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Pérez-Granda MJ, Irigoyen-von-Sierakowski Á, Toledo N, Rodríguez E, Cruz ML, Hernanz G, Serra JA, Kestler M, Muñoz P, Guembe M. Impact of an interventional bundle on complications associated with peripheral venous catheters in elderly patients. Eur J Clin Microbiol Infect Dis 2024; 43:703-712. [PMID: 38326546 DOI: 10.1007/s10096-024-04771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/31/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE Elderly patients admitted to geriatrics departments often require peripheral venous catheters (PVC), which should be inserted and maintained following a series of preventive recommendations. Our objective was to evaluate the impact of a training bundle comprising measures aimed at reducing complications associated with the use of PVC in elderly patients admitted to a tertiary teaching hospital. METHODS We performed a prospective study of patients who received a PVC within 24 h of admission to a geriatrics department. After a 10-month pre-interventional period, we implemented an educational and interventional bundle over a 9-month period. Follow-up was until catheter withdrawal. We analyzed and compared clinical and microbiological data between both study periods. RESULTS A total of 344 patients (475 PVC) were included (pre-intervention period, 204 patients (285 PVC); post-intervention period, 140 patients (190 PVC)). No statistically significant differences in demographic characteristics were observed between the study periods. The colonization and phlebitis rates per 1000 admissions in both periods were, respectively, 36.7 vs. 24.3 (p = 0.198) and 81.5 vs. 65.1 (p = 0.457). The main reason for catheter withdrawal was obstruction/malfunctioning (33.3%). Obstruction rate was higher for those inserted in the hand than for those inserted at other sites (55.7% vs. 44.3%, p = 0.045). CONCLUSIONS We found no statistically significant differences regarding phlebitis and catheter tip colonization rates. It is necessary to carry out randomized studies assessing the most cost-effective measure to reduce complications associated with PVC.
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Affiliation(s)
- María Jesús Pérez-Granda
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo, 46, 28007, Madrid, Spain
- Department of Nursing, School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - Álvaro Irigoyen-von-Sierakowski
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Neera Toledo
- Intermal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Eva Rodríguez
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Luisa Cruz
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Giovanna Hernanz
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José Antonio Serra
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Biomedical Research Networking Centre On Frailty and Healthy Ageing, CIBERFES, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Martha Kestler
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo, 46, 28007, Madrid, Spain.
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
- Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain.
| | - María Guembe
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo, 46, 28007, Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
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Trączyński M, Patalas A, Rosłan K, Suszyński M, Talar R. Assessment of needle-tissue force models based on ex vivo measurements. J Mech Behav Biomed Mater 2024; 150:106247. [PMID: 37988883 DOI: 10.1016/j.jmbbm.2023.106247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 10/20/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023]
Abstract
Needle insertion is one of the most common procedures in clinical practice. Existing statistics reveal that success rates of needle insertions can be low, leading to potential complications and patient discomfort. Real-time imaging techniques like ultrasound and X-ray can assist in improving precision, but even experienced practitioners may face challenges in visualizing the needle tip. Researchers have proposed models of force interactions during needle insertions into biological tissue to enhance accuracy. This article presents an evaluation of the forces acting on intravenous needles during insertion into skin. The aim was to explore mathematical models, compare them with data from tests on animal specimens, and select the most suitable model for future research. The experimental setup involved conducting needle insertion tests on animal-originated cadavers, using the Brucker Universal Mechanical Tester device, which measured the force response during vertical movement of the needle. The research was divided into 2 stages. In Stage I, force measurements were recorded for both the insertion and extraction phases of the hypodermic needles. The measurements were conducted for several different needle sizes, speed and insertion angles. In Stage II, five different models were examined to determine how well they matched the experimental data. Based on the analysis of fit quality coefficients, the Gordon's exponential model was identified as the best fit to the measured data. The influence of needle size, insertion angle, and insertion speed on the measured force values was confirmed. Different insertion speeds revealed the viscoelastic properties of the tested samples. The presence of the skin layer affected the puncture force and force values for subsequent layers.
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Affiliation(s)
- Marek Trączyński
- Institute of Mechanical Technology, Poznan University of Technology, Poznań, 60-965, Poland.
