Improving central line maintenance to reduce central line-associated bloodstream infections

Drews, Frank A.; Bakdash, Jonathan Z.; Gleed, Jeremy R.

doi:10.1016/j.ajic.2017.05.017

Cited by 18 publications

(11 citation statements)

References 26 publications

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“…Our analysis extends previous studies on working conditions in health care that predispose performance breakdowns (Drews, Bagdash, & Gleed, 2017; Drews, Musters, Markham, & Samore, 2007; Drews, Zadra, & Gleed, 2018; Hickam et al, 2003). To our knowledge, no prior studies explicitly compared the impact of device and human-initiated interruptions on the frequency of patient hazards.…”

Section: Discussionsupporting

confidence: 86%

Interruptions and Delivery of Care in the Intensive Care Unit

et al. 2019

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This study samples interruption frequency in intensive care unit (ICU) settings to assess the relationship between interruptions and common patient hazards. Background: Task interruptions are accident contributors in numerous industries. Recently, studies on health care interruptions and their impact on patient hazards have received attention. Method: Seven ICUs in four hospitals participated in a 24-month study. Experienced ICU nurses directly observed nursing tasks, interruptions, and patient hazards (delays in care, breaks in device task protocols, and patient safety hazards). Results: During 1,148 hours of observation, 175 nurses performed 74,733 nursing tasks. Interruptions occurred at a rate of 4.95 per hour, and 8.4% of tasks were interrupted. Interruptions originated mostly from humans (65.9%), alarms (24.1%), and others (10%). A total of 774 patient hazards were observed, with a hazard occurring on average every 89 minutes. Relative to noninterrupted tasks, device alarm interrupted nonstructured tasks were associated with increased rates of delays in care and safety hazards (rate ratio [RR] = 3.19). In contrast, rate of delays in care and safety hazards did not increase during human interrupted tasks (RR = 1.13). Rates of protocol nonadherence varied by device type and were highest during artificial airway, medication administration, chest tube, and supplemental oxygen management. Conclusion: Interruptions in the ICU are frequent and contribute to patient hazards, especially when caused by device alarms during nonstructured tasks. Nonadherence to protocols is common and contributed to patient hazards. Application: The findings suggest a need for improvement in task and device design to reduce patient hazards.

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Section: Discussionsupporting

confidence: 86%

Interruptions and Delivery of Care in the Intensive Care Unit

et al. 2019

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“…[38] It was also proposed recently that the use of a central venous catheter maintenance kit could significantly reduce the incidence of CLABSI. [39]…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors associated with mortality in mechanically ventilated patients in the intensive care unit

Liang¹,

Li²,

Dong³

et al. 2019

Medicine

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Data on outcomes of patients receiving mechanical ventilation (MV) in China are scarce.To investigate factors associated with the prognosis of patients given MV in the intensive care unit (ICU).A 12-year (January 1, 2006–December 31, 2017) retrospective cohort study.ICU of Beijing Geriatric Hospital, China.A total of 905 patients aged ≥16 years given MV during the study period.None.Among 905 patients included (610 men; median age, 78 years; Acute Physiology and Chronic Health Evaluation [APACHE]-II score, 27.3 ± 8.9), 585 survived (388 men; median age, 77 years; average APACHE-II score, 25.6 ± 8.4), and 320 died in the ICU (222 men; median age, 78 years; APACHE-II score, 30.6 ± 8.9). All-cause ICU mortality was 35.4%. In patients aged <65 years, factors associated with ICU mortality were APACHE-II score (odds ratio [OR], 1.108; 95% confidence interval [95% CI], 1.021–1.202; P = .014), nosocomial infection (OR, 6.618; 95% CI, 1.065–41.113; P = .043), acute kidney injury (OR, 17.302; 95% CI, 2.728–109.735; P = .002), invasive hemodynamic monitoring (OR, 10.051; 95% CI, 1.362–74.191; P = .024), MV for cardiopulmonary resuscitation (OR, 0.122; 95% CI, 0.016–0.924; P = .042), duration of MV (OR, 0.993; 95% CI, 0.988–0.998; P = .008), successful weaning from MV (OR, 0.012; 95% CI, 0.002–0.066; P < .001), and renal replacement therapy (OR, 0.039; 95% CI, 0.005–0.324; P = .003). In patients aged ≥65 years, factors associated with mortality were APACHE-II score (OR, 1.062; 95% CI, 1.030–1.096; P < .001), nosocomial infection (OR, 2.427; 95% CI, 1.359–4.334; P = .003), septic shock (OR, 2.017; 95% CI, 1.153–3.529; P = .014), blood transfusion (OR, 1.939; 95% CI, 1.174–3.202; P = .010), duration of MV (OR, 0.999; 95% CI, 0.999–1.000; P = .043), and successful weaning from MV (OR, 0.027; 95% CI, 0.015–0.047; P < .001).APACHE-II score, successful weaning, and nosocomial infection in the ICU are independently associated with the prognosis of patients given MV in the ICU.

