A Tiered Approach for Preventing Central Line–Associated Bloodstream Infection

Patel, Payal; Olmsted, Russell N.; Hung, Louella; Popovich, Kyle J.; Meddings, Jennifer; Jones, Karen; Calfee, David P.; Fowler, Karen E.; Saint, Sanjay; Chopra, Vineet

doi:10.7326/m18-3469

Cited by 16 publications

(16 citation statements)

References 69 publications

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“…These alternatives need to be included in the plan for VADs. 1,4 Utilizing the expertise of the vascular access nurse to address and recommend patient-specific vascular access needs is an example of structural empowerment. This is supported by the American Nurses Credentialing Center Magnet designation program.…”

Section: Discussionmentioning

confidence: 99%

“…3 A knowledge gap persists within the medical community pertaining to best practice guidelines for vascular access device (VAD) therapy. 4 This deficit contributes to the overuse of PICCs. In this investigation, providers at this institution often ordered urgent and unnecessary PICCs as the first vascular access for a patient admitted to the intensive care unit (ICU).…”

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confidence: 99%

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Developing a Nurse-Driven Vascular Access Device Order Set Using the Electronic Medical Record

Bechdel

Bardman

Machemer

2022

Journal of Infusion Nursing

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The Art and Science of Infusion Nursing P eripherally inserted central catheters (PICCs) have an important role for reliable venous access in patient care. However, overutilization of PICCs combined with an absence of a standardized ordering process leads to inappropriately placed central lines in the acute care setting. 1 , 2 A "just-in-case phenomenon" of PICC insertions also exists, leading to unnecessarily placed central lines when not clinically indicated. 2 In addition, inappropriately placed central lines may lead to complications increasing the risk of patient harm. Among these complications are thrombosis, central line-associated bloodstream infections (CLABSIs), and mechanical complications. 3 A knowledge gap persists within the medical community pertaining to best practice guidelines for vascular access device (VAD) therapy. 4 This deficit contributes to the overuse of PICCs. In this investigation, providers at this institution often ordered urgent and unnecessary PICCs as the first vascular access for a patient admitted to the intensive care unit (ICU). Other examples of unnecessary PICC placement included placing a PICC for the "possible" administration of vasopressors in a clinically stable patient, for patients requiring a power injection study, or per patient request for blood sampling.These identified problems empowered the vascular access nurses to develop a nurse-driven electronic medical

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Developing a Nurse-Driven Vascular Access Device Order Set Using the Electronic Medical Record

Bechdel

Bardman

Machemer

2022

Journal of Infusion Nursing

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“…No entanto, o índice de positividade foi baixo nesse domínio. Estudo destaca que bundles de manutenção que incluem a desinfecção do hub foram associados à redução da IPCS (17) .…”

Section: Discussionunclassified

Adesão ao bundle de manutenção de Cateter Venoso Central em uma Unidade de Terapia Intensiva

Quadros

Stocco

Cristoff

et al. 2022

Rev. esc. enferm. USP

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RESUMO Objetivo: Verificar a adesão ao bundle de manutenção do Cateter Venoso Central em uma Unidade de Terapia Intensiva, após intervenção educativa aos profissionais que realizam o cuidado aos pacientes em uso desse cateter. Method: Estudo descritivo-exploratório, realizado em duas fases, fase 1 – intervenção educativa, e fase 2 – verificação/observação da adesão. Os dados foram organizados no Microsoft Excel ® e analisados por meio do Stata®. Resultados: Participaram da fase 1 63 profissionais e da fase 2, 44. A amostra foi constituída de 64 oportunidades de observações. Entre os domínios observados, o registro de indicação de permanência apresentou 8% de taxa de conformidade; a técnica asséptica no manuseio do cateter, 3%; a manutenção do sistema de infusão, 15%; e os cuidados com o curativo do cateter venoso central, 17%. Os domínios representam uma assistência indesejada, conforme o Índice de Positividade de avaliação da qualidade da assistência. Conclusion: Os achados mostram a necessidade de discussões, treinamentos e investimentos em estratégias constantes para a prevenção de infecções primárias de corrente sanguínea relacionadas ao cateter venoso central.

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“…Several lines of evidence suggest that the items of emphasis regarding the Centers for Disease Control and Prevention's tiered approach remain important. 11,12 First, the device utilization ratios for both central lines and urinary catheters declined over the 4-year period, suggesting that implementation of programs to emphasize removal and/or alternatives are effective. During the 4-year study period, a system-wide policy regarding midline catheters (introduced in 2017) was enacted, likely contributing to reduced central line utilization.…”

Section: Discussionmentioning

confidence: 99%

Trends in central-line-associated bloodstream infections and catheter-associated urinary tract infections in a large acute-care hospital system in New York City, 2016-2019

Kaminski

Episcopia

Malik

et al. 2020

Infect. Control Hosp. Epidemiol.

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Background: Central-line bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) negatively impact clinical outcomes and hospital reimbursement. In this report, 4 year trends involving 11 hospitals in New York City were examined. Methods: Data from the National Healthcare Safety Network (NHSN) were extracted for 11 acute-care hospitals belonging to the NYC Health + Hospital system from 2016 through 2019. Trends in device infections per 1,000 patient days, device utilization ratios, and standardized infection ratios (SIRs) were examined for the 11 hospitals and for the entire system. Results: Over the 4-year period, there were progressive declines in central-line days, infections per 1,000 central-line days, and device utilization ratios for the system. The average annual SIRs for the system also declined: 1.40 in 2016, 1.09 in 2017, 1.04 in 2018, and 0.82 in 2019. Case-mix indices correlated with SIRs for CLABSIs. Level 1 trauma centers had higher SIRs and a disproportionately greater number of CLABSIs in patients located in NHSN-defined surgical intensive care units. Similar trends with CAUTIs were noted, with progressive declines in catheter days, infections per 1,000 patient days, device utilization ratios, and SIRs (1.42 in 2016, 0.93 in 2017, 1.18 in 2018, and 0.78 in 2019) over the 4-year period. Conclusions: Across an 11-hospital system, continuing efforts to reduce device utilization and infection rates resulted in declining SIRs for CLABSIs and CAUTIs. Hospitals with higher case-mix indices, and particularly level 1 trauma centers, had significantly higher central-line infection rates and SIRs.

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A Tiered Approach for Preventing Central Line–Associated Bloodstream Infection

Cited by 16 publications

References 69 publications

Developing a Nurse-Driven Vascular Access Device Order Set Using the Electronic Medical Record

Developing a Nurse-Driven Vascular Access Device Order Set Using the Electronic Medical Record

Adesão ao bundle de manutenção de Cateter Venoso Central em uma Unidade de Terapia Intensiva

Trends in central-line-associated bloodstream infections and catheter-associated urinary tract infections in a large acute-care hospital system in New York City, 2016-2019

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