| | - Adam Patalas
- Institute of Mechanical Technology, Poznan University of Technology, Poznań, 60-965, Poland
| | - Katarzyna Rosłan
- Department of Orthopedics and Pediatric Traumatology, Poznan University of Medical Sciences, Poznań, 61-545, Poland
| | - Marcin Suszyński
- Institute of Mechanical Technology, Poznan University of Technology, Poznań, 60-965, Poland
| | - Rafał Talar
- Institute of Mechanical Technology, Poznan University of Technology, Poznań, 60-965, Poland
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Benenson S, Ben-Yosef Y, Schwartz C, Cohen MJ, Oster Y. Sources of primary bloodstream infections in internal medicine patients - a cohort study. Eur J Intern Med 2023; 113:69-74. [PMID: 37117089 DOI: 10.1016/j.ejim.2023.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/20/2023] [Accepted: 04/22/2023] [Indexed: 04/30/2023]
Abstract
PURPOSE To describe the sources of bloodstream infections (BSIs) in internal-medicine patients, on admission and during hospitalization, and to determine the proportion of BSIs in which no secondary cause could be defined (i.e., primary-BSI). METHODS We analyzed all BSIs at the internal-medicine wards of the two campuses of the Hadassah Hebrew-University Medical Center, during 2017-2018. We defined the BSI source of each event (secondary, Central-line associated BSI (CLABSI) or primary non-CLABSI) and compared BSIs present on admission (POA) to hospital acquired (HA). RESULTS There were 595 patient-unique BSI events, 316 (53.1%) POA-BSI and 279 (46.9%) HA-BSI. Overall, 309 (51.9%) were secondary, 194 (32.6%) primary non-CLABSI and 92 (15.5%) CLABSI. Primary non-CLABSI in the POA-BSI group was 20.6% vs. 46.2% in the HA-BSI group (p = 0.001). The length of hospital stay (LOS) of the HA-BSI group was longer than in the POA-BSI group (mean LOS, 19 days vs. 13.6 days, p = 0.01) and mortality rate was higher (48.7% vs. 19%, p = 0.001). Staphylococcus aureus was more common in primary non-CLABSI than in CLABSI and secondary BSI (29.5%, 12.8% and 16.2%, respectively). CONCLUSIONS The proportion of primary non-CLABSI among HA-BSI events is very high (46.2%). The absence of any plausible source for these BSIs, and the fact that in our hospital more than 90% of patients in medicine wards have peripheral lines, suggests that these may be a possible source for primary non-CLABSIs. Measures to prevent peripheral-line associated BSI (PLABSI), like those implemented successfully for the prevention of CLABSI, should be considered.
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Affiliation(s)
- Shmuel Benenson
- Faculty of Medicine, Hebrew University of Jerusalem, Israel; Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
| | | | - Carmela Schwartz
- Faculty of Medicine, Hebrew University of Jerusalem, Israel; Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Matan J Cohen
- Faculty of Medicine, Hebrew University of Jerusalem, Israel; Clalit Health Services, Jerusalem District, Affiliated With The Hebrew University, 1 Ygal Alon St, Bet Shemesh, Jerusalem, Israel.
| | - Yonatan Oster
- Faculty of Medicine, Hebrew University of Jerusalem, Israel; Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Díaz-García J, Mesquida A, Sánchez-Carrillo C, Reigadas E, Muñoz P, Escribano P, Guinea J. Monitoring the Epidemiology and Antifungal Resistance of Yeasts Causing Fungemia in a Tertiary Care Hospital in Madrid, Spain: Any Relevant Changes in the Last 13 Years? Antimicrob Agents Chemother 2021; 65:e01827-20. [PMID: 33468487 PMCID: PMC8097463 DOI: 10.1128/aac.01827-20] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/29/2020] [Indexed: 02/06/2023] Open
Abstract
We conducted an updated analysis on yeast isolates causing fungemia in patients admitted to a tertiary hospital in Madrid, Spain, over a 13-year period. We studied 896 isolates associated with 872 episodes of fungemia in 857 hospitalized patients between January 2007 and December 2019. Antifungal susceptibility was assessed by EUCAST EDef 7.3.2. Mutations conferring azole and echinocandin resistance were further studied, and genotyping of resistant clones was performed with species-specific microsatellite markers. Candida albicans (45.8%) was the most frequently identified species, followed by the Candida parapsilosis complex (26.4%), Candida glabrata (12.3%), Candida tropicalis (7.3%), Candida krusei (2.3%), other Candida spp. (3.1%), and non-Candida yeasts (2.8%). The rate of fluconazole resistance in Candida spp. was 4.7%, ranging from 0% (C. parapsilosis) to 9.1% (C. glabrata). The overall rate of echinocandin resistance was 3.1%. Resistance was highly influenced by the presence of intrinsically resistant species. Although the number of isolates between 2007 and 2013 was almost 2-fold higher than that in the period from 2014 to 2019 (566 versus 330), fluconazole resistance in Candida spp. was greater in the second period (3.5% versus 6.8%; P < 0.05), while overall resistance to echinocandins remained stable (3.5% versus 2.4%; P > 0.05). Resistant clones were collected from different wards and/or time points, suggesting that there were no epidemiological links. The number of fungemia episodes has been decreasing over the last 13 years, with a slight increase in the rate of fluconazole resistance and stable echinocandin resistance. Antifungal resistance is not the cause of the spread of resistant clones.
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Affiliation(s)
- Judith Díaz-García
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Aina Mesquida
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Carlos Sánchez-Carrillo
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - Elena Reigadas
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
- Medicine Department, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Pilar Escribano
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Jesús Guinea
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
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López-López C, Collados-Gómez L, García-Manzanares ME, Segura-Paz AM, López-Gutierrez AM, Pérez-García S. Prospective cohort study on the management and complications of peripheral venous catheter in patients hospitalised in Internal Medicine. Rev Clin Esp 2021; 221:151-156. [PMID: 32513436 DOI: 10.1016/j.rce.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyse compliance with the recommendations on the insertion-maintenance of peripheral venous catheter (PVC) and the incidence of complications according to the healthcare department that inserted the PVCs. PATIENTS AND METHODS We conducted a prospective cohort follow-up study of PVCs, from their insertion in the emergency or internal medicine (IM) department until their withdrawal. RESULTS We monitored 590 PVCs, 274 from the emergency department and 316 from IM. In terms of compliance with the process indicators, there was a cannulation rate in the antecubital fossa of 3.5 and 1.6 per 100 catheters-day (P<.001) in the emergency and IM departments, respectively. The sterile placement rates were 1.6 and 12.4 (P<.001), and the rate for transparent dressing was 2.1 and 11.5 (P<.001) per 100 catheters-day in the emergency and IM departments, respectively. The complications rates showed no differences between the departments. The most common complication was phlebitis (95 cases, 16.1%). CONCLUSIONS Compliance with the insertion-maintenance recommendations for PVC showed differences between the departments; however, the incidence of complications was similar.
