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Wang Z, Kowal SF, Carslaw N, Kahan TF. Photolysis-driven indoor air chemistry following cleaning of hospital wards. INDOOR AIR 2020; 30:1241-1255. [PMID: 32485006 DOI: 10.1111/ina.12702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/17/2020] [Accepted: 05/19/2020] [Indexed: 05/25/2023]
Abstract
Effective cleaning techniques are essential for the sterilization of rooms in hospitals and industry. No-touch devices (NTDs) that use fumigants such as hydrogen peroxide (H2 O2 ), formaldehyde (HCHO), ozone (O3 ), and chlorine dioxide (OClO) are a recent innovation. This paper reports a previously unconsidered potential consequence of such cleaning technologies: the photochemical formation of high concentrations of hydroxyl radicals (OH), hydroperoxy radicals (HO2 ), organic peroxy radicals (RO2 ), and chlorine radicals (Cl) which can form harmful reaction products when exposed to chemicals commonly found in indoor air. This risk was evaluated by calculating radical production rates and concentrations based on measured indoor photon fluxes and typical fumigant concentrations during and after cleaning events. Sunlight and fluorescent tubes without covers initiated photolysis of all fumigants, and plastic-covered fluorescent tubes initiated photolysis of only some fumigants. Radical formation was often dominated by photolysis of fumigants during and after decontamination processes. Radical concentrations were predicted to be orders of magnitude greater than background levels during and immediately following cleaning events with each fumigant under one or more illumination condition. Maximum predicted radical concentrations (1.3 × 107 molecule cm-3 OH, 2.4 ppb HO2 , 6.8 ppb RO2 and 2.2 × 108 molecule cm-3 Cl) were much higher than baseline concentrations. Maximum OH concentrations occurred with O3 photolysis, HO2 with HCHO photolysis, and RO2 and Cl with OClO photolysis. Elevated concentrations may persist for hours after NTD use, depending on the air change rate and air composition. Products from reactions involving radicals could significantly decrease air quality when disinfectants are used, leading to adverse health effects for occupants.
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Affiliation(s)
- Zixu Wang
- Department of Environment and Geography, University of York, York, UK
| | - Shawn F Kowal
- Department of Chemistry, Syracuse University, Syracuse, NY, USA
| | - Nicola Carslaw
- Department of Environment and Geography, University of York, York, UK
| | - Tara F Kahan
- Department of Chemistry, Syracuse University, Syracuse, NY, USA
- Department of Chemistry, University of Saskatchewan, Saskatoon, SK, Canada
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Massey D, Craswell A, Ray-Barruel G, Ullman A, Marsh N, Wallis M, Cooke M. Undergraduate nursing students' perceptions of the current content and pedagogical approaches used in PIVC education. A qualitative, descriptive study. NURSE EDUCATION TODAY 2020; 94:104577. [PMID: 32947210 DOI: 10.1016/j.nedt.2020.104577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 07/21/2020] [Accepted: 08/17/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The peripheral intravenous catheter (PIVC) is the most frequently used invasive medical device. PIVCs fail for a variety of reasons and failure often results in serious adverse events leading to patient discomfort, delays in treatment, increased health care costs and even death. Undergraduate nurses assess and manage PIVCs as part of their clinical learning. To date, no study has explored undergraduate nurses' perceptions of the education they receive about PIVCs. AIM We sought to critically explore the current state of education regarding PIVCs from the perspectives of undergraduate nurses. METHODS This qualitative study involved semi-structured interviews with third-year undergraduate nurses. Data were collected across two sites in Queensland, Australia. Fourteen face-to-face interviews were conducted and a modified 5-step qualitative content analysis was used to analyze the data. FINDINGS We identified three key domains relating to participants' experiences of PIVC education: 1) Universities provide foundational knowledge about PIVC assessment, management and removal; 2) Clinical practice consolidates and drives undergraduate nurses' knowledge, skills and confidence about PIVCs; and 3) inconsistencies in clinical practice and between individual clinicians impedes learning and knowledge translation about PIVCs. CONCLUSION Nursing students benefit from theoretical content delivered in the university setting. Practical application of theory and skill development whilst on clinical placement is variable. The current undergraduate curriculum, related to management of patients with a PIVC, is disjointed and inconsistent and this inconsistency may negatively impact patient safety.
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Affiliation(s)
- Debbie Massey
- School of Health and Social Sciences, Gold Coast Campus, Southern Cross University, Bilinga, Queensland 4225, Australia.
| | - Alison Craswell
- School of Nursing, Midwifery and Paramedicine, 90 Sippy Downs Drive, Sippy Downs, Queensland 4556, Australia
| | - Gillian Ray-Barruel
- QEII Jubilee Hospital, Alliance for Vascular Access, Teaching and Research, Menzies Health Institute Queensland, Griffith University, Kessels Rd, Nathan, Australia
| | - Amanda Ullman
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Kessels Rd, Nathan, Queensland, Australia
| | - Nicole Marsh
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Kessels Rd, Nathan, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Kessels Rd, Nathan, Queensland, Australia; School of Nursing, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Queensland, Australia
| | - Marianne Wallis
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Queensland 4556, Australia; Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Kessels Rd, Nathan, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Kessels Rd, Nathan, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Kessels Rd, Nathan, Queensland, Australia
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203
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Masamoto T, Yano R. Characteristics of expert nurses' assessment of insertion sites for peripheral venous catheters in elderly adults with hard-to-find veins. Jpn J Nurs Sci 2020; 18:e12379. [PMID: 33025696 DOI: 10.1111/jjns.12379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/26/2020] [Accepted: 08/15/2020] [Indexed: 11/28/2022]
Abstract
AIM To clarify the characteristics of expert nurses' assessments when selecting an insertion site for a peripheral venous catheter (PVC). METHODS Participants were 11 competent (control group) and 13 expert nurses. Using a simulated patient, we recorded the procedures participants followed when selecting a site for a PVC insertion. The researchers interviewed the nurses after the procedure by asking targeted questions about the site selection to clarify the factors influencing that selection. During the interview, a video of that nurse's procedure was observed, and each step performed during the procedure was investigated. RESULTS We identified three assessment characteristics specific to expert nurses that influenced their PVC site selection: (a) focusing on a patient's unique characteristics and choosing the appropriate procedure for that individual; (b) avoiding complications and paying attention to the patient's daily self-care needs; and (c) carefully considering the patient's fear and fatigue during site selection and catheter insertion. Other assessments, based on the general knowledge and skill acquired by nurses in selecting a PVC site, were common to both groups: arm selection based on the patient's preference and site selection to avoid nerve injuries or complications. The control group's approach was assessed on the basis of their confidence in selecting a site for a PVC insertion. CONCLUSIONS Expert nurses assessed the patient's individual characteristics and daily self-care needs and helped mitigate the patient's anxiety. Our findings provide a basis for educational programs that share how expert nurses assess sites for a PVC insertion.
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Affiliation(s)
| | - Rika Yano
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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204
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Marsh N, Webster J, Ullman AJ, Mihala G, Cooke M, Chopra V, Rickard CM. Peripheral intravenous catheter non‐infectious complications in adults: A systematic review and meta‐analysis. J Adv Nurs 2020; 76:3346-3362. [DOI: 10.1111/jan.14565] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/20/2020] [Accepted: 07/29/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Nicole Marsh
- Nursing and Midwifery Research Centre Royal Brisbane and Women's Hospital Brisbane Queensland Australia
- Alliance for Vascular Access Teaching and Research Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
- School of Nursing and Midwifery Griffith University Brisbane Australia
| | - Joan Webster
- Nursing and Midwifery Research Centre Royal Brisbane and Women's Hospital Brisbane Queensland Australia
- Alliance for Vascular Access Teaching and Research Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
| | - Amanda J. Ullman
- Nursing and Midwifery Research Centre Royal Brisbane and Women's Hospital Brisbane Queensland Australia
- Alliance for Vascular Access Teaching and Research Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
- School of Nursing and Midwifery Griffith University Brisbane Australia
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
- School of Medicine Griffith University Brisbane Queensland Australia
- Centre for Applied Health Economics Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
- School of Nursing and Midwifery Griffith University Brisbane Australia
| | - Vineet Chopra
- Alliance for Vascular Access Teaching and Research Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
- Division of Hospital Medicine Department of Medicine University of Michigan Ann Arbor Michigan USA
| | - Claire M. Rickard
- Nursing and Midwifery Research Centre Royal Brisbane and Women's Hospital Brisbane Queensland Australia
- Alliance for Vascular Access Teaching and Research Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
- School of Nursing and Midwifery Griffith University Brisbane Australia
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205
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Blanco-Mavillard I, Parra-García G, Fernández-Fernández I, Rodríguez-Calero MÁ, Personat-Labrador C, Castro-Sánchez E. Care of peripheral intravenous catheters in three hospitals in Spain: Mapping clinical outcomes and implementation of clinical practice guidelines. PLoS One 2020; 15:e0240086. [PMID: 33007001 PMCID: PMC7531784 DOI: 10.1371/journal.pone.0240086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/19/2020] [Indexed: 12/26/2022] Open
Abstract
Background Peripheral intravenous catheters (PIVCs) are the most widely used invasive devices worldwide. Up to 42% of PIVCs are prematurely removed during intravenous therapy due to failure. To date, there have been few systematic attempts in European hospitals to measure adherence to recommendations to mitigate PIVC failures. Aim To analyse the clinical outcomes from clinical practice guideline recommendations for PIVC care on different hospital types and environments. Methods We conducted an observational study in three hospitals in Spain from December 2017 to April 2018. The adherence to recommendations was monitored via visual inspection in situ evaluations of all PIVCs inserted in adults admitted. Context and clinical characteristics were collected by an evaluation tool, analysing data descriptively. Results 646 PIVCs inserted in 624 patients were monitored, which only 52.7% knew about their PIVC. Regarding PIVC insertion, 3.4% (22/646) patients had at least 2 PIVCs simultaneously. The majority of PIVCs were 20G (319/646; 49.4%) and were secured with transparent polyurethane dressing (605/646; 93.7%). Most PIVCs (357/646; 55.3%) had a free insertion site during the visual inspection at first sight. We identified 342/646 (53%) transparent dressings in optimal conditions (clean, dry, and intact dressing). PIVC dressings in medical wards were much more likely to be in intact conditions than those in surgical wards (234/399, 58.7% vs. 108/247, 43.7%). We identified 55/646 (8.5%) PIVCs without infusion in the last 24 hours and 58/646 (9.0%) PIVCs without infusion for more than 24 hours. Regarding PIVC failure, 74 (11.5%) adverse events were identified, all of them reflecting clinical manifestation of phlebitis. Conclusions Our findings indicate that the clinical outcome indicators from CPG for PIVC care were moderate, highlighting differences between hospital environments and types. Also, we observed that nearly 50% of patients did not know what a PIVC is.
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Affiliation(s)
- Ian Blanco-Mavillard
- Hospital Manacor, Manacor, Spain
- Universitat de les Illes Balears, Palma, Spain
- Care, Chronicity and Evidence in Health Research Group (CurES), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- * E-mail:
| | | | | | - Miguel Ángel Rodríguez-Calero
- Universitat de les Illes Balears, Palma, Spain
- Care, Chronicity and Evidence in Health Research Group (CurES), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Servei de Salut de les Illes Balears, Palma, Spain
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206
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Cotterill S, Tang MY, Powell R, Howarth E, McGowan L, Roberts J, Brown B, Rhodes S. Social norms interventions to change clinical behaviour in health workers: a systematic review and meta-analysis. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background
A social norms intervention seeks to change the clinical behaviour of a target health worker by exposing them to the values, beliefs, attitudes or behaviours of a reference group or person. These low-cost interventions can be used to encourage health workers to follow recommended professional practice.
