access–associated bloodstream infections in hemodialysis (HD). We aimed to determine the infection control measures recommended and implemented in Quebec’s HD units, compliance of local protocols to infection control practice guidelines, and reasons behind the low prevalence of arteriovenous fistulas.MethodsAn online survey was elaborated on the basis of the Centers for Disease Control and Prevention (CDC) and National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines. The questionnaire was validated (construct, content, face validity, and reliability) and sent to all HD units in Quebec (n = 40). Results were analyzed using descriptive statistics, linear regression, and Poisson regression.ResultsThirty-seven (93%) of 40 HD units participated. Thirty (94%) of the 32 centers where central catheters are inserted have written insertion protocols. Compliance with practice guidelines is good, except for full-body draping during catheter insertion (79%) and ointment use at insertion site (3%). Prevention measures for catheter maintenance are in accordance with guidelines, except for skin disinfection with at least 0.5% chlorhexidine and 70% alcohol (67% compliance) and regular antiseptic ointment use at the insertion site (3%). Before fistula cannulation, skin preparation is suboptimal; forearm hygiene is performed in only 61% of cases. Several factors explain the low rate of fistulas, including patient preference (69%) and lack of surgical resources (39%; P = .01).ConclusionsImprovement in standardization of care according to practice guidelines is necessary. Fistula rate could be increased by improving access to surgical resources and patient education. Strategies are now being elaborated to address these findings.

scholarly journals The I-DECIDED clinical decision-making tool for peripheral intravenous catheter assessment and safe removal: a clinimetric evaluation

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e035239 ◽  
Author(s):  
Gillian Ray-Barruel ◽  
Marie Cooke ◽  
Vineet Chopra ◽  
Marion Mitchell ◽  
Claire M Rickard
Keyword(s):  
Decision Making ◽  
Vascular Access ◽  
Content Validity ◽  
Online Survey ◽  
Clinical Decision Making ◽  
Decision Time ◽  
Face Validity ◽  
Intravenous Catheter ◽  
Rater Reliability ◽  
Peripheral Intravenous Catheter

ObjectiveTo describe the clinimetric validation of the I-DECIDED tool for peripheral intravenous catheter assessment and decision-making.Design and settingI-DECIDED is an eight-step tool derived from international vascular access guidelines into a structured mnemonic for device assessment and decision-making. The clinimetric evaluation process was conducted in three distinct phases.MethodsInitial face validity was confirmed with a vascular access working group. Next, content validity testing was conducted via online survey with vascular access experts and clinicians from Australia, the UK, the USA and Canada. Finally, inter-rater reliability was conducted between 34 pairs of assessors for a total of 68 peripheral intravenous catheter (PIVC) assessments. Assessments were timed to ensure feasibility, and the second rater was blinded to the first’s findings. Content validity index (CVI), mean item-level CVI (I-CVI), internal consistency, mean proportion of agreement, observed and expected inter-rater agreements, and prevalence-adjusted bias-adjusted kappas (PABAK) were calculated. Ethics approvals were obtained from university and hospital ethics committees.ResultsThe I-DECIDED tool demonstrated strong content validity among international vascular access experts (n=7; mean I-CVI=0.91; mean proportion of agreement=0.91) and clinicians (n=11; mean I-CVI=0.93; mean proportion of agreement=0.94), and high inter-rater reliability in seven adult medical-surgical wards of three Australian hospitals. Overall, inter-rater reliability was 87.13%, with PABAK for each principle ranging from 0.5882 (‘patient education’) to 1.0000 (‘document the decision’). Time to complete assessments averaged 2 min, and nurse-reported acceptability was high.ConclusionThis is the first comprehensive, evidence-based, valid and reliable PIVC assessment and decision tool. We recommend studies to evaluate the outcome of implementing this tool in clinical practice.Trial registration number12617000067370

scholarly journals Outbreak ofTsukamurellaSpecies Bloodstream Infection among Patients at an Oncology Clinic, West Virginia, 2011–2012

