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Schutte M, van Mansfeld R, de Vries R, Dekker M. DETERMINANTS OF COMPLIANCE WITH INFECTION PREVENTION MEASURES BY PHYSICIANS: A SCOPING REVIEW. J Hosp Infect 2024:S0195-6701(24)00292-5. [PMID: 39214255 DOI: 10.1016/j.jhin.2024.08.011] [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: 05/31/2024] [Revised: 08/05/2024] [Accepted: 08/17/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Despite evidence that application of infection prevention measures can reduce healthcare-associated infections, compliance with these measures is low, especially among physicians. Intervention effects often do not sustain. An overview of determinants for physicians' infection prevention behaviour and successful behaviour change strategies is lacking. AIM To identify what determinants influence physicians' infection prevention behaviour, what strategies to improve compliance have been explored, and whether theories, models and frameworks from implementation science have been used in these studies. METHODS Scoping review methodology. We performed a literature search in PubMed, Embase, APA PsycInfo and Web of Science up to June 2, 2023, in collaboration with a medical information specialist. All study types focusing on infection prevention behaviour of physicians in high-income countries were included. Data on determinants and strategies was extracted; determinants were categorized into the Theoretical Domains Framework (TDF). FINDINGS We included 56 articles. The TDF domains "environmental context and resources", "social influences", "beliefs about consequences", "memory, attention and decision-making", "knowledge" and "skills" were found most relevant. The prevailing determinant covers a theme outside the TDF: socio-demographic factors. Sustainable interventions are multimodal approaches that at least include feedback, education and a champion. Theories, models and frameworks have rarely been used to guide implementation strategy development. CONCLUSION This review presents an overview of determinants of physicians' infection prevention behaviour. Intervention studies rarely specify the determinants that they aim to address and lack theoretical underpinning. Future initiatives should combine knowledge about determinants with implementation science to develop theory-based interventions tailored to determinants.
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Affiliation(s)
- Miriam Schutte
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rosa van Mansfeld
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, The Netherlands
| | - Mireille Dekker
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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Breckwoldt J, Knecht M, Massée R, Flach B, Hofmann-Huber C, Kaap-Fröhlich S, Witt CM, Aeberhard R, Sax H. Operating room technician trainees teach medical students - an inter-professional peer teaching approach for infection prevention strategies in the operation room. Antimicrob Resist Infect Control 2019; 8:75. [PMID: 31114677 PMCID: PMC6518629 DOI: 10.1186/s13756-019-0526-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/23/2019] [Indexed: 11/10/2022] Open
Abstract
Background Education is a cornerstone strategy to prevent health-associated infections. Trainings benefit from being interactive, simulation-based, team-orientated, and early in professional socialization. We conceived an innovative inter-professional peer-teaching module with operating room technician trainees (ORTT) teaching infection prevention behavior in the operating room (OR) to medical students (MDS). Methods ORTT delivered a 2-h teaching module to small groups of MDS in a simulated OR setting with 4 posts: ‘entering OR’; ‘surgical hand disinfection’; ‘dressing up for surgery and preparing a surgical field’, ‘debriefing’. MDS and ORTT evaluated module features and teaching quality through 2 specific questionnaires. Structured field notes by education specialist observers were analyzed thematically. Results On Likert scales from − 2 to + 2, mean overall satisfaction was + 1.91 (±0.3) for MDS and + 1.66 (±0.6 SD) for ORTT while teaching quality was rated + 1.89 (±0.3) by MDS and self-rated with + 1.34 (±0.5) by ORTT. Students and observers highlighted that the training fostered mutual understanding and provided insight into the corresponding profession. Conclusions Undergraduate inter-professional teaching among ORTT and MDS in infection prevention and control proved feasible with high educational quality. Inducing early mutual understanding between professional groups might improve professional collaboration and patient safety. Electronic supplementary material The online version of this article (10.1186/s13756-019-0526-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jan Breckwoldt
- 1Faculty of Medicine, Office of the Dean, University of Zurich, Pestalozzistr. 3-5, CH-8091 Zurich, Switzerland
| | - Monika Knecht
- Careum Training Centre, Gloriastrasse 16, CH-8006 Zurich, Switzerland
| | - Ralph Massée
- Careum Training Centre, Gloriastrasse 16, CH-8006 Zurich, Switzerland
| | - Barbara Flach
- Careum Training Centre, Gloriastrasse 16, CH-8006 Zurich, Switzerland
| | | | - Sylvia Kaap-Fröhlich
- 1Faculty of Medicine, Office of the Dean, University of Zurich, Pestalozzistr. 3-5, CH-8091 Zurich, Switzerland.,Department for Education Development, Careum, Pestalozzistr. 3, CH-8006 Zurich, Switzerland
| | - Claudia M Witt
- 1Faculty of Medicine, Office of the Dean, University of Zurich, Pestalozzistr. 3-5, CH-8091 Zurich, Switzerland.,4Institute for Complementary and Integrative Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Ruth Aeberhard
- Careum Training Centre, Gloriastrasse 16, CH-8006 Zurich, Switzerland
| | - Hugo Sax
- 5Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
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Storr J, Twyman A, Zingg W, Damani N, Kilpatrick C, Reilly J, Price L, Egger M, Grayson ML, Kelley E, Allegranzi B. Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations. Antimicrob Resist Infect Control 2017; 6:6. [PMID: 28078082 PMCID: PMC5223492 DOI: 10.1186/s13756-016-0149-9] [Citation(s) in RCA: 246] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 11/04/2016] [Indexed: 11/16/2022] Open
Abstract
Health care-associated infections (HAI) are a major public health problem with a significant impact on morbidity, mortality and quality of life. They represent also an important economic burden to health systems worldwide. However, a large proportion of HAI are preventable through effective infection prevention and control (IPC) measures. Improvements in IPC at the national and facility level are critical for the successful containment of antimicrobial resistance and the prevention of HAI, including outbreaks of highly transmissible diseases through high quality care within the context of universal health coverage. Given the limited availability of IPC evidence-based guidance and standards, the World Health Organization (WHO) decided to prioritize the development of global recommendations on the core components of effective IPC programmes both at the national and acute health care facility level, based on systematic literature reviews and expert consensus. The aim of the guideline development process was to identify the evidence and evaluate its quality, consider patient values and preferences, resource implications, and the feasibility and acceptability of the recommendations. As a result, 11 recommendations and three good practice statements are presented here, including a summary of the supporting evidence, and form the substance of a new WHO IPC guideline.
