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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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Reynolds H, Gowardman J, Woods C. Care bundles and peripheral arterial catheters. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S34-S41. [PMID: 38271041 DOI: 10.12968/bjon.2024.33.2.s34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
HIGHLIGHTS What we know about the topic: Recommendations for the use of vascular access care bundles to reduce infection are followed for different devices. The risk of arterial catheter-related infection is comparable with short-term, non-cuffed central venous catheters. There are practice concerns for clinicians inserting and caring for peripheral arterial catheters. What this paper adds: The selected studies had a theme of decreased infection after using bundled strategies for all devices. Few studies addressed use of bundles for care of peripheral arterial catheters. High-quality research should be performed about using care bundles for insertion and care of arterial catheters. INTRODUCTION A scoping review of the literature was performed. AIMS/OBJECTIVES To find information on the use of care bundles for care of arterial, central, and peripherally inserted venous catheters. METHODS Data was extracted by 2 independent researchers using standardized methodology. RESULTS Results of 84 studies included 2 (2.4%) randomized controlled trials, 38 (45.2%) observational studies, 29 (34.5%) quality projects, and 15 (17.9%) reviews. Populations had more adults than pediatric patients. All studies had the most prominent theme of decreased infection in all devices after using bundle strategies. DISCUSSION AND CONCLUSIONS The mapping of available evidence strongly supports the use of care bundles to reduce infection in the care of all intravascular devices. However, deficiencies regarding practice concerns about insertion and care of arterial catheters highlight areas for future research with the aim to eliminate the gap in the evidence of studies of care bundles for peripheral arterial catheters.
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Affiliation(s)
- Heather Reynolds
- Department of Anaesthesia & Perioperative Medicine, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia, The University of Queensland, St Lucia, Queensland, Australia, Alliance for Vascular Access Teaching & Research, Griffith University, Nathan, Queensland, Australia
| | - John Gowardman
- Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia, The University of Queensland, St Lucia, Queensland, Australia
| | - Christine Woods
- Department of Anaesthesia & Perioperative Medicine, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia, The University of Queensland, St Lucia, Queensland, Australia
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Lladó Maura Y, Lucía Berga Figuerola M, Rodríguez Moreno MJ, Lluch Garvi V, E Soler Felsner E, Rodríguez-Rodríguez A, Almendral A, Limón E, Fusté E. Response to the letter: Comment on "Care bundle for the prevention of peripheral venous catheter blood stream infections at a secondary care university hospital: Implementation and results". Infect Dis Health 2023; 28:311-313. [PMID: 37543448 DOI: 10.1016/j.idh.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 08/07/2023]
Affiliation(s)
- Yolanda Lladó Maura
- Son Llàtzer University Hospital, Palma, Balearic Islands, Spain; Sepsis Research Group, Health Research Institute of the Balearic Islands (IdISBa), Spain
| | - Magdalena Lucía Berga Figuerola
- Son Llàtzer University Hospital, Palma, Balearic Islands, Spain; Health Research Institute of the Balearic Islands (IdISBa), Spain
| | - M José Rodríguez Moreno
- Son Llàtzer University Hospital, Palma, Balearic Islands, Spain; Health Research Institute of the Balearic Islands (IdISBa), Spain
| | - Verónica Lluch Garvi
- Son Llàtzer University Hospital, Palma, Balearic Islands, Spain; Health Research Institute of the Balearic Islands (IdISBa), Spain
| | - Elisabet E Soler Felsner
- Son Llàtzer University Hospital, Palma, Balearic Islands, Spain; Health Research Institute of the Balearic Islands (IdISBa), Spain
| | - Adrián Rodríguez-Rodríguez
- Internal Medicine Department, Son Llatzer University Hospital, Balearic Islands, Spain; Research Group in Infectious Diseases and HIV, Health Research Institute of the Balearic Islands (IdISBa), Spain
| | - Alexander Almendral
- VINCat Nosocomial Infection Surveillance in Catalonia, Institut Català d'Oncologia, Barcelona, Spain
| | - Enric Limón
- VINCat Nosocomial Infection Surveillance in Catalonia, Institut Català d'Oncologia, Barcelona, Spain; CIBERINFEC, Instituto Carlos III, Madrid, Spain; Department of Public Health, Mental Health, and Maternal and Child Health Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Ester Fusté
- Department of Public Health, Mental Health, and Maternal and Child Health Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, L'Hospitalet de Llobregat, Spain; Department of Pathology and Experimental Therapeutics, University of Barcelona and IDIBELL, Faculty of Medicine and Health Sciences University of Barcelona, L'Hospitalet de Llobregat, Spain.
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Casanova-Vivas S, Micó-Esparza JL, García-Abad I, Hevilla-Cucarella EB, Ballestar-Tarin ML, Blasco JM, García-Molina P. Training, management, and quality of nursing care of vascular access in adult patients: The INCATIV project. J Vasc Access 2023; 24:948-956. [PMID: 34836468 DOI: 10.1177/11297298211059322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND More than one billion of peripheral venous catheters are inserted into hospitalized patients every year. This study sought to identify the status of nursing care in vascular accesses in different hospitals and to evaluate the impact of a series of informative and formative interventions aimed at their care. METHODS Quasi-experimental, multicenter study. A total of 54 nursing professionals of 19 hospitals participated. The intervention consisted of informative talk and three training sessions related to the care and maintenance of vascular accesses and intravenous therapy in the hospital-admitted adult population. This was delivered in four years, with eight periodic cross-sectional assessments conducted before and after each intervention. To assess quality of nursing care in vascular accesses and intravenous therapy, a quality indicator called Standard Variable (VES), was developed and validated with the Delphi methodology. RESULTS A total of 21,108 patients, aged 64.0 years (SD 18.3), were assessed, of which 78.3% (16,516) had some type of vascular access inserted. An average of 22.1% (95% CI: 21.4-22.7) were classified as optimal. In total, 3218 nursing care professionals took part in the training activities. The VES indicator grew steadily throughout the study, raising from 7.8% to 37.6%. Changes were statistically significant between those time points in which one of the described interventions was delivered; however, there were no significant changes between time points with no intervention. CONCLUSIONS This study supports that continuous training interventions can produce improvements in the quality of nursing care and reduce complications in patients with vascular accesses. In addition, the VES indicator was a useful and simple tool to measure quality, but the experience with its use suggests continuous research in the search for standardized indicators that objectify the evaluation and evolution of care.
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Affiliation(s)
- Sonia Casanova-Vivas
- Servicio de Prevención de Riesgos Laborales, Conselleria de Sanidad Universal y Salud Pública, Valencia, Spain
- Facultad de Enfermería y Podología, Universitat de València, Valencia, Spain
| | - José-Luis Micó-Esparza
- Hospital Arnau de Vilanova, Conselleria de Sanidad Universal y Salud Pública, Valencia, Spain
| | - Isidro García-Abad
- Hospital General Universitario de Elche, Conselleria de Sanidad Universal y Salud Pública, Valencia, Spain
| | | | | | - José-María Blasco
- Group of Physiotherapy in the Ageing Processes: Socio and Healthcare Strategies, Departamento de Fisioterapia, Universitat de València, Spain
| | - Pablo García-Molina
- Facultad de Enfermería y Podología, Universitat de València, Valencia, Spain
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Lladó Maura Y, Berga Figuerola ML, Rodríguez Moreno MJ, Lluch Garvi V, Soler Felsner EE, Rodríguez-Rodríguez A, Almendral A, Limón E, Fusté E. Care bundle for the prevention of peripheral venous catheter blood stream infections at a secondary care university hospital: Implementation and results. Infect Dis Health 2023; 28:159-167. [PMID: 36849285 DOI: 10.1016/j.idh.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Venous catheterization for diagnostic and therapeutic purposes is part of routine hospital practice, as approximately 70% of hospitalized patients have a peripheral venous catheter (PVC). This practice, however, can lead to both local complications, (e.g., chemical, mechanical and infectious phlebitis) and systemic complications (e.g., PVC-related bloodstream infections [PVC-BSIs]). Surveillance data and activities are central to preventing nosocomial infections, phlebitis and improving patient care and safety. The aim of this study was to evaluate the impact of a care bundle on reducing PVC-BSI rates and phlebitis at a secondary care hospital in Mallorca, Spain. METHODS Three-phase intervention study targeting hospitalized patients with a PVC. The VINCat criteria were used to define PVC-BSIs and calculate incidence. In phase I (August-December 2015), we retrospectively analyzed baseline PVC-BSI rates at our hospital. In phase II (2016-2017), we conducted safety rounds and developed a care bundle with the goal of reducing PVC-BSI rates. In phase III (2018), we expanded the PVC-BSI bundle to prevent phlebitis and analyzed its impact. RESULTS The incidence of PVC-BSIs decreased from 0.48 episodes per 1000 patient-days in 2015 to 0.17 episodes per 1000 patient-days in 2018. The 2017 safety rounds also detected a reduction in phlebitis (from 4.6% of 2.6%). Overall, 680 healthcare professionals were trained in catheter care and five safety rounds were conducted to assess bedside care. CONCLUSION Implementation of a care bundle significantly reduced PVC-BSI rates and phlebitis at our hospital. Continuous surveillance programs are needed to adapt measures to improve patient care and guarantee safety.
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Affiliation(s)
- Yolanda Lladó Maura
- Son Llàtzer University Hospital, Palma, Balearic Islands, Spain; Sepsis Research Group, Health Research Institute of the Balearic Islands (IdISBa), Spain
| | - Magdalena Lucía Berga Figuerola
- Son Llàtzer University Hospital, Palma, Balearic Islands, Spain; Health Research Institute of the Balearic Islands (IdISBa), Spain
| | - M José Rodríguez Moreno
- Son Llàtzer University Hospital, Palma, Balearic Islands, Spain; Health Research Institute of the Balearic Islands (IdISBa), Spain
| | - Verónica Lluch Garvi
- Son Llàtzer University Hospital, Palma, Balearic Islands, Spain; Health Research Institute of the Balearic Islands (IdISBa), Spain
| | - Elisabet E Soler Felsner
- Son Llàtzer University Hospital, Palma, Balearic Islands, Spain; Health Research Institute of the Balearic Islands (IdISBa), Spain
| | - Adrián Rodríguez-Rodríguez
- Internal Medicine Department, Son Llatzer University Hospital, Balearic Islands, Spain-Research Group in Infectious Diseases and HIV, Health Research Institute of the Balearic Islands (IdISBa), Spain
| | - Alexander Almendral
- VINCat Nosocomial Infection Surveillance in Catalonia, Institut Català d'Oncologia, Barcelona, Spain
| | - Enric Limón
- VINCat Nosocomial Infection Surveillance in Catalonia, Institut Català d'Oncologia, Barcelona, Spain; CIBERINFEC, Instituto Carlos III, Madrid, Spain; Department of Public Health, Mental Health, and Maternal and Child Health Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Ester Fusté
- Department of Public Health, Mental Health, and Maternal and Child Health Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, L'Hospitalet de Llobregat, Spain; Department of Pathology and Experimental Therapeutics, University of Barcelona and IDIBELL, Faculty of Medicine and Health Sciences University of Barcelona, L'Hospitalet de Llobregat, Spain.