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Affiliation(s)
- C López-López
- Grupo de Investigación en Cuidados (InveCuid), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, España; Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, España.
| | - L Collados-Gómez
- Grupo de Investigación en Cuidados (InveCuid), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, España; Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, Madrid, España
| | - M E García-Manzanares
- Grupo de Investigación en Cuidados (InveCuid), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, España; Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, España
| | - A M Segura-Paz
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España
| | - A M López-Gutierrez
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España
| | - S Pérez-García
- Grupo de Investigación en Cuidados (InveCuid), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, España; Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, España; Área Funcional de Investigación, Desarrollo, Innovación y Procesos, Hospital Universitario 12 de Octubre, Madrid, España
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López-López C, Collados-Gómez L, García-Manzanares ME, Segura-Paz AM, López-Gutierrez AM, Pérez-García S. Prospective cohort study on the management and complications of peripheral venous catheter in patients hospitalised in internal medicine. Rev Clin Esp 2021; 221:151-156. [PMID: 33998463 DOI: 10.1016/j.rceng.2020.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/11/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyse compliance with the recommendations on the insertion-maintenance of peripheral venous catheter (PVC) and the incidence of complications according to the healthcare department that inserted the PVCs. PATIENTS AND METHODS We conducted a prospective cohort follow-up study of PVCs, from their insertion in the emergency or internal medicine (IM) department until their withdrawal. RESULTS We monitored 590 PVCs, 274 from the emergency department and 316 from IM. In terms of compliance with the process indicators, there was a cannulation rate in the antecubital fossa of 3.5 and 1.6 per 100 catheters-day (p < .001) in the emergency and IM departments, respectively. The sterile placement rates were 1.6 and 12.4 (p < .001), and the rate for transparent dressing was 2.1 and 11.5 (p < .001) per 100 catheters-day in the emergency and IM departments, respectively. The complications rates showed no differences between the departments. The most common complication was phlebitis (95 cases, 16.1%). CONCLUSIONS Compliance with the insertion-maintenance recommendations for PVC showed differences between the departments; however, the incidence of complications was similar.
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Affiliation(s)
- C López-López
- Grupo de Investigación en Cuidados (InveCuid), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain.
| | - L Collados-Gómez
- Grupo de Investigación en Cuidados (InveCuid), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, Madrid, Spain
| | - M E García-Manzanares
- Grupo de Investigación en Cuidados (InveCuid), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | - A M Segura-Paz
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A M López-Gutierrez
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - S Pérez-García
- Grupo de Investigación en Cuidados (InveCuid), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain; Área Funcional de Investigación, Desarrollo, Innovación y Procesos, Hospital Universitario 12 de Octubre, Madrid, Spain
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Laan BJ, Maaskant JM, Spijkerman IJB, Borgert MJ, Godfried MH, Pasmooij BC, Opmeer BC, Vos MC, Geerlings SE. De-implementation strategy to reduce inappropriate use of intravenous and urinary catheters (RICAT): a multicentre, prospective, interrupted time-series and before and after study. THE LANCET. INFECTIOUS DISEASES 2020; 20:864-872. [PMID: 32151333 DOI: 10.1016/s1473-3099(19)30709-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/29/2019] [Accepted: 11/27/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Catheter-associated bloodstream infections and urinary tract infections are frequently encountered health care-associated infections. We aimed to reduce inappropriate use of catheters to reduce health care-associated infections. METHODS In this multicentre, interrupted time-series and before and after study, we introduced a de-implementation strategy with multifaceted interventions in seven hospitals in the Netherlands. Adult patients admitted to internal medicine, gastroenterology, geriatic, oncology, or pulmonology wards, and non-surgical acute admission units, and who had a (central or peripheral) venous or urinary catheter were eligible for inclusion. One of the interventions was that nurses in the participating wards attended educational meetings on appropriate catheter use. Data on catheter use were collected every 2 weeks by the primary research physician during the baseline period (7 months) and intervention period (7 months), which were separated by a 5 month transition period. The primary outcomes were percentages of short peripheral intravenous catheters and urinary catheters used inappropriately on the days of data collection. Indications for catheter use were based on international guidelines. This study is registered with Netherlands Trial Register, NL5438. FINDINGS Between Sept 1, 2016, and April 1, 2018, we screened 6157 patients for inclusion, of whom 5696 were enrolled: 2650 patients in the baseline group, and 3046 in the intervention group. Inappropriate use of peripheral intravenous catheters occurred in 366 (22·0%, 95% CI 20·0 to 24·0) of 1665 patients in the baseline group and in 275 (14·4%, 12·8 to 16·0) of 1912 patients in the intervention group (incidence rate ratio [IRR] 0·65, 95% CI 0·56 to 0·77, p<0·0001). Time-series analyses showed an absolute reduction in inappropriate use of peripheral intravenous catheters from baseline to intervention periods of 6·65% (95% CI 2·47 to 10·82, p=0·011). Inappropriate use of urinary catheters occurred in 105 (32·4%, 95% CI 27·3 to 37·8) of 324 patients in the baseline group compared with 96 (24·1%, 20·0 to 28·6) of 398 patients in the intervention group (IRR 0·74, 95% CI 0·56 to 0·98, p=0·013). Time-series analyses showed an absolute reduction in inappropriate use of urinary catheters of 6·34% (95% CI -12·46 to 25·13, p=0·524). INTERPRETATION Our de-implementation strategy reduced inappropriate use of short peripheral intravenous catheters in patients who were not in the intensive care unit. The reduction of inappropriate use of urinary catheters was substantial, yet not statistically significant in time-series analysis due to a small sample size. The strategy appears well suited for broad-scale implementation to reduce health care-associated infections. FUNDING Netherlands Organisation for Health Research and Development.
