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Sharpe EL, Curry S, Wyckoff MM. NANN Neonatal Peripherally Inserted Central Catheters: Guideline for Practice, 4th ed. Adv Neonatal Care 2024; 24:313-315. [PMID: 39052577 DOI: 10.1097/anc.0000000000001182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Affiliation(s)
- Elizabeth Li Sharpe
- College of Nursing, The Ohio State University, Columbus, Ohio (Dr Sharpe); Neonatal Intensive Care Unit, Arkansas Children's Hospital, Little Rock, Arkansas (Ms Curry); and College of Nursing, and Doctor of Nursing Practice Program, Samuel Merritt University, Sacramento, California (Dr Wyckoff)
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Star KE, Lindsey K, Reese SM, Paulino L, Hernandez LL, Tynes I, Eiseman K, Tynes J. Reducing central line-associated bloodstream infection with a dedicated CLABSI prevention registered nurse role. Am J Infect Control 2024; 52:659-663. [PMID: 38061403 DOI: 10.1016/j.ajic.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Following a 200% increase in the central line-associated bloodstream infection (CLABSI) standardized infection ratio in a private teaching hospital between 2019 and 2020, a program with the utilization of a CLABSI Prevention Registered Nurse was implemented to reduce CLABSIs through a variety of focused prevention efforts and education. METHODS The CLABSI P-RN project consisted of a dedicated team of RNs that performed interventions that included an audit of all central lines daily, real-time education and remediation, bi-weekly educational handouts, and assistance with 2-person dressing changes. Audit data were utilized to identify trends in gaps in compliance with the CLABSI bundle (ie, daily bathing, dressing integrity). The CLABSI rate/1,000 central line days were tracked in preintervention, intervention, and postintervention time periods. RESULTS During the intervention, the CLABSI rate decreased from 1.4 during the preintervention time period, to 0.4 during the intervention time period (P-value .04). Additionally, daily bathing compliance improved from 84.3% during the preintervention time period, to 90.8% during the intervention time period (P-value .004). DISCUSSION The implementation of the CLABSI P-RN was beneficial in reducing CLABSIs. CONCLUSIONS An expert-trained role dedicated to central line management reduces CLABSI occurrences, reduces health care costs, and improves patient outcomes.
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Affiliation(s)
- Kelsey E Star
- Infection Prevention, Vascular Access, Saint Joseph Hospital, Intermountain Health, Denver, CO.
| | - Kaia Lindsey
- Infection Prevention, Intermountain Health, Broomfield, CO
| | - Sara M Reese
- Infection Prevention, Intermountain Health, Broomfield, CO
| | - Linda Paulino
- Infection Prevention, Vascular Access, Saint Joseph Hospital, Intermountain Health, Denver, CO
| | - Lily L Hernandez
- Infection Prevention, Vascular Access, Saint Joseph Hospital, Intermountain Health, Denver, CO
| | - Irene Tynes
- Infection Prevention, Vascular Access, Saint Joseph Hospital, Intermountain Health, Denver, CO
| | - Karli Eiseman
- Infection Prevention, Vascular Access, Saint Joseph Hospital, Intermountain Health, Denver, CO
| | - John Tynes
- Infection Prevention, Vascular Access, Saint Joseph Hospital, Intermountain Health, Denver, CO
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3
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Draper A, Nelson S, Taylor B, Arroyo C, Gasama H, Russell R. Vascular Access Team Central Line Dressing Changes to Reduce Infection Risk: A Focused Two-Person Approach in High-Risk Patients. JOURNAL OF INFUSION NURSING 2024; 47:175-181. [PMID: 38744242 DOI: 10.1097/nan.0000000000000545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Due to low compliance by bedside nursing with a central line-associated bloodstream infection (CLABSI) prevention bundle and increased CLABSI rates, a mandatory re-education initiative at a 1200-bed university-affiliated hospital was undertaken. Despite this, 2 units, housing high-risk immunocompromised patients, continued to experience increased CLABSI rates. A quality improvement before-after project design in these units replaced bedside nursing staff with 2 nurses from the vascular access team (VAT) to perform central vascular access device (CVAD) dressing changes routinely every 7 days or earlier if needed. The VAT consistently followed the bundled components, including use of chlorhexidine gluconate (CHG)-impregnated dressings on all patients unless an allergy was identified. In this case, a non-CHG transparent semipermeable membrane dressing was used. There were 884 patients with 14 211 CVAD days in the preimplementation period and 1136 patients with 14 225 CVAD days during the postimplementation period. The VAT saw 602 (53.0%) of the 1136 patients, performing at least 1 dressing change in 98% of the patients (n = 589). The combined CLABSI rate for the 2 units decreased from 2.53 per 1000 CVAD days preintervention to 1.62 per 1000 CVAD days postintervention. The estimated incidence rate ratio (IRR) for the intervention was 0.639, a 36.1% reduction in monthly CLABSI rates during the postimplementation period.
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Affiliation(s)
- Amelia Draper
- Author Affiliations: Barnes-Jewish Hospital, St. Louis, Missouri
- Amelia Draper, MSN, RN, AGCNS-BC, CRNI, has more than 26 years of nursing experience and has held roles in bedside nursing, research, leadership, and advanced practice nursing. Most of her nursing background is in vascular access device placement, maintenance, and removal. At the time of this project, Ms Draper was a clinical nurse specialist in the vascular access services department at Barnes-Jewish Hospital, where she completed the data collection for this article. Susan K. Nelson, MSN, RN, CRNI, is the clinical nurse manager of vascular access service, wound/ostomy inpatient service, and diabetes education inpatient service at Barnes-Jewish Hospital in St. Louis. Ms. Nelson has developed and implemented educational classes at Barnes-Jewish Hospital pertaining to vascular access, including basic intravenous therapy, implanted ports, and central venous catheter discontinuation. She is a member of the Infusion Nurses Society and presented "Implementing an Education Program to Empower Nurses Through Vascular Access Skills and Education" at the 2017 INS Annual Meeting. Beth Taylor, DCN, RD-AP, was promoted to a research scientist position at Barnes-Jewish Hospital in St. Louis after receiving her doctorate in 2014. She is active in the Society of Critical Care Medicine (SCCM), sitting on the council from 2013 to 2016 and serving on several committees, most recently as a cochair for the 2021 SCCM 50th anniversary virtual congress. She has lectured in local, national, and international venues and has published several chapters and peer-reviewed articles. Cassandra Arroyo, MS, PhD, is a Harvard-trained biostatistician and social epidemiologist. With over 20 years of experience, she has specific content and methodological expertise in analysis of large national datasets, analysis of hospital databases, epidemiology of obesity, measurement and analysis of physical activity data, social and behavioral determinants of chronic disease, applied community-based participatory methods for health equity, and impact of the built environment on healthful living. In her current role of lead statistical analyst, she specifically focuses on study design and statistical analysis and methods for patient care services research, evidence-based practice, and quality improvement at Barnes-Jewish Hospital in St. Louis. Heather Gasama, MPH, has worked in public health for 10 years, 5 of which have been focused on hospital infection prevention and epidemiology. After receiving her master's in public health, she spent time working with a local public health agency, determined to decrease environmental hazards to human health (including vector-borne illness and chemical pollution and contamination). She has coauthored several abstracts with her infection prevention colleagues giving insight into isolation precautions, central line risk factors contributing to infection, foley justification, and high-level disinfection. Robert Russell, MBA, MPH, has held 2 positions with Barnes-Jewish Hospital in St. Louis, both with a focus on health care analytics. Currently he serves as a healthcare informatics specialist and has been in this role for 3 years, where he is considered a subject matter expert with broad knowledge of all areas of biomedical informatics and can apply his expertise to complex projects and strategic initiatives. Mr Russell's main area of concentration lies within patient safety and quality, with a particular emphasis on infection prevention, specifically targeting the reduction of hospital acquired illnesses such as central line bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), hospital-onset Clostridioides difficile (C diff), and surgical site infections
| | - Susan Nelson
- Author Affiliations: Barnes-Jewish Hospital, St. Louis, Missouri