2014 ◽  
Vol 35 (3) ◽  
pp. 300-306 ◽  
Author(s):  
Isaac See ◽  
Duc B. Nguyen ◽  
Somu Chatterjee ◽  
Thein Shwe ◽  
Melissa Scott ◽  
...  
Keyword(s):  
Infection Control ◽  
Bloodstream Infection ◽  
Case Control Study ◽  
Significant Risk ◽  
Bloodstream Infections ◽  
Case Control ◽  
Control Measures ◽  
Multiple Infection ◽  
Common Source ◽  
Control Study

Objective.To determine the source and identify control measures of an outbreak ofTsukamurellaspecies bloodstream infections at an outpatient oncology facility.Design.Epidemiologic investigation of the outbreak with a case-control study.Methods.A case was an infection in whichTsukamurellaspecies was isolated from a blood or catheter tip culture during the period January 2011 through June 2012 from a patient of the oncology clinic. Laboratory records of area hospitals and patient charts were reviewed. A case-control study was conducted among clinic patients to identify risk factors forTsukamurellaspecies bloodstream infection. Clinic staff were interviewed, and infection control practices were assessed.Results.Fifteen cases ofTsukamurella (Tsukamurella pulmonisorTsukamurella tyrosinosolvens) bloodstream infection were identified, all in patients with underlying malignancy and indwelling central lines. The median age of case patients was 68 years; 47% were male. The only significant risk factor for infection was receipt of saline flush from the clinic during the period September–October 2011 (P= .03), when the clinic had been preparing saline flush from a common-source bag of saline. Other infection control deficiencies that were identified at the clinic included suboptimal procedures for central line access and preparation of chemotherapy.Conclusion.Although multiple infection control lapses were identified, the outbreak was likely caused by improper preparation of saline flush syringes by the clinic. The outbreak demonstrates that bloodstream infections among oncology patients can result from improper infection control practices and highlights the critical need for increased attention to and oversight of infection control in outpatient oncology settings.

Statins and Perioperative Cardiac Complications

2018 ◽  
pp. 60-64
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infection Control ◽  
Strong Evidence ◽  
Substantial Reduction ◽  
Bloodstream Infections ◽  
Control Measures ◽  
Cardiac Complications ◽  
Infection Control Measures ◽  
Safety Initiative

This case focuses on reducing catheter-related bloodstream infections in the intensive care unit (ICU) by asking the question: Can rates of catheter-related bloodstream infections be reduced by implementing a safety initiative involving five simple infection-control measures by ICU staff? Implementation of a safety initiative involving five simple infection-control measures by ICU staff was associated with a substantial reduction in catheter-related bloodstream infections. While it is not certain that the safety initiative—rather than other factors—was responsible for the observed reduction, the study provides strong evidence that this safety initiative should be implemented widely.

scholarly journals A Review of 11 Years ofStenotrophomonas maltophiliaBlood Isolates at a Tertiary Care Institute in Canada

2012 ◽  
Vol 23 (4) ◽  
pp. 165-169 ◽  
Author(s):  
Prenilla Naidu ◽  
Stephanie Smith
Keyword(s):  
Infection Control ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Length Of Hospital Stay ◽  
Bloodstream Infections ◽  
Surveillance Program ◽  
Tertiary Care Centre ◽  
Alberta Hospital ◽  
University Of Alberta ◽  
Drug Of Choice

