Hospitals across the country are diligently working to reduce infection rates. According to the World Health Organization, hospital-acquired infections affect as many as 1.7 million patients in the United States each year. These infections come at an annual cost of $6.5 billion and contribute to more than 90,000 deaths.
Proper hand hygiene is essential in helping to prevent hospital-acquired infections. A recent study performed by French researchers examined three types of healthcare workers. The first type spent a large amount of time with a discreet group of patients like a nurse would. The second group saw more patients but spent less time with each one - similar to doctors. Group three consisted of healthcare workers who interacted with every patient every day like therapists. The study found that if a healthcare worker in group three failed to wash their hands, the spread of disease was three times worse than if someone from group one or two didn't. The study was published online in Proceedings of the National Academy of Sciences. To read more about the study, continue here.
To read another take on hand hygiene and about the Joint Commission's national hand hygiene project, click here.
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Should family members be present during a bedside PICC placement? This is an issue that PICC team members face with every PICC insertion. Lynn Hadaway, M.Ed., RNC, CRNI tackles the issue in a recent blog post here.
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Almost two million patients hospitalized in the U.S. each year develop an infection. These infections occur in as many as one in every 10 patients, result in close to 100,000 deaths and cost upwards of $6 billion. The Wall Street Journal created a top 10 list of infection prevention strategies based on interviews with medical professionals, administrators a non profit company and the Association for Professionals in Infection Control and Epidemiology.
- Undercover Operations - Dr. Philip Carling, an epidemiologist at Caritas Carney Hospital in Dorchester, Mass. developed a solution to uncover how well patient rooms are cleaned. His invisible solution contains fluorescent markers which glow in black light. After spraying patient rooms with the solution, cleaning crews were brought in to perform their normal routine. Later, rooms were examined with a black light and areas missed by the cleaners glowed fluorescent. Sharing results with cleaners helped boost compliance with proper cleaning techniques.
- High-Tech Cleaning Systems - When hospital equipment is disinfected by hand, bacteria often remains. For more thorough disinfecting hospitals are utilizing machines such as Bioquell which sprays a disinfecting hydrogen-peroxide vapor.
- Data Mining - Many hospitals are tracking data to determine how to prevent infections. Lee Memorial Health System in Florida tracks infection rates by surgeon and reports on the results. Low ranking surgeons can then make adjustments to lower their infection rates and improve their ranking.
- Patient Hygiene - Research suggests a daily wash with mild antibacterial soap can dramatically reduce the rate of bloodstream infections. The recommended cleanser is chlorohexidine glutonate.
- Reporting Crackdown - Numerous states have passed laws which require hospitals to report on infection rates. In many cases the reports are publicly available. In addition, Medicare is limiting reimbursement for treatment of hospital-acquired infections.
- Clean hands - Hospitals that utilize strategically-placed dispensers of hand sanitizer have noticed an increase in hand hygiene compliance from less than 50% to more than 80%.
- Embracing the Checklist - Incorporating checklists into bedside medical charts can help reduce rates of infection by requiring shift nurses to answer questions such as: Does this patient have a catheter? If so, is it still necessary?
- Portable Kits - Utilizing all-inclusive kits for common procedures such as intravenous line insertions or dressing changes can limit the possibility for infection. Kits contain all the items needed for procedures and prevent the nurse from running in and out of the patient room during a procedure to find a forgotten item.
- Mouth Maintenance - Regularly cleaning patients' mouths, gums and teeth can help prevent ventilator-associated pneumonia, a common infection found in intensive care units.
- Infection ID - Quick diagnostic tests can identify infected patients in a matter of hours rather than days. This allows for a quick response when patients show symptoms, are tested and found to be infected.
To read the complete article with expanded descriptions of the top 10, click here.
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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.
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Each year U.S. News & World Report releases "America's Best Hospitals" rankings which is a listing of top hospitals in the United States. One category in the report is nursing care. Patients filling out the survey are asked how often their nurses were courteous, listened carefully and gave clear explanation. The hospitals ranked highest for nursing for the year ending December 2008 are:
Mayo Clinic Hospital, Phoenix, AZ
New England Baptist Hospital, Boston, MA
Mayo Clinic, Rochester, MN
University of Kansas Hospital, Kansas City, KS
Brigham and Women's Hospital, Boston, MA
Methodist Medical Center of Illinois, Peoria, IL
Poudre Valley Hospital, Fort Collins, CO
University of North Carolina Hospitals, Chapel Hill, NC
Central DuPage Hospital, Winfield, IL
Christ Hospital, Cincinnati, OH
To see the other top hospitals for nursing care and those hospitals ranked as worst, continue here.