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6
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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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Pittiruti M, Van Boxtel T, Scoppettuolo G, Carr P, Konstantinou E, Ortiz Miluy G, Lamperti M, Goossens GA, Simcock L, Dupont C, Inwood S, Bertoglio S, Nicholson J, Pinelli F, Pepe G. European recommendations on the proper indication and use of peripheral venous access devices (the ERPIUP consensus): A WoCoVA project. J Vasc Access 2023; 24:165-182. [PMID: 34088239 DOI: 10.1177/11297298211023274] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Since several innovations have recently changed the criteria of choice and management of peripheral venous access (new devices, new techniques of insertion, new recommendations for maintenance), the WoCoVA Foundation (WoCoVA = World Conference on Vascular Access) has developed an international Consensus with the following objectives: to propose a clear and useful classification of the currently available peripheral venous access devices; to clarify the proper indication of central versus peripheral venous access; discuss the indications of the different peripheral venous access devices (short peripheral cannulas vs long peripheral cannulas vs midline catheters); to define the proper techniques of insertion and maintenance that should be recommended today. To achieve these purposes, WoCoVA have decided to adopt a European point of view, considering some relevant differences of terminology between North America and Europe in this area of venous access and the need for a common basis of understanding among the experts recruited for this project. The ERPIUP Consensus (ERPIUP = European Recommendations for Proper Indication and Use of Peripheral venous access) was designed to offer systematic recommendations for clinical practice, covering every aspect of management of peripheral venous access devices in the adult patient: indication, insertion, maintenance, prevention and treatment of complications, removal. Also, our purpose was to improve the standardization of the terminology, bringing clarity of definition, and classification.
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Affiliation(s)
| | | | | | - Peter Carr
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | | | | | | | - Godelieve Alice Goossens
- Nursing Centre of Excellence, University Hospitals, Leuven, Belgium and Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Belgium
| | - Liz Simcock
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Christian Dupont
- Cochin University Hospital, Assistance Publique - Hôpitaux de Paris, France
| | | | | | - Jackie Nicholson
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Gilda Pepe
- Catholic University Hospital 'A. Gemelli', Rome, Italy
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8
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van der Kooi TII, Smid EA, Koek MBG, Geerlings SE, Bode LGM, Hopmans TEM, de Greeff SC. The effect of an intervention bundle to prevent central venous catheter-related bloodstream infection in a national programme in the Netherlands. J Hosp Infect 2023; 131:194-202. [PMID: 36414165 DOI: 10.1016/j.jhin.2022.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/13/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Central venous catheters (CVCs) can lead to central line-related bloodstream infections (CRBSIs). A six-item bundle was introduced in 2009 to prevent CRBSI in Dutch hospitals. AIM This study aimed to determine the impact of an intervention bundle on CRBSI risk. METHODS Data were obtained from hospitals participating in the national CRBSI surveillance between 2009 and 2019. Bundle compliance was evaluated as a total ('overall') bundle (all six items) and as an insertion bundle (four items) and a maintenance bundle (two daily checks). We estimated the impact of the overall and partial bundles, using multi-level Cox regression. FINDINGS Of the 66 hospitals in the CRBSI surveillance 56 (84.8%) recorded annual bundle (non)compliance for >80% of the CVCs, for one to nine years. In these 56 hospitals CRBSI incidence decreased from 4.0 to 1.6/1000 CVC days. In the intensive care units (ICUs), compliance was not associated with CRBSI risk (hazard ratio (HR) for the overall, insertion and maintenance bundle were 1.14 (95% confidence interval 0.80-1.64), 1.05 (0.56-1.95) and 1.13 (0.79-1.62)), respectively. Outside the ICU the non-significant association of compliance with the overall bundle (HR 1.36 (0.96-1.93)) resulted from opposite effects of the insertion bundle, associated with decreased risk (HR 0.50 (0.30-0.85)) and the maintenance bundle, associated with increased risk (HR 1.68 (1.19-2.36)). CONCLUSION Following a national programme to introduce an intervention bundle, CRBSI incidence decreased significantly. In the ICU, bundle compliance was not associated with CRBSI risk, but outside the ICU improved compliance with the insertion bundle resulted in a decreased CRBSI risk.
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Affiliation(s)
- T I I van der Kooi
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, the Netherlands.
| | - E A Smid
- Nextens, Book and Periodical Publishing, Amsterdam, the Netherlands
| | - M B G Koek
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, the Netherlands
| | - S E Geerlings
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity, Amsterdam Public Health, the Netherlands
| | - L G M Bode
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, the Netherlands
| | - T E M Hopmans
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, the Netherlands
| | - S C de Greeff
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, the Netherlands
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9
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What fuels suboptimal care of peripheral intravenous catheter-related infections in hospitals? A qualitative study of decision-making among Spanish nurses. Antimicrob Resist Infect Control 2022; 11:105. [PMID: 35986398 PMCID: PMC9389778 DOI: 10.1186/s13756-022-01144-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/14/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Peripheral intravenous catheters (PIVC) are commonly used in hospital worldwide. However, PIVC are not exempt from complications. Catheter-related bloodstream infections (CRBSI) increase morbidity and mortality rates, and costs for the healthcare organization. PIVC care is shaped by the complex mix of professional and organizational culture, such as knowledge gaps, low perception of impact of PIVCs on patient safety, or lack of hospital guidelines.
Aim
To explore determinants of decision-making about the prevention of PIVC-BSI among nurses in Spanish hospitals.
Methods
We conducted a descriptive qualitative study with semi-structured interviews in three public hospitals, the Balearic Islands Health Care Service in Spain. We considered hospital ward nurses working routinely with inpatients at any of the three hospitals for enrolment in the study. We approached relevant informants to identify suitable participants who recruited other participants through a ‘snowball’ technique. Fourteen inpatient nurses from the hospital took part in this study between September and November 2018. We employed several triangulation strategies to underpin the methodological rigour of our analysis and conducted the member checking, showing the information and codes applied in the recording of the interviews to identify the coherence and any discrepancies of the discourse by participants. We used the COREQ checklist for this study.
Findings
We identified four major themes in the analysis related to determinants of care: The fog of decision-making in PIVC; The taskification of PIVC care; PIVC care is accepted to be suboptimal, yet irrelevant; and chasms between perceived determinants of poor PIVC care and its solutions.
Conclusion
The clinical management of PIVCs appear ambiguous, unclear, and fragmented, with no clear professional responsibility and no nurse leadership, causing a gap in preventing infections. Furthermore, the perception of low risk on PIVC care impact can cause a relevant lack of adherence to the best evidence and patient safety. Implementing facilitation strategies could improve the fidelity of the best available evidence regarding PIVC care and raise awareness among nurses of impact that excellence of care.
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10
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Decreased Mortality among Patients with Catheter-Related Bloodstream Infections at Catalan Hospitals (2010-2019). J Hosp Infect 2022; 126:70-77. [PMID: 35594988 DOI: 10.1016/j.jhin.2022.05.009] [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: 01/27/2022] [Revised: 05/03/2022] [Accepted: 05/09/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The incidence of catheter-related bloodstream infections (CRBSI) has fallen over the last decade, especially in intensive care units (ICUs). AIM To assess the existence of concomitant trends in outcomes and to analyse the current risk factors for mortality. METHODS A multicentre retrospective cohort study was conducted at 24 Catalan hospitals participating in the Surveillance of healthcare associated infections in Catalonia (VINCat). All hospital-acquired CRBSI episodes diagnosed from January 2010 to December 2019 were included. A common protocol including epidemiological, clinical and microbiological data was prospectively completed. Mortality at 30 days after bacteraemia onset was analysed using the Cox regression model. FINDINGS Over the study period, 4,795 episodes of CRBSI were diagnosed. Among them, 75% were acquired in conventional wards and central venous catheters were the most frequently involved (61%). The 30-day mortality rate was 13.8%, presenting a significant downward trend over the study period: from 17.9% in 2010 to 10.6% in 2019 (HR 0.95 [0.92-0.98]). The multivariate analysis identified age (HR 1.03 [1.02-1.04]), femoral catheter (HR 1.78 [1.33-2.38]), medical ward acquisition (HR 2.07 [1.62-2.65] and ICU acquisition (HR 3.45 [2.7-4.41]), S. aureus (HR 1.59 [1.27-1.99]) and Candida sp. (HR 2.19 [1.64-2.94]) as risk factors for mortality while the mortality rate associated with episodes originating in peripheral catheters was significantly lower (HR 0.69 [0.54-0.88]). CONCLUSIONS Mortality associated with CRBSI has fallen in recent years but remains high. Intervention programs should focus especially on ICUs and medical wards, where incidence and mortality rates are highest.