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Affiliation(s)
- Julie Storr
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Anthony Twyman
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Walter Zingg
- Infection Control Programme, and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Nizam Damani
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Claire Kilpatrick
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Jacqui Reilly
- Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA UK
| | - Lesley Price
- Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA UK
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
| | - M Lindsay Grayson
- Austin Health and University of Melbourne, 145 Studley Road, PO Box 5555, Heidelberg, VIC Australia
| | - Edward Kelley
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Benedetta Allegranzi
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
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Safdar N, Maki DG. Lost in Translation. Infect Control Hosp Epidemiol 2016; 27:3-7. [PMID: 16418979 DOI: 10.1086/500282] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Accepted: 12/06/2005] [Indexed: 12/20/2022]
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Safdar N. Bloodstream Infection: An Ounce of Prevention Is a Ton of Work. Infect Control Hosp Epidemiol 2016; 26:511-4. [PMID: 16018424 DOI: 10.1086/502576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Evidence-based practice and barriers to compliance: Face bow transfer. J Prosthodont Res 2015; 60:20-2. [PMID: 26481058 DOI: 10.1016/j.jpor.2015.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/24/2015] [Accepted: 09/27/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To recapitulate a 2003 study inquiring of US dental schools whether they teach the face bow transfer by means of a survey in order to determine if compliance with clinical evidence has improved. METHODS The same 54 dental schools surveyed in 2003 were asked the same question regarding whether they teach the use of the face bow transfer in the complete denture curriculum. RESULTS Teaching of the face bow transfer has increased in prevalence from 84% of surveyed schools in 2003 to 93.75% of surveyed schools in 2015. CONCLUSIONS This finding is especially interesting in light of the fact that there is no compelling evidence supporting the use of the face bow transfer with regard to improving patient outcomes. With respect to the continued unjustified teaching of the face bow transfer, some possible reasons for non-compliance with best available evidence are presented using the medical literature for reference.
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Zingg W, Holmes A, Dettenkofer M, Goetting T, Secci F, Clack L, Allegranzi B, Magiorakos AP, Pittet D. Hospital organisation, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus. THE LANCET. INFECTIOUS DISEASES 2015; 15:212-24. [DOI: 10.1016/s1473-3099(14)70854-0] [Citation(s) in RCA: 278] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Sacks GD, Diggs BS, Hadjizacharia P, Green D, Salim A, Malinoski DJ. Reducing the rate of catheter-associated bloodstream infections in a surgical intensive care unit using the Institute for Healthcare Improvement central line bundle. Am J Surg 2014; 207:817-23. [DOI: 10.1016/j.amjsurg.2013.08.041] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 07/27/2013] [Accepted: 08/16/2013] [Indexed: 11/26/2022]
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FRYKHOLM P, PIKWER A, HAMMARSKJÖLD F, LARSSON AT, LINDGREN S, LINDWALL R, TAXBRO K, ÖBERG F, ACOSTA S, ÅKESON J. Clinical guidelines on central venous catheterisation. Swedish Society of Anaesthesiology and Intensive Care Medicine. Acta Anaesthesiol Scand 2014; 58:508-24. [PMID: 24593804 DOI: 10.1111/aas.12295] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2014] [Indexed: 12/17/2022]
Abstract
Safe and reliable venous access is mandatory in modern health care, but central venous catheters (CVCs) are associated with significant morbidity and mortality, This paper describes current Swedish guidelines for clinical management of CVCs The guidelines supply updated recommendations that may be useful in other countries as well. Literature retrieval in the Cochrane and Pubmed databases, of papers written in English or Swedish and pertaining to CVC management, was done by members of a task force of the Swedish Society of Anaesthesiology and Intensive Care Medicine. Consensus meetings were held throughout the review process to allow all parts of the guidelines to be embraced by all contributors. All of the content was carefully scored according to criteria by the Oxford Centre for Evidence-Based Medicine. We aimed at producing useful and reliable guidelines on bleeding diathesis, vascular approach, ultrasonic guidance, catheter tip positioning, prevention and management of associated trauma and infection, and specific training and follow-up. A structured patient history focused on bleeding should be taken prior to insertion of a CVCs. The right internal jugular vein should primarily be chosen for insertion of a wide-bore CVC. Catheter tip positioning in the right atrium or lower third of the superior caval vein should be verified for long-term use. Ultrasonic guidance should be used for catheterisation by the internal jugular or femoral veins and may also be used for insertion via the subclavian veins or the veins of the upper limb. The operator inserting a CVC should wear cap, mask, and sterile gown and gloves. For long-term intravenous access, tunnelled CVC or subcutaneous venous ports are preferred. Intravenous position of the catheter tip should be verified by clinical or radiological methods after insertion and before each use. Simulator-assisted training of CVC insertion should precede bedside training in patients. Units inserting and managing CVC should have quality assertion programmes for implementation and follow-up of routines, teaching, training and clinical outcome. Clinical guidelines on a wide range of relevant topics have been introduced, based on extensive literature retrieval, to facilitate effective and safe management of CVCs.