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Affiliation(s)
- Bart J Laan
- Infectious Diseases, Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
| | - Jolanda M Maaskant
- Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ingrid J B Spijkerman
- Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Marjon J Borgert
- Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Mieke H Godfried
- Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Berend C Pasmooij
- Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Brent C Opmeer
- Clinical Research Unit, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Margreet C Vos
- Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Suzanne E Geerlings
- Infectious Diseases, Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Clinical characteristics of peripheral venous catheter-associated gram-negative bloodstream infection among patients with malignancy. PLoS One 2020; 15:e0228396. [PMID: 31999762 PMCID: PMC6992193 DOI: 10.1371/journal.pone.0228396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 01/14/2020] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Previous studies have suggested that peripheral venous catheter is a significant source of gram-negative bacteraemia in patients with malignancy. We aimed to identify risk factors and develop a clinical prediction rule for the involvement of gram-negative organisms in peripheral venous catheter-associated bloodstream infections (PVC-BSIs) among patients with malignancy. METHODS This retrospective cohort study was conducted at a 700-bed cancer hospital in Japan. Consecutive patients diagnosed with PVC-BSI based on clinical and microbiological criteria were included in this study. Based on clinical and microbiological characteristics of PVC-BSIs in cancer patients, a logistic regression model for predicting gram-negative organisms as causative organisms in PVC-BSIs was then developed. RESULTS Of the 99 patients included in our cohort, 60 patients (60.6%) had gram-negative PVC-BSIs. The median age of patients with PVC-BSIs was 67 years (interquartile range [IQR], 59-74 years), and the median Pitt bactearemia score was 1 (IQR, 0-3). The median duration of catherization was 5 days (IQR, 4-7 days) and 70 patients (70.7%) received peripheral parenteral nutrition that contained amino acids. On multivariable analysis, age ≥65 years (odds ratio [OR], 3.07; 95% confidence interval [CI], 1.10-8.62), showering (OR, 3.15; 95% CI, 1.07-9.26), Pitt bacteraemia score ≥2 points (OR, 6.96; 95% CI, 2.52-19.2), and use of peripheral parenteral nutrition (OR, 0.31; 95% CI, 0.10-0.98) were independent predictors for gram-negative PVC-BSIs among all PVC-BSIs. The simplified PVC-GN scores established to predict gram-negative PVC-BSIs had a optimism-corrected c-index of 0.775. CONCLUSION Gram-negative bacteria were more commonly responsible for PVC-BSI than Gram-positive bacteria among cancer patients in this cohort. Involvement of Gram-negative bacteria in PVC-BSIs could be predicted with readily available clinical variables.
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9
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Høvik LH, Gjeilo KH, Lydersen S, Rickard CM, Røtvold B, Damås JK, Solligård E, Gustad LT. Monitoring quality of care for peripheral intravenous catheters; feasibility and reliability of the peripheral intravenous catheters mini questionnaire (PIVC-miniQ). BMC Health Serv Res 2019; 19:636. [PMID: 31488150 PMCID: PMC6729030 DOI: 10.1186/s12913-019-4497-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/30/2019] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) account for a mean of 38% of catheter associated bloodstream infections (CABSI) with Staphylococcus aureus, which are preventable if deficiencies in best practice are addressed. There exists no feasible and reliable quality surveillance tool assessing all important areas related to PIVC quality. Thus, we aimed to develop and test feasibility and reliability for an efficient quality assessment tool of overall PIVC quality. METHODS The Peripheral Intravenous Catheter- mini Questionnaire, PIVC-miniQ, consists of 16 items calculated as a sum score of problems regarding the insertion site, condition of dressing and equipment, documentation, and indication for use. In addition, it contains background variables like PIVC site, size and insertion environment. Two hospitals tested the PIVC-miniQ for feasibility and inter-rater agreement. Each PIVC was assessed twice, 2-5 min apart by two independent raters. We calculated the intraclass correlation coefficient (ICC) for each hospital and overall. For each of the 16 items, we calculated negative agreement, positive agreement, absolute agreement, and Scott's pi. RESULTS Sixty-three raters evaluated 205 PIVCs in 177 patients, each PIVC was assessed twice by independent raters, in total 410 PIVC observations. ICC between raters was 0.678 for hospital A, 0.577 for hospital B, and 0.604 for the pooled data. Mean time for the bedside assessment of each PIVC was 1.40 (SD 0.0007) minutes. The most frequent insertion site symptom was "pain and tenderness" (14.4%), whereas the most prevalent overall problem was lack of documentation of the PIVC (26.8%). Up to 50% of PIVCs were placed near joints (wrist or antecubital fossae) or were inserted under suboptimal conditions, i.e. emergency department or ambulance. CONCLUSIONS Our study highlights the need for PIVC quality surveillance on ward and hospital level and reports the PIVC-miniQ to be a reliable and time efficient tool suitable for frequent point-prevalence audits.