Objective
To summarise evidence on whether or not social norms interventions are effective in encouraging health worker behaviour change, and to identify the most effective social norms interventions.
Design
A systematic review and meta-analysis of randomised controlled trials.
Data sources
The following databases were searched on 24 July 2018: Ovid MEDLINE (1946 to week 2 July 2018), EMBASE (1974 to 3 July 2018), Cumulative Index to Nursing and Allied Health Literature (1937 to July 2018), British Nursing Index (2008 to July 2018), ISI Web of Science (1900 to present), PsycINFO (1806 to week 3 July 2018) and Cochrane trials (up to July 2018).
Participants
Health workers took part in the study.
Interventions
Behaviour change interventions based on social norms.
Outcome measures
Health worker clinical behaviour, for example prescribing (primary outcome), and patient health outcomes, for example blood test results (secondary), converted into a standardised mean difference.
Methods
Titles and abstracts were reviewed against the inclusion criteria to exclude any that were clearly ineligible. Two reviewers independently screened the remaining full texts to identify relevant papers. Two reviewers extracted data independently, coded for behaviour change techniques and assessed quality using the Cochrane risk-of-bias tool. We performed a meta-analysis and presented forest plots, stratified by behaviour change technique. Sources of variation were explored using metaregression and network meta-analysis.
Results
A total of 4428 abstracts were screened, 477 full texts were screened and findings were based on 106 studies. Most studies were in primary care or hospitals, targeting prescribing, ordering of tests and communication with patients. The interventions included social comparison (in which information is given on how peers behave) and credible source (which refers to communication from a well-respected person in support of the behaviour). Combined data suggested that interventions that included social norms components were associated with an improvement in health worker behaviour of 0.08 standardised mean differences (95% confidence interval 0.07 to 0.10 standardised mean differences) (n = 100 comparisons), and an improvement in patient outcomes of 0.17 standardised mean differences (95% confidence interval 0.14 to 0.20) (n = 14), on average. Heterogeneity was high, with an overall I
2 of 85.4% (primary) and 91.5% (secondary). Network meta-analysis suggested that three types of social norms intervention were most effective, on average, compared with control: credible source (0.30 standardised mean differences, 95% confidence interval 0.13 to 0.47); social comparison combined with social reward (0.39 standardised mean differences, 95% confidence interval 0.15 to 0.64); and social comparison combined with prompts and cues (0.33 standardised mean differences, 95% confidence interval 0.22 to 0.44).
Limitations
The large number of studies prevented us from requesting additional information from authors. The trials varied in design, context and setting, and we combined different types of outcome to provide an overall summary of evidence, resulting in a very heterogeneous review.
Conclusions
Social norms interventions are an effective method of changing clinical behaviour in a variety of health service contexts. Although the overall result was modest and very variable, there is the potential for social norms interventions to be scaled up to target the behaviour of a large population of health workers and resulting patient outcomes.
Future work
Development of optimised credible source and social comparison behaviour change interventions, including qualitative research on acceptability and feasibility.
Study registration
This study is registered as PROSPERO CRD42016045718.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 41. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sarah Cotterill
- Centre for Biostatistics, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Mei Yee Tang
- Centre for Biostatistics, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Rachael Powell
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Elizabeth Howarth
- Centre for Biostatistics, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Laura McGowan
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Jane Roberts
- Outreach and Evidence Search Service, Library and E-learning Service, Northern Care Alliance, NHS Group, Royal Oldham Hospital, Oldham, UK
| | - Benjamin Brown
- Health e-Research Centre, Farr Institute for Health Informatics Research, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Centre for Primary Care, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Sarah Rhodes
- Centre for Biostatistics, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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207
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Carre Y, Moal B, Germain C, Frison E, Dubreuil M, Chansel C, Berger V, Boulestreau H, Lasheras-Bauduin A, Rogues AM. Randomized study of antiseptic application technique in healthy volunteers before vascular access insertion (TApAS trial). J Infect 2020; 81:532-539. [DOI: 10.1016/j.jinf.2020.08.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/23/2020] [Accepted: 08/14/2020] [Indexed: 02/04/2023]
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208
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Fabiani A, Eletto V, Dreas L, Beltrame D, Sanson G. Midline or long peripheral catheters in difficult venous access conditions? A comparative study in patients with acute cardiovascular diseases. Am J Infect Control 2020; 48:1158-1165. [PMID: 31973988 DOI: 10.1016/j.ajic.2019.12.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/29/2019] [Accepted: 12/30/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Midline catheters (MCs) are commonly inserted in patients with difficult venous access (DVA) needing peripheral access. Recently, the alternative placement of ultrasound-guided long peripheral catheters (LPCs) has spread. However, no study has compared the reliability of the 2 devices. This study aims to compare the safety and reliability of MCs and LPCs in DVA patients. METHODS A retrospective cohort study was conducted, enrolling 184 DVA patients. Polyurethane MCs and 2 lengths of polyethylene LPCs (8/10 cm and 18 cm) were compared. The independent effect of catheter type on uncomplicated catheter survival was determined through a Cox regression analysis. RESULTS The relative incidences of overall catheter-related complications (CRCs) were 15.84 of 1,000, 10.64 of 1,000, and 6.27 of 1,000 catheter-days for 8/10 cm-LPCs, 18 cm-LPCs, and MCs, respectively. The relative incidences of catheter-related bloodstream infections were 0.72 of 1,000 for both length LPCs and 0.48 of 1,000 catheter-days for MCs. Compared to MCs, a significant increase in CRC risk for 8/10 cm LPCs (hazard ratio [HR] 5.328; 95% confidence interval [CI] 2.118-13.404; P < 0.001) was found, along with a nonsignificant trend toward an increased risk for 18 cm-LCPs (HR 2.489; 95% CI 0.961-6.448; P = 0.060). CONCLUSION MCs allow for longer uncomplicated indwelling times than LPCs. The decision regarding which catheter to use should consider the planned duration of intravenous therapy, the patient's clinical condition, and the cost of the device.
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Affiliation(s)
- Adam Fabiani
- Cardiothoracic-Vascular Department, Azienda Sanitaria Universitaria Integrata, Strada di Fiume 447, Trieste, Italy
| | - Valentina Eletto
- Cardiothoracic-Vascular Department, Azienda Sanitaria Universitaria Integrata, Strada di Fiume 447, Trieste, Italy
| | - Lorella Dreas
- Cardiothoracic-Vascular Department, Azienda Sanitaria Universitaria Integrata, Strada di Fiume 447, Trieste, Italy
| | - Daria Beltrame
- Cardiothoracic-Vascular Department, Azienda Sanitaria Universitaria Integrata, Strada di Fiume 447, Trieste, Italy
| | - Gianfranco Sanson
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, Trieste, Italy.
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209
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Dislodgement Forces and Cost Effectiveness of Dressings and Securement for Peripheral Intravenous Catheters: A Randomized Controlled Trial. J Clin Med 2020; 9:jcm9103192. [PMID: 33019691 PMCID: PMC7601033 DOI: 10.3390/jcm9103192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/24/2020] [Accepted: 09/26/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives: Peripheral intravenous catheters (PIVC) are the most frequently used invasive devices in medicine. PIVC failure before treatment completion is a significant concern and occurs in 33–69% of patients. Partial dislodgement and accidental removal are some of the reasons for PIVC failure. The most effective dressing and securement method for preventing accidental removal remains unclear. It was the aim of this study to compare the force required to dislodge a PIVC with four commonly used dressing and securement methods. Additionally, costs were calculated. Methods: Truncated 18-gauge i.v. cannulas were attached onto the forearm of 209 volunteers using four different dressings and securements (sterile absorbent wound dressing covered by two different types of elastic polyester fleece, bordered and non-bordered polyurethane). The force during continuously stronger pulling until dislodgement was recorded. Results: The highest resistance against dislodgement forces could be observed with a sterile absorbent wound dressing covered by two incised elastic polyester fleece dressings. Commercially-manufactured bordered and non-bordered polyurethan film dressings were 20% to 75% more expensive than sterile absorbent wound dressings covered by elastic polyester fleece dressing. Conclusions: Elastic polyester fleece secured a PIVC against accidental removal by external force best, compared to commercially-manufactured bordered and non-bordered polyurethane film dressing.
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210
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Helder OK, van Rosmalen J, van Dalen A, Schafthuizen L, Vos MC, Flint RB, Wildschut E, Kornelisse RF, Ista E. Effect of the use of an antiseptic barrier cap on the rates of central line-associated bloodstream infections in neonatal and pediatric intensive care. Am J Infect Control 2020; 48:1171-1178. [PMID: 31948717 DOI: 10.1016/j.ajic.2019.11.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND The use of antiseptic barrier caps reduced the occurrence of central line-associated bloodstream infections (CLABSI) in adult intensive care settings. We assessed the effect of the use of antiseptic barrier caps on the incidence of CLABSI in infants and children and evaluated the implementation process. METHODS We performed a mixed-method, prospective, observational before-after study. The CLABSI rate was documented during the "scrub the hub method" and the antiseptic barrier cap phase. Main outcomes were the number of CLABSIs per 1,000 catheter days (assessed with a Poisson regression analysis) and nurses' adherence to antiseptic barrier cap protocol. RESULTS In total, 2,248 patients were included. The rate of CLABSIs per 1,000 catheter days declined from 3.15 to 2.35, resulting in an overall incidence reduction of 22% (95% confidence interval, -34%, 55%; P = .368). Nurses' adherence to the antiseptic barrier cap protocol was 95.2% and 89.0% for the neonatal intensive care unit and pediatric intensive care unit, respectively. DISCUSSION The CLABSI reducing effect of the antiseptic barrier caps seems to be more prominent in the neonatal intensive care unit population compared with the pediatric intensive care unit population. CONCLUSIONS The antiseptic barrier cap did not significantly reduce the CLABSI rates in this study.
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Affiliation(s)
- Onno K Helder
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands; Erasmus MC Create4Care, Erasmus MC, Rotterdam, the Netherlands.
| | | | - Anneke van Dalen
- Department of Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Laura Schafthuizen
- Department of Internal Medicine, Section of Nursing Science, Erasmus MC, Rotterdam, the Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, the Netherlands
| | - Robert B Flint
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Pharmacy, Erasmus MC, Rotterdam, the Netherlands
| | - Enno Wildschut
- Department of Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - René F Kornelisse
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Erwin Ista
- Department of Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Internal Medicine, Section of Nursing Science, Erasmus MC, Rotterdam, the Netherlands
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211
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Lindberg M, Skytt B, Lindberg M. Continued wearing of gloves: a risk behaviour in patient care. Infect Prev Pract 2020; 2:100091. [PMID: 34368725 PMCID: PMC8336026 DOI: 10.1016/j.infpip.2020.100091] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/10/2020] [Indexed: 02/08/2023] Open
Abstract
Background The wearing of gloves is included in the standard principles for preventing healthcare associated infections. A continued wearing of gloves may, however, result in the transmission of organisms instead of preventing infections. Few studies have explored how common it is for surfaces to be touched by potentially contaminated gloves. Methods Secondary analysis of field notes from 48 hours of unstructured observations of healthcare personnel's actions during patient care. The new focus was on to what extent healthcare personnel wore gloves that should have been removed or changed, what surfaces were touched by contaminated gloves and what patient-related activities were involved. Results A continued wearing of gloves occurred in about half of the observed episodes of patient care. On average, 3.3 surfaces were touched by contaminated gloves. The surfaces most frequently touched were ‘unused single-use items’, ‘equipment controls/switches/regulators/flush buttons’ and ‘bed linen’. This occurred mostly while helping patients with ‘personal hygiene’, when performing ‘test taking’ or during procedures involving the operation of medical or other ‘equipment’. Conclusion The continued wearing of gloves during patient-related activities carries the risk of organism transmission, as the gloves touch many surfaces. The most critical moments seem to be when the use of gloves is considered essential. A better understanding of the motivators of improper glove-use behaviour is needed to develop interventions that rectify the improper use of gloves.