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Affiliation(s)
- P. FRYKHOLM
- Department of Surgical Sciences; Anaesthesiology and Intensive Care Medicine; University Hospital; Uppsala University; Uppsala Sweden
| | - A. PIKWER
- Department of Clinical Sciences Malmö; Anaesthesiology and Intensive Care Medicine; Skåne University Hospital; Lund University; Malmö Sweden
| | - F. HAMMARSKJÖLD
- Department of Anaesthesiology and Intensive Care Medicine; Ryhov County Hospital; Jönköping Sweden
- Division of Infectious Diseases; Department of Clinical and Experimental Medicine; Faculty of Health Sciences; Linköping University; Linköping Sweden
| | - A. T. LARSSON
- Department of Anaesthesiology and Intensive Care Medicine; Gävle-Sandviken County Hospital; Gävle Sweden
| | - S. LINDGREN
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - R. LINDWALL
- Department of Clinical Sciences; Division of Anaesthesiology and Intensive Care Medicine; Karolinska Institute; Danderyd University Hospital; Stockholm Sweden
| | - K. TAXBRO
- Department of Anaesthesiology and Intensive Care Medicine; Ryhov County Hospital; Jönköping Sweden
| | - F. ÖBERG
- Department of Anaesthesiology and Intensive Care Medicine; Karolinska University Hospital Solna; Stockholm Sweden
| | - S. ACOSTA
- Department of Clinical Sciences Malmö; Vascular Centre; Skåne University Hospital; Lund University; Malmö Sweden
| | - J. ÅKESON
- Department of Clinical Sciences Malmö; Anaesthesiology and Intensive Care Medicine; Skåne University Hospital; Lund University; Malmö Sweden
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Zingg W, Cartier V, Inan C, Touveneau S, Theriault M, Gayet-Ageron A, Clergue F, Pittet D, Walder B. Hospital-wide multidisciplinary, multimodal intervention programme to reduce central venous catheter-associated bloodstream infection. PLoS One 2014; 9:e93898. [PMID: 24714418 PMCID: PMC3979709 DOI: 10.1371/journal.pone.0093898] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 03/09/2014] [Indexed: 11/19/2022] Open
Abstract
Central line-associated bloodstream infection (CLABSI) is the major complication of central venous catheters (CVC). The aim of the study was to test the effectiveness of a hospital-wide strategy on CLABSI reduction. Between 2008 and 2011, all CVCs were observed individually and hospital-wide at a large university-affiliated, tertiary care hospital. CVC insertion training started from the 3rd quarter and a total of 146 physicians employed or newly entering the hospital were trained in simulator workshops. CVC care started from quarter 7 and a total of 1274 nurses were trained by their supervisors using a web-based, modular, e-learning programme. The study included 3952 patients with 6353 CVCs accumulating 61,366 catheter-days. Hospital-wide, 106 patients had 114 CLABSIs with a cumulative incidence of 1.79 infections per 100 catheters. We observed a significant quarterly reduction of the incidence density (incidence rate ratios [95% confidence interval]: 0.92 [0.88-0.96]; P<0.001) after adjusting for multiple confounders. The incidence densities (n/1000 catheter-days) in the first and last study year were 2.3/1000 and 0.7/1000 hospital-wide, 1.7/1000 and 0.4/1000 in the intensive care units, and 2.7/1000 and 0.9/1000 in non-intensive care settings, respectively. Median time-to-infection was 15 days (Interquartile range, 8-22). Our findings suggest that clinically relevant reduction of hospital-wide CLABSI was reached with a comprehensive, multidisciplinary and multimodal quality improvement programme including aspects of behavioural change and key principles of good implementation practice. This is one of the first multimodal, multidisciplinary, hospital-wide training strategies successfully reducing CLABSI.
