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Adžemović T, Govindan S, Zheutlin A, Horowitz J, Heath M, Kuhn L, Nabeel M, Kalra SK, Dhillon D, Kaatz S, Swaminathan L, Harba N, Chopra V. Awareness of peripheral IV catheters among nurses, physicians, and trainees: A prospective cohort study. Am J Infect Control 2024:S0196-6553(24)00532-7. [PMID: 38844143 DOI: 10.1016/j.ajic.2024.05.018] [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: 01/18/2024] [Revised: 05/24/2024] [Accepted: 05/25/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Peripheral intravenous catheters (PIVs) are the most frequently used invasive device in hospitalized patients. These devices are not benign and are associated with complications. However, clinician awareness of them is variable and poorly understood. METHODS We conducted a prospective, multicenter, observational point prevalence study to assess awareness of PIV presence among clinicians caring for hospitalized patients in 4 hospitals between May 2018 and February 2019 located in Michigan, USA. We first assessed patients for the presence of a PIV then interviewed their providers. Differences in awareness by provider type were assessed via χ² tests; P < .05 was considered statistically significant. Analyses were performed on Stata MP v16. RESULTS A total of 1,385 patients and 4,003 providers were interviewed. Nurses had the greatest awareness of overall PIV presence, 98.6%, while attendings were correct 88.1% of the time. Nurses were more likely to correctly assess PIV presence and exact location than physicians (67.7% vs <30% for all others). Awareness of PIV presence did not significantly vary in patients on contact precautions or those receiving infusions. CONCLUSIONS Given the ubiquity of PIVs and known complications, methods to increase awareness to ensure appropriate care and removal are necessary.
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Affiliation(s)
- Tessa Adžemović
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Sushant Govindan
- Department of Pulmonary and Critical Care Medicine, Kansas City VA Medical Center, Kansas City, KS
| | | | - Jennifer Horowitz
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Megan Heath
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Latoya Kuhn
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | | | - Smita K Kalra
- Division of Hospital Medicine, University of California Irvine School of Medicine, Orange, CA
| | - Dilshan Dhillon
- Division of Cardiology, Ascension St. John Hospital, Detroit, MI
| | - Scott Kaatz
- Division of Hospital Medicine, Henry Ford Health, Detroit, MI
| | | | - Nejla Harba
- University of Michigan School of Literature Sciences and the Arts, Ann Arbor, MI
| | - Vineet Chopra
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.
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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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Xu HG, Keogh S, Ullman AJ, Marsh N, Tobiano G, Rickard CM, Clark J, Griffin B. Implementation frameworks, strategies and outcomes used in peripheral intravenous catheter studies: A systematic review. J Clin Nurs 2023; 32:6706-6722. [PMID: 36970881 DOI: 10.1111/jocn.16671] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/28/2023] [Accepted: 02/17/2023] [Indexed: 03/29/2023]
Abstract
AIMS The aim of this study was to critically evaluate implementation frameworks, strategies and/or outcomes used to optimise peripheral intravenous catheter (PIVC) care and/or promote guideline adherence. BACKGROUND Although a considerable volume of research has investigated the effectiveness of PIVC interventions and treatments to promote performance and prevent harm, how to best implement this evidence into dynamic clinical settings and populations is not well understood. Implementation science is central to translating evidence-based knowledge to the bedside; however, there is a gap in identifying the best implementation framework, strategies and/or outcomes to optimise PIVC care and/or guideline adherence. DESIGN A systematic review. METHOD The review was conducted using innovative automation tools. Five databases and clinical trial registries were searched on 14 October 2021. Qualitative and quantitative PIVC intervention studies reporting implementation strategies were included in the review. Data were extracted independently by experienced researchers in pairs. The Mixed Method Appraisal tool was used to assess the quality of individual studies. Narrative synthesis was used to present the findings. The systematic review was reported following the PRISMA checklist. RESULTS Of 2189 references identified, 27 studies were included in the review. Implementation frameworks were used in 30% (n = 8) of studies, with most used during the preparation (n = 7, 26%) and delivery phase (n = 7, 26%) and then evaluation phase (n = 4, 15%). Multifaceted strategies were commonly adopted (n = 24, 89%) to promote PIVC care or study interventions which were clinician (n = 25, 93%) and patient-targeted (n = 15, 56%). The most commonly reported implementation outcomes were fidelity (n = 13, 48%) and adoption (n = 6, 22%). Most studies were scored as low quality (n = 18, 67%). CONCLUSION We call for researchers and clinicians to work together and use implementation science frameworks to guide study design, implementation and evaluation in future PIVC studies, to improve evidence translation and thereby improve patient outcomes.