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“…making use intuitive) and ‘minimizing physical effort’ (i.e. making adherence convenient) were found to improve adherence when applied in the development of medical devices [ 21 , 22 ]. Good usability of medical products was shown to improve patient safety, e.g.…”

Section: Discussionmentioning

confidence: 99%

Do wearable alcohol-based handrub dispensers increase hand hygiene compliance? - a mixed-methods study

Keller

Wolfensberger

Clack

et al. 2018

Antimicrob Resist Infect Control

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BackgroundHand Hygiene (HH) compliance was shown to be poor in several studies. Improving the availability of alcohol-based hand rub (ABHR) is a cornerstone for increasing HH compliance.MethodsIn this study, we introduced wearable dispensers for ABHR in an Emergency Department (ED) well equipped with mounted ABHR dispensers and accompanied this single-modal intervention by a quasi-experimental mixed-method study. The study was performed in the ED of the University Hospital Zurich, Switzerland, a 950-bed tertiary teaching hospital. During a five-week baseline period and a seven-week intervention period, we observed HH compliance according to the WHO ‘Five Moments’ concept, measured ABHR consumption, and investigated perceived ABHR availability, self-reported HH compliance and knowledge of HH indications by questionnaire. Multivariable logistic regression was used to identify independent determinants for HH compliance. In addition, semi-structured interviews were conducted and thematically analyzed to assess barriers and facilitators for the use of the newly introduced dispensers.ResultsAcross 811 observed HH opportunities, the HH compliance for all moments was 56% (95% confidence interval (CI), 51–62%) during baseline and 64% (CI, 59–68%) during intervention period, respectively. In the multivariable analysis adjusted for sex, profession, and WHO HH moment, there was no difference in HH compliance between baseline and intervention (adjusted Odds ratio: 1.22 (0.89–1.66), p = 0.22), No significant changes were observed in consumption and perceived availability of ABHR. During intervention, 7.5% ABHR was consumed using wearable dispensers. HCP perceived wearable dispensers as unnecessary since mounted dispensers were readily accessible. Poor ergonomic design of the wearable dispenser emerged as a main barrier, especially its lid and fastening mechanism. Interviewees identified two ideal situations for wearable dispensers, HCP who accompany patients from ED to other wards, and HCP approaching a patient from a non-patient areas in the ED such as the central working station or the meeting room.ConclusionThe introduction of wearable dispensers did not increase observed hand hygiene compliance or ABHR consumption in an ED already well equipped with mounted dispensers. For broader acceptance and use, wearable dispensers might benefit from an optimized ergonomic design.

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Improving central line maintenance to reduce central line-associated bloodstream infections

Cited by 18 publications

References 26 publications

Interruptions and Delivery of Care in the Intensive Care Unit

Interruptions and Delivery of Care in the Intensive Care Unit

Prognostic factors associated with mortality in mechanically ventilated patients in the intensive care unit

Do wearable alcohol-based handrub dispensers increase hand hygiene compliance? - a mixed-methods study

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