- Amelia Draper, MSN, RN, AGCNS-BC, CRNI, has more than 26 years of nursing experience and has held roles in bedside nursing, research, leadership, and advanced practice nursing. Most of her nursing background is in vascular access device placement, maintenance, and removal. At the time of this project, Ms Draper was a clinical nurse specialist in the vascular access services department at Barnes-Jewish Hospital, where she completed the data collection for this article. Susan K. Nelson, MSN, RN, CRNI, is the clinical nurse manager of vascular access service, wound/ostomy inpatient service, and diabetes education inpatient service at Barnes-Jewish Hospital in St. Louis. Ms. Nelson has developed and implemented educational classes at Barnes-Jewish Hospital pertaining to vascular access, including basic intravenous therapy, implanted ports, and central venous catheter discontinuation. She is a member of the Infusion Nurses Society and presented "Implementing an Education Program to Empower Nurses Through Vascular Access Skills and Education" at the 2017 INS Annual Meeting. Beth Taylor, DCN, RD-AP, was promoted to a research scientist position at Barnes-Jewish Hospital in St. Louis after receiving her doctorate in 2014. She is active in the Society of Critical Care Medicine (SCCM), sitting on the council from 2013 to 2016 and serving on several committees, most recently as a cochair for the 2021 SCCM 50th anniversary virtual congress. She has lectured in local, national, and international venues and has published several chapters and peer-reviewed articles. Cassandra Arroyo, MS, PhD, is a Harvard-trained biostatistician and social epidemiologist. With over 20 years of experience, she has specific content and methodological expertise in analysis of large national datasets, analysis of hospital databases, epidemiology of obesity, measurement and analysis of physical activity data, social and behavioral determinants of chronic disease, applied community-based participatory methods for health equity, and impact of the built environment on healthful living. In her current role of lead statistical analyst, she specifically focuses on study design and statistical analysis and methods for patient care services research, evidence-based practice, and quality improvement at Barnes-Jewish Hospital in St. Louis. Heather Gasama, MPH, has worked in public health for 10 years, 5 of which have been focused on hospital infection prevention and epidemiology. After receiving her master's in public health, she spent time working with a local public health agency, determined to decrease environmental hazards to human health (including vector-borne illness and chemical pollution and contamination). She has coauthored several abstracts with her infection prevention colleagues giving insight into isolation precautions, central line risk factors contributing to infection, foley justification, and high-level disinfection. Robert Russell, MBA, MPH, has held 2 positions with Barnes-Jewish Hospital in St. Louis, both with a focus on health care analytics. Currently he serves as a healthcare informatics specialist and has been in this role for 3 years, where he is considered a subject matter expert with broad knowledge of all areas of biomedical informatics and can apply his expertise to complex projects and strategic initiatives. Mr Russell's main area of concentration lies within patient safety and quality, with a particular emphasis on infection prevention, specifically targeting the reduction of hospital acquired illnesses such as central line bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), hospital-onset Clostridioides difficile (C diff), and surgical site infections
| | - Beth Taylor
- Author Affiliations: Barnes-Jewish Hospital, St. Louis, Missouri
- Amelia Draper, MSN, RN, AGCNS-BC, CRNI, has more than 26 years of nursing experience and has held roles in bedside nursing, research, leadership, and advanced practice nursing. Most of her nursing background is in vascular access device placement, maintenance, and removal. At the time of this project, Ms Draper was a clinical nurse specialist in the vascular access services department at Barnes-Jewish Hospital, where she completed the data collection for this article. Susan K. Nelson, MSN, RN, CRNI, is the clinical nurse manager of vascular access service, wound/ostomy inpatient service, and diabetes education inpatient service at Barnes-Jewish Hospital in St. Louis. Ms. Nelson has developed and implemented educational classes at Barnes-Jewish Hospital pertaining to vascular access, including basic intravenous therapy, implanted ports, and central venous catheter discontinuation. She is a member of the Infusion Nurses Society and presented "Implementing an Education Program to Empower Nurses Through Vascular Access Skills and Education" at the 2017 INS Annual Meeting. Beth Taylor, DCN, RD-AP, was promoted to a research scientist position at Barnes-Jewish Hospital in St. Louis after receiving her doctorate in 2014. She is active in the Society of Critical Care Medicine (SCCM), sitting on the council from 2013 to 2016 and serving on several committees, most recently as a cochair for the 2021 SCCM 50th anniversary virtual congress. She has lectured in local, national, and international venues and has published several chapters and peer-reviewed articles. Cassandra Arroyo, MS, PhD, is a Harvard-trained biostatistician and social epidemiologist. With over 20 years of experience, she has specific content and methodological expertise in analysis of large national datasets, analysis of hospital databases, epidemiology of obesity, measurement and analysis of physical activity data, social and behavioral determinants of chronic disease, applied community-based participatory methods for health equity, and impact of the built environment on healthful living. In her current role of lead statistical analyst, she specifically focuses on study design and statistical analysis and methods for patient care services research, evidence-based practice, and quality improvement at Barnes-Jewish Hospital in St. Louis. Heather Gasama, MPH, has worked in public health for 10 years, 5 of which have been focused on hospital infection prevention and epidemiology. After receiving her master's in public health, she spent time working with a local public health agency, determined to decrease environmental hazards to human health (including vector-borne illness and chemical pollution and contamination). She has coauthored several abstracts with her infection prevention colleagues giving insight into isolation precautions, central line risk factors contributing to infection, foley justification, and high-level disinfection. Robert Russell, MBA, MPH, has held 2 positions with Barnes-Jewish Hospital in St. Louis, both with a focus on health care analytics. Currently he serves as a healthcare informatics specialist and has been in this role for 3 years, where he is considered a subject matter expert with broad knowledge of all areas of biomedical informatics and can apply his expertise to complex projects and strategic initiatives. Mr Russell's main area of concentration lies within patient safety and quality, with a particular emphasis on infection prevention, specifically targeting the reduction of hospital acquired illnesses such as central line bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), hospital-onset Clostridioides difficile (C diff), and surgical site infections
| | - Cassandra Arroyo
- Author Affiliations: Barnes-Jewish Hospital, St. Louis, Missouri
- Amelia Draper, MSN, RN, AGCNS-BC, CRNI, has more than 26 years of nursing experience and has held roles in bedside nursing, research, leadership, and advanced practice nursing. Most of her nursing background is in vascular access device placement, maintenance, and removal. At the time of this project, Ms Draper was a clinical nurse specialist in the vascular access services department at Barnes-Jewish Hospital, where she completed the data collection for this article. Susan K. Nelson, MSN, RN, CRNI, is the clinical nurse manager of vascular access service, wound/ostomy inpatient service, and diabetes education inpatient service at Barnes-Jewish Hospital in St. Louis. Ms. Nelson has developed and implemented educational classes at Barnes-Jewish Hospital pertaining to vascular access, including basic intravenous therapy, implanted ports, and central venous catheter discontinuation. She is a member of the Infusion Nurses Society and presented "Implementing an Education Program to Empower Nurses Through Vascular Access Skills and Education" at the 2017 INS Annual Meeting. Beth Taylor, DCN, RD-AP, was promoted to a research scientist position at Barnes-Jewish Hospital in St. Louis after receiving her doctorate in 2014. She is active in the Society of Critical Care Medicine (SCCM), sitting on the council from 2013 to 2016 and serving on several committees, most recently as a cochair for the 2021 SCCM 50th anniversary virtual congress. She has lectured in local, national, and international venues and has published several chapters and peer-reviewed articles. Cassandra Arroyo, MS, PhD, is a Harvard-trained biostatistician and social epidemiologist. With over 20 years of experience, she has specific content and methodological expertise in analysis of large national datasets, analysis of hospital databases, epidemiology of obesity, measurement and analysis of physical activity data, social and behavioral determinants of