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Affiliation(s)
- Hui Grace Xu
- NHMRC Centre of Research Excellence (CRE) in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Emergency Department, Queen Elizabeth II Jubilee Hospital, Queensland Health, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Samantha Keogh
- School of Nursing and Midwifery, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Amanda J Ullman
- NHMRC Centre of Research Excellence (CRE) in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Nicole Marsh
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Georgia Tobiano
- NHMRC CRE in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Claire M Rickard
- NHMRC Centre of Research Excellence (CRE) in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Bronwyn Griffin
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
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Hontoria-Alcoceba R, López-López C, Hontoria-Alcoceba V, Sánchez-Morgado AI. Implementation of Evidence-Based Practice in Peripheral Intravenous Catheter Care. J Nurs Care Qual 2023; 38:226-233. [PMID: 36727916 DOI: 10.1097/ncq.0000000000000688] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Inserting a peripheral intravenous (PIV) catheter is a common health care procedure; however, risks include phlebitis, extravasation, and accidental dislodgement. Using evidence-based practices (EBPs) can reduce these risks. PURPOSE The purpose of this study was to implement an evidence-based PIV catheter care bundle and a decision-making algorithm. METHODS A quasi-experimental study design was used. A care bundle and an evidence-based decision-making algorithm were implemented on a medical unit. Outcomes included length of PIV catheter dwell time, phlebitis and other complications, and health professionals' adherence to the interventions. RESULTS A total of 364 PIV catheters were assessed. PIV catheter dwell time decreased from 3.6 to 2.9 days ( P < .001), and phlebitis rates decreased from 14.8% to 4.9% ( P < .05). Health professionals' adherence increased from 84.3% to 91.8%. CONCLUSIONS Implementing EBPs can improve care provided to patients with PIV catheters.
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Affiliation(s)
- Rocío Hontoria-Alcoceba
- Internal Medicine Service (Mss R. Hontoria-Alcoceba and Sánchez-Morgado) and Emergency and Trauma Intensive Care Unit (Dr López-López), Hospital Universitario 12 de Octubre, Madrid, Spain; Researcher of Care Research Group (InveCuid), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (Dr López-López); Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain (Dr López-López); and Emergency Medical Service of Madrid SUMMA 112, Madrid, Spain (Ms V. Hontoria-Alcoceba)
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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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Zingg W, Barton A, Bitmead J, Eggimann P, Pujol M, Simon A, Tatzel J. Best practice in the use of peripheral venous catheters: A scoping review and expert consensus. Infect Prev Pract 2023; 5:100271. [PMID: 36910422 PMCID: PMC9995289 DOI: 10.1016/j.infpip.2023.100271] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 01/25/2023] [Indexed: 02/05/2023] Open
Abstract
Background Peripheral intravenous catheters (PIVCs) are the most commonly used invasive medical device in health care with an overall failure rate of 35-50%. Most complications are non-infectious, but local site and bloodstream infections can also occur. Even if PIVC-related infections are rare, the total number of affected patients and the preponderance of Staphylococcus aureus as related pathogen due to the frequent use of these devices are relevant arguments to implement preventive strategies. The aim of this document is to raise awareness that infections caused by PIVCs are a relevant problem that can be reduced by practice change. Methods A panel of experts discussed this topic based on evidence and proposed practice points by consensus. Discussion Despite published evidence-based guidelines, current practice concerning aseptic techniques during insertion and care of PIVCs often are substandard. These devices have become commonplace and tend to be perceived as safe. An overall lack of awareness about the true risks associated with the use of PIVCs results in limited surveillance and prevention efforts. Conclusion Successful insertion and maintenance bundles in central venous lines are a blueprint to the implementation of adapted bundle strategies in the prevention of PIVC-associated infections. There is a need for studies to specifically investigate infection prevention in PIVCs and to agree on effective and implementable bundles.
