Hospitals in Michigan lowered the rate of bloodstream infections in their patients by following a five-step checklist. The study published in the
New England Journal of Medicine found that implementing the checklist reduced the rate of bloodstream infections related to catheter use by 66%. Despite this success, utilization of the checklist remains limited. The checklist itself isn't complicated:
- Wash hands
- Clean patient's skin with chlorohexidine
- Wear protective cap and gown and use a surgical drape during the procedure
- Avoid catheter insertion through the groin if possible
- Remove unnecessary catheters
Peter Pronovost, the patient-safety expert who led the study, spoke with The Wall Street Journal to share insights on why more hospitals haven't benefited from using the checklist. To read excerpts from his interview, click here.
Photo Credit: Adesigna
According to a 2009 study, approximately 5 million central venous catheters are placed each year. Implantable ports provide reliable venous, arterial, epidural and peritoneal access and can be used to administer IV fluids, medications and to obtain blood samples. However complications including occlusion, infection, catheter migration and catheter separation from portal body can frequently occur.
A recent study conducted in a rural hematology-oncology clinic focused on infection. A port infection can present as local tenderness, pain, erythema, induration or edema at the insertion or exit site or over the port pocket. Patients may also have purulent or serous drainage, fever and chills. To prevent infection, aseptic technique should be utilized for dressing changes. In addition, clinicians should follow accessing and deaccessing procedures and keep the exit clear of potential sources of infection. The 62 patients included in the study were receiving a minimum of two complete cycles of chemotherapy after port insertion. Ports were accessed and deaccessed following outlined protocol.
*Steps for Accessing Ports:
- Wash hands. Assess the port site for erythema, warmth or drainage.
- Palpate the outline of the portal body.
- Wash hands.
- Apply nonsterile gloves. Cleanse port site with chlorohexidine swab in a circular motion for 30 seconds. Allow to dry for 30 seconds.
- Spray ethyl chloride.
- Stabilize portal body with one hand. Insert Huber needle (link to EZ Huber product page) into septum with other hand. Ensure patency by blood return. If no blood return, use interventions to assess port's patency.
- Stabilize port with gauze and tape or apply transparent dressing.
*Steps for Deaccessing Ports:
- Wash hands. Apply nonsterile gloves.
- Inspect exit site.
- Flush device with 20 ml normal saline followed by 5 ml heparin flush (100 units/ml). During final flush, clamp tubing to port.
- Stabilize port and remove needle.
- Apply bandage.
Six of the 62 patients in the study experienced a port infection, with four of the six ports requiring removal. The total number of catheter days for the implanted ports was 7,277. Patient catheter days ranged from 32-288. The study concluded that consistent, routine care is the best preventative measure against port complications. The entire study can be found in the October 2009 issue of the Clinical Journal of Oncology Nursing.
*The port access and de-access protocols are those that were used by the authors for this study. Please follow institutional policies and procedures regarding port access and de-access.
Each year hospital-acquired infections sicken 1.7 million patients and kill another 99,000. To improve these statistics, hospital staff members across the country are taking action. At Pacific Hospital in Long Beach, California, only dangerous bacteria are targeted. Hospital staff feed patients yogurt to keep digestive bacteria balanced, bathe patients with soap designed to maintain skin's natural pH and use antibiotics only when necessary.
Another bright spot in the infection control fight is the checklist designed by Dr. Peter Pronovost from Johns Hopkins University and Hospitals. Pronovost's checklist protocol is aimed at reducing infections when inserting a central venous catheter. According to his checklist doctors should:
- Wash their hands with soap
- Clean the patient's skin with chlorhexidine antiseptic
- Put sterile drapes over the entire patient
- Wear a sterile mask, hat, gown and gloves
- Put a sterile dressing over the catheter site
In Michigan, more than 1,700 lives and $246 million were saved in the first three years the checklist was adopted, according to the state hospital association. Other hospitals across the United States, the United Kingdom, Spain and Peru are adopting the checklist. To read more about how hospitals are preventing infection, click here.
Photo Credit: @rild
A hospital in Scotland has introduced a nurse-led vascular access service to reduce waiting times for patients needing long term venous access for treatments including chemotherapy, long-term antibiotics and renal dialysis. The nurses who are part of the service insert central venous catheters and are also responsible for the training and education of other healthcare professionals. Since implementation of the service the hospital has seen a reduction in complications. For more information on the service and the process the hospital followed to implement it, click here.
Photo Credit: Elfsternberg
A study published in the March 25, 2009 edition of the Journal of the American Medical Association showed use of a chlorhexidine gluconate (CHG) impregnated sponge in intravascular catheter dressings reduced rates of catheter-related infections (Read study abstract
here.)
The Biopatch* protective disk with CHG is designed to continually release CHG allowing for unsoiled adherent dressing changes to increase from every three days to every seven days.
The Biopatch is available in
Navilyst Medical PICC Convenience Kits. To learn more, click
here.
*Biopatch is a registered trademark of Ethicon.
According to the Centers for Disease Control and Prevention, from 1997-2005 MRSA (methicillin-resistant Staphylococcus aureus) central line associated bloodstream infections declined by 50 percent in intensive care units except pediatric units where rates of incidence remained the same.
The specific cause of the decline is unknown but CDC researchers acknowledge that numerous steps have been taken to improve the safety of catheter insertion and care. Successful hospitals are utilizing a collaborative approach forming teams including medical directors, nurse managers, infection control and others involved in central line placement, access and maintenance. These teams are responsible for creating protocols and processes as well as making recommendations for implementation.
One step hospitals have taken to help eliminate infections is utilization of prepackaged kits for catheter insertion. For more information on other strategies for infection prevention, continue reading here.
Photo Credit: Interplast