chronic disease, applied community-based participatory methods for health equity, and impact of the built environment on healthful living. In her current role of lead statistical analyst, she specifically focuses on study design and statistical analysis and methods for patient care services research, evidence-based practice, and quality improvement at Barnes-Jewish Hospital in St. Louis. Heather Gasama, MPH, has worked in public health for 10 years, 5 of which have been focused on hospital infection prevention and epidemiology. After receiving her master's in public health, she spent time working with a local public health agency, determined to decrease environmental hazards to human health (including vector-borne illness and chemical pollution and contamination). She has coauthored several abstracts with her infection prevention colleagues giving insight into isolation precautions, central line risk factors contributing to infection, foley justification, and high-level disinfection. Robert Russell, MBA, MPH, has held 2 positions with Barnes-Jewish Hospital in St. Louis, both with a focus on health care analytics. Currently he serves as a healthcare informatics specialist and has been in this role for 3 years, where he is considered a subject matter expert with broad knowledge of all areas of biomedical informatics and can apply his expertise to complex projects and strategic initiatives. Mr Russell's main area of concentration lies within patient safety and quality, with a particular emphasis on infection prevention, specifically targeting the reduction of hospital acquired illnesses such as central line bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), hospital-onset Clostridioides difficile (C diff), and surgical site infections
| | - Heather Gasama
- Author Affiliations: Barnes-Jewish Hospital, St. Louis, Missouri
- Amelia Draper, MSN, RN, AGCNS-BC, CRNI, has more than 26 years of nursing experience and has held roles in bedside nursing, research, leadership, and advanced practice nursing. Most of her nursing background is in vascular access device placement, maintenance, and removal. At the time of this project, Ms Draper was a clinical nurse specialist in the vascular access services department at Barnes-Jewish Hospital, where she completed the data collection for this article. Susan K. Nelson, MSN, RN, CRNI, is the clinical nurse manager of vascular access service, wound/ostomy inpatient service, and diabetes education inpatient service at Barnes-Jewish Hospital in St. Louis. Ms. Nelson has developed and implemented educational classes at Barnes-Jewish Hospital pertaining to vascular access, including basic intravenous therapy, implanted ports, and central venous catheter discontinuation. She is a member of the Infusion Nurses Society and presented "Implementing an Education Program to Empower Nurses Through Vascular Access Skills and Education" at the 2017 INS Annual Meeting. Beth Taylor, DCN, RD-AP, was promoted to a research scientist position at Barnes-Jewish Hospital in St. Louis after receiving her doctorate in 2014. She is active in the Society of Critical Care Medicine (SCCM), sitting on the council from 2013 to 2016 and serving on several committees, most recently as a cochair for the 2021 SCCM 50th anniversary virtual congress. She has lectured in local, national, and international venues and has published several chapters and peer-reviewed articles. Cassandra Arroyo, MS, PhD, is a Harvard-trained biostatistician and social epidemiologist. With over 20 years of experience, she has specific content and methodological expertise in analysis of large national datasets, analysis of hospital databases, epidemiology of obesity, measurement and analysis of physical activity data, social and behavioral determinants of chronic disease, applied community-based participatory methods for health equity, and impact of the built environment on healthful living. In her current role of lead statistical analyst, she specifically focuses on study design and statistical analysis and methods for patient care services research, evidence-based practice, and quality improvement at Barnes-Jewish Hospital in St. Louis. Heather Gasama, MPH, has worked in public health for 10 years, 5 of which have been focused on hospital infection prevention and epidemiology. After receiving her master's in public health, she spent time working with a local public health agency, determined to decrease environmental hazards to human health (including vector-borne illness and chemical pollution and contamination). She has coauthored several abstracts with her infection prevention colleagues giving insight into isolation precautions, central line risk factors contributing to infection, foley justification, and high-level disinfection. Robert Russell, MBA, MPH, has held 2 positions with Barnes-Jewish Hospital in St. Louis, both with a focus on health care analytics. Currently he serves as a healthcare informatics specialist and has been in this role for 3 years, where he is considered a subject matter expert with broad knowledge of all areas of biomedical informatics and can apply his expertise to complex projects and strategic initiatives. Mr Russell's main area of concentration lies within patient safety and quality, with a particular emphasis on infection prevention, specifically targeting the reduction of hospital acquired illnesses such as central line bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), hospital-onset Clostridioides difficile (C diff), and surgical site infections
| | - Robert Russell
- Author Affiliations: Barnes-Jewish Hospital, St. Louis, Missouri
- Amelia Draper, MSN, RN, AGCNS-BC, CRNI, has more than 26 years of nursing experience and has held roles in bedside nursing, research, leadership, and advanced practice nursing. Most of her nursing background is in vascular access device placement, maintenance, and removal. At the time of this project, Ms Draper was a clinical nurse specialist in the vascular access services department at Barnes-Jewish Hospital, where she completed the data collection for this article. Susan K. Nelson, MSN, RN, CRNI, is the clinical nurse manager of vascular access service, wound/ostomy inpatient service, and diabetes education inpatient service at Barnes-Jewish Hospital in St. Louis. Ms. Nelson has developed and implemented educational classes at Barnes-Jewish Hospital pertaining to vascular access, including basic intravenous therapy, implanted ports, and central venous catheter discontinuation. She is a member of the Infusion Nurses Society and presented "Implementing an Education Program to Empower Nurses Through Vascular Access Skills and Education" at the 2017 INS Annual Meeting. Beth Taylor, DCN, RD-AP, was promoted to a research scientist position at Barnes-Jewish Hospital in St. Louis after receiving her doctorate in 2014. She is active in the Society of Critical Care Medicine (SCCM), sitting on the council from 2013 to 2016 and serving on several committees, most recently as a cochair for the 2021 SCCM 50th anniversary virtual congress. She has lectured in local, national, and international venues and has published several chapters and peer-reviewed articles. Cassandra Arroyo, MS, PhD, is a Harvard-trained biostatistician and social epidemiologist. With over 20 years of experience, she has specific content and methodological expertise in analysis of large national datasets, analysis of hospital databases, epidemiology of obesity, measurement and analysis of physical activity data, social and behavioral determinants of chronic disease, applied community-based participatory methods for health equity, and impact of the built environment on healthful living. In her current role of lead statistical analyst, she specifically focuses on study design and statistical analysis and methods for patient care services research, evidence-based practice, and quality improvement at Barnes-Jewish Hospital in St. Louis. Heather Gasama, MPH, has worked in public health for 10 years, 5 of which have been focused on hospital infection prevention and epidemiology. After receiving her master's in public health, she spent time working with a local public health agency, determined to decrease environmental hazards to human health (including vector-borne illness and chemical pollution and contamination). She has coauthored several abstracts with her infection prevention colleagues giving insight into isolation precautions, central line risk factors contributing to infection, foley justification, and high-level disinfection. Robert Russell, MBA, MPH, has held 2 positions with Barnes-Jewish Hospital in St. Louis, both with a focus on health care analytics. Currently he serves as a healthcare informatics specialist and has been in this role for 3 years, where he is considered a subject matter expert with broad knowledge of all areas of biomedical informatics and can apply his expertise to complex projects and strategic initiatives. Mr Russell's main area of concentration lies within patient safety and quality, with a particular emphasis on infection prevention, specifically targeting the reduction of hospital acquired illnesses such as central line bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), hospital-onset Clostridioides difficile (C diff), and surgical site infections