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Affiliation(s)
- Lise Husby Høvik
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Postbox 8905, 7491, Trondheim, Norway. .,Gemini Center for Sepsis Research, St. Olavs Hospital and Norwegian University of Science and Technology (NTNU), Trondheim, Norway. .,Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim, Norway.
| | - Kari Hanne Gjeilo
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Postbox 8905, 7491, Trondheim, Norway.,Department of Cardiothoracic Surgery, Department of Cardiology and National Competence Centre for Complex Symptom Disorders, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Claire M Rickard
- Alliance for Vascular Access teaching and Research, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Benedikte Røtvold
- Department of Anesthesia, Levanger Hospital, Clinic of Surgery, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Jan Kristian Damås
- Gemini Center for Sepsis Research, St. Olavs Hospital and Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Centre of Molecular Inflammation Research, Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway.,Department of Infectious Diseases, St. Olavs Hospital, Trondheim, Norway
| | - Erik Solligård
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Postbox 8905, 7491, Trondheim, Norway.,Gemini Center for Sepsis Research, St. Olavs Hospital and Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim, Norway
| | - Lise Tuset Gustad
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Postbox 8905, 7491, Trondheim, Norway.,Gemini Center for Sepsis Research, St. Olavs Hospital and Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Medicine, Levanger Hospital, Clinic of Medicine and rehabilitation, Nord-Trøndelag Hospital Trust, Levanger, Norway
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10
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Clinical Features of Bloodstream Infections Associated with Peripheral Versus Central Venous Catheters. Infect Dis Ther 2019; 8:343-352. [PMID: 31368046 PMCID: PMC6702512 DOI: 10.1007/s40121-019-00257-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction This study aimed to compare the clinical characteristics and prognoses of central venous catheter-associated bloodstream infections (CVC-BSIs) with peripheral venous catheter-associated BSIs (PVC-BSIs). Methods This retrospective observational study was conducted between April 2011 and March 2013 at a teaching hospital in Tokyo, Japan. Adult patients who developed CVC-BSIs and PVC-BSIs more than 2 days after admission were included. Patients with both CVC-BSIs and PVC-BSIs were excluded. Clinical characteristics of patients with CVC-BSIs and PVC-BSIs were obtained from medical records, and 30-day all-cause mortality was measured as the clinical outcome. Results We enrolled 124 PVC-BSI cases and 110 CVC-BSI cases. Median age, age-adjusted Charlson score, Sequential Organ Failure Assessment score, sex, and ward type at BSI onset did not differ significantly between the two groups. The median duration of catheter indwelling was significantly shorter in the PVC-BSI group than in the CVC-BSI group. Staphylococcus aureus and Gram-negative bacilli infections were more frequent and coagulase-negative staphylococci (CNS) and Candida spp. infections were less frequent in the PVC-BSI group than in the CVC-BSI group. The prevalence of oxacillin resistance among causative S. aureus and CNS, 30-day all-cause mortality, and appropriateness of empirical and definitive antimicrobial therapies did not differ significantly between the two groups. Conclusion The pathogen species distribution varies between PVC-BSIs and CVC-BSIs. However, all-cause mortality does not differ between the two groups. PVCs are not safer than CVCs with respect to BSIs; therefore, it is necessary to use similar precautions relevant to CVC use in order to avoid unnecessary use of PVCs.
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11
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Collaborative, Innovative Quality Improvement Activity: Development of Queensland Ambulance Service Stickers: Drivers, Approaches, Implementation, and Outcomes. Adv Emerg Nurs J 2019; 41:43-47. [PMID: 30702533 DOI: 10.1097/tme.0000000000000228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article discusses the implementation of 3 targeted interventions aimed at reducing infection rates in patients due to prolonged in situ intravascular catheters (IVCs) during their admission to the hospital. These IVCs are inserted by paramedics with Queensland Ambulance Service (QAS) in prehospital settings. The 3 interventions involved were the application of "QAS-IVC" stickers by QAS paramedics to indicate QAS-inserted IVCs, the implementation of mandatory IVC documentation during patient handover, and clinician engagement to provide patient education on IVC infection signs. Audits undertaken in wards reflected that the interventions were apparent and beneficial; this is evident from the limited number of patients having in-dwelling QAS-IVC and increased awareness among medical staff and patients alike. We, however, did not have comparative data to objectively quantify the success of the interventions implemented.
