December arrived with bitter cold, a touch of snow, and my first holiday season as part of a married couple. This included the usual trips across the great state of Ohio, the places where we grew up, met, and started our life together.

Conversations with friends and family shifted from wedding planning to family building and career goals as we took a moment to reflect on 2017, refresh mentally, and turn an eye toward the future. I did the same with the professional side of my life, recounting to my father-in-law all that AVA and the Journal of the

Abstract

Background: Peripheral intravenous catheters (PIVs) have been considered as having lower risk of infection than central lines. However, research is limited regarding numbers of primary bloodstream infections related to peripheral lines and prevention of peripheral line-associated bloodstream infections (PLABSI).

Methods: Our aim was to create and monitor compliance with a new PIV maintenance bundle using disinfecting caps and tips and to assess whether this bundle would lead to a decrease in PLABSI rates. Weekly audits were conducted to measure compliance with both the new PIV bundle and our existing central line-associated bloodstream infection (CLABSI) bundle. We also audited the disconnection method used for intravenous line tubing (peripheral and central lines) before and during the study intervention period.

Results: A compliance rate of close to 90% with the use of the disinfecting caps and tips was attained. Using a PLABSI bundle successfully decreased primary bloodstream infections due to PIVs (from 0.57 infections per 1000 patient-days preintervention to 0.11 infections per 1000 patient-days; p < 0.001). We confirmed that improving care for PIVs would decrease primary bloodstream infections associated with these devices.

Conclusions: Using a PIV maintenance bundle including disinfecting caps and tips can effectively lower the rate of primary bloodstream infections attributable to PIV lines.

Abstract

Background: Effective and reliable venous access is among the cornerstones of modern medical therapy in oncology.

Materials and Methods: This was a prospective observational study of collected data of patients with a diagnosis of any cancer, at a tertiary care oncology hospital in Ahmadabad, Gujarat, India, during a 2-year period.

Results: A Hickman catheter was inserted in 200 patients and most commonly used in solid malignancies (n = 103; 51.5%), followed by hematologic conditions (n = 93; 48.5%). Among solid malignancies, hepatoblastoma (n = 21; 10.5%) was the most common indication, whereas in hematologic malignancies acute lymphoblastic leukemia was the most common indication (n = 56; 28%) for Hickman catheter insertion. Hickman catheters were inserted most commonly in the right side (n = 170; 85%) of the venous system. The various complications in the Hickman study group in descending order were 28 patients (14%) developed arrhythmias, 15 patients (7.5%) developed infection, 12 patients (6%) developed bleeding, 8 patients (4%) developed pneumothorax, 7 patients (3.5%) developed catheter blockage, and 6 patients (3%) required premature catheter removal. The median time of Hickman catheter in situ was 207 days.

Conclusions: The most disturbing aspect of treatment of patients with cancer is multiple painful venipunctures made for administration of cytotoxic agents, antibiotics, blood products, and nutritional supplements. The focus of this prospective observational research was to study the various indications for Hickman catheter in different solid and hematologic malignancies as well as the various complications and outcomes in pediatric and adult cancer patients.

Abstract

Purpose: Hospitals devote significant resources developing protocols to minimize the incidence of central line-associated bloodstream infections (CLABSIs), a source of increased patient morbidity and health care costs; however, few of these protocols, especially centralized protocols, are reported in the literature. This study characterizes the development and effectiveness of a pediatric hospital's centralized CLABSI prevention bundle.

Design and Methods: The study was designed as a retrospective interrupted time series to quantify the effectiveness of the prevention bundle that was developed and implemented by nursing leadership in infection control, and both the neonatal and pediatric intensive care units between 2006 and 2014. The study period was subdivided into pre-, peri-, post-, and second peri-intervention periods based on the implementation status of the bundle. Segmented linear regression was used to model and compare the CLABSI rates for each intervention period overall as well as the 5 individual hospital units.

Results: The hospital's modeled CLABSI rate during the preintervention period was 3.80 out of 1000 line days and was significantly reduced to 0.45 (P < 0.001). Clear decreases in unit CLABSI rates were observed and all units were below corresponding National Healthcare Safety Network CLABSI rates after the study.

Conclusions: The centralized CLABSI prevention bundle reduced and sustained low CLABSI rates overall and within each hospital unit demonstrating the success of the bundle.

Practice Implications: A centralized CLABSI prevention bundle can universalize central line care, simplify infection control, and improve quality of care to help sustain low CLABSI rates throughout the hospital.

Patient Advocacy: the Challenge is to be a Voice in All Circumstances

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