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Affiliation(s)
- Walter Zingg
- Infection Control Programme, University of Geneva Hospitals, Geneva, Switzerland
| | - Vanessa Cartier
- Division of Anaesthesiology, University of Geneva Hospitals, Geneva, Switzerland
| | - Cigdem Inan
- Division of Anaesthesiology, University of Geneva Hospitals, Geneva, Switzerland
| | - Sylvie Touveneau
- Infection Control Programme, University of Geneva Hospitals, Geneva, Switzerland
- Nursing Department, University of Geneva Hospitals, Geneva, Switzerland
| | - Michel Theriault
- Nursing Department, University of Geneva Hospitals, Geneva, Switzerland
| | - Angèle Gayet-Ageron
- Infection Control Programme, University of Geneva Hospitals, Geneva, Switzerland
| | - François Clergue
- Division of Anaesthesiology, University of Geneva Hospitals, Geneva, Switzerland
| | - Didier Pittet
- Infection Control Programme, University of Geneva Hospitals, Geneva, Switzerland
- WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Bernhard Walder
- Division of Anaesthesiology, University of Geneva Hospitals, Geneva, Switzerland
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Haskins R, Osmotherly PG, Southgate E, Rivett DA. Physiotherapists' knowledge, attitudes and practices regarding clinical prediction rules for low back pain. ACTA ACUST UNITED AC 2014; 19:142-51. [DOI: 10.1016/j.math.2013.09.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 08/23/2013] [Accepted: 09/23/2013] [Indexed: 12/27/2022]
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Lobo RD, Oliveira MS, Garcia CP, Caiaffa Filho HH, Levin AS. Pandemic 2009 H1N1 influenza among health care workers. Am J Infect Control 2013; 41:645-7. [PMID: 23276624 DOI: 10.1016/j.ajic.2012.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 07/27/2012] [Accepted: 08/22/2012] [Indexed: 11/24/2022]
Abstract
To evaluate factors associated with pandemic influenza among health care workers (HCWs), a case-case-control study was conducted with 52 confirmed cases, 120 influenza-negative cases, and 102 controls. Comorbidities (odds ratio [OR], 19.05; 95% confidence interval [95% CI]: 4.75-76.41), male sex (OR, 5.11; 95% CI: 1.80-14.46), and being a physician (OR, 8.58; 95% CI: 2.52-29.27) were independent risk factors for pandemic influenza infection among HCWs. Contact with symptomatic coworker or social contact was protective (OR, 0.11; 95% CI: 0.04-0.29). To our knowledge, this is the first study of factors associated with acquiring influenza involving HCW in nonsevere cases.
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Yacopetti N, Davidson PM, Blacka J, Spencer TR. Preventing contamination at the time of central venous catheter insertion: a literature review and recommendations for clinical practice. J Clin Nurs 2013; 22:611-20. [PMID: 23294428 DOI: 10.1111/j.1365-2702.2012.04340.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2012] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the evidence base and rationale underpinning the various infections control strategies during central venous catheter insertion and to promote discussion about the key, recurring concepts and recommendations in the literature. Logistical and organisational factors relating to central venous catheter insertion are also examined. BACKGROUND Catheter-related bloodstream infections following the insertion of central venous catheters are associated with significant patient mortality and morbidity, prolonged hospital stays and increased economic costs. Limited published literature specifically examines microbial contamination during the peri-insertion process. METHODS An integrative literature review supervised by a health informatics librarian was undertaken. On the basis of these data, considerations for clinical practice are provided. Retrieved articles were categorised under the following themes: risk of contamination at insertion; clinical and organisational impact of contamination; strategies for reducing contamination; controversies and challenges with decontamination strategies; recommendations for practice and implications for further research and organisational practice. RESULTS Specific recommendations for reducing catheter-related bloodstream infections based on recurring themes include the following: reducing microbial burden on skin prior to the central venous catheter insertion; decreasing contact of gloves and insertion equipment with the patient's skin; using specifically trained staff to prepare and maintain a sterile field; and ensuring a sterile technique is adhered to throughout the central venous catheter insertion process. The need for organisational, procedural and clinical practices to support better healthcare outcomes is demonstrated. Highlighting the importance of executive support and regular review of policy and guidelines are necessary to improve patient outcomes. CONCLUSIONS Preventing infections related to central venous catheters requires the integration of clinical, organisational and workforce factors.
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Affiliation(s)
- Nicholas Yacopetti
- Department of Anaesthetic, St Vincent's Public Hospital, Darlinghurst, NSW, Australia.
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What do central venous catheter-associated bloodstream infections have to do with bundles?g. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2011; 16:215-8. [PMID: 18159546 DOI: 10.1155/2005/582156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2005] [Accepted: 07/18/2005] [Indexed: 01/13/2023]
Abstract
Interest in the patient safety agenda continues to grow in North America. In the United States (US), the Institute for Healthcare Improvement (IHI) has begun a campaign to make health care safer and more effective by encouraging hospitals to implement interventions they believe can avoid 100,000 deaths between January 2005 and July 2006 (1). The IHI, a not-for-profit organization founded in 1991, promotes the improvement of health by advancing the quality and value of health care (2). Three of the six areas for action chosen by the IHI for their '100,000 Lives Campaign' relate to prevention of nosocomial infections: central line infections, surgical site infections and ventilator-associated pneumonia. In Canada, a grassroots patient safety campaign modelled after the IHI's '100,000 Lives Campaign' has formed (3). This 'Safer Healthcare Now!' campaign focuses on the same six strategies chosen for the '100,000 Lives Campaign'. Across the country, hospitals are being invited to join the 'Safer Healthcare Now!' campaign.