BACKGROUND:Stenotrophomonas maltophiliahas emerged as a significant nosocomial pathogen with increasing resistance to trimethoprim/sulphamethoxazole (TMP/SMX), the current drug of choice for treatment.OBJECTIVES: To describe the microbiological and clinical characteristics ofS maltophiliabloodstream infections (BSIs) over an 11-year period at a tertiary care centre in Canada.METHODS: All adultS maltophiliaBSIs from 1999 to 2009 in a 750-bed tertiary care teaching hospital (University of Alberta Hospital, Edmonton, Alberta) were identified through the infection control nosocomial infection surveillance program. Demographic and clinical data were extracted from the infection control database and from patient charts. Microbiological data were confirmed through the laboratory information system.RESULTS: Twenty-five episodes ofS maltophiliaBSI (0.9% of all BSIs) involving 24 patients were identified between 1999 and 2009. The patient age range was 18 to 83 years (average 45.7 years). The majority were men (14 of 24 [58.3%]). The mean length of hospital stay was 83.3 days (range eight to 310 days). The rate ofS maltophiliaBSIs per 1000 admissions ranged from 0.04 to 0.22 (average 0.09). Greater than one-half of the episodes (13 of 25 [52%]) were admitted to the intensive care unit before BSI onset. Laboratory data were available for 24 of the 25 isolates. Polymicrobial infections were present in 11 of 24 (45.8%) patients. Resistance to TMP/SMX occurred in 8.3% of all infections. Fifteen per cent of isolates were resistant to ticarcillin/clavulanate. Mortality attributed to bacteremia was 16.7%.CONCLUSIONS: In the University of Alberta Hospital, the rate ofS maltophiliaBSI remains low and constant, and TMP/SMX remains the drug of choice for treatment.

scholarly journals Biological hazards associated with microblading and evaluation of its infection control procedures and wound care

2018 ◽  
Author(s):  
Emily Wong ◽  
BCIT School of Health Sciences, Environmental Health ◽  
Helen Heacock
Keyword(s):  
British Columbia ◽  
Infection Control ◽  
Online Survey ◽  
Wound Care ◽  
Control Measures ◽  
Years Of Experience ◽  
Chi Square ◽  
Attitudes And Practices ◽  
Infection Control Measures ◽  
Bloodborne Pathogen

  Background: Microblading is emerging as one of the fastest growing beauty trends, appearing in tattoo shops, hair salons, and even in private home studios. The procedure uses a tool with single blade to penetrate the upper layer of the dermis and deposit semi-permanent pigments to mimic hair-like strokes. This study compares the risks of microblading to those in tattooing and analyzes the similarities in order to determine the biological hazards associated with microblading. Currently, there is a lack of knowledge on microblading practices specifically, and the purpose of this study was to evaluate the level of infection control knowledge and practices in place, as well as the attitudes towards regulations in British Columbia. Method: Self-administered electronic surveys created on Google Forms were distributed to microblading establishments in B.C. through email. The survey assessed the knowledge, attitudes, and practices of microbladers in B.C. through a series of questions regarding demographics, infection control, and wound care. A list of 130 microblading establishments were contacted and asked to participate in the online survey. Results: Among the 130 microblading establishments contacted, 41 agreed to participate. The majority of microbladers had a college certificate or diploma, 1-5 years of experience, and have taken a bloodborne pathogen course. Over 31% of the participants operated both in microblading as well as permanent makeup, 27% operated solely as microbladers, and 22% of the participants had both microblading and spa operations. The most prevalent form of training was a microblading course that lasted a week or longer, and 78% of the participants felt that there should be more training required for becoming a microblader. There was no association between the years of experience and level of pathogen knowledge according to the Chi square test (p=0.78), and no association between the attitude towards regulations regarding microblading and the number of infection control measures in place (p=0.38). However, there was a statistically significant association between taking a bloodborne pathogen course and knowing the correct bloodborne pathogens of concern. Conclusion: Microbladers in British Columbia are fairly new and thus only have 1-5 years of experience, and minimal training of week-long microblading courses. A majority of them feel that more training or certification should be required and that there should be more regulations regarding microblading. The results indicated that education and training provide the most knowledge rather than years of experience. This suggests that health authorities should focus on providing more access to education for microblading, such as offering a TattooSafe program for tattooing microblading, and permanent makeup, similar to FoodSafe, and developing more material to inform microblading fact sheets.  

scholarly journals 208 - Person-centred infection prevention and control during a pandemic: The Dementia Isolation Toolkit