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Affiliation(s)
- M Lindberg
- Faculty of Health and Occupational Studies, Department of Caring Sciences, University of Gävle, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Centre for Research and Development, Uppsala University, Region Gävleborg, Gävle, Sweden
| | - B Skytt
- Faculty of Health and Occupational Studies, Department of Caring Sciences, University of Gävle, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - M Lindberg
- Faculty of Health and Occupational Studies, Department of Caring Sciences, University of Gävle, Sweden
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Gavin NC, Kleidon TM, Larsen E, O'Brien C, Ullman A, Northfield S, Mihala G, Runnegar N, Marsh N, Rickard CM. A comparison of hydrophobic polyurethane and polyurethane peripherally inserted central catheter: results from a feasibility randomized controlled trial. Trials 2020; 21:787. [PMID: 32928286 PMCID: PMC7489010 DOI: 10.1186/s13063-020-04699-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 08/24/2020] [Indexed: 11/21/2022] Open
Abstract
Background To evaluate the feasibility of an efficacy trial comparing a hydrophobic polyurethane peripherally inserted central catheter (PICC) with a standard polyurethane PICC. Methods This pilot randomised controlled trial (RCT) was conducted between May 2017 and February 2018. Adult participants (n = 111) were assigned to hydrophobic polyurethane PICC with proximal valve (intervention) or a polyurethane PICC with external clamp (standard care). Primary outcome was trial feasibility including PICC failure. Secondary outcomes were central line-associated bloodstream infection, local infection, occlusion, thrombosis, fracture and dislodgement, phlebitis, local or systemic allergic reaction, and PICC dwell time. Results All feasibility outcomes were achieved, apart from eligibility criteria. In total, 338 patients were screened, 138 were eligible (41%), and of these 111 were randomised (80%). Patients received the allocated PICC in 106 (95%) insertions. No patients withdrew from the study and there was no missing data. PICC failure was 24% (13/55) in the intervention group and 22% (12/55) in the standard care group (p = 0.820). PICC failure per 1000 PICC days was 16.3 in the intervention group and 18.4 in the control group (p = 0.755). The average dwell time was 12 days in the intervention and 8 days in the control group. Conclusions This study demonstrates the feasibility of an efficacy trial of PICC materials in an adult population, once adjustments were made to include not only in-patients, but also patients being discharged to the Hospital in the Home service. Trial registration Australia and New Zealand Clinical Trials Registry ACTRN12616001578493. Prospectively registered on 16 November 2016. The trial protocol was published a priori (Kleidon et al., Vasc Access 3:15–21, 2017).
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Affiliation(s)
- Nicole C Gavin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland, 4029, Australia. .,Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia. .,School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia. .,Institute of Health and Biomendical Institute to Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia.
| | - Tricia M Kleidon
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia.,Children's Hospital Queensland, South Brisbane, Queensland, 4101, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia
| | - Emily Larsen
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, 4111, Australia
| | - Catherine O'Brien
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia
| | - Amanda Ullman
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia.,Children's Hospital Queensland, South Brisbane, Queensland, 4101, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, 4111, Australia
| | - Sarah Northfield
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland, 4029, Australia
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, 4222, Australia.,Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia
| | - Naomi Runnegar
- Infection Management Services, Princess Alexandra Hospital, Woolloongabba, Queensland, 4102, Australia.,PA-Southside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, 4102, Australia
| | - Nicole Marsh
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia.,School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, 4111, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, 4111, Australia
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213
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Xie N, Hu Z, Ye Z, Xu Q, Chen J, Lin Y. A systematic review comparing early with late removal of indwelling urinary catheters after pelvic organ prolapse surgery. Int Urogynecol J 2020; 32:1361-1372. [PMID: 32886172 DOI: 10.1007/s00192-020-04522-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND An indwelling catheter is routinely used after pelvic organ prolapse surgery to prevent urinary retention. However, the timing of catheter removal remains controversial. OBJECTIVES To investigate the optimal timing of catheter removal following prolapse surgery. METHODS Electronic databases including the Cochrane Center Controlled Test Center, Embase, CINAHL, MEDLINE, PubMed, Web of Science and CNKI were searched up to January 2010. Randomized controlled trials (RCTs) comparing different timings of catheter removal after prolapse surgery were eligible. Results from RCTs comparing early versus late removal were pooled, and different durations of catheterization were divided into three sub-comparisons (≤ 2 days versus > 2 days; ≤ 1 day versus 2 days; < 1 day versus 1 day). Primary outcomes were urinary tract infection (UTI) and re-catheterization. Secondary outcomes were the length of hospital stay and patient-reported outcomes. RESULTS Seven RCTs with 964 women were involved in the analysis. Early catheter removal was associated with a reduced incidence of UTI (RR 0.46, 95% CI 0.24 to 0.9) but an increased risk of re-catheterization (RR 2.67, 95% CI 1.6 to 4.48). Significant differences in primary outcomes were found in the sub-comparison of ≤ 2 days versus > 2 days. Three of six trials found a significantly shorter length of hospital stay in the early removal group. The results for postoperative pain were mixed. CONCLUSION Among patients following pelvic organ prolapse surgery, early catheter removal is preferred. Moreover, the timing for removal is preferably within 2 days postoperatively.
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Affiliation(s)
- Nansha Xie
- Department of Urogynecology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Zeyin Hu
- Department of Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zengjie Ye
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiong Xu
- Department of Urogynecology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jie Chen
- Department of Pediatric Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Yan Lin
- Department of Nursing Administrative Office, Guangzhou Women and Children's Medical Center, Guangzhou, China.
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214
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Slater K, Cooke M, Fullerton F, Whitby M, Hay J, Lingard S, Douglas J, Rickard CM. Peripheral intravenous catheter needleless connector decontamination study-Randomized controlled trial. Am J Infect Control 2020; 48:1013-1018. [PMID: 31928890 DOI: 10.1016/j.ajic.2019.11.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Needleless connectors (NCs) were introduced to reduce health care work needlestick injuries (NSIs). If not decontaminated prior to use, NCs can be a portal for patient blood stream infections. The optimal disinfectant, and its application duration, for NC decontamination has not been empirically established. METHODS Factorial design randomized controlled trial comparing 70% isopropyl alcohol (IPA) and 2% chlorhexidine gluconate (CHG) in 70% IPA for 5, 10, or 15 seconds, in adult medical patients with peripheral intravenous catheters. RESULTS At baseline, 153 of 300 NCs (51%) grew microorganisms commonly found on the skin. Decontamination was successful in 150/153 (98%). There was no significant difference in decontamination between 70% IPA or 2% CHG in 70% IPA (P = .62), or decontamination for 5, 10, or 15 seconds (P = .21). CONCLUSIONS There was no difference in the effectiveness of 70% IPA and 2% CHG in 70% IPA for NC decontamination for peripheral intravenous catheters in the clinical environment. Successful decontamination was not different for applications of 5, 10, and 15 seconds; 15 seconds did not always remove all microorganisms. Factors such as cost, feasibility of compliance, and low risk of allergy support 5 seconds decontamination with 70% IPA as an acceptable approach.
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215
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King MF, López-García M, Atedoghu KP, Zhang N, Wilson AM, Weterings M, Hiwar W, Dancer SJ, Noakes CJ, Fletcher LA. Bacterial transfer to fingertips during sequential surface contacts with and without gloves. INDOOR AIR 2020; 30:993-1004. [PMID: 32329918 DOI: 10.1111/ina.12682] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/26/2020] [Accepted: 04/14/2020] [Indexed: 05/05/2023]
Abstract
Bacterial transmission from contaminated surfaces via hand contact plays a critical role in disease spread. However, the fomite-to-finger transfer efficiency of microorganisms during multiple sequential surface contacts with and without gloves has not been formerly investigated. We measured the quantity of Escherichia coli on fingertips of participants after 1-8 sequential contacts with inoculated plastic coupons with and without nitrile gloves. A Bayesian approach was used to develop a mechanistic model of pathogen accretion to examine finger loading as a function of the difference between E coli on surfaces and fingers. We used the model to determine the coefficient of transfer efficiency (λ), and influence of swabbing efficiency and finger area. Results showed that λ for bare skin was higher (49%, 95% CI = 32%-72%) than for gloved hands (30%, CI = 17%-49%). Microbial load tended toward a dynamic equilibrium after four and six contacts for gloved hands and bare skin, respectively. Individual differences between volunteers' hands had a negligible effect compared with use of gloves (P < .01). Gloves reduced loading by 4.7% (CI = -12%-21%) over bare skin contacts, while 20% of participants accrued more microorganisms on gloved hands. This was due to poor fitting, which created a larger finger surface area than bare hands.
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Affiliation(s)
| | | | | | - Nan Zhang
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China, SAR
| | - Amanda M Wilson
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Martijn Weterings
- Institute of Life Technologies, University of Applied Sciences and Arts Western, Sion, Valais-Wallis, Switzerland
| | - Waseem Hiwar
- School of Civil Engineering, University of Leeds, Leeds, UK
| | - Stephanie J Dancer
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
- Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire, Glasgow, UK
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216
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Casimero C, Ruddock T, Hegarty C, Barber R, Devine A, Davis J. Minimising Blood Stream Infection: Developing New Materials for Intravascular Catheters. MEDICINES (BASEL, SWITZERLAND) 2020; 7:E49. [PMID: 32858838 PMCID: PMC7554993 DOI: 10.3390/medicines7090049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/22/2020] [Accepted: 08/24/2020] [Indexed: 12/19/2022]
Abstract
Catheter related blood stream infection is an ever present hazard for those patients requiring venous access and particularly for those requiring long term medication. The implementation of more rigorous care bundles and greater adherence to aseptic techniques have yielded substantial reductions in infection rates but the latter is still far from acceptable and continues to place a heavy burden on patients and healthcare providers. While advances in engineering design and the arrival of functional materials hold considerable promise for the development of a new generation of catheters, many challenges remain. The aim of this review is to identify the issues that presently impact catheter performance and provide a critical evaluation of the design considerations that are emerging in the pursuit of these new catheter systems.
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Affiliation(s)
| | | | | | | | | | - James Davis
- School of Engineering, Ulster University, Jordanstown BT37 0QB, Northern Ireland, UK; (C.C.); (T.R.); (C.H.); (R.B.); (A.D.)
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217
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Development of an information leaflet and diagnostic flow chart to improve the management of urinary tract infections in older adults: a qualitative study using the Theoretical Domains Framework. BJGP Open 2020; 4:bjgpopen20X101044. [PMID: 32576575 PMCID: PMC7465577 DOI: 10.3399/bjgpopen20x101044] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/30/2020] [Indexed: 01/21/2023] Open
Abstract
Background Urinary tract infections (UTIs), older age, lack of access to health care, and recent antibiotic use are risk factors for Escherichia coli (E. coli) bloodstream infections. Aim To explore the diagnosis and management of UTIs in primary care to inform the development of an information leaflet, a diagnostic flow chart, and recommendations for other resources. Design & setting The study had a qualitative design and was undertaken in primary care settings and care homes. Method Interviews and focus groups were informed by the Theoretical Domains Framework (TDF) with 31 care home staff, three residents, six relatives, 57 GP staff, and 19 members of the public. An inductive thematic analysis was used and themes were placed in the Behaviour Change Wheel (BCW) to recommend interventions. Results Care home staff were pivotal for identifying suspected UTI, alerted clinicians to symptoms that influenced prescribing decisions, and reported confusion or behavioural changes as the most common diagnostic sign. Care home staff lacked knowledge about asymptomatic bacteriuria (ASB) and sepsis, and incorrectly diagnosed UTI using urine dipsticks. GP staff used urine dipsticks to rule out UTI and reported that stopping dipsticks would require a culture change, clear protocols, and education about ASB. Many prescribers believed that stopping urine dipstick use should help to reduce antibiotic use. Conclusion A consistent message about ASB and UTI diagnosis and management in older adults should be communicated across the care pathway. Resource development should increase capability, motivation, and opportunity to improve management of suspected UTIs. An educational leaflet for older adults and a diagnostic flow chart for clinicians have been developed, and recommendations for interventions are discussed.
