Abstract

Background: Implementation of the Institute for Healthcare Improvement's Central Line Bundle in 2005 did not result in attainment of 0 central line-associated bloodstream infections (CLABSIs).

Purpose: To establish process improvements to eliminate CLABSIs.

Methods: Infection Prevention and Intravenous Therapy Departments at our institution formed a collaborative partnership in 2008 to eliminate CLABSIs. Staff education, daily surveillance, and implementing evidence-based practice into policies, protocols, and product selection were utilized. A study designed to capture and track multiple interventions from the beginning versus time was implemented.

Results: There were a total of 7 CLABSIs over 5 years, which trended down by year from 3 to 2 to 1 to 1 to 0. The average annual CLABSI rate of infections per 1,000 catheter line days declined from 1.068 to 0.849 to 0.508 to 0.449 to 0.000. The full 3-year simple average from 2009 to 2011, after all of the key interventions were phased-in, was 0.3048.

Conclusions: Collaboration and commitment played a role in implementing changes. Empowering staff through education that increases knowledge, understanding, and skills improves patient safety and patient outcomes. Process changes and practice protocols supported by evidence-based practice along with efficacious products played a crucial part in getting to 0 CLABSIs. Layered kits with products placed in the correct order of use can increase aseptic technique compliance. Prompt identification of individual CLABSI episodes with prompt intervention to the specific individuals involved has been shown to be cost-effective and can be implemented in most hospitals.

Abstract

Background: There have been very few studies conducted to assess the infection risk of repairing a ruptured or broken tunneled central venous access device or a ruptured peripherally inserted central catheter (PICC), a procedure that is fairly common in a certain population of patients.

Methods: In a retrospective review of repairs to both tunneled central venous access devices and PICCs in a large metropolitan health system, 258 medical records were reviewed. During a 4-year period there were 258 repairs, 202 to PICC lines and 56 to tunneled catheters. The system-wide infection database was the source queried to provide evidence for and confirmation of a central line infection. This database is maintained by the infection control team using strict guidelines, reducing inter-rater reliability issues.

Results: The Fisher exact test for proportions was used to compare infection rates between repaired infected and repaired noninfected lines. The infection rate was 5% in repaired catheters and 5.9% in unrepaired catheters (P = 1.00). On average, repaired catheters were in place longer (mean log [time-days in situ] 2.71 vs 2.31). Despite repairs and longer dwell times the repaired catheters did not have a significantly higher rate of infection when compared with unrepaired catheters.

Conclusions: Despite longer dwell times the infection rate for repaired catheters was not statistically significant when compared with unrepaired catheters.

Abstract

The development of frameworks for nursing research, practice, and education is in its infancy. The focus in clinical research has commonly been on the variables patient and practice, not on the significant variable, technology products. However, in interventional and medical cardiology and orthopedic surgery, for example, products used are significant variables that affect clinical outcomes and subsequent recalls. The purpose of this article is to introduce the Healthcare and Technology Synergy (HATS) framework and discuss its use in comparative effectiveness research on health care-associated infections as well as its usefulness in nursing practice, education, and policy. Research in nursing that focuses on product as a variable has examined intravenous connectors and their association with catheter-related bloodstream infections, but more research specific to technology products is needed. The significance of products in nursing has been underappreciated, and the variable has been underutilized in research. This is a study limitation that can significantly affect research outcomes. Use of the HATS framework in nursing research can facilitate the development of clinically relevant nursing curricula, practice interventions, and policy based on research results. Appropriate development and evaluation of research that uses the HATS framework also has implications for cost-benefit analyses, product evaluation, and implementation of evidence-based practices.

Abstract

Background: Video sharing networks such as YouTube have revolutionized communication. Whilst access is freely available uploaded videos can contain non peer-reviewed information. This has consequences for the scientific and health care community, when the challenge in teaching is to present clinical procedures that follow empirical methods.

Objective: To review 50 central venous catheter and peripherally inserted central catheter videos posted on YouTube. The aim was to appraise these videos using current evidenced-based guidelines.

Methods: We searched YouTube using the key words central venous cannulation and peripherally inserted central catheter insertion on September 21, 2012. We consecutively reviewed 50 videos for both procedures.

Results: There was poor adherence to evidence-based guidelines in the critiqued videos. There was a difference in adherence with the use of appropriate skin antisepsis in the 2 groups (18% for central venous catheters vs 52% for peripherally inserted central catheters; p = 0.009). And a large proportion in both groups compromised aseptic technique (37% for central venous catheters vs 38% for peripherally inserted central catheter; p = 0.940). The use of ultrasound guidance during procedures was also different between the 2 groups (33% for central venous catheters vs 85% for peripherally inserted central catheters; p = 0.017).

Conclusions: This critique of instructional videos related to the insertion of central venous catheters and peripherally inserted central catheters uploaded to YouTube has highlighted poor adherence to current evidence-based guidelines. This lack of adherence to empirical guidelines can pose risks to clinical learning and ultimately to patient safety.