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Affiliation(s)
- Walter Zingg
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Andrew Barton
- Frimley Health NHS Foundation Trust, Frimley, United Kingdom
| | - James Bitmead
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Miquel Pujol
- University Hospital de Bellvitge, Barcelona, Spain.,CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Arne Simon
- Saarland University Clinic, Homburg, Germany
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Buchanan C, Burt A, Moureau N, Murray D, Nizum N. Registered Nurses' Association of Ontario (RNAO) best practice guideline on the assessment and management of vascular access devices. J Vasc Access 2023:11297298231169468. [PMID: 37125815 DOI: 10.1177/11297298231169468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
INTRODUCTION Vascular access is the most common invasive procedure performed in health care. This fundamental procedure must be performed in a safe and effective manner. Vascular access devices (VADs) are often the source of infections and other complications, yet there is a lack of clear guidance on VADs for health providers across different settings. A Best Practice Guideline (BPG) was developed by the Registered Nurses' Association of Ontario (RNAO) to provide evidence-based recommendations on the assessment and management of VADs. METHODS RNAO BPGs are based on systematic reviews of the literature following the GRADE approach. Experts on the topic of vascular access were selected to form a panel. Systematic reviews were conducted on six research areas: education, vascular access specialists, blood draws, daily review of peripheral VADs, visualization technologies, and pain management. A search for relevant research studies published in English limited to January 2013 was applied to eight databases. All studies were independently assessed for eligibility and risk of bias by two reviewers based on predetermined inclusion and exclusion criteria. The GRADE approach was used to determine certainty of the evidence. RESULTS Over 65,000 articles were screened related to the six priority research questions. Of these, 876 full-text publications were examined for relevance, with 174 articles designated to inform nine recommendations in the BPG on the subject areas of: comprehensive health teaching, practical education for health providers, blood draws, daily review of peripheral VADs, visualization technologies, and pain management. In June 2021, the RNAO published the BPG on vascular access, which included the recommendations and other supporting resources. CONCLUSION The vascular access BPG provides high quality guidance and updated recommendations, and can serve as a primary resource for health providers assessing and managing VADs.
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Affiliation(s)
| | - Amy Burt
- Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Nancy Moureau
- PICC Excellence, Hartwell, GA, USA; Griffith University, Brisbane, QLD
| | | | - Nafsin Nizum
- Registered Nurses' Association of Ontario, Toronto, ON, Canada
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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: 49] [Impact Index Per Article: 49.0] [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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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: 2] [Impact Index Per Article: 1.0] [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: 13] [Impact Index Per Article: 6.5] [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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Loftus MJ, Young-Sharma TE, Wati S, Badoordeen GZ, Blakeway LV, Byers SM, Cheng AC, Jenney AW, Naidu R, Prasad A, Prasad V, Tudravu L, Vakatawa T, van Gorp E, Wisniewski JA, Rafai E, Stewardson AJ, Peleg AY. Epidemiology, antimicrobial resistance and outcomes of Staphylococcus aureus bacteraemia in a tertiary hospital in Fiji: A prospective cohort study. THE LANCET REGIONAL HEALTH - WESTERN PACIFIC 2022; 22:100438. [PMID: 35373162 PMCID: PMC8969155 DOI: 10.1016/j.lanwpc.2022.100438] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
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13
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Ruegg L, Faucett M, Clawson A, Subedi S. Reducing the prevalence of antecubital fossa peripheral intravenous cannulation. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S8-S14. [PMID: 35094536 DOI: 10.12968/bjon.2022.31.2.s8] [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: 06/14/2023]
Abstract
UNLABELLED Observational studies have found that placement of peripheral intravenous cannulas (PIVCs) in the antecubital fossa (ACF) is associated with increased risks of infection, including healthcare-associated Staphylococcus aureus bacteraemia (HA-SAB). Avoiding placement of the PIVC in the ACF area along with other preventive measures such as aseptic technique, staff education on documentation, standardised insertion packs and alerts for timely removal, may reduce the overall risk of acquiring an HA-SAB. AIM To implement a multimodal awareness programme on ACF cannulas and the risk of infection, and to reduce PIVC-associated HA-SAB in one hospital in Australia. METHOD The authors performed a baseline digital survey to identify root causes for clinical decision making related to PIVCs and to raise awareness of the project. The authors performed weekly audits and provided feedback on four key wards over 12 weeks. Simple linear regression was used to look at the trend of ACF cannulation rates over time. HA-SAB rates were calculated per 10 000 occupied bed days. FINDINGS Improved insertion documentation was observed during the intervention period. The ACF cannulation rates decreased by 0.03% per day during the study, although this did not quite reach statistical significance (P=0.06). There were no PIVC-associated SAB events during the intervention period. The SAB rates decreased by 0.02% per day over the period of the study.
