Abstract

Infection prevention and control is a core element of patient safety and in the reduction of central line-associated bloodstream infections. These deadly infections can cause a mortality rate of approximately 12%–25% in inpatient populations. Bloodstream infections can in many cases be prevented through the adoption of evidence-based standards from organizations such as the Centers for Disease Control and Prevention and the Association for Vascular Access. Vascular access professionals play a critical role in infection prevention in patient care by practicing frequent hand hygiene, maintaining a clean and sanitary clinical environment of care, and performing proper skin antisepsis before the insertion of a vascular access catheter. Each of these interventions contributes to the overall goal of eliminating central line-associated bloodstream infections in these very vulnerable patients.

Abstract

Background: Patients who have a central line (CL) are at increased risk for developing a CL-associated bloodstream infection (CLABSI), which increases morbidity, length of stay, and cost. Our goal is zero CLABSI infections.

Methodology: In 2009 our organization implemented a CL bundle to prevent CLABSIs, and staff education was introduced in 2012. In 2013 a 2% chlorhexidine gluconate (CHG) wipe was introduced and used to clean around CL dressings. In 2014 a new CL dressing was adopted and during 2015 the organization began using a 3.15% CHG/70% alcohol swab for disinfection of needleless connectors. A final intervention was put into place in 2015 called “nose to toes” in which a patient is bathed from nose to toes (excluding the face) using 2% CHG wipes.

Results: Before implementation of the above methods, our intensive care unit had an average infection rate of 1.9/1000 CL-days in 2009. Incidence of CLABSIs continued to decrease as the organization implemented the additional products and practices. In the 15 months following implementation, the ICU has been able to consistently maintain a zero CLABSI rate.

Conclusions: The implementation of these changes in practice along with bringing in new products has made it possible to achieve the goal of reaching and maintaining zero infections. Due to the successful results in our intensive care unit, we have implemented these changes to all patient care areas in the hospital for use on all CLs.

Abstract

Interventions that address the increasing threat of multidrug resistance are the responsibility of all health care disciplines. Vascular access teams ensure that vascular access needs are met, facilitating antimicrobial agent administration. Competent vascular access practice includes participation on interprofessional teams and provision of expert knowledge that enables medication administration and process monitoring.

Abstract

Background: A large, urban community hospital developed an insertion bundle to support the safe implementation of a policy of extended dwell time (clinical indication) for inpatient peripheral intravenous lines (PIVs).

Methods: Internal evaluation of practices through direct observations as well as evidence-based guidelines and historic data on PIV-related bloodstream infections helped drive the bundle elements. A surveillance plan was in place to continue measurement of these outcomes during the postimplementation period.

Results: At 12 months following implementation, the organization documented a 37% reduction (P = .03) in primary bacteremias (combining PIV and central line-associated bloodstream [CLABSI] infections) and a 19% percent reduction in PIV bloodstream infections. CLABSI rates were also reviewed, as 20% of CLABSI were noted to also have peripheral access present during the year prior to implementation. CLABSI standardized infection ratios for the publicly reported intensive care units decreased from 1.3 to 0.32 (P = .02). In addition, intravenous line start kit use decreased 48% during the year following bundle implementation.

Conclusions: Careful planning and development of an education bundle and an insertion bundle in a community hospital setting allowed for longer dwell times and a trend of decreased bloodstream infections.

Abstract

Objective: We aimed to identify trends in vascular access modalities for renal hemodialysis and to evaluate the influence of service modifications on service performance and patient outcomes.

Methods: Retrospective analysis of incident and prevalent hemodialysis patients treated by the Gold Coast Hospital and Health Service, Queensland, Australia, between January 2004 and December 2013 was conducted. A comparison of patient demographic characteristics and analysis of trends in access modality and outcomes was performed for each group over the study period. Modifications to service structure and practice changes were also evaluated.

Results: A total of 1787 patients (456 incident and 1331 prevalent) and 1671 procedures were examined. The proportion of patients starting hemodialysis on a catheter decreased from 79.2% to 63.6%. Patients starting hemodialysis on a fistula increased from 16.7% to a peak of 61.5% but fell to 27.3% in 2003. Catheter use in prevalent patients decreased from 11.7% to 6.1%, whilst fistula use increased from 60.6% to 88.5%. Graft access remained low for the incident group (0.0%–9.1%) and was reduced in prevalent patients from 27.7% to 4.9%. Bloodstream infection rates were reduced from 1.88 to 1.60 per 1000 dwelling-days. Endovascular and surgical revision of arteriovenous access was increased.

Conclusions: Coordinated and multidisciplinary access service provided earlier referral for planned incident access with fewer catheters and increased fistulas with reduced bloodstream infection rates. Modifications to this vascular access service are associated with improved permanent access rates for incident and prevalent patients. There was an overall improvement of service performance and patient outcomes.