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At West Virginia University Hospital (WVUH) a team of nurses is responsible for placing peripherally inserted central catheters (PICCs). The WVUH PICC team places approximately 200 PICCs per month and noticed a lag time between placement and clearance of the PICC. The standard of care for PICCs is for a nurse to place the PICC and wait for clearance for use from a radiologist. Since radiologists are responsible for films hospital-wide, the clearance step was slowing down the process. To take the first step towards solving the issue, the PICC team at WVUH enrolled in a PICC tip interpretation class. After the educational step, a study was conducted to determine if the PICC team interpreting tip placement was faster than and as accurate as waiting for a radiologist.
The study included all adult PICC placements between April 10, 2008 and July 10, 2008. Any patient with incomplete documentation was removed from the sample. The interpretation time was compared for MDs and RNs. The study determined that MDs take longer to interpret the X-rays than RNs. Agreement on X-ray interpretation was also studied. It was determined that RNs and MDs will agree on interpretation of X-rays between 93.8% and 97.8% of the time.
Based on the results of the study, the policies at WVUH will be rewritten to allow nurses to give radiological clearance of PICCs. In addition, PICC team members will complete yearly competency updates along with radiology department physicians to maintain proficiency. PICC patients will benefit by not having to wait as long for radiologist clearance to start IV therapy.
To read the abstract of the study or to purchase a copy of the full study, click here.
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A recent study published in the American Journal of Infection Control examined the levels of bacteria on healthcare workers' lab coats. The study involved a cross section of medical and surgical grand rounds attendees at a large teaching hospital. Participants completed a survey and cultured their lab coat using a moistened swab on the lapels, pocket and cuffs. Of the 149 white coats in the study, 34 (23%) were contaminated with S aureus, of which 6 (18%) were methicillin-resistant S aureus (MRSA). Providers working with patients had higher contamination levels and the study suggests that white coats may contribute to patient-to-patient transmission of S aureus. Read the entire study in the March 2009 issue of the American Journal of Infection Control, the official journal of the Association for Professionals in Infection Control and Epidemiology (APIC).
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Central venous catheters (CVC) are essential for treating children with cancer. They reduce the need for multiple needlesticks and the associated pain and anxiety. In addition, they can be used to deliver chemotherapy, parenteral fluids, blood products and analgesics. Despite the positives, children with CVCs are at increased risk for bloodstream infections. Complications associated with CVCs include pneumothorax, air embolism, nerve injury, catheter malposition, infection and occlusion.
A recent study had four objectives:
1. To decrease CVC-related bloodstream infection rates in children with cancer through a comprehensive educational intervention.
2. To determine if the frequency of catheter hub colonization of CVCs in children with cancer would decrease following the educational intervention.
3. To evaluate nurses' knowledge of CVC care.
4. To determine risk factors influencing CVC-related bloodstream infections in children with cancer.
The study was conducted in the cancer center of a large children's hospital and included patients ranging in age from infancy to 18 years. A 45 minute educational program on CDC guidelines, most frequent guideline violations and information on catheter-related infections was presented to all caregivers. Following the educational presentation, catheter-related bloodstream infections were tracked for six months in order to determine the rate of infection. Study findings showed that the educational program increased nurses' knowledge and instances of catheter-related bloodstream infections decreased. You can read the full article in the March 2009 issue of Oncology Nursing Forum or purchase it online here.
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A cleverly-named study: "PICC the music and travel to the port of relaxation: The effects of music on perceived pain and anxiety in patients receiving PICCs and Port-A-Caths" explored how music impacted patients undergoing PICC or port insertion. Study participants were broken into three groups: no music, background music selected by staff or music selected by the patient delivered through headphones. In the PICC placement patients, no significant differences in pain, anxiety or blood pressure were noted in the three groups. For port placement patients, those listening to their own music with headphones had a significant reduction in anxiety compared with the no music group. To read the study abstract or purchase the full study, click here.
To read an expanded discussion of the study, pick up the Fall 2009 issue of the Journal of the Association for Vascular Access (JAVA).
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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.