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Puoti MG, D'Eusebio C, Littlechild H, King E, Koeglmeier J, Hill S. Risk factors for catheter-related bloodstream infections associated with home parental nutrition in children with intestinal failure: A prospective cohort study. Clin Nutr 2023; 42:2241-2248. [PMID: 37806076 DOI: 10.1016/j.clnu.2023.09.007] [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: 12/16/2022] [Revised: 08/24/2023] [Accepted: 09/10/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND & AIMS Catheter-related bloodstream infection (CRBSI) is the most common, potentially life-threatening complication of long-term parenteral nutrition (PN). We prospectively assessed the incidence and risk factors for CRBSI in children receiving long-term home PN (HPN) for intestinal failure (IF) in a single IF rehabilitation center. METHODS Data regarding episodes and potential risk factors for CRBSI in children on HPN were prospectively recorded. RESULTS Forty-one of 75 children were diagnosed with CRBSI. The overall CRBSI rate was 1.61 per 1000 catheter days. The indications for HPN were gastrointestinal motility disorders in 35%, short bowel syndrome (SBS) in 28% graft versus host disease (GvHD) post bone marrow transplant in 17%, congenital enteropathy in 15%, and severe neurodevelopmental impairment in 5%. Gastrointestinal motility disorders had significantly higher CRBSI rate compared to other groups (p < 0.0005; 2.74 in motility group vs 1.54 in GvHD group vs 0.52 in congenital enteropathies vs 0.36 in SBS group vs 0.67 in severe neurodevelopmental delay). Multivariate analysis revealed that enterocutaneous distal stoma (ileostomy or colostomy) (HR 3.35 [95% CI, 1.63-6.86]; p < 0.001), age <2 years (HR 0.28 [95% CI, 0.15-0.53]; p < 0.0001), male sex (HR 2.28 [95% CI, 1.51-3.43]; p < 0.0001), non-use of taurolidine citrate lock (HR 2.70 [95% CI, 1.72-4.11]; p < 0.0001) and gastrointestinal motility disorder (HR 3.02 [95% CI, 1.81-4.91]; p < 0.001) were independent risk factors for developing CRBSI. CONCLUSIONS Extra care in managing PN connections and disconnections should be taken in children with an underlying gastrointestinal motility disorder, distal enterocutaneous stoma, male sex and those aged <2 years since they are at a significantly higher risk of CRBSI. Early introduction of taurolidine lock should be considered.
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Affiliation(s)
- Maria Giovanna Puoti
- Great Ormond Street Hospital for Children, Department of Paediatric Gastroenterology, Division of Intestinal Failure and Nutritional Rehabilitation, London, UK
| | - Chiara D'Eusebio
- Paediatric Hospital Regina Margherita, Dietetic and Clinical Nutrition Unit, University of Turin, Turin, Italy
| | - Hannah Littlechild
- Great Ormond Street Hospital for Children, Department of Paediatric Gastroenterology, Division of Intestinal Failure and Nutritional Rehabilitation, London, UK
| | - Emily King
- Great Ormond Street Hospital for Children, Department of Paediatric Gastroenterology, Division of Intestinal Failure and Nutritional Rehabilitation, London, UK
| | - Jutta Koeglmeier
- Great Ormond Street Hospital for Children, Department of Paediatric Gastroenterology, Division of Intestinal Failure and Nutritional Rehabilitation, London, UK
| | - Susan Hill
- Great Ormond Street Hospital for Children, Department of Paediatric Gastroenterology, Division of Intestinal Failure and Nutritional Rehabilitation, London, UK.
