Prävention von Infektionen, die von Gefäßkathetern ausgehen: Teil 2 - Periphervenöse Verweilkanülen und arterielle Katheter Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut

Compliance assessment regarding the PVC management on normal wards of a university hospital

Objective

The risk of peripheral venous catheter (PVC) infections in inpatients is often underestimated, even if it is lower than that for central venous catheters. Guidelines for the prevention of PVC-associated infections describe the evidence-based management of PVCs. The aims of this study were the development of standardized methods for compliance assessment regarding PVC management and the evaluation of self-reported knowledge and implementations among healthcare providers regarding PVC care.

Method

We developed a checklist based on the recommendation of the Commission of Hospital Hygiene and Infection Prevention at the Robert Koch Institute (KRINKO) Berlin for the standardized evaluation of PVC management. The following parameters were collected and evaluated: condition of the puncture site, condition of the bandage, presence of an extension set, presence of a plug, and documentation. The checklist was applied in 14 normal wards in 2019. After feedback of the ward staff on the results, it was applied again in 2020 in the same wards. For retrospective data analysis, we used a newly developed PVC-quality index. After the second evaluation in 2020, we carried out an anonymous survey among the healthcare providers.

Results

The evaluation of 627 indwelling PVCs showed a significant increase in compliance related to the presence of an extension set (p=0.049) and documentation (p<0.001) in the 2nd year. The quality index increased in 12 out of 14 wards. The participants of the survey were aware of the in-house standard "Prevention of vascular catheter-associated infections", with a mean score of 4.98 on a Likert scale (1=not aware, 7=completely aware). The main barrier to implementation of the preventive measures was the time factor. Survey participants were more aware of PVC placement than PVC care.

Conclusion

The PVC quality index is a valuable tool for the assessment of compliance regarding PVC management in daily practice. Feedback from the ward staff on the results of compliance assessment improves PVC management, but the outcome is very heterogeneous.

Phlebitis und Thrombose der Armvenen: Fallberichte aus der phlebologischen Sprechstunde

Phlebitiden und Thrombosen der Armvenen sind in der phlebologischen Sprechstunde eher selten. In dieser Fortbildung in Bildern werden 3 unterschiedliche Fälle mit Phlebitis und/oder Thrombose der Armvenen vorgestellt und kommentiert.

"Beyond the Guidelines" - Deviations in Adherence to Infection Control Measures in Tyrolean hospitals, Austria

BACKGROUND

Hospital-acquired infections (HAI) represent increasing problems in health-care facilities worldwide. Adequate infection control measures are key elements in preventing those infections. Expert societies have published recommendations that help to reduce HAI.

METHODS

In November 2019, a questionnaire-based point-prevalence survey, eliciting the adherence of 14 Tyrolean hospitals to the recommendations of the Centers of Disease Control and Prevention (CDC) was performed. Additionally, standard infection control measures performed by different medical (clinical and infection control specialists) disciplines as well as the performed infection control measures of nurses and physicians were compared.

RESULTS

The survey revealed varying adherence to CDC-recommendations of different medical disciplines, with highest congruence by the infection control specialists and lower congruencies by all surveyed clinical disciplines. Concordance rate between nurses and physicians was high.

DISCUSSION

Explanations for the varying congruencies of clinical disciplines on the one hand and the infection control specialists on the other hand may be versatile. Possible lacks of knowledge about the required hygiene measures should be taken into account.

CONCLUSION

The present survey showed moderate adherence of Tyrolean hospitals to the recommendations provided by CDC, however with noticeable differences between different medical disciplines. Nurses and doctors in most cases reported identically.

Deterioration in hygiene behavior among fifth-year medical students during the placement of intravenous catheters: a prospective cohort comparison of practical skills

BACKGROUND

The American Association of Medical Colleges has defined peripheral intravenous cannulation as one of the eight practical skills that a medical student should possess upon graduation. Since following a standard hygiene protocol can reduce the rate of complications such as bloodstream infections, the medical student's compliance to hygienic standards is highly relevant.