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15
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Prevention of catheter-related bloodstream infection in patients on hemodialysis. Nat Rev Nephrol 2011; 7:257-65. [DOI: 10.1038/nrneph.2011.28] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Maximal sterile barrier precautions do not reduce catheter-related bloodstream infections in general surgery units: a multi-institutional randomized controlled trial. Ann Surg 2010; 251:620-3. [PMID: 20224364 DOI: 10.1097/sla.0b013e3181d48a6a] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate whether maximal sterile barrier precautions (MSBPs) during central venous catheter (CVC) insertion are truly effective in preventing catheter-related bloodstream infections (CRBSIs) in patients in general surgical units. SUMMARY BACKGROUND DATA The reported effectiveness of MSBPs was based on the results of a single-center randomized controlled trial by Raad et al and the majority of the patients (99%) in the study were chemotherapy outpatients. METHODS Between March 14, 2004 and December 28, 2006, the patients scheduled for CVC insertion in surgical units at 9 medical centers in Japan were randomly assigned to either an MSBP group (n = 211) or a standard sterile barrier precaution (SSBP) group (n = 213). This study was registered in the UMIN Clinical Trials Registry (registration ID number: UMIN000001400). RESULTS The median (range) duration of catheterization was 14 days (0-92 days) in the MSBP group and 14 days (0-112 days) in the SSBP group. There were 5 cases (2.4%) of CRBSI in the MSBP group and 6 cases (2.8%) in the SSBP group (relative risk, 0.84; 95% confidence interval, 0.26-2.7; P = 0.77). The rate of CRBSIs per 1000 catheter days was 1.5 in the MSBP group and 1.6 in the SSBP group. There were 8 cases (3.8%) of catheter-related infections in the MSBP group and 7 cases (3.3%) in the SSBP group (relative risk, 1.2; 95% confidence interval, 0.43-3.1; P = 0.78). The rate of catheter-related infection per 1000 catheter days was 2.4 in the MSBP group and 1.9 in the SSBP group. CONCLUSIONS This study is larger in sample size than the one performed by Raad et al and could not demonstrate better prevention of CRBSIs by MSBP compared with SSBP. A large randomized controlled trial or at least a meta-analysis of any other studies in the literature is necessary to reach to a conclusion on this issue.
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Mimoz O, Moreira R, Frasca D, Boisson M, Dahyot-Fizelier C. [Practice assessment of central venous lines care in surgical ICU of French university hospitals]. ACTA ACUST UNITED AC 2010; 29:104-12. [PMID: 20106630 DOI: 10.1016/j.annfar.2009.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Accepted: 11/16/2009] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Recommendations on insertion and maintenance of central venous catheters (CVC) in intensive care unit (ICU) patients were updated in 2002. The aim of this study was to estimate their knowledge and/or application by physicians in French university hospital ICUs. METHODS Two forms were sent to 124 professors of anaesthesia and intensive care encouraging them to participate to the survey. The first one was completed by the physician in charge of each unit and concerned the structure and activity of the unit in 2006. The second one was filled by each junior or senior physician working in the units and asked for experience, CVC insertion modalities and knowledge of CVC care protocols. RESULTS Forty-one (75 %) university hospitals with at least one adult surgical ICU took part to the study. A questionnaire was filled by 124 senior (75 % of the staff) and 53 junior (43 % of the staff) physicians inserting an average of 10 CVC per month (range, 1-35). A written protocol for CVC insertion was known by 127 (72 %) of them. CVC insertion was done while wearing sterile gown (97 %), cap (100 %) and surgical mask (100 %) and using large sterile drapes (96 %). The antiseptic solution used for cutaneous antisepsis was povidone iodine in aqueous (36 %) or alcoholic solution (40 %), or an alcoholic solution of chlorhexidine (24 %) applied one (9 %), two (64 %) or three (27 %) times before insertion. A 4-times disinfection sequence (washing, rinsing, drying and disinfection) was performed by 161 (91 %) physicians. Ultrasound-guided insertion was realized by only eight (5 %) operators. CVCs were made of polyurethane (84 %), usually multi-lumens (>96 %) and rarely tunnelised (14 %). Only two physicians (1 %) sometimes use catheters coated with antibiotics or antiseptics. The site for catheter insertion was mostly the sub-clavian (47 %) or internal jugular vein (34 %), and rarely the femoral vein (20 %). CVCs were secured with a thread (99 %) and covered with a semi-permeable dressing (76 %). Concerning CVCs maintenance, 91 % of physicians acknowledged the existence of a written protocol in the unit. Dressings were changed every day (10 %), every two days (49 %), every three days (29 %) or every four days or more (12 %) by using the same antiseptic solution and semi-permeable transparent dressing in 78 % of cases. Venous lines changes were done during dressing maintenance (48 %), every day in case of administration of lipids (32 %) or just after administration of blood products via the catheter (32 %). Routine change of CVC was rarely recommended (11 %). CONCLUSION The high number of answers allows setting of a precise state of CVCs insertion practices in adult surgical ICUs. Recommendations for central venous catheter insertion and maintenance are not still known and\or applied.
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Affiliation(s)
- O Mimoz
- EA3809 INSERM, ERI 23, service d'anesthésie réanimation, CHU de Poitiers, université de Poitiers, 1 rue de la milétrie, Poitiers cedex, France.