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12
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Laan BJ, Nieuwkerk PT, Geerlings SE. Patients knowledge and experience with urinary and peripheral intravenous catheters. World J Urol 2019; 38:57-62. [PMID: 30680418 PMCID: PMC6954151 DOI: 10.1007/s00345-018-02623-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 12/29/2018] [Indexed: 12/18/2022] Open
Abstract
Purpose Inappropriate use of urinary and intravenous catheters is still frequent. The use of catheters is associated with some serious complications, such as health care associated infections (HAIs). An efficient way to reduce HAIs is to avoid inappropriate use of catheters, but the role for patients in quality improvement initiatives is unclear. The aim of this study is to investigate patients knowledge and experience with catheters, to design patient interventions to reduce inappropriate catheter use. Methods We assessed patient’s knowledge and experience with catheters using a self report questionnaire, and included patients with a urinary and/or peripheral intravenous catheter (PIVC) during the baseline measurements of a quality improvement project to reduce inappropriate catheters use. Results A total number of 82 patients completed the questionnaire, of which 49 had a urinary catheter and 72 a PIVC. Patients were unaware about the indication for their urinary catheter in 20.9% and PIVC in 19.5%. Nevertheless, 65.3% reported symptoms due to urinary catheters and 37.5% for PIVCs. Interestingly, only 25.5% and 22.4% reported that they would ask their doctor if the catheter could be removed. Conclusions There is a lack of knowledge about the indication for having a urinary and peripheral intravenous catheter in a substantial part of patients. Although catheters cause symptoms, patients in general do not ask if the catheter could be removed. Doctors should give more information and ask more questions about catheters to their patients. Quality improvement initiatives stimulating patients to actively participate in their treatment are needed. Electronic supplementary material The online version of this article (10.1007/s00345-018-02623-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bart J Laan
- Internal Medicine, Infectious Diseases, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Pythia T Nieuwkerk
- Medical Psychology, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, Amsterdam, Netherlands
| | - Suzanne E Geerlings
- Internal Medicine, Infectious Diseases, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands.
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13
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Short-Term Peripheral Venous Catheter-Related Bloodstream Infections: Evidence for Increasing Prevalence of Gram-Negative Microorganisms from a 25-Year Prospective Observational Study. Antimicrob Agents Chemother 2018; 62:AAC.00892-18. [PMID: 30126952 DOI: 10.1128/aac.00892-18] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/13/2018] [Indexed: 12/31/2022] Open
Abstract
The aim of this study was to describe the etiology and outcome of short-term peripheral venous catheter (PVC)-related bloodstream infections (PVCRBSI) in a 25-year period (1992 to 2016) and to identify predictive factors of Gram-negative PVCRBSI. This was a prospective observational study including all episodes of PVCRBSI. A multivariate logistic regression model adjusted for calendar year was built to explore factors associated with a Gram-negative bacterial etiology. Over the study period, 711 episodes of PVCRBSI were identified. Incidence rate of PVCRBSI increased from 0.06 to 0.13 episodes/1,000 patient-days. A Gram-negative bacterial etiology was demonstrated in 162 (22.8%) episodes. There was a significant increase in the proportion of Gram-negative infections (22.6% in 1992 to 1996 versus 33.2% in 2012 to 2016). Independent predictive factors of Gram-negative PVCRBSI were the following: being in the hospital for more than 7 days with a catheter in situ for more than 3 days (adjusted odds ratio [aOR], 1.80; 95% confidence interval [CI], 1.20 to 2.69), surgery in the previous month (aOR, 2.39; 95% CI, 1.40 to 4.09), and antimicrobial treatment with beta-lactams (aOR, 1.80; 95% CI, 1.16 to 2.78). In conclusion, we reported an increase in the prevalence of Gram-negative PVCRBSI over the last 25 years. Factors associated with a Gram-negative bacterial etiology were being in the hospital for more than 7 days with a catheter in situ for more than 3 days, having undergone surgery, and having received antimicrobial treatment with beta-lactams.
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14
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Reduction in Percentage of Clusters of Candida albicans and Candida parapsilosis Causing Candidemia in a General Hospital in Madrid, Spain. J Clin Microbiol 2018; 56:JCM.00574-18. [PMID: 29743306 DOI: 10.1128/jcm.00574-18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 05/04/2018] [Indexed: 12/20/2022] Open
Abstract
The presence of clusters in units with a high incidence of candidemia suggests the need for the prevention of candidemia. We analyzed the percentage of patients involved in clusters and its evolution over a large period of time in a tertiary hospital. We studied 432 patients admitted to Gregorio Marañón Hospital with candidemia caused by Candida albicans (n = 276) or Candida parapsilosis (n = 156) between January 2007 and December 2014. Incident isolates were genotyped. A cluster was defined as a group of ≥2 patients infected by an identical genotype; we considered clusters to be "tracking clusters" when the patients involved in the cluster were admitted to the same ward within a period of 24 months. The study period was split into two periods, 2007 to 2010 (period 1) and 2011 to 2014 (period 2). The number of episodes of C. albicans and C. parapsilosis candidemia (n = 262 versus n = 170, respectively), the mean incidence (1.62 versus 1.36 episodes per 1,000 admissions, respectively), and the percentage of episodes caused by clusters (overall clusters [40% versus 12%] and tracking clusters [18% versus 3%], respectively) were significantly lower in period 2 than in period 1. Linear regression analysis showed a positive correlation between the overall number of episodes of candidemia and episodes caused by clusters (r2 = 0.89). We found a reduction in the number of episodes of candidemia caused by C. albicans and C. parapsilosis and a decrease in the percentage of episodes caused by clusters over time. Interestingly, the reduction was accompanied by the implementation of a campaign to reduce the number of catheter-related infections.
