Teaming Up to Take Down Community-Acquired Bloodstream Infections: A Program Aimed at Educating and Training Nurses in the Community

Adult oncology patients' experiences of living with a central venous catheter: a systematic review and meta-synthesis

BACKGROUND

The incidence of cancer is increasing globally, and a greater number of patients will receive treatments though central vascular access devices (CVADs). Only a few qualitative studies describe the experience of adult oncology patients living with CVADs, and no systematic review of literature has been published on this topic. We therefore aimed to systematically synthesize the evidence of the qualitative studies on the experience of adult oncology patients with CVADs to report the implications of living with this device, and to inform healthcare professionals (HCPs) about problematic aspects of care for this population.

METHODS

A comprehensive literature review was conducted on PUBMED, MEDLINE, SCOPUS, COCHRANE, and WEB OF SCIENCE, and was updated on May 25, 2021. Nine studies fulfilled the inclusion criteria. The evidence was synthesized using the meta-aggregation approach proposed by the Joanna Briggs Institute.

RESULTS

Four themes emerged: During catheter implantation oncology patients typically experience reluctance, apprehension and acceptance; The nature of the information, knowledge transmission and HCPs' competence all influence the patient's confidence; How the presence of a catheter impacts the patient's daily life, their self-perception and their social behavior; The catheter is a symbol of disease, a friend that helps prevent problems, and its removal is perceived as physical and psychological liberation.

CONCLUSION

This systematic review evidenced some problematic aspects related to patient information, education and device management, and gaps in nursing skills on handling the device. The results of this review should be used as a framework for improvement interventions.

Standardize, Engage, and Collaborate: An Initiative to Reduce Community Acquired Central Line Blood Stream Infections Across the Continuum of Care

BACKGROUND

Community acquired blood stream infections (CA-CLABSI) are a major source of morbidity and mortality for pediatric patients. Many organizations discharge pediatric patients to home health agencies to care for central lines. To reduce the incidence of CA-CLABSIs requires a concentrated effort between hospitals and home health agencies. It is important for home health agencies to be accountable for the care and maintenance they provide to patients with central lines. Local Problem: At a large children's hospital, CA-CLABSI metrics and collaboration with home health agencies to reduce CACLABSI events lacked organizational standardization.

METHODS

An organizational committee was formed to establish standards of care for CA-CLABSI follow-up and reduction.

RESULTS

As a result of the committee's work, several best practices resulted including the creation of a CA-CLABSI resource booklet; a screening tool to identify contributing risks associated with a CA-CLABSI, and increased awareness of CA-CLABSIs. Since implementation of these best practices, the organization has seen a 30% reduction in the number of CA-CLABSIs. Standardization of CA-CLABSI efforts and proactive surveillance of central line care may lead to decreases in the number of CA-CLABSI events. Collaboration between service lines may identify siloed best practices that can be implemented organizationally that may have a large impact.

A Day in the Life of a CVAD

Patients are increasingly receiving therapy at home via central vascular access devices (CVADs). Limited data exist regarding patients' experiences with outpatient CVADs. This study characterized outpatient CVAD care via 14-day patient diaries. Information included location, frequency, and purpose of CVAD access episodes and who performed CVAD care. Across all patients, 77% of care was provided in the patient's home compared with other sites. Home care was provided via self-care (48%), by a family member/caregiver (25%), or by a nurse (27%). Flushing the device was the most frequent reason for device access (52%). An occlusion rate of 9.57 per 1000 device days was also noted. Further examination of CVAD maintenance and patient/care provider education is warranted.