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Stefanidis CJ. Prevention of catheter-related bacteremia in children on hemodialysis: time for action. Pediatr Nephrol 2009; 24:2087-95. [PMID: 19629533 DOI: 10.1007/s00467-009-1254-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Accepted: 06/15/2009] [Indexed: 01/14/2023]
Abstract
This editorial commentary discusses the strategies for prevention of catheter-related bacteremia (CRB) in children on hemodialysis, which is associated with high morbidity and the increase of hospital cost. There is evidence that the use of arteriovenous fistulae in children on hemodialysis is associated with lower infection rates. Therefore, the use of catheters in these patients should be decreased by improving arteriovenous fistulae use rates or by increasing peritoneal dialysis patient recruitment. However, despite the wide adoption of such policies, hemodialysis catheters are still being used in a significant number of cases. For these patients, implementation of effective strategies for preventing contamination of the catheter hub should be a priority. The appropriate recording and evaluation of CRB rates are important for assessing preventive policies. In addition, the successful management of a CRB is essential for preventing recurrence of bacteremia. Recently it was documented in a number of randomized clinical trials that antimicrobial lock solutions were effective for preventing CRB. It is suggested that the use of antimicrobial locks should be considered in children who are at high risk of developing CRB, with caution for their long-term use, because of the possibility of bacterial resistance. Now is the time for action, and all preventive steps should be performed simultaneously to minimize the risk of CRB.
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Affiliation(s)
- Constantinos J Stefanidis
- Department of Pediatric Nephrology, "P. & A. Kyriakou" Children's Hospital, Levadias and Thivon Str, Goudi, Athens, Greece.
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A broad-spectrum look at catheter-related bloodstream infections: many aspects, many populations. JOURNAL OF INFUSION NURSING 2009; 32:80-6. [PMID: 19289921 DOI: 10.1097/nan.0b013e318198d30c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The issue of central vascular catheter-related bloodstream infections is prominent in medical literature and practice today, both in the United States and throughout the international healthcare community. In its 2002 report on Guidelines for the Prevention of Intravascular Catheter-Related Infections, the Centers for Disease Control and Prevention estimated that 250,000 cases of central vascular catheter-related infections occur annually. This article is a review of current literature pertaining to catheter-related bloodstream infections. Included are resources from 2004 onward, as well as resources such as the Centers for Disease Control and Prevention, the Institute for Healthcare Improvement, and the National Guideline Clearinghouse.
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Abstract
CRBSIs are expensive, prevalent, and often fatal complications. In the past few years, several preventive interventions have been applied with excellent results toward decreasing CRBSIs. Studies show that most CRBSIs are preventable; therefore, health care organizations should strive to substantially reduce if not eliminate them. In addition to being a measure of quality of care, reducing infections will soon be a bottom-line issue, given that the Centers for Medicare and Medicaid Services announced its decision to cease paying hospitals from October 2008 for some care necessitated by "preventable complications", including CRBSIs. Therefore, health care facilities that do not make the necessary adjustments to improve the quality of their patient care and avoid harm may be economically penalized. This article reviews the available evidence on and possible barriers to the widespread use of preventive strategies. The health care community has struggled to build a culture that can eliminate the barriers obstructing high-quality care. These new approaches must facilitate collaboration among caregivers. During the past few years, much effort has been dedicated to researching causes for inadequate patient care and executing interventions to improve processes of care; only now are projects beginning to focus on evaluating whether patients are safer. This article discusses the prevention of CRBSIs and shows that substantial reductions in the rate of these infections are possible. It is no longer acceptable for health care organizations to have the goal of being at the CDC mean for rate of infections; they should strive to substantially reduce or even eliminate them. Patients deserve no less.
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Affiliation(s)
- Jose M Rodriguez-Paz
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, 297 Meyer, Baltimore, MD 21287, USA.
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Csomós A, Orbán E, Konczné Réti R, Vass E, Darvas K. [Intensive care nurses' knowledge about the evidence-based guidelines of preventing central venous catheter related infection]. Orv Hetil 2008; 149:929-34. [PMID: 18467262 DOI: 10.1556/oh.2008.28346] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine intensive care unit (ICU) nurses' knowledge of evidence-based guidelines for preventing central venous catheter (CVC) related infection. METHOD We used a validated multiple-choice questionnaire which was distributed to intensive care units between October and December 2006. We collected demographic data, like gender, years of ICU experience, number of ICU beds and whether respondents hold a special degree in intensive care. RESULTS We collected 178 questionnaires from 11 intensive care units; the mean score was 3.66 on 10 questions (37%). Eighteen per cent knew that CVCs should be replaced on indication only, and 61% knew that this recommendation concerns also replacement over a guidewire. Recommendations for replacing pressure transducers and tubing every 4 days, and for using coated devices in patients requiring a CVC < 5 days in settings with high infection rates were recognized only by 48% and 66%, respectively. Regarding CVC dressings, 15% knew that these should be changed only when indicated and at least once weekly, and 35% recognized that both poly-urethane and gauze dressings can be recommended. Only 20% checked 2% aqueous chlorhexidine as recommended disinfection solution; 14% knew antibiotic ointments are not recommended because they trigger resistance. The recommendation to replace administration sets within 24 hours after administering lipid emulsions was recognized by 85%, but it was known by 5% only that these sets should be replaced every 96 hours when administering neither lipid emulsions nor blood products. Professional seniority and the number of intensive care beds in the ICU where nurses work showed not to be associated with better scores on the test. DISCUSSION Knowledge regarding CVC-related infection is poor among Hungarian nurses. Prevention guidelines should be included in the nurse education curriculum as well as in continuing refresher nursing education programs.