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Picaud JC, Faton S, Pradat P, Pastor-Diez B, Martelin A, Armoiry X, Hays S. A new perfusion system to reduce the burden of central-venous-line-associated bloodstream infections in neonates. J Hosp Infect 2024; 143:203-212. [PMID: 37858805 DOI: 10.1016/j.jhin.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/22/2023] [Accepted: 10/08/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Central-venous-line-associated bloodstream infection (CLABSI) is a significant cause of morbidity and mortality in preterm infants. As there is large variation in the reported effect of multi-modal preventive strategies, it could be relevant to propose new additional strategies. AIM To assess the impact of a new perfusion system on CLABSI rate. METHODS A before-and-after study was performed in infants born at <32 weeks of gestation or with birth weight <1500 g who required a multi-perfusion system connected to a central venous line. In the first 12-month period ('before'), the pre-existing perfusion system (multiple stopcocks) was used. An intervention period then occurred with implementation of a new perfusion closed system, without change in 'bundles' related to various aspects of central line care. During the second 12-month period ('after'), the CLABSI rate was assessed and compared with the pre-intervention period. FINDINGS In total, 313 infants were included in this study (before: N=163; after: N=150), and 46% had birth weight <1000 g. The change in perfusion system resulted in a significant decrease in CLABSI rate from 11.3 to 2.2 per 1000 catheter-days (P<0.001). The period was independently associated with an 88% reduction in the risk of CLABSI after implementation of the new perfusion system [odds ratio (OR) 0.12, 95% confidence interval (CI) 0.03-0.39; P<0.001]. The duration of central line use was also associated with CLABSIs (for each additional day: OR 1.05, 95% CI 1.02-1.07; P<0.001). CONCLUSIONS Implementation of the new perfusion system was feasible in a large neonatal unit, and reduced the CLABSI rate soon after implementation.
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Affiliation(s)
- J C Picaud
- Service de néonatologie, Hopital universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Laboratoire CarMen, INSERM, INRA, Claude Bernard University Lyon 1, Pierre-Bénite, France.
| | - S Faton
- Service de néonatologie, Hopital universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - P Pradat
- Centre de recherche clinique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - B Pastor-Diez
- Service de néonatologie, Hopital universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - A Martelin
- Pharmacie, Hôpital de la Croix-Rousse, Lyon, France
| | - X Armoiry
- University of Lyon, School of Pharmacy/UMR CNRS 5510 MATEIS/Edouard Herriot Hospital, Pharmacy Department, Lyon, France; University of Warwick, Warwick Medical School, Coventry, UK
| | - S Hays
- Service de néonatologie, Hopital universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
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Summerlin-Long S, DiBiase LM, Padgett M, Mack J, Clark C, Teal L, Sickbert-Bennett E. A helping hand: The impact of a central line insertion support team. Am J Infect Control 2023; 51:1438-1440. [PMID: 37865892 DOI: 10.1016/j.ajic.2023.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/01/2023] [Accepted: 09/02/2023] [Indexed: 10/23/2023]
Abstract
As part of a central line-associated bloodstream infections prevention initiative, our academic medical center formed a dedicated nursing team to assist with central line insertions and provide support with caring for difficult lines and dressings. During the program's first 3 years, the proportion of insertion-related central line-associated bloodstream infections occurring in areas within the team's scope declined overall by 47%.
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Affiliation(s)
- Shelley Summerlin-Long
- Department of Infection Prevention, UNC Health, Chapel Hill, NC, USA; Public Health Leadership, UNC Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Lauren M DiBiase
- Department of Infection Prevention, UNC Health, Chapel Hill, NC, USA; Department of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Melody Padgett
- Adult Specialty Care Team, UNC Health, Chapel Hill, NC, USA
| | - Jennifer Mack
- Adult Specialty Care Team, UNC Health, Chapel Hill, NC, USA
| | - Christa Clark
- Department of Infection Prevention, UNC Health, Chapel Hill, NC, USA
| | - Lisa Teal
- Department of Infection Prevention, UNC Health, Chapel Hill, NC, USA
| | - Emily Sickbert-Bennett
- Department of Infection Prevention, UNC Health, Chapel Hill, NC, USA; Department of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Dept of Epidemiology, UNC Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Hightower HB, Young JA, Thomas J, Smith JJ, Hobby-Noland D, Palombo G, McCaskey M, Benton B, Hutto C, Coghill C, McCullough B, Hayes L, Martin C, Chewning JH. Reduction of Central-line-Associated Bloodstream Infections in a Tertiary Neonatal Intensive Care Unit through Simulation Education. Pediatr Qual Saf 2022; 7:e610. [PMID: 38585503 PMCID: PMC10997285 DOI: 10.1097/pq9.0000000000000610] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/08/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Critically ill neonates and those with complex medical conditions frequently require the use of central venous lines. Unfortunately, central line-associated bloodstream infections (CLABSIs) result in significant morbidity and mortality, and the cost and increased length of stay burden the healthcare system. Previous studies have demonstrated that standardized care bundles can decrease CLABSI rates, but achieving sustained improvement has proven difficult. Methods All patients admitted to the Neonatal Intensive Care Unit between 2014 and 2020 who had a CVL were included in this study. First, we recorded all CLABSI events and total CVL days according to defined criteria. Then, in late 2016, we instituted simulation-based nursing training for CVL care. Results Job Instruction Sheets were initially introduced to Neonatal Intensive Care Unit nursing staff simultaneously with one-on-one teaching sessions between instructors and bedside nurses. Intermittent performance audits and re-education for identified deficiencies did not improve the CLABSI rate per 1000 line days. After instituting simulation-based CVL training in 2016, there was a decreased rate of CLABSI events per 1000 line days sustained over time (x = 0.692). Conclusions Standardized care bundles and Hospital-acquired Condition interactor audits were insufficient to reduce the CLABSI rate. However, combining care bundles and education with simulation-based training significantly decreased CLABSI rates. One-on-one intensive training and continued ongoing monitoring were critical to producing a sustained reduction. This experience demonstrates that supervised, interactive education combined with simulation can significantly impact patient outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Cecelia Hutto
- From the University of Alabama at Birmingham, Birmingham, Ala
| | - Carl Coghill
- From the University of Alabama at Birmingham, Birmingham, Ala
| | | | - Leslie Hayes
- From the University of Alabama at Birmingham, Birmingham, Ala
| | - Colin Martin
- From the University of Alabama at Birmingham, Birmingham, Ala
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A Quality Improvement Initiative to Provide Timely Central Vascular Access in a Neonatal Intensive Care Unit. Adv Neonatal Care 2022; 22:203-209. [PMID: 34407057 DOI: 10.1097/anc.0000000000000941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Timely central venous access is essential in the care of critically ill neonates. Peripherally inserted central catheters (PICCs) are the preferred form of central venous access when umbilical venous catheters cannot be placed or are discontinued. However, time delays increase risk for injury from peripheral intravenous lines and may contribute to inconsistent delivery of necessary fluids and medications. PURPOSE The aim of this quality improvement project was to decrease wait times for PICC placement in the neonatal intensive care unit (NICU). METHODS A unit-based PICC team was developed consisting of NICU nurses and attending neonatologists and implemented in 2 phases. Data were collected from chart reviews before, during, and after implementation of the team. We tracked time between PICC order and placement and number of attempts. Hospital metrics on peripheral intravenous line infiltrations and central line-associated blood stream infection were also monitored. At the end of the project, we continued tracking outcomes to determine whether gains would be sustained past the project period. RESULTS Implementation of a unit-based interdisciplinary specialty team led to a 50% reduction in mean PICC wait times from 1.2 days to 0.58 days. Benefits of the initiative were sustained past the initial project period. IMPLICATIONS FOR PRACTICE The development of a dedicated, local team played a key role in improving vascular access in the NICU. IMPLICATIONS FOR RESEARCH Proximity of specialized teams provides a solution to address gaps in care in the NICU.