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Crivelli A, Fabeiro M, Puga M, Dieguez N, Giunta L, Pochettino F, Balacco M, Merlo G, Garrido V, Fain H, Buncuga M, Martinuzzi A, Cascarón MF, Delgado N, Capurro G, Bernardis V, Ghiglieri C, Hassam A, Soria O, Serra D, Morando L, Flores A, Gonzalez HF, Fernandez A. Care of patients on home parenteral nutrition during the first year of the COVID-19 pandemic: Management of central line-associated bloodstream infections. Clin Nutr ESPEN 2022; 52:250-253. [PMID: 36513461 PMCID: PMC9670592 DOI: 10.1016/j.clnesp.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIM The aim of this study was to analyze central line-associated bloodstream infections (CLABSI) in home parenteral nutrition (HPN) patients assisted by an interdisciplinary team during the first year of the COVID-19 pandemic in Argentina. METHODS Longitudinal, retrospective and analytical study of patients on HPN for ≥90 days during 2020. Data collection included age (adults >18 years, pediatric ≤18 years), gender, diagnosis, type of catheter, number of lumens, venous access, days on HPN, infusion modality and number of CLABSI-associated events. In COVID-19 cases, number of patients, disease progression, mortality rate and microorganisms involved were analyzed. RESULTS A total of 380 patients were included, 120 (31.6%) pediatric and 260 (68.4%) adult patients. Median age was 44.50 years (10; 62.25). Twelve patients (3.15% of the total) had COVID-19; of these, two pediatric and seven adult patients had no complications, and three adults died of COVID-19 pneumonia. The diagnoses observed were benign chronic intestinal failure (CIF, n = 311), grouped into short bowel (n = 214, 56.3%), intestinal dysmotility (n = 56, 14.7%), intestinal fistula (n = 20, 5.3%), and extensive small bowel mucosal disease (n = 21, 5.5%); malignant tumors (n = 52, 13.7%); other (n = 17, 4.4%). Total catheter days were 103,702. Median days of PN duration per patient were 366 (176.2, 366). The types of catheters used were tunneled (317 patients, 83.4%); peripherally inserted central (PICC) line (55 patients, 14.5%) and ports (8 patients; 2.1%). A total of 111 CLABSI was registered, with a prevalence of 1.09/1000 catheter days (adult, 0.86/1000 days; pediatric, 1.51/1000 days). The microorganisms identified in infectious events were Gram + bacteria (38, 34.5%); Gram-bacteria (36, 32%); mycotic (10, 9%); polymicrobial (4, 3.6%); negative culture and signs/symptoms of CLABSI (23, 20.3%). The odds ratio between pediatric and adult patients was 2.29 (1.35, 3.90). CONCLUSION The rate of CLABSI during the COVID-19 pandemic was within the ranges reported by international scientific societies. The risk of CLABSI was higher in pediatric patients, and mortality rate in COVID-19 infected patients was higher than in the general population.
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Affiliation(s)
- Adriana Crivelli
- Unidad de Soporte Nutricional y Enfermedades Malabsortivas, Hospital Interzonal General de Agudos “Gral. José de San Martín”, La Plata, Argentina,Corresponding author. Unidad de Soporte Nutricional y Enfermedades Malabsortivas, Hospital Interzonal General de Agudos “Gral. José de San Martín”, Calle 1 y 70, 1900 La Plata, Argentina
| | - Marcela Fabeiro
- Servicio de Nutrición y Dietética Del Hospital de Niños de La Plata, Argentina
| | | | | | | | | | | | | | - Verónica Garrido
- Servicio de Nutrición y Dietética Del Hospital de Niños de La Plata, Argentina
| | | | | | | | | | | | - Gabriela Capurro
- Servicio de Cuidados Intensivos Hospital Interzonal “Oscar Allende” de Mar Del Plata, Argentina
| | | | | | | | | | | | | | | | - Horacio F. Gonzalez
- Instituto de Desarrollo e Investigaciones Pediátricas (IDIP) Hospital de Niños La Plata, Argentina
| | - Adriana Fernandez
- Servicio de Nutrición y Dietética Del Hospital de Niños de La Plata, Argentina
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Sieverding L, Michel J, Urla C, Sturm E, Winkler F, Hofbeck M, Fuchs J, Hilberath J, Warmann SW. Spectrum of Interventional Procedures During Hybrid Central Line Placement in Pediatric Intestinal Rehabilitation Patients With End-Stage Vascular Access. Front Nutr 2022; 9:863063. [PMID: 35419386 PMCID: PMC8995563 DOI: 10.3389/fnut.2022.863063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/07/2022] [Indexed: 12/01/2022] Open
Abstract