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Badia-Cebada L, Peñafiel J, Saliba P, Andrés M, Càmara J, Domenech D, Jiménez-Martínez E, Marrón A, Moreno E, Pomar V, Vaqué M, Limón E, Masats Ú, Pujol M, Gasch O. Trends in the epidemiology of catheter-related bloodstream infections; towards a paradigm shift, Spain, 2007 to 2019. Euro Surveill 2022; 27:2100610. [PMID: 35551704 PMCID: PMC9101967 DOI: 10.2807/1560-7917.es.2022.27.19.2100610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BackgroundCatheter-related bloodstream infections (CRBSI) are frequent healthcare-associated infections and an important cause of death.AimTo analyse changes in CRBSI epidemiology observed by the Infection Control Catalan Programme (VINCat).MethodsA cohort study including all hospital-acquired CRBSI episodes diagnosed at 55 hospitals (2007-2019) in Catalonia, Spain, was prospectively conducted. CRBSI incidence rates were adjusted per 1,000 patient days. To assess the CRBSI rate trend per year, negative binomial models were used, with the number of events as the dependent variable, and the year as the main independent variable. From each model, the annual rate of CRBSI diagnosed per 1,000 patient days and the incidence rate ratio (IRR) with its 95% confidence intervals (CI) were reported.ResultsDuring the study, 9,290 CRBSI episodes were diagnosed (mean annual incidence rate: 0.20 episodes/1,000 patient days). Patients' median age was 64.1 years; 36.6% (3,403/9,290) were female. In total, 73.7% (n = 6,845) of CRBSI occurred in non-intensive care unit (ICU) wards, 62.7% (n = 5,822) were related to central venous catheter (CVC), 24.1% (n = 2,236) to peripheral venous catheters (PVC) and 13.3% (n = 1,232) to peripherally-inserted central venous catheters (PICVC). Incidence rate fell over the study period (IRR: 0.94; 95%CI: 0.93-0.96), especially in the ICU (IRR: 0.88; 95%CI: 0.87-0.89). As a whole, while episodes of CVC CRBSI fell significantly (IRR: 0.88; 95%CI: 0.87-0.91), peripherally-inserted catheter CRBSI (PVC and PICVC) rose, especially in medical wards (IRR PICVC: 1.08; 95%CI: 1.05-1.11; IRR PVC: 1.03; 95% 1.00-1.05).ConclusionsOver the study, CRBSIs associated with CVC and diagnosed in ICUs decreased while episodes in conventional wards involving peripherally-inserted catheters increased. Hospitals should implement preventive measures in conventional wards.
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Affiliation(s)
- Laia Badia-Cebada
- Internal Medicine Department, Hospital Universitari Parc Taulí, Sabadell, Spain,School of Medicine, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Judit Peñafiel
- Unit of Statistics, Hospital Universitari de Bellvitge/Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Patrick Saliba
- VINCat programme: Infection Control Catalan Programme, Barcelona, Spain
| | - Marta Andrés
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Consorci de Terrassa, Spain
| | - Jordi Càmara
- Department of Microbiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain,CIBER de Enfermedades Respiratorias (CIBERes), ISCIII, Madrid, Spain
| | - Dolors Domenech
- Infection Control Nurse, Hospital Josep Trueta, Girona, Spain
| | - Emili Jiménez-Martínez
- Infection Control Nurse, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Anna Marrón
- Infectious Diseases Department, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Encarna Moreno
- Infection Control Nurse, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Virginia Pomar
- Infectious Diseases Unit, Department of Internal Medicine, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Montserrat Vaqué
- Infection Control Nurse, Hospital de Barcelona, Barcelona, Spain
| | - Enric Limón
- VINCat programme: Infection Control Catalan Programme, Barcelona, Spain
| | - Úrsula Masats
- Infection Control Nurse, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Miquel Pujol
- Department of Infectious diseases, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Oriol Gasch
- School of Medicine, Universitat Autònoma de Barcelona, Sabadell, Spain,Infectious Diseases Department, Hospital Universitari Parc Taulí, Sabadell, Spain,Institut d’Investigació i Innovació Parc Taulí, Sabadell, Spain
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12
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An eight-year multicenter study on short-term peripheral intravenous catheter-related bloodstream infection rates in 100 intensive care units of 9 countries in Latin America: Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama, and Venezuela. Findings of the International Nosocomial Infection Control Consortium (INICC). Infect Control Hosp Epidemiol 2021; 42:1098-1104. [PMID: 33441207 DOI: 10.1017/ice.2020.1373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Data on short-term peripheral intravenous catheter-related bloodstream infections per 1,000 peripheral venous catheter days (PIVCR BSIs per 1,000 PVC days) rates from Latin America are not available, so they have not been thoroughly studied. METHODS International Nosocomial Infection Control Consortium (INICC) members conducted a prospective, surveillance study on PIVCR BSIs from January 2010 to March 2018 in 100 intensive care units (ICUs) among 41 hospitals, in 26 cities of 9 countries in Latin America (Argentina, Brazil, Colombia, Costa Rica, Dominican-Republic, Ecuador, Mexico, Panama, and Venezuela). The Centers for Disease Control and Prevention (CDC) National Health Safety Network (NHSN) definitions were applied, and INICC methodology and INICC Surveillance Online System software were used. RESULTS In total, 10,120 ICU patients were followed for 40,078 bed days and 38,262 PVC days. In addition, 79 PIVCR BSIs were identified, with a rate of 2.06 per 1,000 PVC days (95% confidence interval [CI], 1.635-2.257). The average length of stay (ALOS) of patients without a PIVCR BSI was 3.95 days, and the ALOS was 5.29 days for patients with a PIVCR BSI. The crude extra ALOS was 1.34 days (RR, 1.33; 95% CI, 1.0975-1.6351; P = .040).The mortality rate in patients without PIVCR BSI was 3.67%, and this rate was 6.33% in patients with a PIVCR BSI. The crude extra mortality was 1.70 times higher. The microorganism profile showed 48.5% gram-positive bacteria (coagulase-negative Staphylococci 25.7%) and 48.5% gram-negative bacteria: Acinetobacter spp, Escherichia coli, and Klebsiella spp (8.5% each one), Pseudomonas aeruginosa (5.7%), and Candida spp (2.8%). The resistances of Pseudomonas aeruginosa were 0% to amikacin and 50% to meropenem. The resistance of Acinetobacter baumanii to amikacin was 0%, and the resistance of coagulase-negative Staphylococcus to oxacillin was 75%. CONCLUSIONS Our PIVCR BSI rates were higher than rates from more economically developed countries and were similar to those of countries with limited resources.
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How do I manage a patient with enterococcal bacteraemia? Clin Microbiol Infect 2020; 27:364-371. [PMID: 33152537 DOI: 10.1016/j.cmi.2020.10.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Enterococcal bacteraemia (EB) is common, particularly in the nosocomial setting, and its management poses a challenge for clinicians and microbiologists. OBJECTIVES The aim was to summarize the more relevant features of EB and to provide a practical state-of-the-art on the topics that more directly affect its management. SOURCES Pubmed articles from inception to 31 May 2020. CONTENT The following topics are covered: epidemiological, clinical and microbiological characteristics and factors associated with prognosis of EB; diagnosis and work-up, including the use of echocardiography to rule out endocarditis; antibiotic management with special focus on antimicrobial resistance and complicated EB; and the role of infectious disease consultation and the use of bundles in EB. In addition, three clinical vignettes are presented to illustrate the practical application of the guidance provided, and major gaps in the current evidence supporting EB management are discussed. IMPLICATIONS EB is associated with large burdens of morbidity and mortality, particularly among fragile and immunosuppressed patients presenting complicated bacteraemia due to multidrug-resistant enterococci. Most cases of EB are caused by Enterococcus faecalis, followed by E. faecium. EB often presents as polymicrobial bacteraemia. Rapidly identifying patients at risk of EB is crucial for timely application of diagnostic techniques and empiric therapy. Early alert systems and rapid diagnostic techniques, such as matrix-assisted desorption ionization-time of flight mass spectrometry, especially if used together with infectious disease consultation within bundles, appear to improve management and prognosis of EB. Echocardiography is also key in the work-up of EB and should probably be more extensively used, although its exact indications in EB are still debated. Multidisciplinary approaches are warranted due to the complexity and severity of EB.
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14
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Tseng YH, Wong MY, Huang TY, Lin BS, Tung CW, Huang YK. Molecular characterization of clinical isolates from vascular access infection: A single-institution study. Microbiologyopen 2020; 9:e1126. [PMID: 33006272 PMCID: PMC7658447 DOI: 10.1002/mbo3.1126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/11/2020] [Accepted: 09/12/2020] [Indexed: 12/12/2022] Open
Abstract
Hemodialysis requires repeated, reliable access to the systemic circulation; therefore, a well‐functioning vascular access (VA) procedure is crucial for stable hemodialysis. VA infections (VAIs) constitute the most challenging complication and cause considerable morbidity, loss of access, and even death. In this study, we investigated the molecular profiles of different bacterial isolates retrieved from various types of VA grafts. We collected clinical isolates from hemodialysis patients with VAIs in our institution for the period between 2013 and 2018. We identified the bacterial isolates using standard biochemical procedures; we used a polymerase chain reaction for coagulase‐negative staphylococci (CoNS) and Burkholderia cepacia complex (BCC) species identification. The antibiotic resistance and molecular profile were analyzed using the disk diffusion method and multilocus sequence typing, respectively. We studied 150 isolates retrieved from patients with VAI and observed that Staphylococcus aureus was the predominant bacterial species, followed by S. argenteus, BCC, and CoNS. According to multilocus sequence typing data, we identified a wide variety of sequence types (STs) in S. aureus isolates, with ST59, ST45, and ST239 being the predominant types. Burkholderia cepacia with two new ST types, namely ST1723 and ST1724, accounted for most of the BCC infections, along with ST102 B. contaminans, which were mainly isolated from infected tunneled‐cuffed catheters. In summary, the increased incidence of S. argenteus and BCC infections provides insights into their potential clinical effects in VAIs. The various STs identified in different bacterial species indicate the high genetic diversity of bacterial species isolated from VAIs in our institution.