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Affiliation(s)
- Leanne Ruegg
- Clinical Nurse Consultant, Vascular Access Surveillance and Education, Department of Infectious Diseases, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Mark Faucett
- Clinical Nurse, Vascular Access Surveillance and Education, Department of Infectious Diseases, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Andrew Clawson
- Resident Medical Officer, Department of Emergency Medicine, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Shradha Subedi
- Infectious Diseases Physician, Department of Infectious Diseases, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
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Shadbolt R, We MLS, Kohan R, Porter M, Athalye-Jape G, Nathan E, Shrestha D, Strunk T. Neonatal Staphylococcus Aureus Sepsis: a 20-year Western Australian experience. J Perinatol 2022; 42:1440-1445. [PMID: 35752689 PMCID: PMC9616716 DOI: 10.1038/s41372-022-01440-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose of this study was to characterise neonatal Staphylococcus aureus (SA) sepsis in Western Australia (WA) between 2001 and 2020 at the sole tertiary neonatal intensive care unit (NICU), examine risk factors for sepsis in the cohort, and compare short- and long-term outcomes to control infants without any sepsis. METHODS Retrospective cohort study at the Neonatal Directorate at King Edward Memorial Hospital (KEMH) and Perth Children's Hospital, using electronic databases and patient medical records. RESULTS The overall incidence of SA sepsis was 0.10 per 1000 live births (62/614207). From 2001 to 2010 the incidence was 0.13/1000 live births, reducing to 0.07/1000 live births from 2011 to 2020. SA was most frequently isolated from endotracheal aspirates, and infants with SA sepsis had longer median duration of ventilatory support than those without any sepsis (31 days vs 18 days respectively, p < 0.001). In our cohort, SA sepsis was associated with worse neurodevelopmental outcomes compared to infants without any sepsis. CONCLUSIONS The incidence of neonatal SA sepsis has reduced over the last 20 years, suggesting potential effectiveness of the preventative interventions implemented. Endotracheal tube (ETT) colonisation and prolonged ventilation may be under-recognised as potential sources of SA infection. Our study suggests SA sepsis may negatively impact neurodevelopmental outcomes.
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Affiliation(s)
- Rachel Shadbolt
- grid.1012.20000 0004 1936 7910Medical School, University of Western Australia, Perth, WA Australia
| | - Michael Lee Shee We
- grid.1012.20000 0004 1936 7910Medical School, University of Western Australia, Perth, WA Australia
| | - Rolland Kohan
- Centre for Neonatal Research and Education and Division of Paediatrics, Medical School, University of Western Australia, Perth, WA, Australia. .,Telethon Kids Institute, Perth, WA, Australia. .,Neonatal Directorate, Child and Adolescent Health Service, Perth, WA, Australia.
| | - Michelle Porter
- grid.2824.c0000 0004 0589 6117Microbiology Department, PathWest Laboratories, Perth, WA Australia
| | - Gayatri Athalye-Jape
- grid.1012.20000 0004 1936 7910Centre for Neonatal Research and Education and Division of Paediatrics, Medical School, University of Western Australia, Perth, WA Australia ,grid.414659.b0000 0000 8828 1230Telethon Kids Institute, Perth, WA Australia ,Neonatal Directorate, Child and Adolescent Health Service, Perth, WA Australia
| | - Elizabeth Nathan
- grid.415259.e0000 0004 0625 8678Division of Obstetrics and Gynaecology, University of Western Australia and the Women and Infants Research Foundation, King Edward Memorial Hospital, Perth, WA Australia
| | - Damber Shrestha
- Neonatal Directorate, Child and Adolescent Health Service, Perth, WA Australia
| | - Tobias Strunk
- grid.1012.20000 0004 1936 7910Centre for Neonatal Research and Education and Division of Paediatrics, Medical School, University of Western Australia, Perth, WA Australia ,grid.414659.b0000 0000 8828 1230Telethon Kids Institute, Perth, WA Australia ,Neonatal Directorate, Child and Adolescent Health Service, Perth, WA Australia
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Abstract
TOPIC This article presents an overview of the burden of peripheral intravenous catheter infections and current evidence-based recommendations for prevention. CLINICAL RELEVANCE Peripheral intravenous catheters are ubiquitous in most health care settings, fostering an acceptance of the peripheral intravenous catheter as benign and inevitable. This device, however, is far from benign, with reported failure rates as high as 90% from complications such as infection and phlebitis. Although reported rates of bloodstream infection related to peripheral intravenous catheters are much lower than those attributed to central venous catheters, the exponentially higher use of peripheral intravenous catheters indicates that the absolute number of peripheral venous catheter-related bloodstream infections is likely as high as and may surpass the number of central venous catheter-related bloodstream infections, with significant associated morbidity and mortality. PURPOSE OF PAPER Sustained improvements in outcomes related to peripheral intravenous catheters will depend on recognition of the root causes of failure and increased commitment to practice patterns consistent with infusion therapy standards of practice, effective education about peripheral intravenous catheters, accurate documentation of all aspects of peripheral intravenous catheter management, and consistent surveillance of patient outcomes related to peripheral intravenous catheters. CONTENT COVERED This article reviews the significant burden of peripheral intravenous catheter infections, barriers to effective peripheral intravenous catheter management, and current evidence-based recommendations to prevent this source of patient harm.