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15
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Mermel LA. Short-term Peripheral Venous Catheter-Related Bloodstream Infections: A Systematic Review. Clin Infect Dis 2018; 65:1757-1762. [PMID: 29020252 DOI: 10.1093/cid/cix562] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/20/2017] [Indexed: 01/01/2023] Open
Abstract
Short-term peripheral venous catheters (PVCs) are commonly used in healthcare settings. To determine the magnitude of bloodstream infections (BSIs) related to their use, PubMed, article bibliographies, and the authors' library were searched for pertinent articles. The incidence of PVC-related BSIs was 0.18% among 85063 PVCs. Short-term PVCs accounted for a mean of 6.3% and 23% of nosocomial BSIs and nosocomial catheter-related BSIs, respectively. Prolonged dwell time and catheter insertion under emergent conditions increased risk of PVC-related bloodstream infection (PVCR-BSI). If approximately 200 million PVCs are successfully inserted into adult patients each year in the United States, there may be many PVCR-BSIs occurring yearly. Clinicians should obtain blood cultures in patients with evidence of PVC infection and systemic symptomatology such as fever, carefully inspect the PVC insertion site in bacteremic or fungemic patients, and remove PVCs associated with localized infection with or without associated BSI.
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Affiliation(s)
- Leonard A Mermel
- Department of Medicine, Alpert Medical School of Brown University.,Division of Infectious Diseases and Department of Epidemiology and Infection Control, Rhode Island Hospital, Providence
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16
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Guembe M, Pérez-Granda MJ, Capdevila JA, Barberán J, Pinilla B, Bouza E. Impact of a training program on adherence to recommendations for care of venous lines in internal medicine departments in Spain. Eur J Clin Microbiol Infect Dis 2018; 37:1163-1168. [PMID: 29569044 DOI: 10.1007/s10096-018-3236-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 03/14/2018] [Indexed: 10/17/2022]
Abstract
A high percentage of venous lines (VLs) are placed in non-ICU patients, particularly those treated in the internal medicine department (IMD). We assessed adherence to VL care after a training program aimed at nurses and clinicians attending patients admitted to Spanish IMDs. We performed a multicenter prospective observational point prevalence study in 14 Spanish IMDs in 2013 and 2016. We included all adult patients (> 18 years) admitted to IMDs on the study day and reviewed nursing records for patients with VL in place before and after a 1-year training program during 2015. Answers from an interview with head nurses of the IMDs regarding commonly used practices in the daily management of VLs were also compared. A total of 638 and 693 patients were seen during each period, respectively, and 530 and 598 patients had ≥ 1 VL implanted (83.1 vs. 86.3%). Catheters were considered unnecessary in 12.8 and 15.0% of cases (p = 0.28). Daily recording of the need for catheter use increased from 43.8 to 71.8% (p < 0.001). Furthermore, daily monitoring of the insertion site remained very frequent (94.4 vs. 92.2%; p = 0.16). The date of insertion was recorded in 86.3 and 85.5% of cases (p = 0.73), and no combination of closed connectors with open caps increased from 74.8 to 90.3% (p < 0.001). Overall, head nurses' knowledge improved in 4 out of 14 recommendations assessed (28.6%). A simple and easy program for training on management of VLs in Spanish IMDs was associated with improved quality of care.
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Affiliation(s)
- María Guembe
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain. .,Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain. .,Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, C/ Dr. Esquerdo, 46, 28007, Madrid, Spain.
| | - María Jesús Pérez-Granda
- Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain.,Cardiac Surgery Postoperative Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José Antonio Capdevila
- Grupo de Trabajo en Enfermedades Infecciosas de la Sociedad Española de Medicina Interna (GTEI-SEMI), Madrid, Spain.,Department of Internal Medicine, Hospital de Mataró, Barcelona, Spain
| | - José Barberán
- Grupo de Trabajo en Enfermedades Infecciosas de la Sociedad Española de Medicina Interna (GTEI-SEMI), Madrid, Spain.,Department of Internal Medicine, Hospital de Montepríncipe, Madrid, Spain
| | - Blanca Pinilla
- Grupo de Trabajo en Enfermedades Infecciosas de la Sociedad Española de Medicina Interna (GTEI-SEMI), Madrid, Spain.,Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Emilio Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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17
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Gledstone-Brown L, McHugh D. Review article: Idle ‘just-in-case’ peripheral intravenous cannulas in the emergency department: Is something wrong? Emerg Med Australas 2017; 30:309-326. [DOI: 10.1111/1742-6723.12877] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 08/20/2017] [Accepted: 09/09/2017] [Indexed: 11/27/2022]
Affiliation(s)
| | - Douglas McHugh
- Frank H. Netter MD School of Medicine; Quinnipiac University; Hamden Connecticut USA
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18
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19
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Guembe M, Pérez-Granda MJ, Capdevila JA, Barberán J, Pinilla B, Martín-Rabadán P, Bouza E. Nationwide study on peripheral-venous-catheter-associated-bloodstream infections in internal medicine departments. J Hosp Infect 2017; 97:260-266. [PMID: 28716670 DOI: 10.1016/j.jhin.2017.07.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 07/04/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND The use of peripheral venous catheters (PVCs) has increased outside intensive care units, as has the rate of PVC-associated-bloodstream infection (PVC-BSI). PVCs are widely used in internal medicine departments (IMDs), but data on the incidence of PVC-BSI and its characteristics in IMDs are scarce. AIM To assess the incidence of PVC-BSI episodes detected in IMDs in Spain. METHODS A one-year multi-centre prospective observational cohort study in 14 Spanish IMDs was undertaken. Adult patients admitted with at least one PVC and bacteraemia were included in the study. Demographic and clinical data were provided by local coordinators. FINDINGS Seventy episodes of PVC-BSI were recorded, representing an overall rate of 1.64 PVC-BSI episodes/1000 IMD admissions. The mean age of patients was 67.44 (standard deviation 16.72) years. It was estimated that 25.7% of PVCs were no longer necessary. Staphylococcus aureus was the most frequently isolated micro-organism (41.7%). Phlebitis was clinically evident in 44 (62.9%) episodes, and proved to be an independent predictor of catheter insertion in emergency departments (odds ratio 5.44). The crude and attributable mortality rates were 12.9% and 5.7%, respectively. CONCLUSIONS PVCs carry a significant risk for bacteraemia in Spanish IMDs. Phlebitis is not always clinically evident in patients with bacteraemia in this population. The study findings support the need for educational and interventional preventive measures in both IMDs and emergency departments to reduce the rate of PVC-BSI and associated comorbidities, and costs.