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8
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Abstract
BACKGROUND Central line-associated bloodstream infections (CLABSIs) are an ongoing concern in health care, resulting in increased mortality, morbidity, length of stay, and additional costs to hospitals. LOCAL PROBLEM Despite intermittent improvements in CLABSI rates within our facility, long-term sustainment has been challenging. METHODS This was a quality improvement project including a collaborative rounding approach supported by specialty nursing roles. INTERVENTIONS In addition to implementing a variety of evidence-based interventions, the rounding team performed audits to assess performance and created focused education tools to address the identified opportunities within each individual unit. RESULTS High levels of engagement as evidenced by increased audit completion resulted in CLABSI reductions. However, 2 peaks in CLABSI rates were associated with higher volumes of coronavirus disease (COVID-19) hospitalizations and decreased audits. CONCLUSIONS Despite challenges correlated with COVID-19, a collaborative rounding team promotes and enhances awareness of prevention methods and a culture of safety.
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Knowledge and Practices for Central Line Infection Prevention Among Brazilian Nurses: A Mixed-Methods Study. Adv Neonatal Care 2022; 22:180-187. [PMID: 35703927 DOI: 10.1097/anc.0000000000000893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The risk of central line-associated bloodstream infections (CLABSIs) increases when preventive guidelines are not adhered to. However, studies have generally been quantitative and aimed at determining the effectiveness of CLABSI prevention bundles. Few studies have used a mixed-methods approach to investigate nursing professionals' knowledge and practices regarding CLABSI prevention. PURPOSE To determine nursing professionals' knowledge and practices regarding CLABSI prevention and identify facilitators and barriers to adherence to CLABSI prevention strategies in a Brazilian neonatal intensive care unit. METHODS A mixed-methods approach was used. Nursing professionals answered questionnaires regarding knowledge and practices surrounding CLABSI prevention. Semistructured interviews explored barriers nursing professionals face that hinder adherence to CLABSI preventive practices. FINDINGS Nursing professionals had moderate knowledge regarding CLABSI prevention practices. Daily assessment of the continued need for central venous lines (CVLs), hub disinfection before and after handling, and hand hygiene before handling CVLs were practices less adhered to. Interviews revealed barriers to adherence to preventive practices included lack of adequate equipment, resources for hand hygiene, and inadequate physical structure. Increased education and awareness of safe CVL practices and accountability of the entire healthcare team may improve adherence to CLABSI prevention practices. Results of this study reinforce the importance of considering current nursing practices when developing strategies to increase adherence to CLABSI prevention guidelines. IMPLICATIONS FOR PRACTICE Providing continuing education may increase adherence to CLABSI prevention strategies. IMPLICATIONS FOR RESEARCH Research is needed to develop strategies aimed at increasing nursing adherence to CLABSI prevention strategies.
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10
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Georgeades C, Rothstein AE, Plunk MR, Arendonk KV. Iatrogenic vascular trauma and complications of vascular access in children. Semin Pediatr Surg 2021; 30:151122. [PMID: 34930587 DOI: 10.1016/j.sempedsurg.2021.151122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Vascular access is frequently a critical component of the diagnostic and therapeutic procedures required to manage childhood illnesses, including many emergent conditions and critical illnesses. Vascular access in the pediatric population presents unique challenges, and many clinical and technical factors must be considered to avoid complications that can occur with vascular access procedures. This article reviews various aspects of vascular access and associated iatrogenic trauma in children, including risk factors, management of complications, and preventive measures to avoid complications. It is only with a comprehensive understanding of the topic that vascular access in children can be performed safely, effectively, and efficiently.
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Affiliation(s)
- Christina Georgeades
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, 999N 92nd Street, Suite 320, Milwaukee, WI 53226, United States.
| | - Abby E Rothstein
- Division of Vascular and Endovascular Surgery, Department of Surgery, Medical College of Wisconsin, 8701W. Watertown Plank Road, Milwaukee, WI 53226, United States
| | - Matthew R Plunk
- Department of Radiology, Children's Wisconsin and Medical College of Wisconsin, 9000W. Wisconsin Avenue, MS-721, Milwaukee, WI 53226, United States
| | - Kyle Van Arendonk
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, 999N 92nd Street, Suite 320, Milwaukee, WI 53226, United States
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11
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SUCCESSFUL INTERVENTIONS TO IMPROVE EFFICIENCY AND REDUCE PATIENT VISIT DURATION IN A RETINA PRACTICE. Retina 2021; 41:2157-2162. [PMID: 33758134 PMCID: PMC8448795 DOI: 10.1097/iae.0000000000003169] [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: 11/26/2022]
Abstract
PURPOSE To reduce the total clinic visit duration among retina providers in an academic ophthalmology department. METHODS All patient encounters across all providers in the department were analyzed to determine baseline clinic visit duration time, defined as the elapsed time between appointment time and checkout. To increase photography capacity, a major bottleneck identified through root cause analysis, four interventions were implemented: training ophthalmic technicians to perform fundus photography in addition to optical coherence tomographies, relocating photography equipment to be adjacent to examination rooms, procuring three additional Optos widefield retinal photography units, and shifting staff schedules to better align with that of the providers. These interventions were implemented in the clinics of two retina providers. RESULTS The average baseline visit duration for all patients across all providers was 87 minutes (19,550 patient visits). The previous average visit duration was 80 minutes for Provider 1 (557 patient visits) and 81 minutes for Provider 2 (1,246 patient visits). In the 4 weeks after interventions were implemented, the average visit duration decreased to 60 minutes for Provider 1 and 57 minutes for Provider 2. CONCLUSION A systematic approach and a multidisciplinary team resulted in targeted, cost-effective interventions that reduced total visit durations.