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Affiliation(s)
- Barb Nickel
- Barb Nickel is the critical care clinical nurse specialist for CHI Health St. Francis, Grand Island, Nebraska. She is a member of the Infusion Nurses Society Standards of Practice Committee
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16
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Bhatt CR, Meek R, Martin C, Stuart RL, Lim Z, Bumpstead S, Egerton‐Warburton D. Effect of multimodal interventions on peripheral intravenous catheter-associated Staphylococcus aureus bacteremia and insertion rates: An interrupted time-series analysis. Acad Emerg Med 2021; 28:909-912. [PMID: 33529465 DOI: 10.1111/acem.14225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/24/2021] [Accepted: 01/28/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Chhavi R. Bhatt
- School of Clinical Sciences at Monash Health Monash University Clayton Victoria Australia
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Robert Meek
- School of Clinical Sciences at Monash Health Monash University Clayton Victoria Australia
- Department of Emergency Medicine Monash Health Clayton Victoria Australia
| | - Catherine Martin
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Rhonda L. Stuart
- School of Clinical Sciences at Monash Health Monash University Clayton Victoria Australia
- Monash Infectious Diseases Monash Health Clayton Victoria Australia
| | - Zhengjie Lim
- Department of Anaesthesia Austin Hospital Heidelberg Victoria Australia
| | - Suzanne Bumpstead
- School of Clinical Sciences at Monash Health Monash University Clayton Victoria Australia
- Department of Emergency Medicine Monash Health Clayton Victoria Australia
| | - Diana Egerton‐Warburton
- School of Clinical Sciences at Monash Health Monash University Clayton Victoria Australia
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
- Department of Emergency Medicine Monash Health Clayton Victoria Australia
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17
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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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Hategeka C, Ruton H, Karamouzian M, Lynd LD, Law MR. Use of interrupted time series methods in the evaluation of health system quality improvement interventions: a methodological systematic review. BMJ Glob Health 2020; 5:e003567. [PMID: 33055094 PMCID: PMC7559052 DOI: 10.1136/bmjgh-2020-003567] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND When randomisation is not possible, interrupted time series (ITS) design has increasingly been advocated as a more robust design to evaluating health system quality improvement (QI) interventions given its ability to control for common biases in healthcare QI. However, there is a potential risk of producing misleading results when this rather robust design is not used appropriately. We performed a methodological systematic review of the literature to investigate the extent to which the use of ITS has followed best practice standards and recommendations in the evaluation of QI interventions. METHODS We searched multiple databases from inception to June 2018 to identify QI intervention studies that were evaluated using ITS. There was no restriction on date, language and participants. Data were synthesised narratively using appropriate descriptive statistics. The risk of bias for ITS studies was assessed using the Cochrane Effective Practice and Organisation of Care standard criteria. The systematic review protocol was registered in PROSPERO (registration number: CRD42018094427). RESULTS Of 4061 potential studies and 2028 unique records screened for inclusion, 120 eligible studies assessed eight QI strategies and were from 25 countries. Most studies were published since 2010 (86.7%), reported data using monthly interval (71.4%), used ITS without a control (81%) and modelled data using segmented regression (62.5%). Autocorrelation was considered in 55% of studies, seasonality in 20.8% and non-stationarity in 8.3%. Only 49.2% of studies specified the ITS impact model. The risk of bias was high or very high in 72.5% of included studies and did not change significantly over time. CONCLUSIONS The use of ITS in the evaluation of health system QI interventions has increased considerably over the past decade. However, variations in methodological considerations and reporting of ITS in QI remain a concern, warranting a need to develop and reinforce formal reporting guidelines to improve its application in the evaluation of health system QI interventions.