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Affiliation(s)
- Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, Puzi City, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Min Yi Wong
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, Puzi City, Taiwan.,Microbiology Research and Treatment Center, Chiayi Chang Gung Memorial Hospital, Puzi City, Taiwan.,Institute of Imaging and Biomedical Photonics, College of Photonics, National Chiao Tung University, Tainan, Taiwan
| | - Tsung-Yu Huang
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Microbiology Research and Treatment Center, Chiayi Chang Gung Memorial Hospital, Puzi City, Taiwan.,Division of Infectious Diseases, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Puzi City, Taiwan
| | - Bor-Shyh Lin
- Institute of Imaging and Biomedical Photonics, College of Photonics, National Chiao Tung University, Tainan, Taiwan
| | - Chun-Wu Tung
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Nephrology, Chiayi Chang Gung Memorial Hospital, Puzi City, Taiwan
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, Puzi City, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Microbiology Research and Treatment Center, Chiayi Chang Gung Memorial Hospital, Puzi City, Taiwan
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15
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Six-year multicenter study on short-term peripheral venous catheters-related bloodstream infection rates in 204 intensive care units of 57 hospitals in 19 cities of India: International Nosocomial Infection Control Consortium (INICC) findings. Am J Infect Control 2020; 48:1001-1008. [PMID: 32151486 DOI: 10.1016/j.ajic.2019.12.026] [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: 07/15/2019] [Revised: 12/27/2019] [Accepted: 12/28/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Short-term peripheral venous catheters-related bloodstream infections (PVCR-BSIs) rates have not been systematically studied in developing countries, and data on their incidence by number of device-days are not available. METHODS Prospective, surveillance study on PVCR-BSI conducted from September 1, 2013 to May 31, 2019 in 204 intensive care units (ICUs), members of the International Nosocomial Infection Control Consortium (INICC), from 57 hospitals in 19 cities of India. We applied US INICC definition criteria and reported methods using the INICC Surveillance Online System. RESULTS We followed 7,513 ICU patients for 296,893 bed-days and 295,795 short term peripheral venous catheter (PVC)-days. We identified 863 PVCR-BSIs, amounting to a rate of 2.91/1,000 PVC-days. Mortality in patients with PVC but without PVCR-BSI was 4.14%, and 11.59% in patients with PVCR-BSI. The length of stay in patients with PVC but without PVCR-BSI was 4.13 days, and 5.9 days in patients with PVCR-BSI. The micro-organism profile showed 68% of gram negative bacteria: Escherichia coli (23%), Klebsiella spp (15%), Pseudomonas aeruginosa (5%), and others. The predominant gram-positive bacteria were Staphylococcus aureus (10%). CONCLUSIONS PVCR-BSI rates found in our ICUs were much higher than rates published from industrialized countries. Infection prevention programs must be implemented to reduce the incidence of PVCR-BSIs.
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16
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Hebeisen U, Babouee Flury B, Atkinson A, Marschall J, Buetti N. Catheter-related bloodstream infections due to coagulase-negative staphylococci managed with catheter removal: Recurrences are rare. Am J Infect Control 2020; 48:837-839. [PMID: 31753551 DOI: 10.1016/j.ajic.2019.10.013] [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: 06/11/2019] [Revised: 10/11/2019] [Accepted: 10/11/2019] [Indexed: 11/18/2022]
Abstract
Little research has been carried out on recurrences of catheter-related bloodstream infection due to coagulase-negative staphylococci (CoNS-CRBSI). The main objective of this study was to characterize patients with CoNS-CRBSI and infection recurrence after catheter removal. We included 184 CoNS-CRBSI episodes. Only 8 patients experienced recurrent bacteremia and none of them developed secondary infection of preexisting orthopedic or intravascular implant material.
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Affiliation(s)
- Ursula Hebeisen
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - Baharak Babouee Flury
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - Andrew Atkinson
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland; Paediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - Niccolò Buetti
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland; UMR 1137 - IAME Team 5 - DeSCID: Decision SCiences in Infectious Diseases, Control and Care Inserm/University Paris Diderot, Sorbonne Paris Cité, Paris, France.
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17
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Rosenthal VD, Bat-Erdene I, Gupta D, Rajhans P, Myatra SN, Muralidharan S, Mehta Y, Rai V, Hung NV, Luxsuwong M, Tapang ARD, Guo X, Trotter A, Kharbanda M, Rodrigues C, Dwivedy A, Shah S, Poojary A, Todi SK, Chabukswar S, Bhattacharyya M, Ramachandran B, Ramakrishnan N, Purkayasta SK, Sakle AS, Kumar S, Warrier AR, Kavathekar MS, Sahu S, Mubarak A, Modi N, Jaggi N, Gita N, Mishra SB, Sahu S, Jawadwala B, Zala D, Zompa T, Mathur P, Nirkhiwale S, Vadi S, Singh S, Agarwal M, Sen N, Karlekar A, Punia DP, Kumar S, Gopinath R, Nair PK, Gan CS, Chakravarthy M, Sandhu K, Kambam C, Mohanty SK, Varaiya A, Pandya N, Subhedar VR, Vanajakshi MR, Singla D, Tuvshinbayar M, Patel M, Ye G, Lum LCS, Zaini RHM, Batkhuu B, Dayapera KM, Nguyet LT, Berba R, Buenaflor MCS, Ng JA, Siriyakorn N, Thu LTA. Six-year study on peripheral venous catheter-associated BSI rates in 262 ICUs in eight countries of South-East Asia: International Nosocomial Infection Control Consortium findings. J Vasc Access 2020; 22:34-41. [PMID: 32406328 DOI: 10.1177/1129729820917259] [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] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Short-term peripheral venous catheter-associated bloodstream infection rates have not been systematically studied in Asian countries, and data on peripheral venous catheter-associated bloodstream infections incidence by number of short-term peripheral venous catheter days are not available. METHODS Prospective, surveillance study on peripheral venous catheter-associated bloodstream infections conducted from 1 September 2013 to 31 May 2019 in 262 intensive care units, members of the International Nosocomial Infection Control Consortium, from 78 hospitals in 32 cities of 8 countries in the South-East Asia Region: China, India, Malaysia, Mongolia, Nepal, Philippines, Thailand, and Vietnam. For this research, we applied definition and criteria of the CDC NHSN, methodology of the INICC, and software named INICC Surveillance Online System. RESULTS We followed 83,295 intensive care unit patients for 369,371 bed-days and 376,492 peripheral venous catheter-days. We identified 999 peripheral venous catheter-associated bloodstream infections, amounting to a rate of 2.65/1000 peripheral venous catheter-days. Mortality in patients with peripheral venous catheter but without peripheral venous catheter-associated bloodstream infections was 4.53% and 12.21% in patients with peripheral venous catheter-associated bloodstream infections. The mean length of stay in patients with peripheral venous catheter but without peripheral venous catheter-associated bloodstream infections was 4.40 days and 7.11 days in patients with peripheral venous catheter and peripheral venous catheter-associated bloodstream infections. The microorganism profile showed 67.1% were Gram-negative bacteria: Escherichia coli (22.9%), Klebsiella spp (10.7%), Pseudomonas aeruginosa (5.3%), Enterobacter spp. (4.5%), and others (23.7%). The predominant Gram-positive bacteria were Staphylococcus aureus (11.4%). CONCLUSIONS Infection prevention programs must be implemented to reduce the incidence of peripheral venous catheter-associated bloodstream infections.
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Affiliation(s)
| | - Ider Bat-Erdene
- Infection Control Professionals of Mongolia, and Intermed Hospital, Ulaanbaatar, Mongolia
| | - Debkishore Gupta
- BM Birla Heart Research Centre, Kolkata, India.,The Calcutta Medical Research Institute, Kolkata, India
| | | | - Sheila Nainan Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - S Muralidharan
- G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, India
| | | | - Vineya Rai
- Adult Intensive Care Unit, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | | | | | - Xiuqin Guo
- Dong E Peoples Hospital, Shandong, P.R. China
| | | | | | - Camilla Rodrigues
- P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | | | - Sweta Shah
- Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | | | | | | | | | | | | | | | | | - Siva Kumar
- Kovai Medical Center and Hospital, Coimbatore, India
| | | | | | | | - Aisha Mubarak
- Kerala Institute of Medical Sciences, Thiruvananthapuram, India
| | - Nikhil Modi
- Indraprastha Apollo Hospital, New Delhi, India
| | | | | | | | | | | | | | - Tenzin Zompa
- Max Super Speciality Hospital, Dehradun, Dehradun, India
| | | | | | | | - Sanjeev Singh
- Amrita Institute of Medical Sciences and Research Center, Kochi, India
| | | | | | - Anil Karlekar
- Escorts Heart Institute & Research Centre, New Delhi, India
| | - D P Punia
- Mahatma Gandhi Hospital, Jaipur, India
| | | | | | | | - Chin Seng Gan
- Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Kavita Sandhu
- Max Super Speciality Hospital, Saket, New Delhi, India
| | | | | | - Ami Varaiya
- Dr. Balabhai Nanavati Super Speciality Hospital, Mumbai, India
| | | | | | - M R Vanajakshi
- Columbia Asia Referral Hospital-Yeshwanthpur, Bangalore, India
| | | | | | - Mayur Patel
- Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India
| | | | - Lucy Chai See Lum
- Pediatric Intensive Care, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | | | | | | | - Regina Berba
- Philippine General Hospital, Manila, Philippines
| | | | | | | | - Le Thi Anh Thu
- Cho Ray Hospital, Ho Chi Minh City, Vietnam.,For a list of the remaining co-authors of this study, see Appendix 1
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18
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Six-year multicenter study on short-term peripheral venous catheters-related bloodstream infection rates in 246 intensive units of 83 hospitals in 52 cities of 14 countries of Middle East: Bahrain, Egypt, Iran, Jordan, Kingdom of Saudi Arabia, Kuwait, Lebanon, Morocco, Pakistan, Palestine, Sudan, Tunisia, Turkey, and United Arab Emirates-International Nosocomial Infection Control Consortium (INICC) findings. J Infect Public Health 2020; 13:1134-1141. [PMID: 32295756 DOI: 10.1016/j.jiph.2020.03.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 01/29/2020] [Accepted: 03/16/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Short-term peripheral venous catheters-related bloodstream infections (PVCR-BSIs) rates have not been systematically studied, and data on their incidence by number of device-days is not available. METHODS Prospective, surveillance study on PVCR-BSI conducted from September 1st, 2013 to 31st Mays, 2019 in 246 intensive care units (ICUs), members of the International Nosocomial Infection Control Consortium (INICC), from 83 hospitals in 52 cities of 14 countries in the Middle East (Bahrain, Egypt, Iran, Jordan, Kingdom of Saudi Arabia, Kuwait, Lebanon, Morocco, Pakistan, Palestine, Sudan, Tunisia, Turkey, and United Arab Emirates). We applied U.S. RESULTS We followed 31,083 ICU patients for 189,834 bed-days and 202,375 short term peripheral venous catheter (PVC)-days. We identified 470 PVCR-BSIs, amounting to a rate of 2.32/1000 PVC-days. Mortality in patients with PVC but without PVCR-BSI was 10.38%, and 29.36% in patients with PVC and PVCR-BSI. The mean length of stay in patients with PVC but without PVCR-BSI was 5.94 days, and 16.84 days in patients with PVC and PVCR-BSI. The microorganism profile showed 55.2 % of gram-positive bacteria, with Coagulase-negative Staphylococci (31%) and Staphylococcus aureus (14%) being the predominant ones. Gram-negative bacteria accounted for 39% of cases, and included: Escherichia coli (7%), Klebsiella pneumoniae (8%), Pseudomonas aeruginosa (5%), Enterobacter spp. (3%), and others (29.9%), such as Serratia marcescens. CONCLUSIONS PVCR-BSI rates found in our ICUs were much higher than rates published from USA, Australia, and Italy. Infection prevention programs must be implemented to reduce the incidence of PVCR-BSIs.