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Affiliation(s)
- Akos Csomós
- Semmelweis Egyetem, Altalános Orvostudományi Kar I. Sebészeti Klinika Budapest Ulloi út 78. 1082.
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Papadimos TJ, Hensely SJ, Duggan JM, Hofmann JP, Khuder SA, Borst MJ, Fath JJ. Intensivist supervision of resident-placed central venous catheters decreases the incidence of catheter-related blood stream infections. Patient Saf Surg 2008; 2:11. [PMID: 18447937 PMCID: PMC2386777 DOI: 10.1186/1754-9493-2-11] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Accepted: 04/30/2008] [Indexed: 11/10/2022] Open
Abstract
Catheter-related blood stream infections (CRBSI) cause significant morbidity and mortality. A retrospective study of a performance improvement project in our teaching hospital's surgical intensive care unit (SICU) showed that intensivist supervision was important in reinforcing maximal sterile barriers (MSB) use during the placement of a central venous catheter (CVC) in the prevention of CRBSI. A historical control period, 1 January 2001-31 December 2003, was established for comparison. From 1 January 2003-31 December 2007, MSB use for central venous line placement was mandated for all operators. However, in 2003 there was no intensivist supervision of CVC placements in the SICU. The use of MSB alone did not cause a significant change in the CRBSI rate in the first year of the project, but close supervision by an intensivist in years 2004-2007, in conjunction with MSB use, demonstrated a significant drop in the CRBSI rate when compared to the years before intensivist supervision (2001-2003), p < .0001. A time series analysis comparing monthly rates of CRBSI (2001-2007) also revealed a significant downward trend, p = .028. Additionally, in the first year of the mandated MSB use (2003), 85 independently observed resident-placed CVCs demonstrated that breaks in sterile technique (34/85), as compared those placements that had no breaks in technique (51/85), had more CRBSI, 6/34 (17.6%) vs. 1/51 (1.9%), p < .01. Interventions to reduce CRBSI in our SICU needed emphasis on adequate supervision of trainees in CVC placement, in addition to use of MSB, to effect lower CRBSI rates.
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Affiliation(s)
- Thomas J Papadimos
- Department of Anesthesiology, University of Toledo College of Medicine, 3000 Arlington Avenue, Toledo, USA
| | - Sandra J Hensely
- Infection Control Department, University of Toledo College of Medicine, 3000 Arlington Avenue, Toledo, USA
| | - Joan M Duggan
- Department of Medicine, University of Toledo College of Medicine, 3000 Arlington Avenue, Toledo, USA
| | - James P Hofmann
- Department of Anesthesiology, University of Toledo College of Medicine, 3000 Arlington Avenue, Toledo, USA
| | - Sadik A Khuder
- Department of Medicine, University of Toledo College of Medicine, 3000 Arlington Avenue, Toledo, USA
| | - Marilyn J Borst
- Department of Surgery, University of Toledo College of Medicine, 3000 Arlington Avenue, Toledo, USA
| | - John J Fath
- Department of Surgery, University of Toledo College of Medicine, 3000 Arlington Avenue, Toledo, USA
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Demetriades D, May A, Gamble H. When Does a Centers for Disease Control and Prevention Recommendation Become Standard of Care? Perhaps in the Courtroom. American College of Surgeons Mock Trial: Line Sepsis Liability. J Am Coll Surg 2008; 206:370-5. [DOI: 10.1016/j.jamcollsurg.2007.07.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2007] [Revised: 07/26/2007] [Accepted: 07/31/2007] [Indexed: 11/25/2022]
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Labeau S, Vereecke A, Vandijck D, Claes B, Blot S. Critical Care Nurses’ Knowledge of Evidence-Based Guidelines for Preventing Infections Associated With Central Venous Catheters: An Evaluation Questionnaire. Am J Crit Care 2008. [DOI: 10.4037/ajcc2008.17.1.65] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Background Lack of adherence to recommended evidence-based guidelines for preventing infections associated with use of central venous catheters may be due to nurses’ lack of knowledge of the guidelines.
Objective To develop a reliable and valid questionnaire for evaluating critical care nurses’ knowledge of evidence-based guidelines for preventing infections associated with central venous catheters.
Methods A total of 10 nursing-related strategies were identified from current evidence-based guidelines for preventing infections associated with use of central venous catheters. Face and content validation were determined for selected interventions and multiple-choice questions (1 question per intervention). The test results of 762 critical care nurses were evaluated for item difficulty, item discrimination, and quality of the response alternatives or options for answers (possible responses).
Results All 10 items had face and content validity. Values for item difficulty ranged from 0.1 to 0.9. Values for item discrimination ranged from 0.05 to 0.41. The quality of the response alternatives (0.0–0.8) indicated widespread misconceptions among the critical care nurses in the sample.
Conclusion The questionnaire is reliable and has face and content validity. Findings from surveys in which this questionnaire is used can lead to better educational programs for critical care nurses on infections associated with use of central venous catheters.