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Affiliation(s)
- Celestin Hategeka
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Hinda Ruton
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- School of Public Health, University of Rwanda, Kigali, Rwanda
| | - Mohammad Karamouzian
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- HIV/STI Surveillance Research Centre, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcome Sciences, Providence Health Research Institute, Vancouver, British Columbia, Canada
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
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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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Nickel B. Peripheral Intravenous Administration of High-Risk Infusions in Critical Care: A Risk-Benefit Analysis. Crit Care Nurse 2020; 39:16-28. [PMID: 31961938 DOI: 10.4037/ccn2019443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
In critical care, the short peripheral intravenous catheter is an essential venous access route, often used in emergency situations to administer high-risk medications and fluid resuscitation. This route of administration is generally viewed as routine and benign. However, a growing body of evidence indicates that the risks inherent to this route are much higher than reported and represent a significant area of patient harm. Few standardized definitions and surveillance methods exist for peripheral intravenous catheter-related complications such as phlebitis, bloodstream infection, and extravasation. Recommendations for peripheral intravenous catheter replacement are based on clinical indications rather than routine replacement, so standards of practice for catheter insertion and management must be consistently applied. This article reviews recent studies that challenge the need for central catheter placement for vasopressor therapy, current knowledge of peripheral intravenous catheter-related adverse events, and evidence-based standards of care for short peripheral intravenous catheter insertion and maintenance.
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Affiliation(s)
- Barb Nickel
- Barb Nickel is the critical care clinical nurse specialist for CHI Health St. Francis, Grand Island, Nebraska. She is a member of the Infusion Nurses Society Standards of Practice Committee
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21
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Peripheral Venipuncture Education Strategies for Nursing Students: An Integrative Literature Review. JOURNAL OF INFUSION NURSING 2020; 43:24-32. [PMID: 31876771 DOI: 10.1097/nan.0000000000000351] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This integrative literature review identified strategies to teach peripheral venipuncture to nursing students. The following databases were searched for primary studies: Biblioteca Virtual em Saúde (BVS), PubMed, Web of Science, Education Resources Information Center (ERIC), SCOPUS, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The final sample was composed of 24 studies. The literature ranged from descriptive studies to controlled clinical trials and methodologic studies to construct products/instruments for teaching peripheral venipuncture. The most frequently identified teaching strategies were theoretical contents taught via theoretical lecture, e-learning courses, video lessons, and demonstration by specialists combined with practical exercises using a mannequin, human arms, and/or haptic devices. Despite the different methods used currently, the best patient outcomes were achieved when the student received the theoretical content in an educational setting before the practical training on a mannequin and/or a virtual simulator.
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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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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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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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25
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Incidence of peripheral intravenous catheter failure and complications in paediatric patients: Systematic review and meta analysis. Int J Nurs Stud 2020; 102:103488. [DOI: 10.1016/j.ijnurstu.2019.103488] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 10/28/2019] [Accepted: 11/18/2019] [Indexed: 11/22/2022]
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26
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Li Q, Li R, Zhang H, Chen T, Cao Y, Deng P, Ruan S, Lin C, Chen N. ERAS Optimization of Cluster Intervention Strategies in Perioperative Period of Acute Stanford Type A Aortic Dissection. Health (London) 2020. [DOI: 10.4236/health.2020.1211106] [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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27
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Høvik LH, Gjeilo KH, Lydersen S, Rickard CM, Røtvold B, Damås JK, Solligård E, Gustad LT. Monitoring quality of care for peripheral intravenous catheters; feasibility and reliability of the peripheral intravenous catheters mini questionnaire (PIVC-miniQ). BMC Health Serv Res 2019; 19:636. [PMID: 31488150 PMCID: PMC6729030 DOI: 10.1186/s12913-019-4497-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/30/2019] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) account for a mean of 38% of catheter associated bloodstream infections (CABSI) with Staphylococcus aureus, which are preventable if deficiencies in best practice are addressed. There exists no feasible and reliable quality surveillance tool assessing all important areas related to PIVC quality. Thus, we aimed to develop and test feasibility and reliability for an efficient quality assessment tool of overall PIVC quality. METHODS The Peripheral Intravenous Catheter- mini Questionnaire, PIVC-miniQ, consists of 16 items calculated as a sum score of problems regarding the insertion site, condition of dressing and equipment, documentation, and indication for use. In addition, it contains background variables like PIVC site, size and insertion environment. Two hospitals tested the PIVC-miniQ for feasibility and inter-rater agreement. Each PIVC was assessed twice, 2-5 min apart by two independent raters. We calculated the intraclass correlation coefficient (ICC) for each hospital and overall. For each of the 16 items, we calculated negative agreement, positive agreement, absolute agreement, and Scott's pi. RESULTS Sixty-three raters evaluated 205 PIVCs in 177 patients, each PIVC was assessed twice by independent raters, in total 410 PIVC observations. ICC between raters was 0.678 for hospital A, 0.577 for hospital B, and 0.604 for the pooled data. Mean time for the bedside assessment of each PIVC was 1.40 (SD 0.0007) minutes. The most frequent insertion site symptom was "pain and tenderness" (14.4%), whereas the most prevalent overall problem was lack of documentation of the PIVC (26.8%). Up to 50% of PIVCs were placed near joints (wrist or antecubital fossae) or were inserted under suboptimal conditions, i.e. emergency department or ambulance. CONCLUSIONS Our study highlights the need for PIVC quality surveillance on ward and hospital level and reports the PIVC-miniQ to be a reliable and time efficient tool suitable for frequent point-prevalence audits.