Background Loss of available central vein access sites for parenteral nutrition delivery represents one of the main indications for intestinal transplantation in children with intestinal failure. Placement of central venous catheters can be challenging in advanced loss of patent venous pathways. We recently described the hybrid technique (interventional plus surgical approach) of central line placement in children. The aim of this study was to describe and analyze the interventions used during the hybrid procedures regarding feasibility, safety and outcome. Methods We retrospectively analyzed the course of all children in our intestinal rehabilitation program undergoing hybrid central line placement. We evaluated patients' conditions, interventional techniques and surgical peculiarities as well as outcome. Results 203 children were treated in our intestinal rehabilitation program between 2010 and 2021. Due to loss of venous access, hybrid technique was performed in 53 children during 76 interventions. In 40 cases the same vessel was reused via Seldinger technique. Among the 30 ultrasound-guided new vessel punctures, 12 were performed by puncture of collateral vessels. Extended interventions due to thoracic central venous obstruction and/or thrombosis requiring additional access via a femoral vein for rehabilitation of the vascular system was performed during 29 procedures including catheter extraction (1), angioplasties (18), stent placement (1), revascularization (5) and thrombectomy (4). Placement of a central line was not possible in 6 children which eventually underwent extended thoracic/vascular surgery: in three children the previously placed catheter could not be removed, in one child, placement of a thrombectomy-catheter was not possible because of inferior vena cava occlusion, and in two children, revascularization failed. Intestinal transplantation was considered in one patient because of impending loss of vascular access. Two self-limiting minor extravasations and one intervention-associated pericardial effusion occurred. Conclusions Hybrid interventions for central venous catheter placement and vascular rehabilitation enable a high success rate in children with intestinal failure and end-stage vascular access, circumventing the need for intestinal transplantation or advanced surgery. The relevant procedures are complex and require a foresighted and individualized approach with a wide range of interventional techniques. If performed with expertise, this combined interventional/surgical approach is feasible and safe.
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Affiliation(s)
- Ludger Sieverding
- Department of Pediatric Cardiology, University Children's Hospital, University of Tübingen, Tübingen, Germany
| | - Jörg Michel
- Department of Pediatric Cardiology, University Children's Hospital, University of Tübingen, Tübingen, Germany
| | - Christian Urla
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, University of Tübingen, Tübingen, Germany
| | - Ekkehard Sturm
- Department of Pediatric Gastroenterology and Hepatology, University Children's Hospital, University of Tübingen, Tübingen, Germany
| | - Franziska Winkler
- Department of Pediatric Gastroenterology and Hepatology, University Children's Hospital, University of Tübingen, Tübingen, Germany
| | - Michael Hofbeck
- Department of Pediatric Cardiology, University Children's Hospital, University of Tübingen, Tübingen, Germany
| | - Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, University of Tübingen, Tübingen, Germany
| | - Johannes Hilberath
- Department of Pediatric Gastroenterology and Hepatology, University Children's Hospital, University of Tübingen, Tübingen, Germany
| | - Steven Walter Warmann
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, University of Tübingen, Tübingen, Germany
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Mohammed S, Gorski L. Antimicrobial Resistance and Antimicrobial Stewardship in Home Healthcare. Home Healthc Now 2021; 39:238-246. [PMID: 34473111 DOI: 10.1097/nhh.0000000000001012] [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: 11/25/2022]
Abstract
Antimicrobial resistance, the ability of microbes to become resistant to known antimicrobial medications, is a growing and serious global health concern. There are growing numbers of publications about efforts to educate nurses about antimicrobial resistance, and efforts to involve nurses in antimicrobial stewardship in acute and long-term care settings; however, this has not been the case in home care. Home care organizations are required to address infection control and surveillance, including patient, family, and staff education. Home care nurses play an important role in identifying infections, performing cultures, and teaching patients and families. This article provides an overview of antimicrobial resistance and antimicrobial stewardship and provides antimicrobial stewardship actions for home care nurses and agencies. In the interest of public health, home care agencies and nurses can, and should, educate themselves and patients about antimicrobial resistance and employ antimicrobial stewardship strategies.
