Insertion of central vascular catheter: adherence to infection prevention bundle

Abstract

Objective:To evaluate the compliance of the care process involving insertion of central vascular catheter (CVC) in hemodialysis. Method: Cross-sectional quantitative approach developed at the hemodialysis service of a reference hospital in Sergipe, Brazil. Sample consisting of 1,342 actions evaluated, corresponding to 122 forms for monitoring and control of CVC insertion. Data collection was held from July to December 2016. Results: The adherence rate to the use of the insertion form was 54.9%. The procedure evaluated achieved 93% overall compliance. Of the 11 specific actions observed, seven (64%) presented 100% compliance. The density of the overall incidence of primary bloodstream infections reduced from 10.6 to 3.1 infections per 1,000 patients/day. Conclusion: Although the observed actions reached specific desired conformities, the use of the checklist was lower than expected. Strategies for monitoring, coaching and educational and organizational actions can contribute to safe care.

Análise das práticas assistenciais para prevenção das infecções primárias da corrente sanguínea

“…Estudos em hospitais brasileiros (9,16) e no âmbito internacional (10,(17)(18) também encontraram bons resultados relacionados à HM antes da inserção, antissepsia da pele e secagem do antisséptico previamente à punção e reforçaram a importância de valorizar mais a utilização de barreira máxima e de evitar as punções femorais, evidenciando redução significativa de IPCS após a utilização dos princípios propostos pelos bundles e aplicação do checklist de inserção segura.…”

Surgical site infection prevention bundle for children submitted to cardiac surgery

“…The bundle strategy methodology presupposes that joint application of interventions is proven to be more efficient than the application of isolated measures (11,13) . Adherence to bundle use has been thus presenting significant results for the reduction of SSI in children submitted to cardiac surgery, concomitantly to permanent education activities (5)(6)(7) .…”

“…Bundles are "packages" of specific care procedures that, when implemented collectively, improve healthcare results (8)(9) . It is a light-hard technology proposed by the Institute for Healthcare Improvement (10) , whose construction is based on the best evidence for health practice (10) with the objective of reducing adverse events related to health care (8,(11)(12)(13) .…”

Blood Current Infection Related to Central Venous Catheter Use: Bundle Interventions

“…(5) Primary bloodstream infection related to the use of CVC reflects an unfavorable complication for both the patient and the hospital, which has an increase in costs, given that the patient's stay in the inpatient unit will be longer, as well as the need for tests and drugs for the treatment of IPCS. (6) The main causes of catheter-related bloodstream infection (CRBSI) are contamination of the catheter installation site by the skin microbiota, infusion of contaminated intravenous solutions, contamination of the access routes, through the hematogenous route and by the hands of the professionals who perform the installation, which shows ineffective hand hygiene prior to catheter maintenance. (4) As for the risk factors that favor the development of infections resulting from blood, the presence of comorbidities, inadequate nutrition, catheter permanence time, catheter insertion site and handling by professionals stand out.…”