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218
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Pinelli F, Balsorano P, Mura B, Pittiruti M. Reconsidering the GAVeCeLT Consensus on catheter-related thrombosis, 13 years later. J Vasc Access 2020; 22:501-508. [PMID: 32772785 DOI: 10.1177/1129729820947594] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Catheter-related thrombosis represents one of the most common complications following central venous access insertion. Despite the amount of available studies, many aspects surrounding catheter-related thrombosis remain controversial. Thirteen years ago, the Italian Study Group for Long Term Central Venous Access (GAVeCeLT) developed a nationwide Consensus in order to clarify some key aspects on this topic. Despite most of them still remain valid, however, knowledge around catheter-related thrombosis has greatly evolved over the last decade, with a natural evolution in terms of catheter technologies, insertion techniques, and management bundles. Aims of this editorial are to readdress conclusions of the 2007 GAVeCeLT Consensus in the light of the new relevant evidences that have been added in the last 13 years and to analyze some unsolved issues that still remain debated.
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Affiliation(s)
- Fulvio Pinelli
- Department of Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy
| | - Paolo Balsorano
- Department of Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy
| | - Benedetta Mura
- School of Human Health Science, University of Florence, Florence, Italy
| | - Mauro Pittiruti
- Department of Surgery, Catholic University Hospital, Rome, Italy
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219
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Heaney H, Laing J, Paterson L, Walker AW, Gow NAR, Johnson EM, MacCallum DM, Brown AJP. The environmental stress sensitivities of pathogenic Candida species, including Candida auris, and implications for their spread in the hospital setting. Med Mycol 2020; 58:744-755. [PMID: 31912151 PMCID: PMC7398771 DOI: 10.1093/mmy/myz127] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/02/2019] [Accepted: 12/05/2019] [Indexed: 11/23/2022] Open
Abstract
Candida auris is an emerging pathogenic yeast of significant clinical concern because of its frequent intrinsic resistance to fluconazole and often other antifungal drugs and the high mortality rates associated with systemic infections. Furthermore, C. auris has a propensity for persistence and transmission in health care environments. The reasons for this efficient transmission are not well understood, and therefore we tested whether enhanced resistance to environmental stresses might contribute to the ability of C. auris to spread in health care environments. We compared C. auris to other pathogenic Candida species with respect to their resistance to individual stresses and combinations of stresses. Stress resistance was examined using in vitro assays on laboratory media and also on hospital linen. In general, the 17 C. auris isolates examined displayed similar degrees of resistance to oxidative, nitrosative, cationic and cell wall stresses as clinical isolates of C. albicans, C. glabrata, C. tropicalis, C. parapsilosis, C. krusei, C. guilliermondii, C. lusitaniae and C. kefyr. All of the C. auris isolates examined were more sensitive to low pH (pH 2, but not pH 4) compared to C. albicans, but were more resistant to high pH (pH 13). C. auris was also sensitive to low pH, when tested on contaminated hospital linen. Most C. auris isolates were relatively thermotolerant, displaying significant growth at 47°C. Furthermore, C. auris was relatively resistant to certain combinations of combinatorial stress (e.g., pH 13 plus 47°C). Significantly, C. auris was sensitive to the stress combinations imposed by hospital laundering protocol (pH > 12 plus heat shock at >80°C), suggesting that current laundering procedures are sufficient to limit the transmission of this fungal pathogen via hospital linen.
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Affiliation(s)
- Helen Heaney
- Aberdeen Fungal Group, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Juliette Laing
- NHS Grampian Central Decontamination Unit, Foresterhill Health Campus, Aberdeen, UK
| | - Linda Paterson
- NHS Grampian Central Decontamination Unit, Foresterhill Health Campus, Aberdeen, UK
| | - Alan W Walker
- Rowett Institute, University of Aberdeen, Aberdeen, UK
| | - Neil A R Gow
- Aberdeen Fungal Group, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
- MRC Centre for Medical Mycology, University of Exeter, School of Biosciences, Exeter, UK
| | - Elizabeth M Johnson
- Mycology Reference Laboratory, PHE South West Laboratory, Southmead Hospital, Bristol, UK
| | - Donna M MacCallum
- Aberdeen Fungal Group, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Alistair J P Brown
- Aberdeen Fungal Group, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
- MRC Centre for Medical Mycology, University of Exeter, School of Biosciences, Exeter, UK
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220
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Sturdy A, Basarab M, Cotter M, Hager K, Shakespeare D, Shah N, Randall P, Spray D, Arnold A. Severe COVID-19 and healthcare-associated infections on the ICU: time to remember the basics? J Hosp Infect 2020; 105:593-595. [PMID: 32590012 PMCID: PMC7309729 DOI: 10.1016/j.jhin.2020.06.027] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 11/18/2022]
Affiliation(s)
- A Sturdy
- Department of Infection, St George's Hospital, London, UK.
| | - M Basarab
- Department of Infection, St George's Hospital, London, UK
| | - M Cotter
- Department of Infection, St George's Hospital, London, UK
| | - K Hager
- Department of Infection, St George's Hospital, London, UK
| | - D Shakespeare
- Department of Infection, St George's Hospital, London, UK
| | - N Shah
- Adult Critical Care Directorate, St George's Hospital, London, UK
| | - P Randall
- Adult Critical Care Directorate, St George's Hospital, London, UK
| | - D Spray
- Adult Critical Care Directorate, St George's Hospital, London, UK
| | - A Arnold
- Department of Infection, St George's Hospital, London, UK
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221
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Ojo SA. Reflections on setting up a nurse-led paediatric peripherally inserted central catheter service. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:S16-S20. [PMID: 32697637 DOI: 10.12968/bjon.2020.29.14.s16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of this article is to present the experience of starting a paediatric peripherally inserted central catheter (PICC) service and setting up a nurse-led paediatric PICC insertion service. The periods in review are divided into two: the trial phase and the interim service phase. The trial phase took place between October 2014 and December 2016. During this period, a total of 55 lines were inserted. The interim service phase, which is ongoing, pending the ratification of the business case, has resulted in 301 inserted PICC lines. The interim period discussed covers January 2017 to December 2019.
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Affiliation(s)
- Samuel A Ojo
- Intravascular Nurse Practitioner, Variety Children's Hospital, King's College Hospital NHS Foundation Trust, London
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222
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Rosengarten L, Camara C. A guide to central venous access devices in children. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:S6-S14. [PMID: 37243306 DOI: 10.12968/bjon.2020.29.14.s6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Central venous access devices (CVADs) are commonly used in the care of children both in the short term and long term. Health professionals providing care for children who have CVADs in place are required to have a clear understanding of the benefits and risks associated with their use. This article introduces the different types of CVADs commonly used in paediatrics and provides step-by-step guidance on the use and care of these devices.
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Affiliation(s)
- Leah Rosengarten
- Lecturer, Children's Nursing, Department of Health and Life Sciences, University of Northumbria, Newcastle
| | - Claire Camara
- Graduate Tutor, Children's Nursing, Department of Health and Life Sciences, University of Northumbria, Newcastle
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223
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Prieto J, Wilson J, Bak A, Denton A, Flores A, Lusardi G, Reid M, Shepherd L, Whittome N, Loveday H. A prevalence survey of patients with indwelling urinary catheters on district nursing caseloads in the United Kingdom: The Community Urinary Catheter Management (CCaMa) Study. J Infect Prev 2020; 21:129-135. [PMID: 32655693 DOI: 10.1177/1757177420901550] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 12/07/2019] [Indexed: 11/16/2022] Open
Abstract
Background Catheter-associated urinary tract infection (CAUTI) is common in both hospitals and the community. Aim To investigate the prevalence of indwelling urinary catheters on district nursing caseloads in the UK. Methods Participants were recruited through the Infection Prevention Society (IPS). An electronic survey was undertaken on a single day between November 2017 and January 2018. Data were analysed using descriptive statistics. Findings A total of 49,575 patients were included in the survey, of whom 5352 had an indwelling urinary catheter. This gave a point prevalence of 10.8% (95% confidence interval [CI] = 10.53-11.07), which varied between organisations, ranging from 2.36% (95% CI = 2.05-2.73) to 22.02% (95% CI = 20.12-24.05). Of catheters, 5% were newly placed (within four weeks). Of these, most (77%) had a documented indication for insertion. Only half of patients with a newly placed catheter had a plan for its removal. This varied between organisations in the range of 20%-96%. Only 13% of patients had a patient-held management plan or 'catheter passport' but these patients were significantly more likely to also have an active removal plan (28/36 [78%] vs. 106/231 [46%]; P < 0.0001). Alternative bladder management strategies had been considered for 70/267 (26%) patients. Discussion The management of patients with an indwelling urinary catheter represents a significant component of district nursing caseloads. Given the high proportion of newly catheterised patients without an active management plan for removal of the catheter, the establishment of an optimal management pathway should be the focus of future prevention efforts.
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Affiliation(s)
| | - Jennie Wilson
- Richard Wells Research Centre, University of West London, London, UK
| | - Aggie Bak
- Richard Wells Research Centre, University of West London, London, UK
| | | | | | | | - Matthew Reid
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | | | | | - Heather Loveday
- Richard Wells Research Centre, University of West London, London, UK
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224
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Mason MF, Wallis M, Lord B, Barr N. Prehospital use of peripheral intravenous catheters and intraosseous devices: An integrative literature review of current practices and issues. Australas Emerg Care 2020; 23:196-202. [PMID: 32636164 DOI: 10.1016/j.auec.2020.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/06/2020] [Accepted: 06/11/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Peripheral intravenous catheters and intraosseous devices have been widely used in the prehospital setting for a considerable period. Changes in technology and guidelines have led to an increase in situations where use of these devices in a prehospital setting is recommended. Despite being commonplace they are not without risk of harm to the patient. STUDY OBJECTIVE To examine critically the research-based literature related to incidence of insertion of peripheral intravenous catheters and intraosseous devices, the use of these vascular access devices and to determine which health professionals insert them, most commonly, in the prehospital setting. METHODS An integrative review was undertaken using material retrieved following a systematic search of research literature databases, grey literature and secondary sources written in English. No date limit was applied to the search and the searching was undertaken until September 2019. Articles specifically addressing peripheral intravenous catheter and intraosseous device use in the prehospital setting were selected. RESULTS The search resulted in 20 articles being included in the review, 17 related to peripheral intravenous catheters and three for intraosseous devices. All articles related to observational studies across a variety of services and settings. CONCLUSION The role of vascular access in the prehospital setting continues to be significant, particularly for patients who are critically unwell. This review identified that differences in service structure, geography and the patient's condition all impact on the insertion and use of these vascular access devices. Despite this there are limited data reported that can allow prehospital clinicians and services to benchmark their practice.
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Affiliation(s)
- Matthew F Mason
- School of Nursing Midwifery and Paramedicine, University of the Sunshine Coast, Australia.
| | - Marianne Wallis
- School of Nursing Midwifery and Paramedicine, University of the Sunshine Coast, Australia.
| | - Bill Lord
- Department of Community Emergency Health and Paramedic Practice, Monash University, Australia.
| | - Nigel Barr
- School of Nursing Midwifery and Paramedicine, University of the Sunshine Coast, Australia.