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Clare S, Rowley S. Best practice skin antisepsis for insertion of peripheral catheters. ACTA ACUST UNITED AC 2021; 30:8-14. [PMID: 33433273 DOI: 10.12968/bjon.2021.30.1.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article discusses the importance of effective skin antisepsis prior to the insertion of peripheral intravenous catheters (PIVCs) and how best clinical practice is promoted by application of an appropriate method of skin disinfection integrated effectively with a proprietary aseptic non touch technique, or other standard aseptic technique. Historically under-reported, incidence of infection and risk to patients from PIVCs is now increasingly being recognised, with new research and evidence raising concern and helping to drive new clinical guidance and improvement. The risks posed by PIVCs are particularly significant given increasing PIVC dwell times, due to cannula removal now being determined by new guidance for clinical indication, rather than predefined time frames. Clinical 'best practice' is considered in context of the evidence base, importantly including availability and access to appropriate skin antisepsis products. In the UK, and other countries, ChloraPrep is the only skin antisepsis applicator licensed as a drug to disinfect skin and help prevent infections before invasive medical procedures, such as injections, blood sampling, insertion of PIVCs and minor or major surgery.
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Affiliation(s)
- Simon Clare
- Research and Practice Development Director ANTT, The Association for Safe Aseptic Practice
| | - Stephen Rowley
- Clinical Director ANTT, The Association for Safe Aseptic Practice
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Abstract
The Infusion Therapy Standards of Practice provide evidence-based recommendations as published by the Infusion Nurses Society every 5 years. This article provides a brief overview of the development process and short summaries of selected standards with attention to highlighting the relevance to home care agencies and nurses. The Standards should be reviewed by any home care organization that provides home infusion therapy.
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Affiliation(s)
- Lisa A Gorski
- Lisa Gorski, MS, RN, HHCNS-BC, CRNI, FAAN , is a Clinical Education Specialist/Clinical Nurse Specialist, Ascension at Home Wisconsin, Milwaukee, Wisconsin
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Rowley S, Clare S. How widely has ANTT been adopted in NHS hospitals and community care organisations in England and Scotland? ACTA ACUST UNITED AC 2020; 29:924-932. [DOI: 10.12968/bjon.2020.29.16.924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: To the detriment of patient safety, the important clinical competency of aseptic technique has been notoriously variable in practice, and described ambiguously in the literature, internationally. From a UK perspective, attempts have been made to improve patient safety by reducing variability and improving education and practice through standardisation. The Welsh Government mandated Aseptic Non Touch Technique (ANTT®) as a specific national standard in 2015. All healthcare organisations in England are required by the Health and Social Care Act 2008 to have a single standard aseptic technique, demonstrable by the clinical governance indicators of education, training, competency assessment and compliance audit. In Scotland, an education-based initiative was launched by NHS Education for Scotland in 2012. To review the impact of these and other initiatives on the current status of aseptic technique, all NHS trusts in England and NHS health boards in Scotland were assessed under the Freedom of Information procedure. Findings: 93% of NHS trusts in England use a single standard for aseptic technique. In 88% of these trusts the single standard was stipulated as being ANTT. In Scotland, 62% of NHS acute and community care hospitals within health boards use a single standard. In 56% of these, the single standard was ANTT. When including those that use ANTT in combination with other techniques ANTT usage is 73%. Conclusion: These data demonstrate significant progress in standardising aseptic technique education, assessment and governance, and confirms ANTT as the de facto aseptic technique used in NHS trusts in England and health boards in Scotland.
