1
|
Cobo-Sánchez JL, Blanco-Mavillard I, Pelayo-Alonso R, Mancebo-Salas N, Fernandez-Fernandez I, De Pedro-Gomez JE. Validity of a catheter exit site clinical assessment scale for the early detection of exit site infections in patients on haemodialysis with a central venous catheter: protocol for a multicentre validation study in Spain (EXITA Study). BMJ Open 2022; 12:e065724. [PMID: 36691132 PMCID: PMC9454082 DOI: 10.1136/bmjopen-2022-065724] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 06/15/2022] [Accepted: 07/18/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Haemodialysis patients with central venous catheter (HD-CVC) are at increased risk of exit site infections (ESIs) and catheter-related bloodstream infections, causing an increase of hospitalisation, morbidity and mortality rates. The main aim of the EXITA Study is to develop and validate an instrument for the early detection of HD-CVC ESIs. METHODS AND ANALYSIS EXITA is a multicentre prospective cohort study to validate the proposed instrument with a sample of 457 HD-CVCs: 92 in the ESI group and 365 in the non-ESI group. Sample size was calculated using Epidat V.4.2 software, with 95% and 90% expected sensitivity and specificity, respectively, an ESI incidence around 20% and 5%-10% precision range. During each haemodialysis session, the absence or presence of each item will be assessed by nurses. If any item is present, a microbiological study of pericatheter skin smears and/or exit site exudate will be carried out. HD-CVC ESI will be diagnosed when the pericatheter skin smears and/or exit site exudate culture are positive (≥15 CFU/mL by semiquantitative Maki's technique or ≥1000 CFU/mL by Cleri's technique). To validate the scale, a logistic regression analysis will be performed: the β coefficients of each of the signs/symptoms of the scale to be validated will be estimated. We will use logit function and calculate ESI probability=elogit ESI/1+elogit ESI. ETHICS AND DISSEMINATION The study has been approved by the Research Ethics Committee with Medical Products of Cantabria (approval code 2019.146). We will obtain informed consent from all participants before data collection. We will publish the study results in a peer-reviewed scientific journal.
Collapse
Affiliation(s)
- José Luis Cobo-Sánchez
- Nursing Quality, Training, Research, Development and Innovation Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
- Nursing Department, Escuela Universitaría de Enfermería Clínica Mompía-Universidad Católica Santa Teresa de Jesús de Ávila (UCAV), Mompía, Spain
| | - Ian Blanco-Mavillard
- Implementation, Research and Innovation Unit, Hospital de Manacor, Manacor, Spain
- Care, Chronicity and Evidence in Health Research Group (CurES), IdISBa, Palma de Mallorca, Spain
- Nursing and Physiotherapy Department, Balearic Islands University, Palma, Spain
| | - Raquel Pelayo-Alonso
- Nephrology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Noelia Mancebo-Salas
- Department of Nursing, Escuela Universitaria de Enfermería Cruz Roja Española, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Joan Ernest De Pedro-Gomez
- Care, Chronicity and Evidence in Health Research Group (CurES), IdISBa, Palma de Mallorca, Spain
- Nursing and Physiotherapy Department, Balearic Islands University, Palma, Spain
| |
Collapse
|
2
|
Berger S, Winchester K, Principe RB, Culverwell E. Prevalence of peripheral intravenous catheters and policy adherence: A point prevalence in a tertiary care university hospital. J Clin Nurs 2021; 31:2324-2330. [PMID: 34535927 DOI: 10.1111/jocn.16051] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/09/2021] [Accepted: 09/06/2021] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To determine prevalence and policy adherence for peripheral intravenous catheters (PIVC) in adult inpatients at a tertiary care university hospital (with about 83,000 inpatient admissions annually). BACKGROUND Up to 80% of hospitalised patients receive intravenous therapy, most commonly via PIVCs. However, these devices are not risk-free. Studies indicate that PIVC management standards in clinical practice are inadequate despite established policies promoting best practice. This leads to premature failure resulting in treatment delays, extended length of stay and potential compromised venous access for subsequent IV therapy. DESIGN Observational point prevalence study. METHODS Study undertaken on all adult acute care medical, surgical and oncology wards. Data were collected by senior registered nurses working in pairs on a single day. Descriptive statistics used to analyse data. SQUIRE 2.0 checklist for quality improvement reporting used. RESULTS There were 449 adult inpatients in 19 wards on survey day. One hundred and ninety-seven had one or more PIVCs in situ. The total number of PIVCs in-situ was 212. PIVC Prevalence was 47%. PIVCs were inserted in points of flexion such as antecubital fossa, back of hand or wrist in 52% of patients. Only 19% of cases had documented assessment of 8-hourly visual infusion phlebitis (VIP) score. Patients had local signs of phlebitis in 14.4% of cases. Patients were not aware of the reason/need for their PIVC in 44% of cases. CONCLUSIONS Discrepancies between evidence-based guidelines and local policy in clinical practice were identified including high rates of PIVC insertion in points of flexion and poor documentation. These quality problems increase likelihood of adverse patient outcomes especially when associated with limited patient awareness of the reason for their PIVC. RELEVANCE TO CLINICAL PRACTICE Poor adherence to best practice standards is 'accepted but unacceptable'. PIVC failure is costly to both patients and health systems. A strong focus on improvement in PIVC care and management is needed.