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Chinese expert consensus and practice guideline of totally implantable access port for digestive tract carcinomas. World J Gastroenterol 2020. [DOI: 10.3748/wjg.v26.i25.0000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
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Zhang KC, Chen L. Chinese expert consensus and practice guideline of totally implantable access port for digestive tract carcinomas. World J Gastroenterol 2020; 26:3517-3527. [PMID: 32742123 PMCID: PMC7366063 DOI: 10.3748/wjg.v26.i25.3517] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/27/2020] [Accepted: 06/10/2020] [Indexed: 02/06/2023] Open
Abstract
Totally implantable access port is a fully implantable drug delivery system that is implanted subcutaneously and can be retained for a long time. Advantages of ports include a simple nursing process, low risk of infection and embolism, and high patient comfort. In order to promote the standardized application of ports in the treatment of digestive tract tumors and reduce port-related complications, the Chinese Research Hospital Association Digestive Tumor Committee, the Chinese Association of Upper Gastrointestinal Surgeons, the Chinese Gastric Cancer Association, and the Gastrointestinal Surgical Group of Chinese Surgical Society Affiliated to Chinese Medical Association have organized multidisciplinary expert discussions at the General Hospital of the People’s Liberation Army and nation-wide expert letter reviews and on-site seminars, and formulated an expert consensus of the operation guidelines.
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Affiliation(s)
- Ke-Cheng Zhang
- Department of General Surgery & Institute of General Surgery, The First Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Lin Chen
- Department of General Surgery & Institute of General Surgery, The First Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
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Atkins L, Sallis A, Chadborn T, Shaw K, Schneider A, Hopkins S, Bunten A, Michie S, Lorencatto F. Reducing catheter-associated urinary tract infections: a systematic review of barriers and facilitators and strategic behavioural analysis of interventions. Implement Sci 2020; 15:44. [PMID: 32624002 PMCID: PMC7336619 DOI: 10.1186/s13012-020-01001-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 05/18/2020] [Indexed: 11/18/2022] Open
Abstract
Background Reducing the need for antibiotics is crucial in addressing the global threat of antimicrobial resistance. Catheter-associated urinary tract infection (CAUTI) is one of the most frequent device-related infections that may be amenable to prevention. Interventions implemented nationally in England target behaviours related to catheter insertion, maintenance and removal, but the extent to which they target barriers to and facilitators of these behaviours is unclear. This strategic behavioural analysis applied behavioural science frameworks to (i) identify barriers to and facilitators of behaviours that lead to CAUTI (CAUTI-related behaviours) in primary, community and secondary care and nursing homes; (ii) describe the content of nationally adopted interventions; and (iii) assess the extent to which intervention content is theoretically congruent with barriers and facilitators. Methods A mixed-methods, three-phased study: (1) systematic review of 25 studies to identify (i) behaviours relevant to CAUTI and (ii) barriers to and facilitators of CAUTI-related behaviours, classified using the COM-B model and Theoretical Domains Framework (TDF); (2) content analysis of nationally adopted CAUTI interventions in England identified through stakeholder consultation, classified using the Behaviour Change Wheel (BCW) and Behaviour Change Techniques Taxonomy (BCTTv1); and (3) findings from 1 and 2 were linked using matrices linking COM-B and TDF to BCW/BCTTv1 in order to signpost to intervention design and refinement. Results The most frequently reported barriers to and facilitators of CAUTI-related behaviours related to ‘environmental context and resources’; ‘knowledge’; ‘beliefs about consequences’; ‘social influences’; ‘memory, attention and decision processes’; and ‘social professional role and identity.’ Eleven interventions aiming to reduce CAUTI were identifed. Interventions were primarily guidelines and included on average 2.3 intervention functions (1–5) and six BCTs (2–11), most frequently ‘education’, ‘training’ and ‘enablement.’ The most frequently used BCT was ‘information about health consequences’ which was used in almost all interventions. Social professional role and identity and environmental context and resources were targeted least frequently with potentially relevant BCTs. Conclusions Interventions incorporated half the potentially relevant content to target identifed barriers to and facilitators of CAUTI-related behaviours. There were missed opportunities for intervention as most focus on shaping knowledge rather than addressing motivational, social and environmental influences. This study suggests that targeting motivational, social and environmental influences may lead to more effective intervention design and refinement.
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Affiliation(s)
- Lou Atkins
- Centre for Behaviour Change, University College London, Alexandra House, 7-19 Queens Square, London, WC1N 3AZ, UK.
| | - Anna Sallis
- Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Tim Chadborn
- Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Karen Shaw
- Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Annegret Schneider
- Centre for Behaviour Change, University College London, Alexandra House, 7-19 Queens Square, London, WC1N 3AZ, UK
| | - Susan Hopkins
- Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Amanda Bunten
- Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, Alexandra House, 7-19 Queens Square, London, WC1N 3AZ, UK
| | - Fabiana Lorencatto
- Centre for Behaviour Change, University College London, Alexandra House, 7-19 Queens Square, London, WC1N 3AZ, UK
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228
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Pinelli F, Pittiruti M, Van Boxtel T, Barone G, Biffi R, Capozzoli G, Crocoli A, Elli S, Elisei D, Fabiani A, Garrino C, Graziano U, Montagnani L, Prato AP, Scoppettuolo G, Zadra N, Zanaboni C, Zerla P, Konstantinou E, Jones M, Rosay H, Simcock L, Stas M, Pepe G. GAVeCeLT-WoCoVA Consensus on subcutaneously anchored securement devices for the securement of venous catheters: Current evidence and recommendations for future research. J Vasc Access 2020; 22:716-725. [PMID: 32613887 DOI: 10.1177/1129729820924568] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Subcutaneously anchored securement devices (or subcutaneous engineered securement devices) have been introduced recently into the clinical practice, but the number of published studies is still scarce. The Italian Group of Long-Term Central Venous Access Devices (GAVeCeLT)—in collaboration with WoCoVA (World Congress on Vascular Access)—has developed a Consensus about the effectiveness, safety, and cost-effectiveness of such devices. Methods: After the definition of a panel of experts, a systematic collection and review of the literature on subcutaneously anchored securement devices was performed. The panel has been divided in two working groups, one focusing on adult patients and the other on children and neonates. Results: Although the quality of evidence is generally poor, since it is based mainly on non-controlled prospective studies, the panel has concluded that subcutaneously anchored securement devices are overall effective in reducing the risk of dislodgment and they appear to be safe in all categories of patients, being associated only with rare and negligible local adverse effects; cost-effectiveness is demonstrated—or highly likely—in specific populations of patients with long-term venous access and/or at high risk of dislodgment. Conclusion: Subcutaneously anchored securement is a very promising strategy for avoiding dislodgment. Further studies are warranted, in particular for the purpose of defining (a) the best management of the anchoring device so to avoid local problems, (b) the patient populations in which it may be considered highly cost-effective and even mandatory, (c) the possible benefit in terms of reduction of other catheter-related complications such as venous thrombosis and/or infection, and—last but not least—(d) their impact on the workload and stress level of nurses taking care of the devices.
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Affiliation(s)
- Fulvio Pinelli
- Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | | | | | | | | | | | - Stefano Elli
- Azienda Ospedaliera San Gerardo, Lombardia, Italy
| | | | - Adam Fabiani
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | | | - Ugo Graziano
- Santobono Pausilipon Azienda Ospedaliera Pediatrica, Napoli, Italy
| | | | - Alessio Pini Prato
- Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | | | | | - Pietro Zerla
- ASST Melegnano e della Martesana, Vizzolo Predabissi, Italy
| | | | - Matt Jones
- East Kent Hospitals University NHS Foundation Trust, Kent, UK
| | | | - Liz Simcock
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Gilda Pepe
- University Hospital Agostino Gemelli, Rome, Italy
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229
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Dowding D, Russell D, Trifilio M, McDonald MV, Shang J. Home care nurses' identification of patients at risk of infection and their risk mitigation strategies: A qualitative interview study. Int J Nurs Stud 2020; 107:103617. [PMID: 32446014 PMCID: PMC7418527 DOI: 10.1016/j.ijnurstu.2020.103617] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/19/2020] [Accepted: 04/18/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is an increase in the number of individuals who receive care at home. A significant proportion of these patients acquire infections during their care episode. Whilst there has been significant focus on strategies for infection prevention and control in acute care environments, there is a lack of research into infection prevention in a home care setting. OBJECTIVES To understand (1) if and how home care nurses identify patients at high risk of infection and (2) the strategies they use to mitigate that risk. DESIGN A qualitative descriptive study, using semi-structured interviews. SETTING A large not for profit home care agency located in the New York region of the United States. PARTICIPANTS Fifty nurses with a range of experience in home care nursing. METHODS Purposive and snowball sampling was used to recruit nurses from across the home care agency with varied years of work experience. Interviews were audio recorded and transcribed. The interviews explored how home care nurses evaluate their patients' risk of developing an infection and if/how they modify the plan of care based on that risk. Data were analysed using thematic analysis. RESULTS Three themes were derived from the data; assessing a patient's risk of infection, the risk assessment process, and strategies for mitigating infection risk. Factors identified by nurses as putting a patient at higher risk of infection included being older, having diabetes, inadequate nutrition; along with inadequate clinical information available at start of care. The patient's knowledge and understanding of infection prevention, and the availability and knowledge of caregivers were also important, as was the cleanliness of the home environment. Given the context of home care, where nurses have little control over the environment and care processes in-between visits, the main strategy for infection prevention was patient and caregiver education. Nurses also discussed the importance of their own infection prevention behaviours, and the ability to adjust a patient's plan of care according to their infection risk. CONCLUSIONS The study highlights the complexity of the risk assessment process in relation to infection. Existing guidelines for infection prevention and control do not adequately cover the home care environment and more research needs to determine which interventions (such as patient/caregiver education) would be most effective to prevent infections in the home care setting.
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Affiliation(s)
- Dawn Dowding
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Room 4.327a, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK; Center for Home Care Policy and Research, Visiting Nurse Service of New York, 5 Penn Plaza, 12th Floor, New York, NY 10001, USA; Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032, USA.
| | - David Russell
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, 5 Penn Plaza, 12th Floor, New York, NY 10001, USA; Department of Sociology, Appalachian State University, ASU Box 32115, 209 Chapell Wilson Hall, 480 Howard Street, Boone, NC 28608, USA.
| | - Marygrace Trifilio
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, 5 Penn Plaza, 12th Floor, New York, NY 10001, USA.
| | - Margaret V McDonald
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, 5 Penn Plaza, 12th Floor, New York, NY 10001, USA.
| | - Jingjing Shang
- Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032, USA.
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Jiménez-Martínez E, Cuervo G, Carratalà J, Hornero A, Ciercoles P, Gabarrós A, Cabellos C, Pelegrin I, Dominguez Luzón MA, García-Somoza D, Càmara J, Tebé C, Adamuz J, Pujol M. A Care Bundle Intervention to Prevent Surgical Site Infections after a Craniotomy. Clin Infect Dis 2020; 73:e3921-e3928. [PMID: 32594119 DOI: 10.1093/cid/ciaa884] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/22/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Although surgical site infections after a craniotomy (SSI-CRAN) are a serious problem involving significant morbidity and costs, information on their prevention is scarce. We aimed to assess whether the implementation of a care bundle was effective in preventing SSI-CRANs. METHODS A historical control study was used to evaluate the care bundle, which included a preoperative shower with 4% chlorhexidine soap, appropriate hair removal, adequate preoperative systemic antibiotic prophylaxis, the administration of 1 g of vancomycin powder into the subgaleal space before closing, and a post-operative dressing of the incisional surgical wound with a sterile absorbent cover. Patients were divided into 2 groups: pre-intervention (January 2013 to December 2015) and intervention (from January 2016 to December 2017). The primary study endpoint was the incidence of SSI-CRANs within a year post-surgery. Propensity score matching was performed and differences between the two study periods were assessed using Cox regression models. RESULTS A total of 595 and 422 patients were included in the pre-intervention and intervention periods, respectively. The incidence of SSI-CRANs was lower in the intervention period (15.3% vs. 3.5%; p < 0.001). Using a propensity score model, 421 pairs of patients were matched. The care bundle intervention was independently associated with a reduced incidence of SSI-CRANs (AOR: 0.23, 95% CI: 0.13-0.40; p < 0.001). CONCLUSION The care bundle intervention was effective in reducing SSI-CRAN rates. The implementation of this multimodal preventive strategy should be considered in centers with high SSI-CRAN incidences.