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19
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Six-year multicenter study on short-term peripheral venous catheters-related bloodstream infection rates in 727 intensive care units of 268 hospitals in 141 cities of 42 countries of Africa, the Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific Regions: International Nosocomial Infection Control Consortium (INICC) findings. Infect Control Hosp Epidemiol 2020; 41:553-563. [PMID: 32183925 DOI: 10.1017/ice.2020.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Short-term peripheral venous catheter-related bloodstream infection (PVCR-BSI) rates have not been systematically studied in resource-limited countries, and data on their incidence by number of device days are not available. METHODS Prospective, surveillance study on PVCR-BSI conducted from September 1, 2013, to May 31, 2019, in 727 intensive care units (ICUs), by members of the International Nosocomial Infection Control Consortium (INICC), from 268 hospitals in 141 cities of 42 countries of Africa, the Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific regions. For this research, we applied definition and criteria of the CDC NHSN, methodology of the INICC, and software named INICC Surveillance Online System. RESULTS We followed 149,609 ICU patients for 731,135 bed days and 743,508 short-term peripheral venous catheter (PVC) days. We identified 1,789 PVCR-BSIs for an overall rate of 2.41 per 1,000 PVC days. Mortality in patients with PVC but without PVCR-BSI was 6.67%, and mortality was 18% in patients with PVC and PVCR-BSI. The length of stay of patients with PVC but without PVCR-BSI was 4.83 days, and the length of stay was 9.85 days in patients with PVC and PVCR-BSI. Among these infections, the microorganism profile showed 58% gram-negative bacteria: Escherichia coli (16%), Klebsiella spp (11%), Pseudomonas aeruginosa (6%), Enterobacter spp (4%), and others (20%) including Serratia marcescens. Staphylococcus aureus were the predominant gram-positive bacteria (12%). CONCLUSIONS PVCR-BSI rates in INICC ICUs were much higher than rates published from industrialized countries. Infection prevention programs must be implemented to reduce the incidence of PVCR-BSIs in resource-limited countries.
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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 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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Lam JC, Gregson DB, Robinson S, Somayaji R, Conly JM, Parkins MD. Epidemiology and Outcome Determinants of Staphylococcus aureus Bacteremia Revisited: A Population-Based Study. Infection 2019; 47:961-971. [PMID: 31270751 DOI: 10.1007/s15010-019-01330-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 05/27/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Staphylococcus aureus bacteremia (SAB) is associated with significant morbidity and mortality. We sought to re-define the burden, epidemiology and mortality-associated risk factors of SAB in a large Canadian health region. METHODS Residents (> 18 years) experiencing SAB from 2012 to 2014 were assessed. Incidence rates were calculated using civic census results. Factors associated with 30-day mortality were determined through multivariate logistic regression. Incidence and risk factors for SAB were compared to 2000-2006 data. RESULTS 780 residents experienced 840 episodes of SAB (MRSA; 20%). Incidence rates increased from 23.5 to 32.0 cases/100,000 from 2012 to 2014; [IRR 1.15 (95% CI 1.07-1.23); p < 0.001]. Compared to a decade ago, incidence of SAB has increased [IRR 1.28 (95% CI 1.21-1.36); p < 0.001] despite minimal change in nosocomial SAB. MRSA proportion did not change through the study (p = 0.3), but did increase relative to a decade ago (20.0% vs 11.0%, p < 0.001). Thirty-day mortality rates were 30.6% and 21.3% for MRSA and MSSA, respectively (p = 0.01), similar to rates from 2000 to 2006. Several clinical, demographic, and biochemical factors were independently associated with SAB mortality. CONCLUSIONS SAB is common within our population resulting in significant mortality. Incidence rates of SAB are increasing in our health region; however, 30-day mortality rates remain stable.
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Affiliation(s)
- John C Lam
- Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Daniel B Gregson
- Departments of Medicine and Pathology and Laboratory Medicine, Calgary Laboratory Services, Snyder Institute for Chronic Disease, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Stephen Robinson
- Department of Medicine, Dalhousie University, 5849 University Ave, Halifax, NS, B3H 4R2, Canada
| | - Ranjani Somayaji
- Departments of Medicine and Microbiology, Immunology and Infectious Diseases, Snyder Institute for Chronic Disease, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - John M Conly
- Departments of Medicine, Microbiology, Immunology and Infectious Diseases, Pathology and Laboratory Medicine, Snyder Institute for Chronic Disease, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Michael D Parkins
- Departments of Medicine and Microbiology, Immunology and Infectious Diseases, Snyder Institute for Chronic Disease, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
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Ray-Barruel G, Xu H, Marsh N, Cooke M, Rickard CM. Effectiveness of insertion and maintenance bundles in preventing peripheral intravenous catheter-related complications and bloodstream infection in hospital patients: A systematic review. Infect Dis Health 2019; 24:152-168. [PMID: 31005606 DOI: 10.1016/j.idh.2019.03.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/22/2019] [Accepted: 03/25/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Evidence-based bundles have reduced central line bloodstream infection rates in adult intensive care units. To tackle peripheral intravenous catheter (PIVC) bloodstream infection, many hospitals have implemented PIVC insertion and maintenance bundles. However, the efficacy of PIVC bundles in preventing PIVC complications and infection in hospital patients is uncertain. The aim of this paper is to synthesize evidence on the effectiveness of PIVC insertion and maintenance bundles on preventing adverse events. METHODS In this systematic review, we searched multiple electronic databases, trial registries, and grey literature for eligible studies published in English (January 2000-December 2018) to identify intervention studies evaluating PIVC insertion or maintenance bundles with two or more components. Search terms: peripheral intravenous catheter/cannula, insertion, maintenance, bundle, infection, infiltration, extravasation, dislodgement, thrombosis, occlusion, and phlebitis. Two reviewers independently conducted data extraction and quality assessments using the Downs and Black checklist. RESULTS Of 14,456 records screened, 13 studies (6 interrupted time-series, 7 before-and-after) were included. Insertion and maintenance bundles included multiple components (2-7 items per bundle). Despite testing different bundles, 12 studies reported reductions in phlebitis and bloodstream infection, and one study reported no change in bloodstream infection and an increase in phlebitis rate. Methodological quality of all studies ranked between 'low' and 'fair'. CONCLUSIONS The effect of PIVC bundles on PIVC complications and bloodstream infection rates remains uncertain. Standardisation of bundle components and more rigorous studies are needed. PROSPERO registration number: CRD42017075142.
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Affiliation(s)
- Gillian Ray-Barruel
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Nathan, Australia; School of Nursing and Midwifery, Griffith University, Nathan, 4111, Australia; QEII Jubilee Hospital, Coopers Plains, Queensland, 4108, Australia; Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia; Princess Alexandra Hospital, Woolloongabba, Queensland, 4102, Australia.
| | - Hui Xu
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Nathan, Australia; Logan Hospital, Meadowbrook, Queensland, 4131, Australia
| | - Nicole Marsh
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Nathan, Australia; School of Nursing and Midwifery, Griffith University, Nathan, 4111, Australia; Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Nathan, Australia; School of Nursing and Midwifery, Griffith University, Nathan, 4111, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Nathan, Australia; School of Nursing and Midwifery, Griffith University, Nathan, 4111, Australia; Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia; Princess Alexandra Hospital, Woolloongabba, Queensland, 4102, Australia
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Hebeisen UP, Atkinson A, Marschall J, Buetti N. Catheter-related bloodstream infections with coagulase-negative staphylococci: are antibiotics necessary if the catheter is removed? Antimicrob Resist Infect Control 2019; 8:21. [PMID: 30719282 PMCID: PMC6352346 DOI: 10.1186/s13756-019-0474-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 01/21/2019] [Indexed: 12/15/2022] Open
Abstract
Background Catheter-related bloodstream infections (CRBSI) with coagulase-negative Staphylococci (CoNS) are a common source of hospital-acquired bloodstream infections. The main objective of this study was to elucidate the role of systemic antibiotic therapy in the setting of catheter removal in adult patients with CoNS-CRBSI. Methods We conducted a retrospective cohort study on patients with CoNS-CRBSI diagnosed between 2008 and 2016 with follow-up for up to 12 months. The main inclusion criterion was a removed intravascular catheter with quantitative catheter tip culture growing CoNS and the same CoNS identified in the blood culture of a given patient. Outcomes were non-resolved infection (i.e. either presence of prolonged bacteremia or symptoms attributed to CoNS-CRBSI > 2 days after catheter removal), recurrence, mortality and length of hospitalization after catheter removal. We compared outcomes between a group with antibiotic treatment prescribed according to current IDSA guidelines (≥5 days, "treatment" group) and a "no-treatment" group. Results Our study population comprised 184 CoNS-CRBSI episodes. Seventy-six percent received antibiotic treatment ≥5 days, while 17% did not receive therapy. Non-resolved infections were absent from the patients who did not receive antibiotics. Severe neutropenia, hematologic cancer and immunosuppression were significantly more frequent in the treatment group. The subgroup analysis with 32 matched pairs showed no significant difference in frequency of non-resolved infection (0% in the no-treatment vs 15.6% in the ≥5 days treatment group, p = 0.06). The remaining outcomes were similar in the two groups. Conclusions Our findings indicate that withholding antimicrobial therapy in CoNS-CRBSI is neither associated with short-term complications nor with long-term recurrences.