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12
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Dye ME, Pugh C, Sala C, Scott TA, Wallace T, Grubb PH, Hatch LD. Developing a Unit-Based Quality Improvement Program in a Large Neonatal ICU. Jt Comm J Qual Patient Saf 2021; 47:654-662. [PMID: 34284954 DOI: 10.1016/j.jcjq.2021.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Quality improvement (QI) methods have been widely adopted in health care. Although theoretical frameworks and models for organizing successful QI programs have been described, few reports have provided practical examples to link existing QI theory to building a unit-based QI program. The purpose of this report is to describe the authors' experience in building QI infrastructure in a large neonatal ICU (NICU). METHODS A unit-based QI program was developed with the goal of fostering the growth of high-functioning QI teams. This program was based on six pillars: shared vision for QI, QI team capacity, QI team capability, actionable data for improvement, culture of improvement, and QI team integration with external collaboratives. Multiple interventions were developed, including a QI dashboard to align NICU metrics with unit and hospital quality goals, formal training for QI leaders, QI coaches imbedded in project teams, a day-long QI educational workshop to introduce QI methodology to unit staff, and a secure, Web-based QI data infrastructure. RESULTS Over a five-year period, this QI infrastructure brought organization and support for individual QI project teams and improved patient outcomes in the unit. Two case studies are presented, describing teams that used support from the QI infrastructure. The Infection Prevention team reduced central line-associated bloodstream infections from 0.89 to 0.36 infections per 1,000 central line-days. The Nutrition team decreased the percentage of very low birth weight infants discharged with weights less than the 10th percentile from 51% to 40%. CONCLUSION The clinicians provide a pragmatic example of incorporating QI organizational and contextual theory into practice to support the development of high-functioning QI teams and build a unit-based QI program.
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13
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Wood LSY, Fuerch JH, Dambkowski CL, Chehab EF, Torres S, Shih JD, Venook R, Wall JK. Novel Neonatal Umbilical Catheter Protection and Stabilization Device in In vitro Model of Catheterized Human Umbilical Cords: Effect of Material and Venting on Bacterial Colonization. Am J Perinatol 2021; 38:560-566. [PMID: 31739365 DOI: 10.1055/s-0039-1700542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Umbilical central lines deliver life-saving medications and nutrition for neonates; however, complications associated with umbilical catheters (UCs) occur more frequently than in adults with central lines (i.e., line migration, systemic infection). We have developed a device for neonatal UC protection and stabilization to reduce catheter exposure to bacteria compared with the standard of care: "goal post" tape configuration. This study analyzes the effect of device venting and material on bacterial load of human umbilical cords in vitro. STUDY DESIGN Catheters were inserted into human umbilical cord segments in vitro, secured with plastic or silicone vented prototype versus tape, and levels of bacterial colonization were compared between groups after 7 days of incubation. RESULTS Nonvented plastic prototype showed increased bacterial load compared with goal post (p = 0.04). Colonization was comparable between the goal post and all vented plastic prototypes (p ≥ 0.30) and when compared with the vented silicone device (p = 1). CONCLUSION A novel silicone device does not increase external bacterial colonization compared with the current standard of care for line securement, and may provide a safe, convenient alternative to standard adhesive tape for UC stabilization. Future studies are anticipated to establish safety in vivo, alongside benefits such as migration and infection reduction.
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Affiliation(s)
- Lauren S Y Wood
- Department of Surgery, Stanford University School of Medicine, Stanford, California.,Division of Pediatric Surgery, Stanford Children's Health, Palo Alto, California
| | - Janene H Fuerch
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford Children's Health, Palo Alto, California
| | - Carl L Dambkowski
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Eric F Chehab
- Department of Bioengineering, Stanford University, Stanford, California
| | - Shivani Torres
- Department of Bioengineering, Stanford University, Stanford, California
| | - Joseph D Shih
- Department of Biology, William Jewell College, Liberty, Missouri
| | - Ross Venook
- Department of Bioengineering, Stanford University, Stanford, California
| | - James K Wall
- Department of Surgery, Stanford University School of Medicine, Stanford, California.,Division of Pediatric Surgery, Stanford Children's Health, Palo Alto, California.,Department of Bioengineering, Stanford University, Stanford, California
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Curry S, Mallard E, Marrero E, Walker M, Weeks R, Harrison HA, Temple M, Holland C, Brandon K. The Impact of a Dedicated Nurse on the Prevention of Central Line-Associated Bloodstream Infections in the NICU. Neonatal Netw 2021; 40:88-97. [PMID: 33731375 DOI: 10.1891/0730-0832/11-t-658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The neonatal population is at increased risk for central line-associated bloodstream infections (CLABSIs) related to prematurity, critical illness, and compromised immune function.1,4,5 METHODS: To address a 30 percent CLABSI rate increase, a quality improvement (QI) project in a Level IV NICU was developed and implemented by the NICU CLABSI team in 2018. The project trialed a dedicated CLABSI prevention-registered nurse (DCP-RN) role with select responsibilities aimed at rate reduction. The DCP-RN spearheaded an RN education plan, addressed prevention bundle compliance, and aided in establishing a reliable apparent cause analysis (ACA) process. RESULTS The outcome resulted in an over 50% reduction in the CLABSI rate and permanent adoption of the DCP-RN role in the NICU.
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15
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Oulego-Erroz I, Fernández-García A, Álvarez-Juan B, Terroba-Seara S, Quintela PA, Rodríguez-Núñez A. Ultrasound-guided supraclavicular cannulation of the brachiocephalic vein may reduce central line-associated bloodstream infection in preterm infants. Eur J Pediatr 2020; 179:1655-1663. [PMID: 32382789 PMCID: PMC7223997 DOI: 10.1007/s00431-020-03663-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 12/15/2022]
Abstract
The objective of this study was to assess the risk of central line-associated bloodstream infection (CLABSI) of ultrasound (US)-guided cannulation of the brachiocephalic vein (BCV) compared to standard epicutaneous cava catheters (ECCs) in preterm infants. This was a retrospective cohort study in preterm infants with a birth weight of less than 1500 g. Each BCV catheter was matched 1:3 with ECCs according to sex, birth weight, and year of insertion. The main outcome was the CLABSI density rate per 1000 days. Secondary outcomes included CLABSI episodes, CLABSI episodes per infant, and CLABSI/death. A multivariate Cox regression analysis was performed to assess whether the type of catheter (ECC vs. BCV) was associated with CLABSI risk. Ninety-six catheters (21 BCVs and 75 ECCs) in 79 infants were included (993 catheter days). BCV catheters were associated with a reduced CLABSI density rate compared to ECCs (3.05/1000 days vs 21.1/1000 days; p < 0.001). ECCs were associated with increased CLABSI risk compared to BCV catheters in multivariate analysis (hazard ratio 36; (95% CI, 2.5-511); p = 0.008).Conclusion: US-guided supraclavicular cannulation of the BCV was associated with a reduced risk of CLABSI compared to ECCs. This finding deserves further multicenter research. What is Known: • An epicutaneous-cava catheter (ECC) is commonly used in preterm infants for routine care (eg. delivery of nutrition and antibiotics) but this device may not suffice in infants who need high-intensity care (multiple drugs, hemodynamic monitoring, fluid resuscitation etc.). • Ultrasound-guided brachiocephalic vein (BCV) catheterization has shown a high success rate and few immediate complications in neonates and small infants but it has never been compared to standard ECCs. What is New: • When the operator in properly trained, US guided cannulation of the BCV in preterm infants is feasible, safe and may reduce the risk of CLABSI compared to standard ECCs. • This fact may expand the use of BCV catheters in selected high-risk preterm infants who need a large bore venous access.