Collapse
Affiliation(s)
- Sarah Berger
- Infection Prevention and Control Service, Canterbury District Health Board, Christchurch, New Zealand.,Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
| | - Kerry Winchester
- Department of Medicine, Canterbury District Health Board, Christchurch, New Zealand
| | - Rommel B Principe
- Department of Medicine, Canterbury District Health Board, Christchurch, New Zealand
| | - Elizabeth Culverwell
- Department of Nursing, Canterbury District Health Board, Christchurch, New Zealand
| |
Collapse
|
3
|
Aghdassi SJS, Schröder C, Gruhl D, Gastmeier P, Salm F. Point prevalence survey of peripheral venous catheter usage in a large tertiary care university hospital in Germany. Antimicrob Resist Infect Control 2019; 8:15. [PMID: 30675342 PMCID: PMC6335674 DOI: 10.1186/s13756-019-0468-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/09/2019] [Indexed: 11/27/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Seven Johannes Sam Aghdassi
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany
- National Reference Center for the Surveillance of Nosocomial Infections, Berlin, Germany
| | - Christin Schröder
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany
- National Reference Center for the Surveillance of Nosocomial Infections, Berlin, Germany
| | - Désirée Gruhl
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany
- National Reference Center for the Surveillance of Nosocomial Infections, Berlin, Germany
| | - Petra Gastmeier
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany
- National Reference Center for the Surveillance of Nosocomial Infections, Berlin, Germany
| | - Florian Salm
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany
- National Reference Center for the Surveillance of Nosocomial Infections, Berlin, Germany
- Institute for Infection Prevention and Hospital Epidemiology, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| |
Collapse
|
4
|
Ullman AJ, Cooke M, Kleidon T, Rickard CM. Road map for improvement: Point prevalence audit and survey of central venous access devices in paediatric acute care. J Paediatr Child Health 2017; 53:123-130. [PMID: 27709723 DOI: 10.1111/jpc.13347] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/14/2016] [Accepted: 07/21/2016] [Indexed: 12/31/2022]
Abstract
AIM To identify the prevalence, management and complications associated with central venous access devices (CVADs) within Australian paediatric facilities, providing a map for clinicians, researchers and managers to focus solutions. METHODS A point prevalence audit and survey of CVAD practices in Australian tertiary paediatric hospitals between September and November 2015, using validated data collection tools. RESULTS Across the six sites, 1027 patients were screened with CVADs prevalent in 26.1% (n = 268), and 261 CVADs in 248 patients available for audit. Variations in management were evident with dressings not meeting the basic criteria of clean, dry and intact for 13.5% of CVADs (n = 35), and non-sterile dressings used to reinforce 26.4% of CVADs (n = 69). Almost half of CVADs (49.4%; n = 132) had no documentation regarding site assessment in the previous 4 h, and 13.4% had no planned use in the next 24 h (35 CVAD). CVAD-associated complications within the previous 7 days were evident in 9.5% of CVADs (n = 27), most commonly catheter blockage (5.7% CVAD, n = 15), and bloodstream infection (1.9% CVAD, n = 5). Peripherally inserted central catheters (16.9%) in comparison to other catheter types (7.4%; P = 0.04), and subsequent CVADs (14.1%) in comparison to initial CVADs (6.5%; P = 0.04), had significantly higher proportions of CVAD-associated complications in the previous 7 days. Variation between the sites' guidelines was evident across many practices. CONCLUSIONS CVADs are prevalent and essential for paediatric health care; however, complications remain a significant problem. Areas identified for improvement were local CVAD guidelines, regular documentation of CVAD site assessment and review of dressing products to improve integrity.
