Prevention of catheter-related infection

Zingg, Walter; Walder, Bernhard; Pittet, Didier

doi:10.1097/qco.0b013e32834811ed

Cited by 32 publications

(27 citation statements)

References 77 publications

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“…Although the contribution of the individual steps of what is called best practice is uncertain, multimodal intervention strategies were effective even if the combination of the specific interventions varied across the studies [123]. Bringing the risk of infection to the attention of healthcare providers already positively impacts patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Bench-to-bedside review: Challenges of diagnosis, care and prevention of central catheter-related bloodstream infections in children

et al. 2013

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Central venous catheters (CVCs) are indispensable in modern pediatric medicine. CVCs provide secure vascular access, but are associated with a risk of severe complications, in particular bloodstream infection. We provide a review of the recent literature about the diagnostic and therapeutic challenges of catheter-related bloodstream infection (CRBSI) in children and its prevention. Variations in blood sampling and limitations in blood culturing interfere with accurate and timely diagnosis of CRBSI. Although novel molecular testing methods appear promising in overcoming some of the present diagnostic limitations of conventional blood sampling in children, they still need to solidly prove their accuracy and reliability in clinical practice. Standardized practices of catheter insertion and care remain the cornerstone of CRBSI prevention although their implementation in daily practice may be difficult. Technology such as CVC impregnation or catheter locking with antimicrobial substances has been shown less effective than anticipated. Despite encouraging results in CRBSI prevention among adults, the goal of zero infection in children is still not in range. More high-quality research is needed in the field of prevention, accurate and reliable diagnostic measures and effective treatment of CRBSI in children.

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Section: Discussionmentioning

confidence: 99%

Bench-to-bedside review: Challenges of diagnosis, care and prevention of central catheter-related bloodstream infections in children

et al. 2013

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“…Strategies for the dissemination of knowledge are based on the Pronovost-model and others [12,24,25]. …”

Section: Methodsmentioning

confidence: 99%

Implementation of a children’s hospital-wide central venous catheter insertion and maintenance bundle

Helder

Kornelisse

Starre

et al. 2013

BMC Health Serv Res

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BackgroundCentral venous catheter-associated bloodstream infections in children are an increasingly recognized serious safety problem worldwide, but are often preventable. Central venous catheter bundles have proved effective to prevent such infections. Successful implementation requires changes in the hospital system as well as in healthcare professionals’ behaviour. The aim of the study is to evaluate process and outcome of implementation of a state-of-the-art central venous catheter insertion and maintenance bundle in a large university children’s hospital.Methods/designAn interrupted time series design will be used; the study will encompass all children who need a central venous catheter. New state-of-the-art central venous catheter bundles will be developed. The Pronovost-model will guide the implementation process. We developed a tailored multifaceted implementation strategy consisting of reminders, feedback, management support, local opinion leaders, and education. Primary outcome measure is the number of catheter-associated infections per 1000 line-days. The process outcome is degree of adherence to use of these central venous catheter bundles is the secondary outcome. A cost-effectiveness analysis is part of the study. Outcomes will be monitored during three periods: baseline, pre-intervention, and post-intervention for over 48 months.DiscussionThis model-based implementation strategy will reveal the challenges of implementing a hospital-wide safety program. This work will add to the body of knowledge in the field of implementation. We postulate that healthcare workers’ willingness to shift from providing habitual care to state-of-the-art care may reflect the need for consistent care improvement. Trial registration: Dutch trials registry, trial # 3635.Trial registrationDutch trials registry (http://www.trialregister.nl), trial # 3635

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“…In certain healthcare institutions, where both bundle interventions and technological solutions have been implemented, the prospect of zero CRBSI is considered to be a potential goal. (Zingg et al, 2011). …”

Section: Introductionmentioning

confidence: 99%

Economic impact of Tegaderm chlorhexidine gluconate (CHG) dressing in critically ill patients

Thokala

Arrowsmith²,

Poku

et al. 2016

Journal of Infection Prevention

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Purpose:To estimate the economic impact of a TegadermTM chlorhexidine gluconate (CHG) gel dressing compared with a standard intravenous (i.v.) dressing (defined as non-antimicrobial transparent film dressing), used for insertion site care of short-term central venous and arterial catheters (intravascular catheters) in adult critical care patients using a cost-consequence model populated with data from published sources.Material and Methods:A decision analytical cost-consequence model was developed which assigned each patient with an indwelling intravascular catheter and a standard dressing, a baseline risk of associated dermatitis, local infection at the catheter insertion site and catheter-related bloodstream infections (CRBSI), estimated from published secondary sources. The risks of these events for patients with a Tegaderm CHG were estimated by applying the effectiveness parameters from the clinical review to the baseline risks. Costs were accrued through costs of intervention (i.e. Tegaderm CHG or standard intravenous dressing) and hospital treatment costs depended on whether the patients had local dermatitis, local infection or CRBSI. Total costs were estimated as mean values of 10,000 probabilistic sensitivity analysis (PSA) runs.Results:Tegaderm CHG resulted in an average cost-saving of £77 per patient in an intensive care unit. Tegaderm CHG also has a 98.5% probability of being cost-saving compared to standard i.v. dressings.Conclusions:The analyses suggest that Tegaderm CHG is a cost-saving strategy to reduce CRBSI and the results were robust to sensitivity analyses.

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Prevention of catheter-related infection

Cited by 32 publications

References 77 publications

Bench-to-bedside review: Challenges of diagnosis, care and prevention of central catheter-related bloodstream infections in children

Bench-to-bedside review: Challenges of diagnosis, care and prevention of central catheter-related bloodstream infections in children

Implementation of a children’s hospital-wide central venous catheter insertion and maintenance bundle

Economic impact of Tegaderm chlorhexidine gluconate (CHG) dressing in critically ill patients

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