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Affiliation(s)
- Stephen Rowley
- Clinical Director, The Association for Safe Aseptic Practice
| | - Simon Clare
- Research and Practice Development Director, The Association for Safe Aseptic Practice
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Samuelsson M, Wennick A. An Exploratory Study of the Everyday Life of Swedish Children on Home Parenteral Nutrition and Their Families. J Pediatr Nurs 2020; 52:e84-e89. [PMID: 32044196 DOI: 10.1016/j.pedn.2020.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/24/2020] [Accepted: 01/25/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Improved survival rates of preterm infants and critically ill children has resulted in an increasing number of children growing up on HPN. However, how the child and the child's family experience HPN is sparsely studied. PURPOSE Thus, this study aims to elucidate the everyday life experiences of children with intestinal failure on HPN from the perspective of the child and the child's family. DESIGN AND METHODS We used a qualitative inductive study that included semi-structured interviews from 13 family members in six families, and we analyzed them using content analysis. RESULTS The family members' experiences had an overall theme, having to take on a full-time (nursing) responsibility, and fell into three categories: family restrictions, family adjustments, and family uncertainty. CONCLUSION Families on HPN had to shoulder an in-home round-the-clock (nursing) responsibility that came with a daily logistical challenge. The complexity of HPN complicates the possibility of external support, so the families choose to keep the burden within the family; consequently single-parent households have limited possibilities for relief and recovery. PRACTICE IMPLICATIONS To minimize the intrusion of the treatment in family's everyday life and, thereby, support the families, health care professionals might find it beneficial to obtain an inventory of the everyday life needs of each specific family when first introducing HPN. Further, by encouraging close kin to participate in the HPN education these families may be unburdened some more. In addition, it is essential that professionals follow the families protocol for management and not the other way around.
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Affiliation(s)
- Maria Samuelsson
- Skåne University Hospital, Malmö, Sweden; Department of Pediatrics, Malmö, Sweden; Malmö University, Faculty of Health and Society, Department of Care Science, Malmö, Sweden.
| | - Anne Wennick
- Malmö University, Faculty of Health and Society, Department of Care Science, Malmö, Sweden
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Brown SK, Davies N, Smyth E, Heather N, Cole C, Keys SC, Beattie RM, Batra A. Intestinal failure: the evolving demographic and patient outcomes on home parenteral nutrition. Acta Paediatr 2018; 107:2207-2211. [PMID: 29754463 DOI: 10.1111/apa.14401] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/08/2018] [Accepted: 05/08/2018] [Indexed: 12/17/2022]
Abstract
AIM We performed this study to examine and understand the evolving demographics and changing outcomes of intestinal failure (IF) and its implications for healthcare delivery. METHOD We conducted a retrospective analysis of outcome data of children on home parenteral nutrition (HPN), over a 15-year period. RESULTS A total of 31 patients received HPN: 15 for short bowel syndrome (SBS), eight neuromuscular disease (NMD) and eight for other causes. The HPN prevalence increased from 1.54 per million children in 2000 to 21.5 in 2016. The outcomes over last 5 years were better than those of previous 10 years. The rate of catheter-related bloodstream infection (CRBSI) had fallen from 4 to 1.3 and IF liver disease (IFALD) from 20% to 7.7%. The aetiology changed over years from SBS being the main cause to NMD contributing 43% to the total in 2016. This was especially relevant as NMD was associated with greater numbers of IFALD (38% vs 6.7%), CRBSI (1.51 vs 0.64/1000 PN days) and mortality. CONCLUSION The outcome of long-term parenteral nutrition (PN) has improved. The increasing number of patients with NMD, coupled with their higher burden of care, results in an increasing health care burden, and the planning of intestinal rehabilitation services needs to reflect this.