Collapse
Affiliation(s)
- Amanda J Ullman
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia.,NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Brisbane, Queensland, Australia.,Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, Queensland, Australia
| | - Marie Cooke
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia.,NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Brisbane, Queensland, Australia.,Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, Queensland, Australia
| | - Tricia Kleidon
- NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Brisbane, Queensland, Australia.,Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, Queensland, Australia.,Children's Health Queensland, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Claire M Rickard
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia.,NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Brisbane, Queensland, Australia.,Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
5
|
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]
|
6
|
Insertion of Peripheral Intravenous Cannulae in the Emergency Department: Factors Associated with First-time Insertion Success. J Vasc Access 2015; 17:182-90. [DOI: 10.5301/jva.5000487] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2015] [Indexed: 11/20/2022] Open
Abstract
Background We sought to identify the reasons for peripheral intravenous cannulae insertion in the emergency department (ED), and the first-time insertion success rate, along with patient and clinician factors influencing this phenomenon. Methods A prospective cohort study of patients requiring peripheral cannulae insertion in a tertiary ED. Clinical and clinician data were obtained. Results A total 734 peripheral intravenous cannula (PIVC) insertions were included in the study where 460 insertions were analysed. The first-time insertion success incidence was 86%. The antecubital fossa (ACF) site accounted for over 50% of insertions. Multivariate logistic regression modelling to predict first-time insertion success for patient factors found: age <40 versus 80+ years, emaciated versus normal patient size, having a visible or palpable vein/s, and ACF versus forearm insertion site to be statistically significant. Statistically significant clinician factors predicting success were: higher number of prior cannulation procedures performed, and increased clinician perception of the likelihood of a successful insertion. When patient and clinician factors were combined in a logistic regression model, emaciated versus normal, visible vein/s, ACF versus forearm site, higher number of prior PIVC procedures performed and increased clinician perceived likelihood of success were statistically associated with first-time insertion success. Conclusions Peripheral intravenous cannulation insertion success could be improved if performed by clinicians with greater procedural experience and increased perception of the likelihood of success. Some patient factors predict cannulation success: ‘normal’ body weight, visible vein/s and cubital fossa placement; venepuncture may be a cheaper alternative for others if intravenous therapy is not imperative.
Collapse
|
7
|
Russell E, Chan RJ, Marsh N, New K. A point prevalence study of cancer nursing practices for managing intravascular devices in an Australian tertiary cancer center. Eur J Oncol Nurs 2014; 18:231-5. [DOI: 10.1016/j.ejon.2013.11.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 11/18/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022]
|
8
|
Ray-Barruel G, Polit DF, Murfield JE, Rickard CM. Infusion phlebitis assessment measures: a systematic review. J Eval Clin Pract 2014; 20:191-202. [PMID: 24401116 PMCID: PMC4237185 DOI: 10.1111/jep.12107] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2013] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Phlebitis is a common and painful complication of peripheral intravenous cannulation. The aim of this review was to identify the measures used in infusion phlebitis assessment and evaluate evidence regarding their reliability, validity, responsiveness and feasibility. METHOD We conducted a systematic literature review of the Cochrane library, Ovid MEDLINE and EBSCO CINAHL until September 2013. All English-language studies (randomized controlled trials, prospective cohort and cross-sectional) that used an infusion phlebitis scale were retrieved and analysed to determine which symptoms were included in each scale and how these were measured. We evaluated studies that reported testing the psychometric properties of phlebitis assessment scales using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. RESULTS Infusion phlebitis was the primary outcome measure in 233 studies. Fifty-three (23%) of these provided no actual definition of phlebitis. Of the 180 studies that reported measuring phlebitis incidence and/or severity, 101 (56%) used a scale and 79 (44%) used a definition alone. We identified 71 different phlebitis assessment scales. Three scales had undergone some psychometric analyses, but no scale had been rigorously tested. CONCLUSION Many phlebitis scales exist, but none has been thoroughly validated for use in clinical practice. A lack of consensus on phlebitis measures has likely contributed to disparities in reported phlebitis incidence, precluding meaningful comparison of phlebitis rates.