METHODS

This unicentric longitudinal cohort study included 177 medical students undergoing OSCE 1 in the winter semesters 2016/2017 and 2017/2018 as well as OSCE 2 during the winter semesters 2018/2019 and 2019/2020 at the University of Cologne. Their performance in peripheral intravenous cannulation was rated by trained student supervisors using a scaled 13-item questionnaire and compared between OSCE 1 and OSCE 2.

RESULTS

Overall, a decline in the correct placement of peripheral intravenous catheters was observed among advanced medical students during OSCE 2 (mean total score: 6.27 ± 1.84) in comparison to their results in OSCE 1 (mean total score: 7.67 ± 1.7). During OSCE 2, the students were more negligent in regard to hygienic behavior, such as disinfection of the puncture site as well as hand disinfection before and after venipuncture. Their patients were also less likely to be informed about the procedure as compared to OSCE 1.

CONCLUSIONS

An unsatisfying performance in regard to peripheral intravenous cannulation was observed in medical students with hygiene compliance deteriorating between the third and fifth year of their study. Thus, we promote an extension of practical hygiene and stress management training in medical school to reduce complications associated with intravenous catheters, such as bloodstream infections.

Manual der Arbeitsgruppe Interventionelle Kardiologie (AGIK) der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e. V. (DGK)

Dieses Manual zur diagnostischen Herzkatheteruntersuchung (Teil 1) ist eine Anwendungsempfehlung für interventionell tätige Ärzte, die den gegenwärtigen Kenntnisstand unter Berücksichtigung neuester Studienergebnisse wiedergibt. Hierzu wurde in den einzelnen Kapiteln speziell auf die Alltagstauglichkeit der Empfehlungen geachtet, sodass dieses Manual jedem interventionell tätigen Kardiologen als Entscheidungshilfe im Herzkatheterlabor dienen soll. Trotz der von vielen Experten eingebrachten praktischen Hinweise kann dieses Manual dennoch nicht die ärztliche Evaluation des individuellen Patienten ersetzen und damit eine Anpassung der Diagnostik bzw. Therapie ersetzen.

[Less is more… in infectious diseases]

BACKGROUND

The increasing development of antimicrobial resistance has been identified as one of the greatest threats to public health and is caused to a relevant extent by falsely indicated antibiotic treatment.

OBJECTIVE

The main aim of this article is to identify areas in infectious disease diagnostics and treatment where overuse occurs and to provide recommendations on how to avoid it.

MATERIAL AND METHODS

The authors identified current and relevant studies on the topic of medical overuse in infectious diseases via a literature search. In particular, contributions from international "less is more" initiatives were included. The focus was on areas in which a reduction of diagnostic and therapeutic measures leads to an optimization of patient outcomes.

RESULTS

In many cases overuse in the context of diagnostics and treatment of infectious diseases not only leads to an unnecessary financial burden on the healthcare system and is not beneficial but can also increase the risk of development of antimicrobial resistance and have adverse consequences for patients.

CONCLUSION

Correct indications as well as focused selection and adequate application of antimicrobial agents is crucial to provide the best possible medical care. Diagnostic and antibiotic stewardship measures, which should be implemented in collaboration with infectious disease specialists, can help to identify and reduce areas of overuse and misuse.

[Peripheral intravenous lines : A multifaceted topic]

Peripheral intravenous lines are indispensable for emergency and intensive medical care. They have a high importance, especially in the context of primary care as well as in the early stages of treatment initiation. This requires in-depth knowledge of the persons being treated. This article describes the most important aspects of the indications, puncture and fixation techniques as well as special features in terms of management and hygiene.

Management of peripheral venous catheters and implementation of guidelines in Germany: a national survey

BACKGROUND

Due to their frequent use, peripheral venous catheters (PVCs) are of importance in terms of catheter-related infections and their prevention. In 2017, revised national guidelines for the prevention of PVC-related infections were published in Germany.