2021 ◽  
Vol 33 (S1) ◽  
pp. 11-11
Author(s):  
Andrea Iaboni ◽  
Hannah Quirt ◽  
Steven Stewart ◽  
Alisa Grigorovich ◽  
Claudia Barned ◽  
...  
Keyword(s):  
Infection Control ◽  
Online Survey ◽  
Moral Distress ◽  
Well Being ◽  
Control Measures ◽  
Infection Prevention And Control ◽  
Term Care ◽  
Care Plans ◽  
Infection Control Measures ◽  
People With Dementia

Objectives:People working in long-term care homes (LTCH) face ethical dilemmas about how to minimize the risk of spread of COVID-19, while also minimizing psychological hardship and other harms of infection control measures on residents. The Dementia Isolation Toolkit (www.dementiaisolationtoolkit.com; DIT) was developed to address the gap in ethical guidance for LTCH on how to safely and effectively isolate people with dementia while supporting the personhood and well-being of residents. In this presentation, we will present the DIT and report on the results of a survey of LTCH staff in Ontario, Canada on their experiences isolating residents in LTCH and the use of the DIT in supporting person-centred isolation care.Methods:A link to an online survey was distributed to LTCH staff through provincial organizations and agencies as well as through social media and the DIT website. Inclusion criteria were LTCH staff working on-site at a LTCH since March 1, 2020, who had direct or indirect experience with the isolation/quarantine of LTCH residents. Results were summarized descriptively.Results:A broad sample of LTCH staff (n=207) participated in the survey, most of whom had experienced an outbreak in their LTCH. Dementia (96%) was the most important barrier to implementation of infection control measures in LTCH, followed by staff distress about the effects of isolation on residents (61%). Important facilitators for isolation included delivery of 1:1 activities in the resident’s room (81%) and designating essential caregivers to provide support (67%), while inadequate staffing levels were reported as a barrier (55%). 65% of respondents indicated some familiarity with the DIT, and of those who had used the toolkit, 62% found it helpful in supporting isolation care, particularly in developing care plans and making and communicating decisions. Of those who had used the DIT, 48% found it fairly or very helpful at reducing their level of distress.Conclusions:Isolation as an infection control and prevention (ICP) measure in LTCH environments can be harmful to residents and create moral distress in staff. ICP guidance and support of LTCH needs to address how to minimize these harms by providing dementia-specific guidance such as in the DIT.

scholarly journals Clinical Experience, Knowledge, Attitudes and Practice of Turkish Pediatric Dentists during the COVID-19 Pandemic

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1140
Author(s):  
Yelda Koç ◽  
Serap Akyüz ◽  
Damla Akşit-Bıçak
Keyword(s):  
Infection Control ◽  
Online Survey ◽  
Current Knowledge ◽  
Public Health Problem ◽  
Control Measures ◽  
P Value ◽  
Online Questionnaire ◽  
Attitudes And Practices ◽  
Infection Control Measures ◽  
Pediatric Dentists

Background and Objectives: “Coronavirus Disease 2019” (COVID-19) is a critical public health problem that has affected all fields, including dentistry. The dental management of children has become even more difficult during the COVID-19 pandemic. The purpose of this study was to evaluate the current knowledge, attitudes and practices of Turkish pediatric dentists who have been providing dental treatments to children during the COVID-19 pandemic. Materials and Methods: After receiving ethical approval, this cross-sectional study was conducted using the Google Forms online survey instrument. An online questionnaire link was sent to all the members of the Turkish Society of Paediatric Dentistry by e-mail and through social media. Statistical analyses were performed using descriptive statistics and Chi-square test; a p-value less than 0.05 was considered statistically significant. Results: A total of 200 pediatric dentists participated in this study and most of them (82%) only performed emergency dental treatments, whereas 18.5% performed both emergency and routine dental practices during the COVID-19 pandemic. The vast majority (72.5%) of pediatric dentists prescribed antibiotics and analgesics to their patients who were not cooperative with non-pharmacological behavior management techniques. The findings of the current study showed that the Turkish pediatric dentists had a good level of knowledge about COVID-19, satisfactorily conducted most of the infection control measures before and after the dental treatments, and attached importance to the use of PPEs; however, infection control measures during the dental treatments could be implemented better. Conclusions: Along with all precautions, the vaccination of healthcare workers and requesting a recent test result from patients showing a lack of COVID-19 disease before dental appointments could be used as effective infection control measures. Additionally, pediatric dentists should continue to follow local and universal guidelines, and education programmes should be frequently implemented in order to keep their COVID-19 management strategies up to date.

