Volume 28: Issue 4

Sarah A. Norris
Citation: Journal of the Association for Vascular Access 28, 4; 10.2309/JAVA-2023-28-04-Foundational

Andrew Todd
Citation: Journal of the Association for Vascular Access 28, 4; 10.2309/JAVA-2023-28-04-Foundational

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Introduction

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Highlights

Insufficient evidence exists on prevention of CLABSIs in the ambulatory setting.
We translated inpatient CLABSI prevention strategies to an ambulatory setting.
After enhancing our bundle, our average monthly CLABSI rate declined by 66%.
We sustained a lower CLABSI rate for 24 months (12 fewer infections per year).

Abstract

Aim:

Central line-associated bloodstream infections (CLABSIs) result in significant morbidity but are largely preventable. Methods to reduce hospital-acquired CLABSIs are well described, but few recommendations exist for how these practices might translate to patients with central lines in the ambulatory setting. This team sought to reduce the mean monthly community-acquired CLABSI rate by 25% from 11.7 to 8.8 per 1000 community line-days in children with intestinal failure who require home parenteral nutrition within 12 months.

Methods:

First, an interprofessional quality improvement team was formed. After baseline data collection, plan-do-study-act cycles began. Tests of change consisted of a central venous catheter (CVC) maintenance bundle. This bundle included a CVC care tote with additional supplies, improved educational materials, and ethanol lock prophylaxis. A control chart was used to display the monthly community-acquired CLABSI rate and observe for special cause variation.

Results:

At baseline, the average monthly community-acquired CLABSI rate was 11.7 per 1000 community catheter-days. The home CVC maintenance bundle was implemented, after which there were 5 consecutive months with no infections. After enhancements to the care bundle and tote, special cause variation was noted, and the average monthly community-acquired CLABSI rate declined by 66% to 4 per 1000 community catheter-days. Special cause variation was noted at 2 other time points without an identifiable cause.

Conclusion:

A lower community-acquired CLABSI rate has been sustained for 24 months and reflects approximately 12 fewer infections per year in this at-risk population.

Abstract

Background and Aim:

Patients with history of injection drug use (IDU) and a vascular access device (VAD) placement during hospitalization may cause concern of VAD misuse or contamination. In this study, we evaluated mean hospital length of stay (LOS), hospitalization cost, and rate of potentially preventable catheter related infections (PPCRIs) for IDU and non-IDU patients with VADs.

Methods:

In this retrospective cohort study, we used the US Premier Healthcare Database claims data from 2019 and 2020. Inpatient admissions (age >10 years) with recorded VAD placement were assigned to 2 cohorts, those with and without a recorded use of prescribed drug treatments for IDU (VAD + IDU and VAD-only cohorts, respectively). Patients with IDU but without VAD served as a control cohort.

Results:

Data from 491,406 patients were analyzed. The rate of IDU among those who received a VAD placement was 3%. Patients identified as VAD + IDU were younger and had a lower Charlson Comorbidity Index than the VAD-only population. The VAD + IDU patients had a mean LOS that was 1.8 times longer and mean cost of care that was 1.9 times higher for all-cause admissions. The ratio of observed/expected PPCRI events increased in 2020 in the VAD + IDU but not in the VAD-only population.

Conclusions:

Compared with patients without IDU, the patients with VAD + IDU in this study had overall longer LOS, higher inpatient cost, and a higher rate of PPCRI during the height of the pandemic. Cost-effective strategies to mitigate the complications and problems associated with receiving care and tampering with VADs are imperative.

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President’s Message

Ineffective: Sutures as an Ineffective Securement Device: Editor’s Message

Improvised Securement

Foundational Support

Introduction

An Interprofessional Quality Improvement Project to Reduce Community-Acquired Central Line-Associated Bloodstream Infections in the Pediatric Intestinal Failure Population

Highlights

Abstract

Aim:

Methods:

Results:

Conclusion:

2023 Association for Vascular Access Scientific Meeting: Poster Abstracts

How Do We Prevent Phlebitis With Vancomycin Infusion? Have We Learned Anything?

Length of Stay, Hospitalization Cost, and Infection Rate for Inpatients With Vascular Access Devices With and Without History of Injection Drug Use ^CE

Abstract

Background and Aim:

Methods:

Results:

Conclusions:

Step Into Leadership: Make a Difference on the AVA Board

Insertion and Maintenance of PICC for a Pediatric Patient with Epidermolysis Bullosa

A Quality Improvement PDSA to Evaluate the Effectiveness of Blood Diversion Using a Three-Way Connector During Blood Culture Collection

Midlines: Useful, Not Universal

A Randomized Control Trial to Determine the Effect of Handball Exercise on Arteriovenous Fistula Maturation

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