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Affiliation(s)
- Lise Husby Høvik
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Postbox 8905, 7491, Trondheim, Norway. .,Gemini Center for Sepsis Research, St. Olavs Hospital and Norwegian University of Science and Technology (NTNU), Trondheim, Norway. .,Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim, Norway.
| | - Kari Hanne Gjeilo
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Postbox 8905, 7491, Trondheim, Norway.,Department of Cardiothoracic Surgery, Department of Cardiology and National Competence Centre for Complex Symptom Disorders, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Claire M Rickard
- Alliance for Vascular Access teaching and Research, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Benedikte Røtvold
- Department of Anesthesia, Levanger Hospital, Clinic of Surgery, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Jan Kristian Damås
- Gemini Center for Sepsis Research, St. Olavs Hospital and Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Centre of Molecular Inflammation Research, Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway.,Department of Infectious Diseases, St. Olavs Hospital, Trondheim, Norway
| | - Erik Solligård
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Postbox 8905, 7491, Trondheim, Norway.,Gemini Center for Sepsis Research, St. Olavs Hospital and Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim, Norway
| | - Lise Tuset Gustad
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Postbox 8905, 7491, Trondheim, Norway.,Gemini Center for Sepsis Research, St. Olavs Hospital and Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Medicine, Levanger Hospital, Clinic of Medicine and rehabilitation, Nord-Trøndelag Hospital Trust, Levanger, Norway
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28
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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: 25] [Impact Index Per Article: 5.0] [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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29
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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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30
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Blauw M, Foxman B, Wu J, Rey J, Kothari N, Malani AN. Risk Factors and Outcomes Associated With Hospital-Onset Peripheral Intravenous Catheter-Associated Staphylococcus aureus Bacteremia. Open Forum Infect Dis 2019; 6:ofz111. [PMID: 30949543 PMCID: PMC6441569 DOI: 10.1093/ofid/ofz111] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/27/2019] [Indexed: 11/13/2022] Open
Abstract
Background Peripheral venous catheters (PVCs) are common in hospitals, but the literature surrounding PVC-associated bacteremia is lacking. We describe incidence rates, risk factors, and outcomes related to PVC-associated Staphylococcus aureus bacteremia (SAB), a common cause of hospital-onset (HO) SAB. Methods This is a retrospective case–control study conducted at a 537-bed teaching community hospital during 2015–2016. Cases were adult inpatients with HO SAB with infectious diseases documentation of the PVC as the only source of bacteremia. Cases were matched 1:2 with controls on approximate PVC insertion date, age, mortality prediction score, and insurance type. Odds ratios (ORs) were estimated using conditional logistic regression. PVC utilization was estimated by a point-prevalence survey from July 2017. Results Of 205 SAB episodes, 160 were community-onset and 45 were HO; 16 (36%) HO cases were PVC-associated. Cases (n = 16) were more likely than controls (n = 32) to have a PVC placed in the antecubital area (odds ratio [OR], 11.9; 95% confidence interval [CI], 1.5–95.7; P = .02) and PVC duration ≥4 days (OR, 4.0; 95% CI, 1.1–15.2; P = .04). The point prevalence of at least 1 PVC in adult inpatients was 86%, and the incidence density of HO PVC–associated SAB was 0.15 per 1000 PVC-days. The mean length of stay for cases was 13.2 days. All cases successfully completed parenteral antibiotics with a mean treatment length of 23.6 days. Conclusions PVC-associated SAB is a common cause of HO SAB that results in significant morbidity. PVC placement in the antecubital area and line duration should be minimized to reduce HO SAB.