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Affiliation(s)
- Ignacio Oulego-Erroz
- Pediatric Intensive Care Unit, Complejo Asistencial Universitario de León, León, Spain
- Working Group on Bedside Ultrasound of the Spanish Society of Pediatric Intensive Care (SECIP), León, Spain
- IBIOMED - Biomedicine Institute of León, University of León, León, Spain
| | - Alba Fernández-García
- Neonatal Intensive Care Unit, Complejo Asistencial Universitario de León, León, Spain
| | - Beatriz Álvarez-Juan
- Neonatal Intensive Care Unit, Complejo Asistencial Universitario de León, León, Spain
| | - Sandra Terroba-Seara
- Neonatal Intensive Care Unit, Complejo Asistencial Universitario de León, León, Spain
| | - Paula Alonso Quintela
- IBIOMED - Biomedicine Institute of León, University of León, León, Spain
- Neonatal Intensive Care Unit, Complejo Asistencial Universitario de León, León, Spain
| | - Antonio Rodríguez-Núñez
- Pediatric Critical, Intermediate and Palliative Care Section, Hospital Clínico Universitario de Santiago, Research Institute of Santiago (IDIS), Santiago, Spain
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Galloway DP, Mathis MS, Wilkinson LT, Venick RS, Wendel D, Cole CR, Martin CA. Effect of the COVID-19 Pandemic on Pediatric Intestinal Failure Healthcare Delivery. JPEN J Parenter Enteral Nutr 2020; 45:50-56. [PMID: 32941671 DOI: 10.1002/jpen.2000] [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: 07/17/2020] [Accepted: 08/18/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has influenced how healthcare is being provided, particularly in patients whose diagnoses require multidisciplinary care, such as pediatric intestinal failure (IF). We sought to ascertain the effects of the COVID-19 pandemic on healthcare delivery for pediatric patients with IF. METHODS A 20-question survey was administered to members of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Intestinal Rehabilitation (IR) Special Interest Group. Input values were "yes" and "no," along with a free-text response. Following a 10-day open survey period, data were divided into cohorts based on patient population size and disease burden by state. Analysis was then performed using the χ2 test application. RESULTS Responses from 29 centers were included in analysis. Centers that followed >50 patients on parenteral nutrition (PN) were more likely to have social workers present in telemedicine visits and observed more central line difficulties among families. Centers located in states with <40,000 reported cases of COVID-19 saw patients less frequently and were more likely to withhold changes to PN prescriptions. Additionally, the survey revealed a significant degree of financial hardship and food insecurity among families. CONCLUSION Many aspects of pediatric IF healthcare delivery have been impacted by the COVID-19 pandemic, both for care providers and caregivers. Despite the availability of telemedicine, IR centers should remain attentive to the global needs of the pediatric IF patient, as well as their families.
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Affiliation(s)
- David P Galloway
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of Alabama at Birmingham, Alabama, Birmingham, USA
| | - Michelle S Mathis
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of Alabama at Birmingham, Alabama, Birmingham, USA
| | - Linda T Wilkinson
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of Alabama at Birmingham, Alabama, Birmingham, USA
| | - Robert S Venick
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California at Los Angeles, California, Los Angeles, USA
| | - Danielle Wendel
- Division of Gastroenterology and Hepatology, Seattle Children's Hospital, University of Washington School of Medicine, Washington, Seattle, USA
| | - Conrad R Cole
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, College of Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, USA
| | - Colin A Martin
- Department of Surgery, Division of Pediatric Surgery, University of Alabama at Birmingham, Alabama, Birmingham, USA
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Factors That Contribute to Cost Differences Based on ICU of Admission in Neonates Undergoing Congenital Heart Surgery: A Novel Decomposition Analysis. Pediatr Crit Care Med 2020; 21:e842-e847. [PMID: 32769705 PMCID: PMC7968580 DOI: 10.1097/pcc.0000000000002507] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We leveraged decomposition analysis, commonly used in labor economics, to understand determinants of cost differences related to location of admission in children undergoing neonatal congenital heart surgery. DESIGN A retrospective cohort study. SETTING Pediatric Health Information Systems database. PATIENTS Neonates (<30 d old) undergoing their index congenital heart surgery between 2004 and 2013. MEASUREMENTS AND MAIN RESULTS A decomposition analysis with bootstrapping determined characteristic (explainable by differing covariate levels) and structural effects (if covariates are held constant) related to cost differences. Covariates included center volume, age at admission, prematurity, sex, race, genetic or major noncardiac abnormality, Risk Adjustment for Congenital Heart Surgery-1 score, payor, admission year, cardiac arrest, infection, and delayed sternal closure.Of 19,984 infants included (10,491 [52%] to cardiac ICU/PICU and 9,493 [48%] to neonatal ICU), admission to the neonatal ICU had overall higher average costs ($24,959 ± $3,260; p < 0.001) versus cardiac ICU/PICU admission. Characteristic effects accounted for higher costs in the neonatal ICU ($28,958 ± $2,044; p < 0.001). Differing levels of prematurity, genetic syndromes, hospital volume, age at admission, and infection contributed to higher neonatal ICU costs, with infection rate providing the most significant contribution ($13,581; p < 0.001). Aggregate structural effects were not associated with cost differences for those admitted to the neonatal ICU versus cardiac ICU/PICU (p = 0.1). Individually, prematurity and age at admission were associated with higher costs due to structural effects for infants admitted to the neonatal ICU versus cardiac ICU/PICU. CONCLUSIONS The difference in cost between neonatal ICU and cardiac ICU/PICU admissions is largely driven by differing prevalence of risk factors between these units. Infection rate was a modifiable factor that accounted for the largest difference in costs between admitting units.
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Jeong YS, Kim JH, Lee S, Lee SY, Oh SM, Lee E, Kim TH, Park SY. Scope of a weekly infection control team rounding in an acute-care teaching hospital: a pilot study. Antimicrob Resist Infect Control 2020; 9:123. [PMID: 32799910 PMCID: PMC7428421 DOI: 10.1186/s13756-020-00787-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/21/2020] [Indexed: 11/10/2022] Open
Abstract
Regular and well-organized inspection of infection control is an essential element of an infection control program. The aim of this study was to identify the functional scope of weekly infection control team rounding (ICTR) in an acute care hospital. We conducted weekly ICTR between January 18 and December 26, 2018 to improve the compliance to infection control and prevention measures at a 734-bed academic hospital in the Republic of Korea and analyzed the results retrospectively. We categorized the results into five groups: “well maintained,” “improvement needed,” “long-term support, such as space or manpower, needed,” “not applicable,” or “could not be observed”. A total of nine categories and 85 sub-elements of infection control and prevention practices were evaluated. The median number of infection control team (ICT) visits per department was 7 (interquartile range [IQR]: 6–7). The ICT assessed a median of 16 elements (IQR: 12–22), and a total of 7452 results were obtained. Of those, 75% were monitored properly, 22% were “not applicable”, and 4% were difficult to observe. The most common practices that were difficult to observe were strategies to prevent catheter-related surgical site infections, pneumonia, and occupationally acquired infections as well as injection safety practices. Although the ICTR was able to maintain regular visits to each department, further strategies beyond regular ICTR are needed to reduce category of “could not observed”. This pilot study may provide an important reference for institutional infection prevention practices as it is the first study to investigate the functional coverage of ICTR.