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Affiliation(s)
- Emilio Jiménez-Martínez
- Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Guillermo Cuervo
- Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto Carlos III, Madrid, Spain
| | - Jordi Carratalà
- Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto Carlos III, Madrid, Spain
| | - Ana Hornero
- Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Pilar Ciercoles
- Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Andres Gabarrós
- Neurosurgery Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Carmen Cabellos
- Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto Carlos III, Madrid, Spain
| | - Ivan Pelegrin
- Infectious Diseases Department, Hospital Parc Taulí, Fundació Institut d'Investigació i Innovació Parc Taulí (I3PT), Sabadell, Spain
| | - Maria Angeles Dominguez Luzón
- Microbiology Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto Carlos III, Madrid, Spain
| | - Dolores García-Somoza
- Microbiology Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Jordi Càmara
- Microbiology Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,Nursing Information Systems Department Support, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Biostatistics Unit, IDIBELL, L'Hospitalet de Llobregat, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto Carlos III, Madrid, Spain.,Research Network for Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
| | - Cristian Tebé
- Biostatistics Unit, IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Jordi Adamuz
- Nursing Information Systems Department Support, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Miquel Pujol
- Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto Carlos III, Madrid, Spain
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231
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Russo PL, Stewardson AJ, Cheng AC, Bucknall T, Mitchell BG. Prevalence of device use and transmission based precautions in nineteen large Australian acute care public hospitals: Secondary outcomes from a national healthcare associated infection point prevalence survey. Infect Dis Health 2020; 25:262-267. [PMID: 32595104 DOI: 10.1016/j.idh.2020.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The use of invasive devices increases the risk of healthcare associated infections (HAI). The recent national HAI point prevalence survey secondary outcomes aimed to estimate the prevalence of patients with an indwelling urinary catheter device and vascular access devices; and also identify prevalence of those managed under transmission based precautions (TBP); and those colonised or infected with a multi drug resistant organism (MDRO). METHODS A point prevalence study was conducted in large acute care Australian public hospitals. All data were collected by two trained Research Assistants. Surveillance methodology was based on the European Centre for Disease Prevention and Control PPS Protocol. Data was also collected on prevalence of TBPs and MDROs. RESULTS A total of 2767 acute adult inpatients were sampled across 19 hospitals. The prevalence of peripheral vascular, central vascular and urinary catheters devices was 55.2% (95%CI: 53.3%-57.1%), 14.8% (95%CI: 13.5%-16.1%) and 20.7% (95%CI: 19.2%-22.3%) respectively. Of the 2767 patients sampled 285 (10.3%, 95%CI: 9.2%-11.5%) were documented as either being infected or colonised with a MDRO, and 781 (11.8%) patients were being managed under the hospital TBP policy. CONCLUSION This is the first national study to describe the prevalence of devices, TBPs and MDROs in Australian healthcare settings. In an era where device use should be constantly reviewed to minimise risk of HAI, and the increasing challenges of managing patients with MDROs, this data can serve as a benchmark for future studies.
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Affiliation(s)
- Philip L Russo
- Department of Nursing Research, Cabrini Institute, Malvern, VIC, Australia; Nursing and Midwifery, Monash University, Frankston, VIC, Australia; Centre for Quality and Patient Safety Research - Alfred Health Partnership, Melbourne, VIC, Australia.
| | - Andrew J Stewardson
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC, Australia.
| | - Allen C Cheng
- School of Public Health and Preventive Medicine, Monash University, Prahran, VIC, Australia; Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, VIC, Australia.
| | - Tracey Bucknall
- Centre for Quality and Patient Safety Research - Alfred Health Partnership, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Prahran, VIC, Australia; School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia.
| | - Brett G Mitchell
- School of Nursing and Midwifery, University of Newcastle, Ourimbah, NSW, Australia.
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232
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Parreira P, B. Sousa L, Marques IA, Costa P, Cortez S, Carneiro F, Cruz A, Salgueiro-Oliveira A. Development of an innovative double-chamber syringe for intravenous therapeutics and flushing: Nurses' involvement through a human-centred approach. PLoS One 2020; 15:e0235087. [PMID: 32584864 PMCID: PMC7316231 DOI: 10.1371/journal.pone.0235087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 06/08/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In nursing practice, flushing the catheters pre and post-drug administration is considered an important clinical procedure to prevent complications, and requires the use of several syringes to comply with international standards of care. We envisioned an innovative double-chamber syringe that enables the filling and administration of both solutions. Following current international recommendations, the development of new medical devices should integrate Health Technology Assessment. The Human-centred design is usually used for that assessment purposes, as a method that actively include end-users in the devices development process. METHOD Application of the Human-Centred Design through the involvement of nurses in the initial stages of the device development in order to accomplish the initial stages of Technology Readiness Level. A multi-method approach was used, including literature/guidelines review, focus groups with end-users and expert panels. RESULTS The involvement of nurses enabled the definition of user requirements and contexts of use, as well as the evaluation of design solutions and prototypes in order to accomplish with usability and ergonomic features of the medical device. CONCLUSIONS Significant contributions were made regarding the final design solution of this innovative double-chamber syringe.
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Affiliation(s)
- Pedro Parreira
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Liliana B. Sousa
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Inês A. Marques
- Coimbra Institute for Clinical and Biomedical Research (iCBR) area of CIMAGO, CNC.IBILI, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Paulo Costa
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Sara Cortez
- Muroplás - Plastic Engineering Industry, Muro, Portugal
| | | | - Arménio Cruz
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Anabela Salgueiro-Oliveira
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
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233
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Comparison of PICC and TIVAP in chemotherapy for patients with thyroid cancer. Oncol Lett 2020; 20:1657-1662. [PMID: 32724407 PMCID: PMC7377162 DOI: 10.3892/ol.2020.11732] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 12/03/2019] [Indexed: 12/19/2022] Open
Abstract
Peripherally inserted central catheters (PICC) and totally implantable venous-access ports (TIVAP) were compared in chemotherapy for patients with thyroid cancer. A retrospective analysis was performed on the clinical data of patients with thyroid cancer who were treated with PICC and TIVAP for chemotherapy in Qingdao Municipal Hospital from January 2013 to March 2018. Patients in the PICC and TIVAP groups were compared in terms of the success rate, indwelling time, complications, quality of life and nursing satisfaction. There was no statistically significant difference in the success rate between the two groups (P>0.05). The indwelling time in the TIVAP group was significantly longer than that in the PICC group (P<0.05). The incidence rate of complications in the TIVAP group (0%) was significantly lower than that in the PICC group (14.58%) (P<0.05). The quality of life score in the PICC group was significantly lower than that in the TIVAP group (P<0.05). There was no statistically significant difference in the nursing satisfaction score between the two groups (P>0.05). In conclusion, as an ideal venous access to chemotherapy for thyroid cancer, TIVAP has longer indwelling time and fewer adverse reactions and improves the quality of life of the patients.
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234
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Atay S, Yilmaz Kurt F. Effectiveness of transparent film dressing for peripheral intravenous catheter. J Vasc Access 2020; 22:135-140. [PMID: 32529940 DOI: 10.1177/1129729820927238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The intravenous applications are the most common type of such interventions. It is underlined that in cases where the peripheral intravenous catheter is not properly secured in place, even a minor movement inside the vein would result in injury of vein. OBJECTIVE The insertion of peripheral intravenous catheter is a common practice. This is a randomized controlled prospective study aiming at investigating the effectiveness of use of transparent film dressing for peripheral intravenous catheter. METHODS The universe of this study included inpatients in the Internal Diseases clinic of a University Hospital, and the sample included a total of 110 peripheral intravenous catheters that were calculated by power analysis. The patient identification form, the peripheral venous catheter and treatment information form, and the visual infusion phlebitis identification scale were used to collect data. The forms were completed by the investigators on the basis of daily observations. The data were assessed by the percentage, chi-square test, and logistic regression analysis via the software SPSS 20.00. RESULTS The individuals in the study group and the control group included in the sample are comparable in terms of gender, having/not having a chronic disease, the site of peripheral intravenous catheter, use of antibiotics, intravenous fluid therapy, and mean age. There were no statistically significant differences between the groups. There was a significant relationship between the dwell time for the catheter and development of any complications and the groups. CONCLUSION The use of transparent film dressing for insertion of peripheral intravenous catheter can be recommended as it increases the dwell time for the catheter and reduces incidence of complications.
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Affiliation(s)
- Selma Atay
- Nursing Department at Faculty of Health Science, Çanakkale Onsekiz Mart University, Canakkale, Turkey
| | - Fatma Yilmaz Kurt
- Nursing Department at Faculty of Health Science, Çanakkale Onsekiz Mart University, Canakkale, Turkey
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235
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Flores A, Wrigley M, Askew P, Craig R, Egan B, Towey L, Shawe J. Use of non-sterile gloves in the ward environment: an evaluation of healthcare workers' perception of risk and decision making. J Infect Prev 2020; 21:108-114. [PMID: 32494294 DOI: 10.1177/1757177420907687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 01/02/2020] [Indexed: 12/16/2022] Open
Abstract
Background Studies have found that inappropriate use of non-sterile gloves (NSG) can affect hand hygiene compliance; the main risks are missing opportunities for hand hygiene and gloves being a vector for microbial transmission. Aim The aims of this study were to explore the accuracy of healthcare worker (HCW) risk assessment and decision making regarding the use of NSG. Methods The study was conducted in two acute NHS Trusts and a community social enterprise. A cross-sectional survey was carried out, followed by qualitative semi-structured interviews. Findings There were highly significant differences at the 95% probability level between staff groups, unqualified staff being significantly more likely than qualified staff to report NSG use when not indicated (P < 0.0001). The primary motivating factor for staff to wear NSG was for personal protection; the secondary factor being the protection of patients. Staff were also motivated by a desire to create an image of professionalism. Respondents were more likely to follow the lead of seniors in their own profession. Discussion The results suggest a necessity for change interventions aimed at unqualified staff such as healthcare assistants (HCAs). It would be beneficial to review the indications for glove use and amend organisational policies accordingly. Leaders in each professional staff group would be required to influence practice across organisations, taking into account motivating factors, and in association with multi-modal interventions to improve practice.