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Affiliation(s)
- Mica Blauw
- Department of Infection Prevention and Control, Ann Arbor, Michigan
| | - Betsy Foxman
- Center for Molecular and Clinical Epidemiology of Infectious Diseases, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Juan Wu
- Department of Academic Research, Ann Arbor, Michigan
| | - Janice Rey
- Department of Infection Prevention and Control, Ann Arbor, Michigan
| | - Neelay Kothari
- Section of Infectious Diseases, Department of Medicine, St. Joseph Mercy Hospital, Ann Arbor, Michigan
| | - Anurag N Malani
- Department of Infection Prevention and Control, Ann Arbor, Michigan.,Section of Infectious Diseases, Department of Medicine, St. Joseph Mercy Hospital, Ann Arbor, Michigan
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31
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Tsuboi M, Hayakawa K, Mezaki K, Katanami Y, Yamamoto K, Kutsuna S, Takeshita N, Ohmagari N. Comparison of the epidemiology and microbiology of peripheral line- and central line-associated bloodstream infections. Am J Infect Control 2019; 47:208-210. [PMID: 30337129 DOI: 10.1016/j.ajic.2018.08.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 08/12/2018] [Accepted: 08/12/2018] [Indexed: 11/15/2022]
Abstract
We retrospectively studied the epidemiology and microbiology of peripheral line-associated bloodstream infection (PLABSI) in comparison with central line-associated bloodstream infection (CLABSI). Among 2,208 bacteremia episodes, 106 (4.8%) PLABSI and 229 (10.4%) CLABSI were identified. In PLABSI, gram-negative rods, especially Enterobacteriaceae, were more frequently identified than in CLABSI, and infectious disease consultation was more frequently involved. The 7-day mortality rate was similar between the 2 groups, suggesting similar adverse effects of PLABSI and CLABSI on patient outcomes.
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Affiliation(s)
- Motoyuki Tsuboi
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kayoko Hayakawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kazuhisa Mezaki
- Microbiology Laboratory, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yuichi Katanami
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kei Yamamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Nozomi Takeshita
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
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32
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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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33
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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: 121] [Impact Index Per Article: 20.2] [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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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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Murdoch F, Danial J, Morris A, Czarniak E, Bishop J, Glass E, Imrie L. The Scottish enhanced Staphylococcus aureus bacteraemia surveillance programme: the first 18 months of data in adults. J Hosp Infect 2017; 97:133-139. [DOI: 10.1016/j.jhin.2017.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/04/2017] [Indexed: 11/28/2022]
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Brouqui P, Boudjema S, Soto Aladro A, Chabrière E, Florea O, Nguyen H, Dufour JC. New Approaches to Prevent Healthcare-Associated Infection. Clin Infect Dis 2017; 65:S50-S54. [DOI: 10.1093/cid/cix433] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Cahill TJ, Baddour LM, Habib G, Hoen B, Salaun E, Pettersson GB, Schäfers HJ, Prendergast BD. Challenges in Infective Endocarditis. J Am Coll Cardiol 2017; 69:325-344. [PMID: 28104075 DOI: 10.1016/j.jacc.2016.10.066] [Citation(s) in RCA: 377] [Impact Index Per Article: 53.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 10/26/2016] [Accepted: 10/30/2016] [Indexed: 02/06/2023]
Abstract
Infective endocarditis is defined by a focus of infection within the heart and is a feared disease across the field of cardiology. It is frequently acquired in the health care setting, and more than one-half of cases now occur in patients without known heart disease. Despite optimal care, mortality approaches 30% at 1 year. The challenges posed by infective endocarditis are significant. It is heterogeneous in etiology, clinical manifestations, and course. Staphylococcus aureus, which has become the predominant causative organism in the developed world, leads to an aggressive form of the disease, often in vulnerable or elderly patient populations. There is a lack of research infrastructure and funding, with few randomized controlled trials to guide practice. Longstanding controversies such as the timing of surgery or the role of antibiotic prophylaxis have not been resolved. The present article reviews the challenges posed by infective endocarditis and outlines current and future strategies to limit its impact.
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Affiliation(s)
- Thomas J Cahill
- Department of Cardiology, Oxford University Hospitals, Oxford, United Kingdom
| | - Larry M Baddour
- Division of Infectious Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Gilbert Habib
- Aix-Marseille Universite, URMITE, Marseille, France; APHM, La Timone Hospital, Cardiology Department, Marseille, France
| | - Bruno Hoen
- Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud, Inserm, Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne, Centre Hospitalier Universitaire de Pointe-à-Pitre/Abymes, Pointe-à-Pitre, France
| | - Erwan Salaun
- APHM, La Timone Hospital, Cardiology Department, Marseille, France
| | - Gosta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Hans Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
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