Collapse
Affiliation(s)
- Gillian Ray-Barruel
- NHMRC Centre for Research Excellence in Nursing, Centre for Health Practice Innovation, Griffith Health Institute, Griffith UniversityBrisbane, Queensland, Australia
| | - Denise F Polit
- NHMRC Centre for Research Excellence in Nursing, Centre for Health Practice Innovation, Griffith Health Institute, Griffith UniversityBrisbane, Queensland, Australia
| | - Jenny E Murfield
- NHMRC Centre for Research Excellence in Nursing, Centre for Health Practice Innovation, Griffith Health Institute, Griffith UniversityBrisbane, Queensland, Australia
| | - Claire M Rickard
- NHMRC Centre for Research Excellence in Nursing, Centre for Health Practice Innovation, Griffith Health Institute, Griffith UniversityBrisbane, Queensland, Australia
| |
Collapse
|
9
|
New KA, Webster J, Marsh NM, Hewer B. Intravascular device use, management, documentation and complications: a point prevalence survey. AUST HEALTH REV 2014; 38:345-9. [DOI: 10.1071/ah13111] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 03/02/2014] [Indexed: 11/23/2022]
Abstract
Objective
To examine the use, management, documentation and complications for intravascular devices in cardiac, medical and surgical inpatients.
Methods
A point prevalence survey was undertaken in a large tertiary hospital in Queensland. Descriptive statistics were used to analyse data.
Results
Of the 327 patients assessed, 192 (58.7%) had one or more devices in situ. Of the 220 devices, 190 (86.4%) were peripheral venous catheters, 25 (11.4%) were peripherally inserted central catheters and five (2.3%) were central venous catheters. Sixty-two of 220 devices (28.2%) were in situ without a clear purpose, whereas 54 (24.7%) had one or more complications, such as redness, pain, tracking, oedema or oozing. There was no documentation on the daily patient care record to indicate that a site assessment had occurred within the past 8 h for 25% of the devices in situ.
Conclusions
The present study identified several problems and highlighted areas for improvement in the management and documentation for intravascular devices. Ongoing education, promoting good clinical practice and reauditing, can be applied to improve the management of devices.
What is known about the topic?
Intravascular devices are associated with health care-related infections, including rare but serious bloodstream infections Measures for reducing healthcare-associated infection related to devices include surveillance with feedback.
What does this paper add?
This paper complements other surveillance data undertaken in similar-sized institutions with similar patients. Ongoing surveillance and education is required to maintain best clinical practice and management of devices.
What are the implications for practitioners?
Health care-associated infections are a serious problem and have negative outcomes for both patients and organisations. Intravascular devices may be associated with bloodstream infections, so prudent clinical care and management of devices is important. All devices should be assessed at least daily for their continued need and removed promptly if no longer required.
Collapse
|
10
|
Flodgren G, Conterno LO, Mayhew A, Omar O, Pereira CR, Shepperd S. Interventions to improve professional adherence to guidelines for prevention of device-related infections. Cochrane Database Syst Rev 2013:CD006559. [PMID: 23543545 DOI: 10.1002/14651858.cd006559.pub2] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are a major threat to patient safety, and are associated with mortality rates varying from 5% to 35%. Important risk factors associated with HAIs are the use of invasive medical devices (e.g. central lines, urinary catheters and mechanical ventilators), and poor staff adherence to infection prevention practices during insertion and care for the devices when in place. There are specific risk profiles for each device, but in general, the breakdown of aseptic technique during insertion and care for the device, as well as the duration of device use, are important factors for the development of these serious and costly infections. OBJECTIVES To assess the effectiveness of different interventions, alone or in combination, which target healthcare professionals or healthcare organisations to improve professional adherence to infection control guidelines on device-related infection rates and measures of adherence. SEARCH METHODS We searched the following electronic databases for primary studies up to June 2012: the Cochrane Effective Paractice and Organisation of Care (EPOC) Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and CINAHL. We searched reference lists and contacted authors of included studies. We also searched the Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effectiveness (DARE) for related reviews. SELECTION CRITERIA We included randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA) studies and interrupted time series (ITS) studies that complied with the Cochrane EPOC Group methodological criteria, and that evaluated interventions to improve professional adherence to guidelines for the prevention of device-related infections. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risk of bias of each included study using the Cochrane EPOC 'Risk of bias' tool. We contacted authors of original papers to obtain missing information. MAIN RESULTS We included 13 studies: one cluster randomised controlled trial (CRCT) and 12 ITS studies, involving 40 hospitals, 51 intensive care units (ICUs), 27 wards, and more than 3504 patients and 1406 healthcare professionals. Six of the included studies targeted adherence to guidelines to prevent central line-associated blood stream infections (CLABSIs); another six studies targeted adherence to guidelines to prevent ventilator-associated pneumonia (VAP), and one study focused on interventions to improve urinary catheter practices. We judged all included studies to be at moderate or high risk of bias.The largest median effect on rates of VAP was found at nine months follow-up with a decrease of 7.36 (-10.82 to 3.14) cases per 1000 ventilator days (five studies and 15 sites). The one included cluster randomised controlled trial (CRCT) observed, improved urinary catheter practices five weeks after the intervention (absolute difference 12.2 percentage points), however, the statistical significance of this is unknown given a unit of analysis error. It is worth noting that N = 6 interventions that did result in significantly decreased infection rates involved more than one active intervention, which in some cases, was repeatedly administered over time, and further, that one intervention involving specialised oral care personnel showed the largest step change (-22.9 cases per 1000 ventilator days (standard error (SE) 4.0), and also the largest slope change (-6.45 cases per 1000 ventilator days (SE 1.42, P = 0.002)) among the included studies. We attempted to combine the results for studies targeting the same indwelling medical device (central line catheters or mechanical ventilators) and reporting the same outcomes (CLABSI and VAP rate) in two separate meta-analyses, but due to very high statistical heterogeneity among included studies (I(2) up to 97%), we did not retain these analyses. Six of the included studies reported post-intervention adherence scores ranging from 14% to 98%. The effect on rates of infection were mixed and the effect sizes were small, with the largest median effect for the change in level (interquartile range (IQR)) for the six CLABSI studies being observed at three months follow-up was a decrease of 0.6 (-2.74 to 0.28) cases per 1000 central line days (six studies and 36 sites). This change was not sustained over longer follow-up times. AUTHORS' CONCLUSIONS The low to very low quality of the evidence of studies included in this review provides insufficient evidence to determine with certainty which interventions are most effective in changing professional behaviour and in what contexts. However, interventions that may be worth further study are educational interventions involving more than one active element and that are repeatedly administered over time, and interventions employing specialised personnel, who are focused on an aspect of care that is supported by evidence e.g. dentists/dental auxiliaries performing oral care for VAP prevention.
Collapse
Affiliation(s)
- Gerd Flodgren
- Department of Public Health, University of Oxford, Oxford, UK.
| | | | | | | | | | | |
Collapse
|
11
|
Bhattacharya S, Mondal AS. Clinical microbiology in the intensive care unit: strategic and operational characteristics. Indian J Med Microbiol 2010; 28:5-10. [PMID: 20061755 DOI: 10.4103/0255-0857.58720] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Infection is a major cause of morbidity and mortality among patients admitted in intensive care units (ICUs). The application of the principles and the practice of Clinical Microbiology for ICU patients can significantly improve clinical outcome. The present article is aimed at summarising the strategic and operational characteristics of this unique field where medical microbiology attempts to venture into the domain of direct clinical care of critically ill patients. The close and strategic partnership between clinical microbiologists and intensive care specialists, which is essential for this model of patient care have been emphasized. The article includes discussions on a variety of common clinical-microbiological problems faced in the ICUs such as ventilator-associated pneumonia, blood stream infections, skin and soft tissue infection, UTI, infection control, besides antibiotic management.
Collapse
Affiliation(s)
- S Bhattacharya
- Department of Microbiology, West Suffolk Hospital NHS Trust, Bury St. Edmund, United Kingdom
| | | |
Collapse
|
12
|
Curran E, Reilly J. Optimising peripheral vascular catheter care offers the greatest potential for prevention of vascular-device-related infections. J Hosp Infect 2008; 69:307. [PMID: 18511149 DOI: 10.1016/j.jhin.2008.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Accepted: 04/04/2008] [Indexed: 10/22/2022]
|