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Affiliation(s)
- Ashley Flores
- Surrey & Sussex Healthcare NHS Trust, Redhill, Surrey, UK
| | | | - Peter Askew
- IMSL, Pale Lane, Hartley Wintney, Hampshire, Hartley Wintney, UK
| | - Rachel Craig
- Ashford & St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
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Park JY, Pardosi JF, Seale H. Examining the inclusion of patients and their family members in infection prevention and control policies and guidelines across Bangladesh, Indonesia, and South Korea. Am J Infect Control 2020; 48:599-608. [PMID: 31919010 PMCID: PMC7132722 DOI: 10.1016/j.ajic.2019.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/02/2019] [Accepted: 10/02/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Although familial involvement during inpatient care is not uncommon in western countries, the types of caring activities that family members in Asian countries provide are significantly different. These activities may place the family member at risk from a health care-associated infection. This study aimed to examine whether the role of patients' families has been accounted for in the infection prevention and control (IPC) guidelines and policy, using examples from Bangladesh (low-income country), Indonesia (middle-income country), and South Korea (high-income country). METHODS The World Health Organization website and Institutional Repository for Information Sharing, Centers for Disease Control and Prevention website, Australian Government Web Archive, Open Grey, Grey Matters, World Bank, and advanced Google search, as well as the Health Department/Ministry of Health websites for each target country and 4 western countries (Australia, Canada, England, and the United States) were searched. Other databases, such as Embase, Medline, CINAHL, Global Health, ProQuest databases, Google scholar, Web of Science, and Scopus were also searched. This was to review the reflection of the cultural influence in IPC policies/guidelines by reviewing those from the global organizations, which are often used as a blueprint for policy development, as well as those from western countries, which hold different cultures in care arrangement. Search was conducted with attention to the key areas: definition and role of carer in the acute health care facility, involvement of patients/family members in IPC activities, patient and family member hand hygiene, and IPC education. RESULTS Ninety-two articles were identified based on the criteria for the study. Only 6 acknowledged that care is provided to hospitalized patients by their family members, and only 1 recommended that family members receive the same level of training as health care workers on IPC precautions. Other guides recommended the provision of information on IPC measures as means of patient involvement in the IPC program. Recognition of family caregivers or inclusion of them in the IPC strategies was not included in the target countries' guidelines. CONCLUSIONS Although health care workers are the primary actors when it comes to providing care in acute health care settings, it is important to expand the IPC guides by considering the role of other caregivers. Policies and guidelines should reflect the cultural influence over healthcare. This is especially true when cultural values strongly influence over healthcare arrangements and the healthcare accommodates these cultural influences in the practice. Further work needs to be undertaken on the level of training/education provided to family members in Bangladesh, Indonesia, and South Korea.
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Affiliation(s)
- Ji Yeon Park
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
| | | | - Holly Seale
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
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Ullman AJ, Bernstein SJ, Brown E, Aiyagari R, Doellman D, Faustino EVS, Gore B, Jacobs JP, Jaffray J, Kleidon T, Mahajan PV, McBride CA, Morton K, Pitts S, Prentice E, Rivard DC, Shaughnessy E, Stranz M, Wolf J, Cooper DS, Cooke M, Rickard CM, Chopra V. The Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics: miniMAGIC. Pediatrics 2020; 145:S269-S284. [PMID: 32482739 DOI: 10.1542/peds.2019-3474i] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Vascular access device decision-making for pediatric patients remains a complex, highly variable process. To date, evidence-based criteria to inform these choices do not exist. The objective of the Michigan Appropriateness Guide for Intravenous Catheters in pediatrics (miniMAGIC) was to provide guidance on device selection, device characteristics, and insertion technique for clinicians, balancing and contextualizing evidence with current practice through a multidisciplinary panel of experts. METHODS The RAND Corporation and University of California, Los Angeles Appropriateness Method was used to develop miniMAGIC, which included the following sequential phases: definition of scope and key terms, information synthesis and literature review, expert multidisciplinary panel selection and engagement, case scenario development, and appropriateness ratings by an expert panel via 2 rounds. RESULTS The appropriateness of the selection, characteristics, and insertion technique of intravenous catheters commonly used in pediatric health care across age populations (neonates, infants, children, and adolescents), settings, diagnoses, clinical indications, insertion locations, and vessel visualization devices and techniques was defined. Core concepts including vessel preservation, insertion and postinsertion harm minimization (eg, infection, thrombosis), undisrupted treatment provision, and inclusion of patient preferences were emphasized. CONCLUSIONS In this study, we provide evidence-based criteria for intravenous catheter selection (from umbilical catheters to totally implanted venous devices) in pediatric patients across a range of clinical indications. miniMAGIC also highlights core vascular access practices in need of collaborative research and innovation.
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Affiliation(s)
- Amanda J Ullman
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and .,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia.,Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Steven J Bernstein
- Patient Safety Enhancement Program and Center for Clinical Management Research, US Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.,Divisions of General Medicine and
| | - Erin Brown
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Ranjit Aiyagari
- Division of Pediatric Cardiology, Department of Pediatrics, and
| | - Darcy Doellman
- Division of Pediatric Cardiology, Department of Pediatrics, and
| | - E Vincent S Faustino
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Section of Pediatric Critical Care Medicine, Department of Pediatrics, School of Medicine, Yale University, New Haven, Connecticut
| | - Beth Gore
- Association for Vascular Access, Herriman, Utah
| | | | - Julie Jaffray
- Keck School of Medicine, University of Southern California and Children's Hospital Los Angeles, Los Angeles, California
| | - Tricia Kleidon
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Prashant V Mahajan
- Department of Emergency Medicine and Pediatrics, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Craig A McBride
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Kayce Morton
- School of Medicine, University of Missouri, Columbia, Missouri
| | - Stephanie Pitts
- St Joseph's Children's Hospital, Tampa, Florida.,B. Braun Medical, Bethlehem, Pennsylvania
| | - Elizabeth Prentice
- Department of Anaesthesia and Pain Management, Royal Children's Hospital, Victoria, Australia
| | - Douglas C Rivard
- Children's Mercy Hospital, Kansas City, Missouri.,School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Erin Shaughnessy
- College of Medicine, University of Arizona and Phoenix Children's Hospital, Phoenix, Arizona
| | - Marc Stranz
- Stranz Crossley Inc, Philadelphia, Pennsylvania
| | - Joshua Wolf
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee.,Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - David S Cooper
- Department of Pediatrics, College of Medicine, University of Cincinnati and Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Vineet Chopra
- Patient Safety Enhancement Program and Center for Clinical Management Research, US Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.,Division of Hospital Medicine, Department of Internal Medicine
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Estrada-Orozco K, Cantor-Cruz F, Larrotta-Castillo D, Díaz-Ríos S, Ruiz-Cardozo MA. Central venous catheter insertion and maintenance: Evidence-based clinical recommendations. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2020; 71:115-162. [PMID: 32770871 DOI: 10.18597/rcog.3413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 04/29/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To share with clinicians supporting evidence of the safest and the most effective processes for central venous catheter insertion and maintenance as a strategy to prevent catheter-associated bloodstream infections. METHODS A literature search was conducted in the Medline via PubMed, Embase Central and Lilacs databases based on a set of clinical questions aimed at improving safety and effectiveness at key moments in the process of central venous catheter insertion and maintenance. The rapid literature review methodology was used. The studies identified were assessed from the quality point of view, using the Joanna Briggs Institute (JBI) tools for qualitative and quantitative studies and for systematic reviews. Clinical practice guidelines were assessed using the AGREE II tool. The evidence is presented in the form of evidence-based clinical recommendations, which were graded in accordance with the JBI methodology. RESULTS Twelve clinical evidence summaries containing evidence related to the safe and effective use of central venous catheters are presented, including the following topics: central venous catheter insertion (CVC), peripherally inserted central catheters (PICC), preoperative assessment, the use of analgesia, field preparation, choice between CVC or PICC, CVC care and maintenance, prevention of complications, and general considerations pertaining to the use of central venous catheters in oncologic patients and in parenteral nutrition. CONCLUSIONS Recommendations on the safe and effective use of central venous access catheters in relation to CVC insertion and maintenance processes are presented in the evidence-based summary model. It is necessary to evaluate their implementation in health outcomes in the institutions where they are developed.
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Affiliation(s)
- Kelly Estrada-Orozco
- Grupo de Evaluación de Tecnologías y Políticas en Salud (GETS), Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia. Centro de Evidencia e Implementación, Bogotá, Colombia. Unidad de Investigación en Seguridad del Paciente, Hospital Universitario Nacional de Colombia, Bogotá, Colombia. Instituto de Investigaciones Clínicas, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Francy Cantor-Cruz
- Grupo de Evaluación de Tecnologías y Políticas en Salud (GETS), Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia. Unidad de Investigación en Seguridad del Paciente, Hospital Universitario Nacional de Colombia, Bogotá, Colombia. Instituto de Investigaciones Clínicas, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Diego Larrotta-Castillo
- Grupo de Evaluación de Tecnologías y Políticas en Salud (GETS), Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia. Unidad de Investigación en Seguridad del Paciente, Hospital Universitario Nacional de Colombia, Bogotá, Colombia. Instituto de Investigaciones Clínicas, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Stefany Díaz-Ríos
- Grupo de Evaluación de Tecnologías y Políticas en Salud (GETS), Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia. Unidad de Investigación en Seguridad del Paciente, Hospital Universitario Nacional de Colombia, Bogotá, Colombia. Instituto de Investigaciones Clínicas, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Miguel A Ruiz-Cardozo
- Grupo de Evaluación de Tecnologías y Políticas en Salud (GETS), Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia. Unidad de Investigación en Seguridad del Paciente, Hospital Universitario Nacional de Colombia, Bogotá, Colombia. Instituto de Investigaciones Clínicas, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
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Paterson RS, Chopra V, Brown E, Kleidon TM, Cooke M, Rickard CM, Bernstein SJ, Ullman AJ. Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review. Pediatrics 2020; 145:S243-S268. [PMID: 32482738 DOI: 10.1542/peds.2019-3474h] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To critically review the evidence for the selection and insertion of pediatric vascular access devices (VADs). DATA SOURCES Data were sourced from the US National Library of Medicine, Cumulative Index to Nursing and Allied Health, the Cochrane Library databases, Embase, and international clinical trial databases. STUDY SELECTION Clinical practice guidelines, systematic reviews, cohort designs, randomized control trials (RCTs), quasi RCTs, before-after trials, or case-control studies that reported on complications and/or risk as well as reliability of VADs in patients aged 0 to 18 years were included. DATA EXTRACTION Articles were independently reviewed to extract and summarize details on the number of patients and catheters, population, age of participants, VAD type, study method, indication, comparators, and the frequency of VAD failure or complications. RESULTS VAD selection and insertion decision-making in general hospitalized and some specialized patient populations were well evidenced. The use of single-lumen devices and ultrasound-guided techniques was also broadly supported. There was a lack of RCTs, and for neonates, cardiac patients, patients with difficult venous access, midline catheters, catheter-to-vein ratio, and near-infrared devices, the lack of evidence necessitated broadening the review scope. LIMITATIONS Limitations include the lack of formal assessment of the quality of evidence and the lack of RCTs and systematic reviews. Consequently, clinical decision-making in certain pediatric populations is not guided by strong, evidence-based recommendations. CONCLUSIONS This is the first synthesis of available evidence for the selection and insertion of VADs in pediatric patients and is important for determining the appropriateness of VADs in pediatric patients.
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Affiliation(s)
- Rebecca S Paterson
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Vineet Chopra
- Patient Safety Enhancement Program and Center for Clinical Management Research, Veterans Affair Ann Arbor Healthcare System, Ann Arbor, Michigan.,Divisions of Hospital Medicine and.,General Medicine, Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, Michigan; and
| | - Erin Brown
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Tricia M Kleidon
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Steven J Bernstein
- Patient Safety Enhancement Program and Center for Clinical Management Research, Veterans Affair Ann Arbor Healthcare System, Ann Arbor, Michigan.,General Medicine, Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, Michigan; and
| | - Amanda J Ullman
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and .,Queensland Children's Hospital, Brisbane, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
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240
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Gyesi-Appiah E, Brown J, Clifton A. Short-term urinary catheters and their risks: an integrated systematic review. ACTA ACUST UNITED AC 2020; 29:S16-S22. [DOI: 10.12968/bjon.2020.29.9.s16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background:This thematic review was part of a bigger literature review into the effects of short-term urinary catheters on patients who are discharged home from an acute hospital.Aims:This integrated review examined the risks associated with short-term urinary catheters.Methods:The MEDLINE, British Nursing Index and CINAHL databases were searched for studies published between 2013 and 2018 that researched the effects of short-term urinary catheters on patients.Findings:Twelve research studies were included, which showed the presence of short-term indwelling urinary catheters increased the risk of infection, length of hospital stay and mortality rates.Conclusion:Short-term urinary catheters should be strictly monitored and removed as soon as they are not required.