Prospective Surveillance for Primary Bloodstream Infections Occurring in Canadian Hemodialysis Units

2002 ◽  
Vol 23 (12) ◽  
pp. 716-720 ◽  
Author(s):  
Geoffrey Taylor ◽  
Denise Gravel ◽  
Lynn Johnston ◽  
John Embil ◽  
Donna Holton ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Vascular Access ◽  
Significant Variation ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Surveillance Program ◽  
Infection Rates ◽  
Prospective Surveillance ◽  
Infection Surveillance

Objective:Bloodstream infections are a major cause of morbidity and mortality in patients receiving long-term hemodialysis. We wanted to determine the incidence of hemodialysis-related bloodstream infections in Canadian centers participating in the Canadian Nosocomial Infection Surveillance Program.Methods:Prospective surveillance for hemodialysis-related bloodstream infections was performed in 11 centers during a 6-month period. Bloodstream infections were defined by published criteria. Hemodialysis denominators included the number of dialysis procedures, the number of patient-days on dialysis, and the frequencies of different types of vascular access.Results:There were 184 bloodstream infections in 133,158 dialysis procedures (1.4 per 1,000) and 316,953 patient-days (0.6 per 1,000). Hemodialysis access through arteriovenous (AV) fistulae was associated with the lowest risk for bloodstream infection (0.2 per 1,000 dialysis procedures). The relative risk for infection was 2.5 with AV graft access, 15.5 with cuffed and tunneled central venous catheter (CVC) access, and 22.5 with uncuffed CVC access (P < .001). There was marked variation among the 11 centers in the means of vascular access used for hemodialysis. Significant variation in infection rates was observed among the centers when controlling for types of access.Conclusions:There was a hierarchy of risk of hemodialysis-related bloodstream infection according to type of vascular access. There was significant variation in the type of vascular access being used among the Canadian hemodialysis centers, and also variation in access-specific infection rates between centers.

Surveillance Strategies: A Primer

1987 ◽  
Vol 8 (11) ◽  
pp. 459-464 ◽  
Author(s):  
Elias Abrutyn ◽  
George H. Talbot
Keyword(s):  
Nosocomial Infection ◽  
Infection Control ◽  
Control Measures ◽  
Regulatory Agencies ◽  
Surveillance Program ◽  
Infection Rates ◽  
Control Programs ◽  
Infection Surveillance ◽  
Surveillance Programs ◽  
And Control

The Centers for Disease Control's Study on the Efficacy of Nosocomial Infection Control (SENIC) showed that infection surveillance and control activities are associated with a decrease in nosocomial infection rates. Moreover, the intensity of activity correlated with the magnitude of the fall in infection rates. These results, plus the guidelines of regulatory agencies, mandate that infection control programs conduct surveillance activities. However, absolute standards for the content and nature of surveillance programs have not been established, and many descriptions of different types of surveillance programs are available. In this primer, we describe the considerations involved in development of a surveillance program with emphasis on issues concerning data collection.Langmuir considers surveillance when applied to disease as meaning the collection of data, the analysis of those data, and the distribution of the resulting information to those needing to know. The definition implies that surveillance is observational and that surveillance activities should be clearly separated from other related activities such as control measures. The latter activities, including their initiation, approval, and funding, are administrative matters underpinned by a scientific base that are undertaken by the recipients of the surveillance data and their analyses. They should be clearly separated from surveillance activities per se. There is also the implication that action results from surveillance; surveillance without action should be abandoned.

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