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Affiliation(s)
- Ursula Patricia Hebeisen
- 1Department of Infectious Diseases, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Andrew Atkinson
- 1Department of Infectious Diseases, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland.,2Paediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
| | - Jonas Marschall
- 1Department of Infectious Diseases, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Niccolò Buetti
- 1Department of Infectious Diseases, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland
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Salgueiro-Oliveira ADS, Basto ML, Braga LM, Arreguy-Sena C, Melo MN, Parreira PMDSD. NURSING PRACTICES IN PERIPHERAL VENOUS CATHETER: PHLEBITIS AND PATIENT SAFETY. TEXTO & CONTEXTO ENFERMAGEM 2019. [DOI: 10.1590/1980-265x-tce-2018-0109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to understand the nursing practices related to peripheral venous catheter and to identify deviations related to the scientific evidence regarding the prevention of phlebitis. Method: qualitative study with data collection by means of participant observation techniques and semi-structured interviews, with 26 and 15 nurses, respectively, from a Portuguese hospital. Data content analysis was performed. Results: In the category “nursing actions”, nursing practices related to: selection of catheter insertion site and its caliber size, evaluation of insertion site for signs of inflammation, insertion site dressing, disinfection of accessories, hand hygiene and patient participation in care emerged. There were situations of deviations in these practices in relation to scientific evidence. Conclusion: Nursing practices presented deviations in relation to scientific evidence, and were influenced by the size of the institution, patient characteristics, and lack of knowledge of nurses regarding certain actions that pose a risk to patient safety. The creation of protocols and the implementation of continuous education are fundamental for the acquisition of competencies by nurses, for correcting deviations and providing a safe quality nursing care to the patient.
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Morales-Cartagena A, Fernández-Ruiz M, Lalueza A, Lora-Tamayo J, San Juan R, López-Medrano F, Origüen J, Chaves F, Aguado JM. Impact on mortality of adherence to evidence-based interventions in patients with catheter-related bloodstream infection due to methicillin-sensitive Staphylococcus aureus. Infect Dis (Lond) 2018; 50:837-846. [PMID: 30325676 DOI: 10.1080/23744235.2018.1501513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Recent studies have demonstrated improved survival when the management of Staphylococcus aureus bloodstream infection (BSI) is compliant with evidence-based therapeutic interventions. Whether this effect extends to low-risk sources, such as catheter-related BSI, remains unclear. METHODS We retrospectively included 225 episodes of methicillin-sensitive S. aureus catheter-related BSI diagnosed in our centre during two non-consecutive periods: 2002-2004 (first period (101 episodes)) and 2009-2013 (second period (124 episodes)). We evaluated the adherence (percentage of compliance = (no. of interventions performed/no. of interventions recommended) × 100) to the following bundle: early catheter removal (≤72 hours), early initiation of appropriate antibiotic therapy, adequate sampling of follow-up blood cultures, transthoracic echocardiography (TTE) during hospitalization and adequate duration of therapy. RESULTS Patients in the second period had a higher burden of comorbidities and more severe underlying conditions. All-cause 30-day mortality was 9.3%, with a significant difference between the first and second periods (13.9% versus 5.6%; p value = .035). Bundle adherence was significantly higher in the second period, particularly for follow-up blood cultures (26.7% versus 48.4%; p value = .001), performance of TTE (45.5% versus 84.7%; p value < .001) and appropriate duration of therapy (34.7% versus 50.0%; p value = .022). Bundle adherence ≥ 55% was associated with lower 30-day mortality (hazard ratio: 0.31; 95% confidence interval: 0.13-0.76). This effect remained significant across propensity score-based models adjusted for septic shock, study period and underlying conditions. CONCLUSIONS There was a survival benefit in adhering to a bundle of evidence-based interventions in the specific setting of catheter-related BSI due to methicillin-sensitive S. aureus.
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Affiliation(s)
- Alejandra Morales-Cartagena
- a School of Medicine , Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense , Madrid , Spain
| | - Mario Fernández-Ruiz
- a School of Medicine , Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense , Madrid , Spain
| | - Antonio Lalueza
- a School of Medicine , Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense , Madrid , Spain
| | - Jaime Lora-Tamayo
- a School of Medicine , Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense , Madrid , Spain
| | - Rafael San Juan
- a School of Medicine , Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense , Madrid , Spain
| | - Francisco López-Medrano
- a School of Medicine , Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense , Madrid , Spain
| | - Julia Origüen
- a School of Medicine , Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense , Madrid , Spain
| | - Fernando Chaves
- b Department of Microbiology, School of Medicine , Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense , Madrid , Spain
| | - José María Aguado
- a School of Medicine , Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense , Madrid , Spain
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Egerton-Warburton D, McAllan F, Ramanan R, Lim ZJ, Nagle D, Dendle C, Stuart R. Human factor-designed multimodal intervention reduces the rate of unused peripheral intravenous cannula insertion. Emerg Med Australas 2018; 31:372-377. [PMID: 30208510 DOI: 10.1111/1742-6723.13165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/21/2018] [Accepted: 07/26/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Our objective was to examine the impact of a human factor-designed multimodal intervention on the proportion of unused peripheral i.v. cannula (PIVC) insertion in our ED. METHODS A pre- and post-multimodal intervention retrospective cohort study was conducted using a structured electronic medical record review within a single adult tertiary ED in Australia. Pre-intervention data was collected 30 days prior to the multimodal intervention, with 30 day post-intervention data collected 3 months after the intervention commenced. The rates of PIVC inserted, the unused rate and the unused but appropriately inserted cannulas were the main outcome measures. RESULTS Intravenous cannula insertion rates decreased by 12.9% (95% confidence interval [CI] 12.19-13.61) between the pre-intervention (1413/4167 [33.9%]; 95% CI 32.5-35.4) and post-intervention cohort (928/4421 [21.0%]; 95% CI 19.8-22.2). An analysis of 754 cases (376 pre-intervention and 378 post-intervention) showed that 139 of 376 (37.0%; 95% CI 32.1-42.1) i.v. cannulas were unused pre-intervention, while 73 of 378 (19.3%; 95% CI 15.4-23.7) was unused post-intervention; an absolute reduction of 17.7% (95% CI 14.98-20.42). The relative risk of an unused i.v. cannula was 0.52 (95% CI 0.41-0.67). The proportion of unused but appropriately inserted i.v. cannulas remained unchanged in both cohorts, with a relative risk of 0.91 (95% CI 0.58-1.42). CONCLUSION Our multimodal intervention successfully reduced the number of unused PIVCs inserted in the ED, with a reduction in overall and unused PIVC insertions without any change in appropriate insertions.
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Affiliation(s)
- Diana Egerton-Warburton
- Emergency Department, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Fern McAllan
- Emergency Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Radha Ramanan
- Haematology Department, Austin Health, Melbourne, Victoria, Australia
| | - Zheng Jie Lim
- Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Daniel Nagle
- Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Claire Dendle
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Rhonda Stuart
- Monash Infectious Diseases, Monash Health, Melbourne, Victoria, Australia
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Blanco-Mavillard I, Bennasar-Veny M, De Pedro-Gómez JE, Moya-Suarez AB, Parra-Garcia G, Rodríguez-Calero MÁ, Castro-Sánchez E. Implementation of a knowledge mobilization model to prevent peripheral venous catheter-related adverse events: PREBACP study-a multicenter cluster-randomized trial protocol. Implement Sci 2018; 13:100. [PMID: 30045737 PMCID: PMC6060537 DOI: 10.1186/s13012-018-0792-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/03/2018] [Indexed: 11/17/2022] Open
Abstract
Background Peripheral venous catheters are the most commonly used invasive devices in hospitals worldwide. Patients can experience multiple adverse events during the insertion, maintenance, and management of these devices. Health professionals aim to resolve the challenges of care variability in the use of peripheral venous catheter through adherence to clinical practice guidelines. The aim of this cluster-randomized controlled trial is to determine the efficacy of a multimodal intervention on incidence of adverse events associated with the use of peripheral venous catheters in adult hospital patients. Additional aims are to analyze the fidelity of nurses and the relationship between contextual factors on the use of best available and the outcomes of the intervention. Methods Five public hospitals in the Spanish National Health System, with diverse profiles, including one university hospital and four second-level hospitals, will be included. In total, 20 hospitalization wards will be randomized for this study by ward to one of two groups. Those in the first group receive an intervention that lasts 12 months implementing evidence-based practice in healthcare related to peripheral catheters through a multimodal strategy, which will contain updated and poster protocols insertion, maintenance and removal of peripheral venous catheters, technologies applied to e-learning, feedback on the results, user and family information related to peripheral catheter, and facilitation of the best evidence by face-to-face training session. Primary outcome measures: Incidence of adverse events associated with the use of peripheral venous catheters is measured by assessing hospital records. Secondary outcome measures: Nurses’ adherence to clinical practice guidelines, clinical outcomes, and the cost of implementing the multimodal intervention. Discussion Clinical implementation is a complex, multifaceted phenomenon which requires a deep understanding of decision-making, knowledge mobilization, and sense making in routine clinical practice. Likewise, the inclusion of strategies that promote fidelity to recommendations through multicomponent and multimodal intervention must be encouraged. The use of a transfer model could counterbalance one of the greatest challenges for organizations, the evaluation of the impact of the implementation of evidence in the professional context through quality indicators associated with prevention and control of infections. Trial registration Current Controlled Trials ISRCTN10438530. Registered 20 March 2018.
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Affiliation(s)
| | - Miquel Bennasar-Veny
- Evidence, Lifestyles and Health Research Group, Research Institute of Health Sciences, Universitat de les Illes Balears, Palma, Spain
| | | | | | | | | | - Enrique Castro-Sánchez
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, UK
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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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Ray-Barruel G, Cooke M, Mitchell M, Chopra V, Rickard CM. Implementing the I-DECIDED clinical decision-making tool for peripheral intravenous catheter assessment and safe removal: protocol for an interrupted time-series study. BMJ Open 2018; 8:e021290. [PMID: 29866733 PMCID: PMC5988165 DOI: 10.1136/bmjopen-2017-021290] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/23/2018] [Accepted: 05/11/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Millions of acute care hospital patients need a peripheral intravenous catheter (PIVC) each year. However, up to half of PIVCs remain in situ when not being used, and 30%-50% of intravenous (IV) catheters develop complications or stop working before treatment is finished, requiring the insertion of a new device. Improved assessment could prompt timely removal of redundant catheters and prevent IV complications. This study aims to validate an evidence-based PIVC assessment and decision-making tool called I-DECIDED and evaluate the effect of implementing this tool into acute hospital clinical practice. METHODS AND ANALYSIS The protocol outlines a prospective, multicentre, mixed-methods study using an interrupted time-series (multiple measures preintervention and postintervention) implementation at three Australian hospitals between August 2017 and July 2018. The study will examine the effectiveness of the I-DECIDED assessment and decision-making tool in clinical practice on prompting timely PIVC removal and early detection of complications. Primary outcomes are prevalence of redundant PIVCs (defined as device in situ without a clear purpose), IV complications (occlusion, dislodgement, infiltration, extravasation and phlebitis) and substandard dressings (loose, lifting, moist or soiled); device utilisation ratios; and primary bloodstream infection rates. Secondary outcomes including staff barriers and enablers to PIVC assessment and removal, patient participation, documentation of PIVC assessment and decisions taken to continue or remove the PIVC will be recorded. Using the Promoting Action on Research Implementation in Health Services framework, we will undertake staff focus groups, bedside patient interviews and PIVC assessments and chart audits. Patients aged 18 years or more with a PIVC will be eligible for inclusion. ETHICS AND DISSEMINATION Ethical approval from Queensland Health (HREC/17/QPCH/47), Griffith University (Ref No. 2017/152) and St Vincent's Health and Aged Care Human Research and Ethics Committee (Ref No. 17/28). Results will be published. TRIAL REGISTRATION NUMBER ANZCTR: 12617000067370; Pre-results.