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Affiliation(s)
- M Guembe
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - M J Pérez-Granda
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Cardiac Surgery Postoperative Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J A Capdevila
- Study Group of Infections of the Sociedad Española de Infecciones Cardiovasculares, Madrid, Spain; Department of Internal Medicine, Hospital de Mataró, Barcelona, Spain
| | - J Barberán
- Study Group of Infections of the Sociedad Española de Infecciones Cardiovasculares, Madrid, Spain; Department of Internal Medicine, Hospital de Montepríncipe, Madrid, Spain
| | - B Pinilla
- Study Group of Infections of the Sociedad Española de Infecciones Cardiovasculares, Madrid, Spain; Department of Internal Medicine, HGU Gregorio Marañón, Madrid, Spain
| | - P Martín-Rabadán
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - E Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Study Group of Infections of the Sociedad Española de Infecciones Cardiovasculares, Madrid, Spain
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20
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Capdevila-Reniu A, Capdevila JA. Peripheral venous catheter, a dangerous weapon. Key points to improve its use. Rev Clin Esp 2017; 217:464-467. [PMID: 28576382 DOI: 10.1016/j.rce.2017.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 04/18/2017] [Accepted: 04/22/2017] [Indexed: 11/26/2022]
Abstract
Catheter-related bacteremia is one of the most important causes of nosocomial infection. Is associated to high rates of morbidity and mortality, including an economic burden. Peripheral venous catheter bacteremia is a leading cause of nosocomial infection in internal medicine departments. In this article, we review some important key points to improve its use and avoid infections.
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Affiliation(s)
| | - J A Capdevila
- Servicio de Medicina Interna, Hospital de Mataró, Mataró, Spain.
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21
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Laan BJ, Spijkerman IJB, Godfried MH, Pasmooij BC, Maaskant JM, Borgert MJ, Opmeer BC, Vos MC, Geerlings SE. De-implementation strategy to Reduce the Inappropriate use of urinary and intravenous CATheters: study protocol for the RICAT-study. BMC Infect Dis 2017; 17:53. [PMID: 28068924 PMCID: PMC5223587 DOI: 10.1186/s12879-016-2154-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 12/22/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Urinary and (peripheral and central) intravenous catheters are widely used in hospitalized patients. However, up to 56% of the catheters do not have an appropriate indication and some serious complications with the use of these catheters can occur. The main objective of our quality improvement project is to reduce the use of catheters without an appropriate indication by 25-50%, and to evaluate the affecting factors of our de-implementation strategy. METHODS In a multicenter, prospective interrupted time series analysis, several interventions to avoid inappropriate use of catheters will be conducted in seven hospitals in the Netherlands. Firstly, we will define a list of appropriate indications for urinary and (peripheral and central) intravenous catheters, which will restrict the use of catheters and urge catheter removal when the indication is no longer appropriate. Secondly, after the baseline measurements, the intervention will take place, which consists of a kick-off meeting, including a competitive feedback report of the baseline measurements, and education of healthcare workers and patients. Additional strategies based on the baseline data and local conditions are optional. The primary endpoint is the percentage of catheters with an inappropriate indication on the day of data collection before and after the de-implementation strategy. Secondary endpoints are catheter-related infections or other complications, catheter re-insertion rate, length of hospital (and ICU) stay and mortality. In addition, the cost-effectiveness of the de-implementation strategy will be calculated. DISCUSSION This study aims to reduce the use of urinary and intravenous catheters with an inappropriate indication, and as a result reduce the catheter-related complications. If (cost-) effective it provides a tool for a nationwide approach to reduce catheter-related infections and other complications. TRIAL REGISTRATION Dutch trial registry: NTR6015 . Registered 9 August 2016.
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Affiliation(s)
- Bart J Laan
- Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Ingrid J B Spijkerman
- Department of Medical Microbiology, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Mieke H Godfried
- Department of Internal Medicine, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Berend C Pasmooij
- Department of Internal Medicine, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jolanda M Maaskant
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Medical Faculty, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Marjon J Borgert
- Department of Internal Medicine, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Brent C Opmeer
- Clinical Research Unit, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Suzanne E Geerlings
- Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Capdevila JA, Guembe M, Barberán J, de Alarcón A, Bouza E, Fariñas MC, Gálvez J, Goenaga MA, Gutiérrez F, Kestler M, Llinares P, Miró JM, Montejo M, Muñoz P, Rodriguez-Creixems M, Sousa D, Cuenca J, Mestres CA. 2016 Expert consensus document on prevention, diagnosis and treatment of short-term peripheral venous catheter-related infections in adults. CIRUGIA CARDIOVASCULAR 2016. [DOI: 10.1016/j.circv.2016.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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