AIM

To describe PVC handling practices and assess the implementation of national guidelines for the prevention of PVC-related infections in German acute care hospitals, 10 months after their release.

METHODS

An online survey on the management of PVCs in hospital wards was conducted. For this, 1191 acute care hospitals participating in the national surveillance system for healthcare-associated infections in Germany were invited to participate. Each hospital was asked to complete the survey for an intensive care unit (ICU), as well as a medical ward and a surgical ward. Participation in the survey was voluntary.

FINDINGS

In total, 701 hospitals (response rate 59%) participated and provided data on 1449 wards (599 ICUs, 446 medical wards, 404 surgical wards). Approximately 43% of wards reported that they had implemented the new national guidelines where necessary. Structured surveillance for PVC-associated infections was established in only 21% of wards. While 94% of wards reported the inclusion of aspects of PVC handling in their general infection prevention education, questions on the training methods yielded diverse results. Approximately 59% of wards reported that they did not routinely use a combination of alcohol and a remanant disinfectant for skin disinfection before PVC insertion.

CONCLUSION

Generally, PVC management in Germany is well organized. However, potential for improvement was identified, particularly considering surveillance and implementation of selected national guidelines.

[Postcardiac arrest treatment guide]

BACKGROUND

Treatment after cardiac arrest has become more complex and interdisciplinary over the last few years. Thus, the clinically active intensive and emergency care physician not only has to carry out the immediate care and acute diagnostics, but also has to prognosticate the neurological outcome.

AIM

The different, most important steps are presented by leading experts in the area, taking into account the interdisciplinarity and the currently valid guidelines.

MATERIALS AND METHODS

Attention was paid to a concise, practice-oriented presentation.

RESULTS AND DISCUSSION

The practical guide contains all important steps from the acute care to the neurological prognosis generation that are relevant for the clinically active intensive care physician.

Point prevalence survey of peripheral venous catheter usage in a large tertiary care university hospital in Germany

Background

Bloodstream infections (BSI) are among the most frequently documented healthcare-associated infections (HAI). Central and peripheral venous catheters (CVC and PVC) are relevant risk factors for BSI. Although the risk for BSI is higher for CVC, PVC are utilized more frequently and are therefore relevant in the context of HAI prevention. Robust data on the prevalence of PVC and associated infections in German hospitals are scarce to this date. The objectives of this survey were to estimate the prevalence of PVC and PVC-associated infections on peripheral wards of a large tertiary care hospital in Germany. The collected data may be utilized for a tailored infection prevention intervention in the future.

Methods

A point prevalence survey was conducted on peripheral wards of a tertiary care hospital with more than 3.000 beds. Data were collected between August 2017 and February 2018. Standardized data collection forms were used for collecting ward, patient and PVC-related data. As endpoints, prevalence of patients with PVC, PVC-associated infections and PVC without usage in the 24 h prior to the survey and without documentation of intended usage in the 24 h after the survey ("unused PVC") were chosen. For data analysis, Kruskal-Wallis test was employed for continuous variables and Chi-squared test or Fisher's exact test for categorical variables. Multivariable analysis and logistic regression were performed for the endpoint unused PVC.

Results

Data from 2.092 patients on 110 wards were collected. The overall prevalence of patients with PVC was 33%. Infections were recorded in 16 patients. Except one case of BSI, these were all local infections at the site of insertion. Of 725 documented PVC, 77 (11%) were unused PVC. Multivariate analysis and logistic regression revealed wards with the practice of regularly obtaining blood from PVC, PVC with dirty or loose insertion dressing, pediatric ward specialty and last inspection of the PVC more than 1 day ago as significant risk factors for unused PVC.

Conclusions

A substantial proportion of patients presented with a PVC on the day of survey. Too few infections were recorded to allow for more detailed analyses. Various risk factors for unused PVC were identified. We hereby present a solid method to obtain an overview about PVC use and to increase awareness for PVC-associated risks. The limitations of point prevalence surveys have to be recognized.