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Affiliation(s)
- Gillian Ray-Barruel
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Centre for Clinical Nursing, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Marion Mitchell
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Vineet Chopra
- Division of Hospital Medicine, Patient Safety Enhancement Program, Michigan Medicine and VA Ann Arbor Health System, Ann Arbor, Michigan, USA
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Centre for Clinical Nursing, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
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Lucet JC. Surveillance des infections associées aux soins en réanimation : simplifier pour progresser ? MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ray-Barruel G, Rickard CM. Helping nurses help PIVCs: decision aids for daily assessment and maintenance. ACTA ACUST UNITED AC 2018; 27:S12-S18. [DOI: 10.12968/bjon.2018.27.8.s12] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Gillian Ray-Barruel
- Research Fellow, Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Claire M Rickard
- Professor of Nursing, Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; Professor of Nursing, School of Nursing and Midwifery, Griffith University, Brisbane, Australia; Professor of Nursing, Division of Nursing, Midwifery and Social Work, University of Manchester, UK
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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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Russell CD, Morris AK. Preventing peripheral venous catheter-related Staphylococcus aureus bacteraemia. Br J Hosp Med (Lond) 2017; 78:666-667. [PMID: 29240506 DOI: 10.12968/hmed.2017.78.12.666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Clark D Russell
- Speciality Trainee in Infectious Diseases and Medical Microbiology, Regional Infectious Diseases Unit, Western General Hospital, Edinburgh EH4 2JP, and ECAT Clinical Lecturer, University of Edinburgh, Edinburgh
| | - A Keith Morris
- Consultant Microbiologist and Infection Prevention Doctor, Department of Clinical Microbiology and Infection Control, Victoria Hospital, Kirkcaldy, Fife
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Gallego-Muñoz C, Guerrero-Navarro N. Key points in the management of peripheral venous catheters. ENFERMERIA CLINICA 2017; 29:202-203. [PMID: 29154101 DOI: 10.1016/j.enfcli.2017.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/04/2017] [Accepted: 10/10/2017] [Indexed: 12/01/2022]
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Saliba P, Hornero A, Cuervo G, Grau I, Jimenez E, García D, Tubau F, Martínez-Sánchez JM, Carratalà J, Pujol M. Mortality risk factors among non-ICU patients with nosocomial vascular catheter-related bloodstream infections: a prospective cohort study. J Hosp Infect 2017; 99:48-54. [PMID: 29128346 DOI: 10.1016/j.jhin.2017.11.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/03/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Vascular catheter-related bloodstream infections (CRBSIs) are highly preventable hospital-acquired infections and a major threat to patient safety. While there is significant information regarding CRBSI outcome among intensive care unit (ICU) patients, data regarding non-ICU patients are scarce. AIM To determine the risk factors associated with 30-day mortality among non-ICU patients with nosocomial CRBSIs. METHODS Prospective cohort study of non-ICU patients with nosocomial CRBSIs in a tertiary care centre between January 2004 and December 2014. The primary outcome was 30-day mortality, defined as death from any cause within 30 days of CRBSI. Follow-up was performed 30 days after CRBSI onset. Time until death was the dependent variable in Cox regression analysis. FINDINGS In total, 546 cases of CRBSI were identified. The mean age of patients was 64.5 years [interquartile range (IQR) 55-75 years], 66% were male, and the mean Charlson score was 3.59 (IQR 2-5). Of the 546 cases, 58.4% resulted from central venous catheters and 41.6% from peripheral venous catheters. The causative agents were Gram-positive cocci (70.1% of cases), Gram-negative bacilli (31.1%) and Candida spp. (1%). Mortality within 30 days was 13.9%, with no significant changes over the study period. Independent risk factors for 30-day mortality were Charlson score ≥4 [hazard ratio (HR) 1.80, 95% confidence interval (CI) 1.19-2.73], Staphylococcus aureus infection (HR 2.67, 95% CI 1.61-4.43) and Candida spp. infection (HR 6.1, 95% CI 2.08-18.04). Age; area of admission; type, use and site of vascular catheter; and administration of appropriate empirical antibiotic treatment were not independent risk factors for 30-day mortality. CONCLUSION Nosocomial CRBSIs outside ICUs are associated with high risk of mortality, particularly among patients with a higher Charlson score and bloodstream infections caused by Staphylococcus aureus and Candida spp.
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Affiliation(s)
- P Saliba
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain; Universitat Internacional de Catalunya, Barcelona, Spain
| | - A Hornero
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - G Cuervo
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - I Grau
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - E Jimenez
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - D García
- Department of Microbiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - F Tubau
- Department of Microbiology, Hospital Universitari de Bellvitge, Barcelona, Spain; CIBER de Enfermedades Respiratorias, ISCIII, Madrid, Spain
| | | | - J Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - M Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain.
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Affiliation(s)
- Kevin Hugill
- Director of Nursing, Hamad Medical Corporation, Doha Qatar
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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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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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41
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Prävention von Infektionen, die von Gefäßkathetern ausgehen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:171-206. [DOI: 10.1007/s00103-016-2487-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Prävention von Infektionen, die von Gefäßkathetern ausgehen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:207-215. [DOI: 10.1007/s00103-016-2488-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Yagnik L, Graves A, Thong K. Plastic in patient study: Prospective audit of adherence to peripheral intravenous cannula monitoring and documentation guidelines, with the aim of reducing future rates of intravenous cannula-related complications. Am J Infect Control 2017; 45:34-38. [PMID: 27836388 DOI: 10.1016/j.ajic.2016.09.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 09/11/2016] [Accepted: 09/12/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Peripheral intravenous cannula (PIVC) insertion is a universal intervention for inpatients and is associated with multiple complications. Effective, simple, reproducible interventions specific to PIVC complication prevention are few and often extrapolated from central venous catheter complication prevention strategies. The objective of this study is to improve compliance with documentation and monitoring PIVC guidelines in the medical ward of a secondary care center. METHODS This study is a prospective run-in audit of adherence to PIVC documentation and monitoring guidelines between the dates of August 30-November 14, 2014, with data recollection from December 25, 2014-January 30, 2015, after intervention implementation. Three interventions were implemented. The Plastic in Patient (PIP) strip is a dedicated column on the journey board, identifying inpatients with PIVCs, prompting assessment of indication at daily multidisciplinary meetings. PIP row is a prompt in the medical admission proforma to review PIVC indication. PIP poster is a visual cue on PIVC trolleys highlighting PIVC management practices. RESULTS Baseline demographics were similar in the pre- and postintervention groups. Documentation significantly improved in the postintervention group (36.4 vs 50%, P = .025). Early identification of nonindicated PIVCs improved in the postintervention group (88.8% vs 97.1%, P = .018) and a trend toward a reduced PIVC-related early phlebitis rate (3.7% vs 0, P = .08). CONCLUSIONS Simple, cost-effective interventions result in improvements in adherence to practice guidelines. Our results suggest a trend toward reduction in phlebitis rates.
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Affiliation(s)
- Lokesh Yagnik
- Department of General Medicine, Rockingham General Hospital, Cooloongup, WA, Australia.
| | - Angela Graves
- Department of General Medicine, Rockingham General Hospital, Cooloongup, WA, Australia
| | - Ken Thong
- Department of General Medicine, Rockingham General Hospital, Cooloongup, WA, Australia
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Rhodes D, Cheng AC, McLellan S, Guerra P, Karanfilovska D, Aitchison S, Watson K, Bass P, Worth LJ. Reducing Staphylococcus aureus bloodstream infections associated with peripheral intravenous cannulae: successful implementation of a care bundle at a large Australian health service. J Hosp Infect 2016; 94:86-91. [PMID: 27346623 DOI: 10.1016/j.jhin.2016.05.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 05/31/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Healthcare-associated Staphylococcus aureus bacteraemia (HA-SAB) results in morbidity, mortality, and increased healthcare costs, and these infections are frequently regarded as preventable. AIM To implement a multi-modal prevention programme for improved processes regarding peripheral intravenous cannula (PIVC) insertion and maintenance, in order to reduce PIVC-associated HA-SAB events in a large Australian health service. METHODS Baseline clinical practice was evaluated for a 12-month pre-intervention period. Measures to reduce HA-SAB risk were introduced between January and September 2013: staff education, improved documentation (including phlebitis scoring), and availability of standardized equipment. Post-intervention auditing was performed during the 27 months following intervention. Baseline and post-intervention HA-SAB and PIVC-associated infection rates were compared. Interrupted time-series and Bayesian change-point analyses were applied to determine the impact of interventions and timing of change. FINDINGS Significantly improved documentation regarding PIVC insertion and management was observed in the post-intervention period, with fewer PIVCs left in situ for ≥4 days (2.6 vs 6.9%, P<0.05). During the baseline period a total of 68 HA-SAB events occurred [1.01/10,000 occupied bed-days (OBDs)] and 24 were PIVC-associated (35% of total, rate 0.39 per 10,000 OBDs). In the post-intervention period, a total of 83 HA-SAB events occurred (0.99 per 10,000 OBDs) and 12 were PIVC-associated (14.4% of total, rate 0.14 per 10,000 OBDs). PIVC-associated SAB rates were 63% lower in the post-intervention period compared to baseline (P=0.018) with a change point observed following full bundle implementation in October 2013. CONCLUSION A successful multi-modal hospital-wide campaign was introduced to reduce PIVC-associated SAB rates. Evaluation of cost-effectiveness and sustainability is required.