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Affiliation(s)
- Evelyn Gyesi-Appiah
- Research Student, De Montfort University, Leicester, and Nurse, University Hospitals of Leicester NHS Trust
| | - Jayne Brown
- Professor of Nursing (Older People), School of Nursing and Midwifery, De Montfort University, Leicester
| | - Andrew Clifton
- Associate Professor, Mental Health Nursing, School of Nursing and Midwifery, De Montfort University, Leicester
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241
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Aziz AM. Strategies to reduce Gram-negative infections: a community perspective. Br J Community Nurs 2020; 25:240-246. [PMID: 32378462 DOI: 10.12968/bjcn.2020.25.5.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Infections caused by Gram-negative bacteria continue to be on the rise, despite efforts by the Government and health service to curb their numbers. Most of these infections arise in the community. The case for targeting community-onset healthcare-associated infections is stark and requires a shift in focus from traditionally providing increased efforts in the hospital setting to a diversion of attention to the community. This article describes the challenges faced with increasing Gram-negative bloodstream infections and explores measures being taken to reduce transmission. As recent guidance has highlighted a proliferation within the community setting this article particularly focuses on a three-point plan for primary care. The strategies laid out are to reduce urinary tract infections, improve hydration and control antibiotic usage. Adopting these strategies will assist in reducing infection and targeting efforts where they are needed most.
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242
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Kleidon TM, Rickard CM, Gibson V, Mihala G, Schults JA, Xu H(G, Bauer MJ, Marsh N, Larsen EN, Cattanach P, Ullman AJ. Smile - Secure my intravenous line effectively: A pilot randomised controlled trial of peripheral intravenous catheter securement in paediatrics. J Tissue Viability 2020; 29:82-90. [DOI: 10.1016/j.jtv.2020.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/06/2020] [Accepted: 03/22/2020] [Indexed: 01/07/2023]
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243
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Park JY, Kwon KT, Lee WK, Kim HI, Kim MJ, Song DY, Yu MH, Park HJ, Lee KH, Chae HJ. The impact of infection control cost reimbursement policy on central line-associated bloodstream infections. Am J Infect Control 2020; 48:560-565. [PMID: 31677923 DOI: 10.1016/j.ajic.2019.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/21/2019] [Accepted: 09/03/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND In September 2016, the Korean National Health Insurance Service began reimbursing infection control (IC) costs on the condition that a certain number of doctors and full-time nurses for IC be allocated to supported hospitals. We analyzed the impact of the IC cost reimbursement policy on central line-associated bloodstream infections (CLABSIs). METHODS A before-and-after study that analyzed the CLABSI rate trends between preintervention (January 2016 to February 2017) and intervention (March to December 2017) periods using autoregression time series analysis was performed in intensive care units (ICUs) at a 750-bed, secondary care hospital in Daegu, Republic of Korea. The enhanced IC team visited ICUs daily, monitored the implementation of CLABSI prevention bundles, and educated all personnel involved in catheter insertion and maintenance from March 2017. RESULTS Autoregressive analysis revealed that the CLABSI rates per month in the preintervention and intervention periods were -0.256 (95% confidence interval, -0.613 to 0.101; P = .15) and -0.602 (95% confidence interval, -0.972 to -0.232; P = .008), respectively. The rates of compliance with maximal barrier precautions significantly improved from the preintervention (36.2%) to the intervention (77.9%) period (χ² test, P < .001). CONCLUSIONS The IC cost reimbursement policy accelerated the decline in CLABSI rates significantly in monitored ICUs. A nationwide study to evaluate the effectiveness of the IC cost reimbursement policy for various health care-associated infections is warranted.
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Affiliation(s)
- Ji Young Park
- Department of Pathology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Ki Tae Kwon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - Won Kee Lee
- Medial Research Collaboration Center, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Hye In Kim
- Division of Infectious Diseases, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Min Jung Kim
- Division of Infectious Diseases, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Do Young Song
- Department of Laboratory Medicine, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Mi Hyae Yu
- Department of Infection Control, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Hyun Ju Park
- Department of Infection Control, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Kyeong Hee Lee
- Department of Infection Control, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Hyun Ju Chae
- Department of Infection Control, Daegu Fatima Hospital, Daegu, Republic of Korea
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244
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Recognising and preventing surgical site infection after orthopaedic surgery. Int J Orthop Trauma Nurs 2020; 37:100751. [PMID: 31954634 DOI: 10.1016/j.ijotn.2019.100751] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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245
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Carr PJ, O'Connor L, Gethin G, Ivory JD, O'Hara P, O'Toole O, Healy P. Study protocol: In the preparation and administration of intravenous medicines, what are the best practice standards that healthcare professionals need to follow to ensure patient safety? HRB Open Res 2020; 3:19. [PMID: 34124573 PMCID: PMC8167500 DOI: 10.12688/hrbopenres.13028.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2020] [Indexed: 09/21/2023] Open
Abstract
Introduction: Intravenous therapy and medicines (IVTM) are the most common invasive interventions in use in healthcare. Prescribed IVTM play an essential role in the treatment of illness, management of chronic conditions and in maintaining health and wellbeing. The intravenous (IV) route is the administration of concentrated medications (diluted or undiluted) directly into peripherally or centrally inserted vascular access devices. Medication safety is a key priority and best practice standards are required to guide the safe preparation and administration of IVTM. Methods: We will conduct a systematic review of the literature pertaining to the preparation and administration of intravenous therapy and medicines. Our search will include studies concerned with the preparation and/or administration of IVTM via peripheral or central vascular access devices. We will be guided by the preferred reporting items for systematic review and meta-analysis (PRISMA) in this review. Literature will include all trial designs, national/international guidelines, and expert consensus opinion made available in English from 2009 to present day. Conclusions: We will synthesise the evidence concerning safe and effective preparation and administration of intravenous therapy and medicines to inform the development of a national guideline for healthcare professionals in Ireland. The availability of up-to-date, contemporaneous evidence-based practice standards will ensure quality and safety for service-users. Registration: This study has been submitted to PROSPERO and we are awaiting confirmation of registration.
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Affiliation(s)
- Peter J. Carr
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Laura O'Connor
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Georgina Gethin
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - John D. Ivory
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | | | - Orla O'Toole
- Clinical Trials Unit, HRB Clinical Research Facility, University Hospital Galway, Galway, Ireland
| | - Patricia Healy
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
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Poovelikunnel TT, Duffy F, Puthussery T, Gangadharan S, McCormack F, Carpenter H, Kizhakedath M, Hawkshaw S. Clinically indicated replacement of peripheral vascular catheters: is it safe for patients? BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:S4-S10. [PMID: 32324461 DOI: 10.12968/bjon.2020.29.8.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Replacing peripheral vascular catheters when clinically indicated rather than routinely has multiple benefits for patients and practitioners. Managing vascular catheters based on clinical indication provides early opportunities for intervention, or catheter removal or replacement. Where clinically indicated, peripheral vascular catheters can be used for a long time, and this is aided by decision-making tools such as the visual infusion phlebitis score and care bundles. Fewer cannulations result in less pain, better patient comfort and a lower risk of infection. For each cannulation avoided, about 20 minutes can be saved for other care activities. Replacing peripheral vascular catheters according to clinical indication can improve patient safety and optimise resource use.
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Affiliation(s)
- Toney T Poovelikunnel
- Assistant Director and Post-Doctoral Researcher Department of Infection Prevention and Control, Beaumont Hospital, and Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland, Ireland
| | - Fionnuala Duffy
- Assistant Director of Nursing, Department of Infection Prevention and Control, Beaumont Hospital, Dublin, Ireland
| | - Thressia Puthussery
- Clinical Nurse Specialist, Department of Infection Prevention and Control, Beaumont Hospital, Dublin, Ireland
| | - Shaini Gangadharan
- Clinical Nurse Specialist, Department of Infection Prevention and Control, Beaumont Hospital, Dublin, Ireland
| | - Fiona McCormack
- Clinical Nurse Specialist, Department of Infection Prevention and Control, Beaumont Hospital, Dublin, Ireland
| | - Helen Carpenter
- Clinical Nurse Manager 2, Department of Infection Prevention and Control, Beaumont Hospital, Dublin, Ireland
| | - Mary Kizhakedath
- Clinical Nurse Manager 2, Department of Infection Prevention and Control, Beaumont Hospital, Dublin, Ireland
| | - Susan Hawkshaw
- Nurse Practice Coordinator Center of Nurse Education, Beaumont Hospital, Dublin, Ireland
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247
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Welyczko N. Peripheral intravenous cannulation: reducing pain and local complications. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:S12-S19. [PMID: 32324463 DOI: 10.12968/bjon.2020.29.8.s12] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Caring for patients with peripheral intravenous cannulas/catheters (PIVCs) is an important part of the nurse's role and insertion of PIVCs has traditionally been a post-registration nursing skill. With the introduction of the Nursing and Midwifery Council Standards of Proficiency for Registered Nurses in 2018, insertion of PIVCs is to be incorporated in pre-registration nursing programmes for all four fields of nursing practice. Although IV cannulation is a commonly performed clinical procedure, it is associated with significant risks and complications, which can cause pain for patients. This article outlines the factors that can cause pain for adult patients requiring a PIVC and recommends that the use of local anaesthetics be more widely considered when inserting a cannula. The identification, prevention and clinical management of commonly occurring painful local complications that can arise post-PIVC insertion are also discussed.
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248
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Malek AE, Raad II. Preventing catheter-related infections in cancer patients: a review of current strategies. Expert Rev Anti Infect Ther 2020; 18:531-538. [PMID: 32237923 DOI: 10.1080/14787210.2020.1750367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Central line-associated bloodstream infections (CLABSI) are a frequent cause of healthcare-associated infections, increasing healthcare costs and decreasing the quality of life for critically and chronically ill patients such as those with cancer. These infections are largely preventable and have been significantly reduced throughout the United States. However, further reduction of CLABSI requires continued innovation in preventive strategies.Areas covered: We provide an overview of the recent medical literature on catheter-related infections among cancer patients, discussing epidemiology, risk factors, and pathogenesis of CLABSI with a focus on the newest and current preventive measures. The data discussed here were retrieved mainly from clinical trials, meta-analyses, and systematic reviews published in the English language using a MEDLINE database search from 1 January 1990 until the end of December 2019.Expert opinion: The growing impact of CLABSI on the healthcare setting and mortality and morbidity rates in cancer patients calls for novel technologies for preventing central line-related infections. Advances in antimicrobial lock therapy are not limited to salvage therapy but have also provided a novel and promising prophylactic approach to CLABSI. Also, the use of antimicrobial-coated catheters with chlorhexidine-impregnated dressings, along with the application of insertion and maintenance bundles, is an effective and cost-effective approach for preventing central line-related infections.
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Affiliation(s)
- Alexandre E Malek
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Issam I Raad
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
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Methods for producing a national infection prevention and control manual (NIPCM) in Scotland. Infect Prev Pract 2020; 2:100058. [PMID: 34316557 PMCID: PMC7195071 DOI: 10.1016/j.infpip.2020.100058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/12/2020] [Indexed: 11/21/2022] Open
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McMullen P, Lewis P, McGugan O, Mortimer K. Perils of the pneumatic tube: how clean are your pods? J Hosp Infect 2020; 104:597-599. [DOI: 10.1016/j.jhin.2019.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
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