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Affiliation(s)
- Yeon Su Jeong
- Infection Control Team, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Jin Hwa Kim
- Infection Control Team, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Seungju Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.,Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - So Young Lee
- Infection Control Team, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Sun Mi Oh
- Infection Control Team, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Eunjung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Tae Hyong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Se Yoon Park
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
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Schmid S, Geffers C, Wagenpfeil G, Simon A. Preventive bundles to reduce catheter-associated bloodstream infections in neonatal intensive care. GMS HYGIENE AND INFECTION CONTROL 2018; 13:Doc10. [PMID: 30588416 PMCID: PMC6289088 DOI: 10.3205/dgkh000316] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This systematic survey includes a total of 27 studies published between 2002 and 2016 on the benefit of preventive bundles for the prevention of central-line associated bloodstream infections (CLABSI) in neonatal intensive care. These studies are mainly cohort studies or studies analyzing an interrupted time series before and after intervention. The studies showed heterogeneity in terms of endpoint definitions (CLABSI), details of the implemented measures, and evidence of a publication bias favoring the use of of preventive bundles. The cumulative analysis showed a statistically and clinically significant benefit of preventive bundles to avoid CLABSI in neonatal intensive care.
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Affiliation(s)
- Sarah Schmid
- University Hospital of the Saarland, Children's Hospital, Pediatric Oncology and Hematology, Homburg, Germany
| | - Christine Geffers
- German National Reference Center for Surveillance of Nosocomial Infections, Institute for Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Germany
| | - Gudrun Wagenpfeil
- Institute for Medical Biometrics, Epidemiology and Medical Computer Sciences, University Hospital of the Saarland, Homburg, Germany
| | - Arne Simon
- University Hospital of the Saarland, Children's Hospital, Pediatric Oncology and Hematology, Homburg, Germany
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20
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Payne V, Hall M, Prieto J, Johnson M. Care bundles to reduce central line-associated bloodstream infections in the neonatal unit: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2018; 103:F422-F429. [PMID: 29175985 DOI: 10.1136/archdischild-2017-313362] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/30/2017] [Accepted: 09/06/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Central line-associated bloodstream infections (CLABSIs) are associated with increased mortality, prolonged hospitalisation and increased healthcare costs. Care bundles have reduced CLABSIs in adult intensive care units (ICUs) but replication in paediatric ICUs has had inconsistent outcomes. A systematic review was performed to assess the evidence for the efficacy of care bundles in reducing CLABSIs in the neonatal unit (NNU). METHODS MEDLINE, CINAHL and EMBASE were searched from January 2010 up to January 2017. The Cochrane Library, Web of Science, Zetoc and Ethos were searched for additional studies. Randomised controlled trials (RCTs), quasi-experimental and observational studies were eligible. The primary outcome measure was CLABSI rates per 1000 central line, or patient, days. A meta-analysis was performed using random effects modelling. RESULTS Twenty-four studies were eligible for inclusion: six were performed in Europe, 12 were in North America, two in Australia and four were in low/middle-income countries. Five were observational studies and 19 were before and after quality improvement studies. No RCTs were found. Meta-analysis revealed a statistically significant reduction in CLABSIs following the introduction of care bundles (rate ratio=0.40 (CI 0.31 to 0.51), p<0.00001), which equates to a 60% reduction in CLABSI rate. CONCLUSION There is a substantial body of quasi-experimental evidence to suggest that care bundles may reduce CLABSI rates in the NNU, though it is not clear which bundle elements are effective in specific settings. Future research should focus on determining what processes promote the effective implementation of infection prevention recommendations, and which elements represent essential components of such care bundles.
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Affiliation(s)
- Victoria Payne
- Faculty of Health Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mike Hall
- Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jacqui Prieto
- Faculty of Health Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mark Johnson
- Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,National Institute for Health Research, Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
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Abstract
BACKGROUND Neonates are at greater risk for central line-associated bloodstream infection (CLABSI) because of prolonged vascular access for nutrition and medications. Skin antisepsis using chlorhexidine gluconate (CHG), particularly the formulation with alcohol (CHG/alcohol), during central line insertion and maintenance activities is a key clinical care process associated with CLABSI reduction. One area of ongoing confusion for many clinicians is whether to adhere to the manufacturer's recommendations that CHG remain on the skin following the procedure to promote persistent microbicidal effects or to foster product removal in hopes of preventing skin-related complications. PURPOSE Determine the effect of a targeted education program on the knowledge and attitudes of nurses who place peripherally inserted central catheters in the NICU regarding the use and removal of CHG antiseptic. METHODS A quasi-experimental presurvey/postsurvey quality improvement project (QI project) recruited participants from the electronic mailing list of a national neonatal nursing organization. RESULTS There was a statistically significant deficiency in knowledge or misinformation related to the use of CHG/alcohol on the presurvey assessment. Eight questions reflecting knowledge consistent with most recent evidence were answered correctly only 11.4-25.7 percent of the time, all of which were considered statistically significant. Following completion of the education program, a nearly 100 percent correct response rate on all but three postsurvey questions resulted. CONCLUSIONS This quality improvement project demonstrated success in the ability to change knowledge surrounding the removal of CHG/alcohol from the skin of babies in the NICU following completion of a targeted education program and the effectiveness of targeted web-based educational programs.
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Worth LJ, Daley AJ, Spelman T, Bull AL, Brett JA, Richards MJ. Central and peripheral line-associated bloodstream infections in Australian neonatal and paediatric intensive care units: findings from a comprehensive Victorian surveillance network, 2008-2016. J Hosp Infect 2017; 99:55-61. [PMID: 29222036 DOI: 10.1016/j.jhin.2017.11.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 11/29/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Healthcare-associated infections in neonatal and paediatric populations are associated with poorer outcomes and healthcare costs, and surveillance is a necessary component of prevention programmes. AIM To evaluate burden of illness, aetiology, and time-trends for central and peripheral line-associated bloodstream infection (CLABSI and PLABSI) in Australian neonatal and paediatric intensive care units (ICUs) between July 1st, 2008 and December 31st, 2016. METHODS Using National Healthcare Safety Network methods, surveillance in neonatal and paediatric units was performed by hospitals participating in the Victorian Healthcare Associated Infection Surveillance System. Mixed effects Poisson regression was used to model infections over time. FINDINGS Overall, 82 paediatric CLABSI events were reported during 37,125 CVC-days (2.21 per 1000 CVC-days), 203 neonatal CLABSI events were reported during 92,169 CVC-days (2.20 per 1000 CVC-days), and 95 neonatal PLABSI events were reported during 142,240 peripheral line-days (0.67 per 1000 peripheral line-days). Over time, a significant decrease in quarterly risk for neonatal CLABSI events was observed (risk ratio (RR): 0.98; 95% confidence interval: 0.97-0.99; P = 0.023) and this reduction was significant for the 751-1000 g birth weight cohort (RR: 0.97; P = 0.015). Most frequently, coagulase-negative Staphylococcus spp. (24.2%) and Staphylococcus aureus (16.1%) were responsible for CLABSI events. A significant reduction in Gram-negative neonatal infections was observed (annual RR: 0.85; P < 0.001). CONCLUSION CLABSI rates in neonatal and paediatric ICUs in our region are low, and neonatal infections have significantly diminished over time. Evaluation of infection prevention programmes is required to determine whether specific strategies can be implemented to further reduce infection risk.
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Affiliation(s)
- L J Worth
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Victoria, Australia; University of Melbourne, Department of Medicine, Victoria, Australia.
| | - A J Daley
- The Royal Women's Hospital, Department of Infectious Diseases and Microbiology, Victoria, Australia; The Royal Children's Hospital, Microbiology Department, Victoria, Australia; University of Melbourne, Department of Paediatrics, Victoria, Australia
| | - T Spelman
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Victoria, Australia
| | - A L Bull
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Victoria, Australia
| | - J A Brett
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Victoria, Australia
| | - M J Richards
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Victoria, Australia
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