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Affiliation(s)
- Sarah Kate Brown
- Department of Paediatric Gastroenterology; University Hospitals Southampton NHS Trust; Southampton UK
| | - Natalie Davies
- Department of Dietetics; University Hospitals Southampton NHS Trust; Southampton UK
| | - Enda Smyth
- Department of Paediatric Gastroenterology; University Hospitals Southampton NHS Trust; Southampton UK
| | - Nicky Heather
- Department of Dietetics; University Hospitals Southampton NHS Trust; Southampton UK
| | - Caroline Cole
- Department of Paediatric Gastroenterology; University Hospitals Southampton NHS Trust; Southampton UK
| | - Simon Charles Keys
- Department of Paediatric Surgery; University Hospitals Southampton NHS Trust; Southampton UK
| | - Robert Mark Beattie
- Department of Paediatric Gastroenterology; University Hospitals Southampton NHS Trust; Southampton UK
| | - Akshay Batra
- Department of Paediatric Gastroenterology; University Hospitals Southampton NHS Trust; Southampton UK
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Impact of flushing with aseptic non-touch technique using pre-filled flush or manually prepared syringes on central venous catheter occlusion and bloodstream infections in pediatric hemato-oncology patients: A randomized controlled study. Eur J Oncol Nurs 2018; 33:78-84. [DOI: 10.1016/j.ejon.2018.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/29/2018] [Accepted: 02/02/2018] [Indexed: 01/10/2023]
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Hybrid interventions for catheter placement in pediatric intestinal rehabilitation patients with end-stage venous access. J Pediatr Surg 2018; 53:553-557. [PMID: 28365108 DOI: 10.1016/j.jpedsurg.2017.03.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/23/2017] [Accepted: 03/19/2017] [Indexed: 11/23/2022]
Abstract
PURPOSE The purpose of this study is to analyze the combined approach of endovascular and open surgical procedures for insertion of permanent central venous catheters in children with intestinal failure and end-stage venous access. METHODS Data of 14 children (16 interventions) with intestinal failure and end-stage venous access, treated within the pediatric intestinal rehabilitation program at our institution between September 2011 and November 2016, were retrospectively reviewed. The patients underwent hybrid endovascular/open surgical approaches for insertion of central venous catheters. Access to central veins was established through endovascular intervention; catheter placement was achieved with combined interventional and surgical measures depending on the individual vascular conditions. RESULTS Median age at intervention was 47months (interquartile range (IQR),29-74), median time for interventions was 66min (IQR,42-111). Catheter placement was successfully achieved in all patients. The median dose of irradiation during angiography was 0.2Gy*cm2 (IQR, 0.2-0.6), no complications occurred during or after interventions. CONCLUSIONS Hybrid endovascular/open surgical procedures can be successfully applied for restoring or maintaining permanent central venous catheters in children with intestinal failure and end-stage venous access. These approaches are a valuable contribution in intestinal rehabilitation programs contributing to a further decrease of the need for intestinal transplantation in affected patients. TYPE OF STUDY Treatment Study. LEVEL OF EVIDENCE Level IV.
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Clare S, Rowley S. Implementing the Aseptic Non Touch Technique (ANTT®) clinical practice framework for aseptic technique: a pragmatic evaluation using a mixed methods approach in two London hospitals. J Infect Prev 2017; 19:6-15. [PMID: 29317909 DOI: 10.1177/1757177417720996] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 06/19/2017] [Indexed: 12/30/2022] Open
Abstract
Background Aseptic technique is an important infection prevention competency for protecting patients from healthcare-associated infection (HAI). Healthcare providers using the Aseptic Non Touch Technique (ANTT®) aseptic technique have demonstrated reduced variability and improved compliance with aseptic technique. Objectives The primary aim of this study is to determine whether standardizing aseptic technique for invasive IV procedures, using the ANTT® - Clinical Practice Framework (CPF), increases staff compliance with the infection prevention actions designed to achieve a safe and effective aseptic technique, and whether this is sustainable over time. Methods A pragmatic evaluation using a mixed-methods approach consisting of an observational audit of practice, a self-report survey and structured interviews with key stakeholders. Compliance with aseptic technique before and after the implementation of ANTT® was measured by observation of 49 registered healthcare professionals. Results Mean compliance with competencies was 94%; each component of practice was improved over baseline: hand hygiene = 63% (P ≤ 0.001); glove use = 14% (P ≤ 0.037); Key-Part protection = 54% (P ≤ 0.001); a non-touch technique = 45% (P ≤ 0.001); Key-Part cleaning = 82% (P ≤ 0.001); and aseptic field management = 80% (P ≤ 0.001). Conclusions Results show implementation of ANTT® improved compliance with the prerequisite steps for safe and effective aseptic technique as defined by the ANTT®-CPF. Improvements in compliance were sustained over four years.
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Affiliation(s)
- Simon Clare
- The Association for Safe Aseptic Practice, Surrey, UK
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