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Affiliation(s)
- D Rhodes
- Infection Prevention and Healthcare Epidemiology Unit, Department of Infectious Diseases, Alfred Health, Melbourne, VIC, Australia
| | - A C Cheng
- Infection Prevention and Healthcare Epidemiology Unit, Department of Infectious Diseases, Alfred Health, Melbourne, VIC, Australia; Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - S McLellan
- Infection Prevention and Healthcare Epidemiology Unit, Department of Infectious Diseases, Alfred Health, Melbourne, VIC, Australia
| | - P Guerra
- Infection Prevention and Healthcare Epidemiology Unit, Department of Infectious Diseases, Alfred Health, Melbourne, VIC, Australia
| | - D Karanfilovska
- Infection Prevention and Healthcare Epidemiology Unit, Department of Infectious Diseases, Alfred Health, Melbourne, VIC, Australia
| | - S Aitchison
- Infection Prevention and Healthcare Epidemiology Unit, Department of Infectious Diseases, Alfred Health, Melbourne, VIC, Australia
| | - K Watson
- Infection Prevention and Healthcare Epidemiology Unit, Department of Infectious Diseases, Alfred Health, Melbourne, VIC, Australia
| | - P Bass
- Infection Prevention and Healthcare Epidemiology Unit, Department of Infectious Diseases, Alfred Health, Melbourne, VIC, Australia
| | - L J Worth
- Infection Prevention and Healthcare Epidemiology Unit, Department of Infectious Diseases, Alfred Health, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.
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Riu M, Chiarello P, Terradas R, Sala M, Garcia-Alzorriz E, Castells X, Grau S, Cots F. Cost Attributable to Nosocomial Bacteremia. Analysis According to Microorganism and Antimicrobial Sensitivity in a University Hospital in Barcelona. PLoS One 2016; 11:e0153076. [PMID: 27055117 PMCID: PMC4824502 DOI: 10.1371/journal.pone.0153076] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 03/23/2016] [Indexed: 11/25/2022] Open
Abstract
AIM To calculate the incremental cost of nosocomial bacteremia caused by the most common organisms, classified by their antimicrobial susceptibility. METHODS We selected patients who developed nosocomial bacteremia caused by Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, or Pseudomonas aeruginosa. These microorganisms were analyzed because of their high prevalence and they frequently present multidrug resistance. A control group consisted of patients classified within the same all-patient refined-diagnosis related group without bacteremia. Our hospital has an established cost accounting system (full-costing) that uses activity-based criteria to analyze cost distribution. A logistic regression model was fitted to estimate the probability of developing bacteremia for each admission (propensity score) and was used for propensity score matching adjustment. Subsequently, the propensity score was included in an econometric model to adjust the incremental cost of patients who developed bacteremia, as well as differences in this cost, depending on whether the microorganism was multidrug-resistant or multidrug-sensitive. RESULTS A total of 571 admissions with bacteremia matched the inclusion criteria and 82,022 were included in the control group. The mean cost was € 25,891 for admissions with bacteremia and € 6,750 for those without bacteremia. The mean incremental cost was estimated at € 15,151 (CI, € 11,570 to € 18,733). Multidrug-resistant P. aeruginosa bacteremia had the highest mean incremental cost, € 44,709 (CI, € 34,559 to € 54,859). Antimicrobial-susceptible E. coli nosocomial bacteremia had the lowest mean incremental cost, € 10,481 (CI, € 8,752 to € 12,210). Despite their lower cost, episodes of antimicrobial-susceptible E. coli nosocomial bacteremia had a major impact due to their high frequency. CONCLUSIONS Adjustment of hospital cost according to the organism causing bacteremia and antibiotic sensitivity could improve prevention strategies and allow their prioritization according to their overall impact and costs. Infection reduction is a strategy to reduce resistance.
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Affiliation(s)
- Marta Riu
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Pietro Chiarello
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Roser Terradas
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- School of Nursing, Hospital del Mar, Barcelona, Spain
| | - Maria Sala
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Department of Epidemiology and Evaluation, Hospital del Mar, Barcelona, Spain
- Redissec (Red de Investigación en Servicios Sanitarios en enfermedades crónicas), Madrid, Spain
| | | | - Xavier Castells
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Department of Epidemiology and Evaluation, Hospital del Mar, Barcelona, Spain
- Redissec (Red de Investigación en Servicios Sanitarios en enfermedades crónicas), Madrid, Spain
| | - Santiago Grau
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Department of Pharmacy, Hospital del Mar, Barcelona, Spain
| | - Francesc Cots
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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High Incidence of Afebrile Bloodstream Infection Detected by Surveillance Blood Culture in Patients on Corticosteroid Therapy after Allogeneic Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2016; 22:371-377. [DOI: 10.1016/j.bbmt.2015.09.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 09/20/2015] [Indexed: 01/23/2023]
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Chopra V, Flanders SA, Saint S, Woller SC, O'Grady NP, Safdar N, Trerotola SO, Saran R, Moureau N, Wiseman S, Pittiruti M, Akl EA, Lee AY, Courey A, Swaminathan L, LeDonne J, Becker C, Krein SL, Bernstein SJ. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results From a Multispecialty Panel Using the RAND/UCLA Appropriateness Method. Ann Intern Med 2015; 163:S1-40. [PMID: 26369828 DOI: 10.7326/m15-0744] [Citation(s) in RCA: 329] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Use of peripherally inserted central catheters (PICCs) has grown substantially in recent years. Increasing use has led to the realization that PICCs are associated with important complications, including thrombosis and infection. Moreover, some PICCs may not be placed for clinically valid reasons. Defining appropriate indications for insertion, maintenance, and care of PICCs is thus important for patient safety. An international panel was convened that applied the RAND/UCLA Appropriateness Method to develop criteria for use of PICCs. After systematic reviews of the literature, scenarios related to PICC use, care, and maintenance were developed according to patient population (for example, general hospitalized, critically ill, cancer, kidney disease), indication for insertion (infusion of peripherally compatible infusates vs. vesicants), and duration of use (≤5 days, 6 to 14 days, 15 to 30 days, or ≥31 days). Within each scenario, appropriateness of PICC use was compared with that of other venous access devices. After review of 665 scenarios, 253 (38%) were rated as appropriate, 124 (19%) as neutral/uncertain, and 288 (43%) as inappropriate. For peripherally compatible infusions, PICC use was rated as inappropriate when the proposed duration of use was 5 or fewer days. Midline catheters and ultrasonography-guided peripheral intravenous catheters were preferred to PICCs for use between 6 and 14 days. In critically ill patients, nontunneled central venous catheters were preferred over PICCs when 14 or fewer days of use were likely. In patients with cancer, PICCs were rated as appropriate for irritant or vesicant infusion, regardless of duration. The panel of experts used a validated method to develop appropriate indications for PICC use across patient populations. These criteria can be used to improve care, inform quality improvement efforts, and advance the safety of medical patients.
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Affiliation(s)
- Vineet Chopra
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott A. Flanders
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Sanjay Saint
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott C. Woller
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Naomi P. O'Grady
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Nasia Safdar
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott O. Trerotola
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Rajiv Saran
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Nancy Moureau
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen Wiseman
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Mauro Pittiruti
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Elie A. Akl
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Agnes Y. Lee
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony Courey
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Lakshmi Swaminathan
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Jack LeDonne
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Carol Becker
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah L. Krein
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Steven J. Bernstein
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
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Marang-van de Mheen PJ, van Bodegom-Vos L. Meta-analysis of the central line bundle for preventing catheter-related infections: a case study in appraising the evidence in quality improvement. BMJ Qual Saf 2015; 25:118-29. [DOI: 10.1136/bmjqs-2014-003787] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 07/01/2015] [Indexed: 11/04/2022]
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Rodríguez-Pardo D, Almirante B, Fernández-Hidalgo N, Pigrau C, Ferrer C, Planes A, Alcaraz R, Burgos R, Pahissa A. Impact of prompt catheter withdrawal and adequate antimicrobial therapy on the prognosis of hospital-acquired parenteral nutrition catheter-related bacteraemia. Clin Microbiol Infect 2014; 20:1205-10. [DOI: 10.1111/1469-0691.12703] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 05/28/2014] [Accepted: 05/30/2014] [Indexed: 11/30/2022]
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Chopra V, Govindan S, Kuhn L, Ratz D, Sweis RF, Melin N, Thompson R, Tolan A, Barron J, Saint S. Do clinicians know which of their patients have central venous catheters?: a multicenter observational study. Ann Intern Med 2014; 161:562-7. [PMID: 25329204 PMCID: PMC4997807 DOI: 10.7326/m14-0703] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Complications associated with central venous catheters (CVCs) increase over time. Although early removal of unnecessary CVCs is important to prevent complications, the extent to which clinicians are aware that their patients have a CVC is unknown. OBJECTIVE To assess how often clinicians were unaware of the presence of triple-lumen catheters or peripherally inserted central catheters (PICCs) in hospitalized patients. DESIGN Multicenter, cross-sectional study. SETTING 3 academic medical centers in the United States. PATIENTS Hospitalized medical patients in intensive care unit (ICU) and non-ICU settings. MEASUREMENTS To ascertain awareness of CVCs, whether a PICC or triple-lumen catheter was present was determined; clinicians were then queried about device presence. Differences in device awareness among clinicians were assessed by chi-square tests. RESULTS 990 patients were evaluated, and 1881 clinician assessments were done. The overall prevalence of CVCs was 21.1% (n=209), of which 60.3% (126 of 209) were PICCs. A total of 21.2% (90 of 425) of clinicians interviewed were unaware of the presence of a CVC. Unawareness was greatest among patients with PICCs, where 25.1% (60 of 239) of clinicians were unaware of PICC presence. Teaching attendings and hospitalists were more frequently unaware of the presence of CVCs than interns and residents (25.8% and 30.5%, respectively, vs. 16.4%). Critical care physicians were more likely to be aware of CVC presence than general medicine physicians (12.6% vs. 26.2%; P=0.003). LIMITATIONS Awareness was determined at 1 point in time and was not linked to outcomes. Patient length of stay and indication for CVC were not recorded. CONCLUSION Clinicians are frequently unaware of the presence of PICCs and triple-lumen catheters in hospitalized patients. Further study of mechanisms that ensure that clinicians are aware of these devices so that they may assess their necessity seems warranted. PRIMARY FUNDING SOURCE None.
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