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Affiliation(s)
- S. Labeau
- S. Labeau is a PhD student in the Faculty of Healthcare, Ghent University College, Ghent, Belgium
| | - A. Vereecke
- A. Vereecke is a master’s student in the Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - D.M. Vandijck
- D.M. Vandijck is a PhD student in the Department of Intensive Care, Ghent University Hospital and the Faculty of Medicine and Health Sciences, Ghent University
| | - B. Claes
- B. Claes is head of the Department of Intensive Care, University Hospital of Antwerp, Antwerp, Belgium
| | - S.I. Blot
- S.I. Blot is a researcher at Ghent University Hospital and a professor in the Faculty of Medicine and Health Sciences of Ghent University and at Ghent University College
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Mayhall CG. In Pursuit of Ventilator-Associated Pneumonia Prevention: The Right Path. Clin Infect Dis 2007; 45:712-4. [PMID: 17712754 DOI: 10.1086/520986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Accepted: 06/03/2007] [Indexed: 01/28/2023] Open
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Krein SL, Hofer TP, Kowalski CP, Olmsted RN, Kauffman CA, Forman JH, Banaszak-Holl J, Saint S. Use of central venous catheter-related bloodstream infection prevention practices by US hospitals. Mayo Clin Proc 2007; 82:672-8. [PMID: 17550746 DOI: 10.4065/82.6.672] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine the extent to which US acute care hospitals have adopted recommended practices to prevent central venous catheter-related bloodstream infections (CR-BSIs). PARTICIPANTS AND METHODS Between March 16, 2005, and August 1, 2005, a survey of infection control coordinators was conducted at a national random sample of nonfederal hospitals with an intensive care unit and more than 50 hospital beds (n=600) and at all Department of Veterans Affairs (VA) medical centers (n=119). Primary outcomes were regular use of 5 specific practices and a composite approach for preventing CR-BSIs. RESULTS The overall survey response rate was 72% (n=516). A higher percentage of VA compared to non-VA hospitals reported using maximal sterile barrier precautions (84% vs 71%; P=.01); chlorhexidine gluconate for insertion site antisepsis (91% vs 69%; P<.001); and a composite approach (62% vs 44%; P=.003) combining concurrent use of maximal sterile barrier precautions, chlorhexidine gluconate, and avoidance of routine central line changes. Those hospitals having a higher safety culture score, having a certified infection control professional, and participating in an infection prevention collaborative were more likely to use CR-BSI prevention practices. CONCLUSION Most US hospitals are using maximal sterile barrier precautions and chlorhexidine gluconate, 2 of the most strongly recommended practices to prevent CR-BSIs. However, fewer than half of non-VA US hospitals reported concurrent use of maximal sterile barrier precautions, chlorhexidine gluconate, and avoidance of routine central line changes. Wider use of CR-BSI prevention practices by hospitals could be encouraged by fostering a culture of safety, participating in infection prevention collaboratives, and promoting infection control professional certification.
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Affiliation(s)
- Sarah L Krein
- Center for Practice Management and Outcomes Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.
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Miranda JA, Trick WE, Evans AT, Charles-Damte M, Reilly BM, Clarke P. Firm-based trial to improve central venous catheter insertion practices. J Hosp Med 2007; 2:135-42. [PMID: 17549773 DOI: 10.1002/jhm.168] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Central venous catheters placed in femoral veins increase the risk of complications. At our institution, residents place most catheters in the femoral vein. OBJECTIVE Determine whether a hands-on educational session reduced femoral venous catheterization and improved residents' confidence and adherence to recommendations for infection control. DESIGN Firm-based clinical trial between November 2004 and March 2005. SETTING General medical wards of Cook County (Stroger) Hospital (Chicago, IL), a public teaching hospital. PARTICIPANTS Internal medicine residents (n = 150). INTERVENTION Before their 4-week rotation, intervention-firm residents received a lecture and practiced placing catheters in mannequins; control-firm residents received the usual training. MEASUREMENTS Venous insertion site, adherence to recommendations for infection control, knowledge and confidence about catheter insertion, and catheter-associated complications RESULTS Residents inserted 54 catheters, or 0.24 insertions per resident per 4-week rotation. There was a nonsignificant decrease in femoral insertions for nondialysis catheters in the intervention group compared to the control group (44% vs. 58%), difference: -14% (95% CI, -52% to 24%). The intervention significantly increased residents' knowledge of complications related to femoral vein catheterization and temporarily increased their confidence about placing internal jugular or subclavian venous catheters. Intervention-group residents were more likely to use masks during catheterization (risk ratio, 2.2; 95% CI, 1.3-2.7), but other practices were similar. CONCLUSIONS Our intervention improved residents' knowledge of complications and use of masks during catheter insertion; however, it did not significantly change venous insertion sites. Catheter insertions on our general medicine wards are infrequent, and the skills acquired during the skills-building session may have deteriorated given the few clinical opportunities for reinforcement.
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Affiliation(s)
- Julio A Miranda
- Department of Medicine, Cook County (Stroger) Hospital, Chicago, Illinois, USA.
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Snapshots for September 2005. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2005. [DOI: 10.1097/01.idc.0000179878.90431.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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