Beyond the bundle - journey of a tertiary care medical intensive care unit to zero central line-associated bloodstream infections

Exline, Matthew C.; Ali, Nora’aini; Zikri, Nancy; Mangino, Julie E.; Torrence, Kelly; Vermillion, Brenda; Clair, Jamie St.; Lustberg, Mark; Pancholi, Preeti; Sopirala, Madhuri M.

doi:10.1186/cc12551

Cited by 61 publications

(53 citation statements)

References 34 publications

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“…[1][2][3][4][5][6][7][8][9][10][11] No período em estudo, após as intervenções estabelecidas, não se reportaram ICSACC no internamento do CIPE do HP-CHUC. Este é um indício positivo, que suporta uma possível correlação entre as intervenções aplicadas e a redução da incidência de ICSACC.…”

Section: Discussionunclassified

“…4 Após a retirada do CVC, a ponta foi enviada sistematicamente para cultura. O isolamento de gérmen, na ausên-cia de sintomas ou sinais clínicos de infeção, foi considerado colonização de cateter.…”

Section: Methodsunclassified

“…[1][2][3][4][5][6][7][8][9][10] As infeções da corrente sanguínea associadas ao uso de cateter central (ICSACC) são um dos tipos mais frequentes de infeções associadas aos cuidados de saúde, resultando em prolongamento do internamento, elevada morbilidade e mortalidade e aumento dos custos hospitalares. [1][2][3][4][5]8,[10][11][12] Para que ocorra uma ICSACC é necessário que os microrganismos tenham acesso à superfície intraluminal ou extraluminal do cateter venoso central (CVC), com subsequente adesão e formação de biofilme, permitindo-lhes uma infeção sustentada com posterior disseminação hematogénea. 1,12,19 Este acesso ocorre através de um de quatro mecanismos: migração da microflora cutânea do doente ao longo do trajeto subcutâneo, com colonização da ponta do CVC; contaminação do lúmen ou das conexões; colonização por via hematogénea; e, mais raramente, por contaminação da solução perfundida.…”

Section: Introductionunclassified

“…15 A introdução e o reforço de intervenções multidisciplinares de educação, monitorização e prevenção destas infeções são de importância reconhecida na otimização da prestação de serviços de saúde 4,6 . O objetivo deste trabalho foi o de realizar um estudo da incidência de episódios de ICSACC após a implementação de um conjunto de medidas multidisciplinares em comparação com controlos históricos.…”

Section: Introductionunclassified

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Estratégia Multidimensional na Redução de Infeção Associada a Cateter Venoso Central em Pediatria

et al. 2016

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RESUMOIntrodução: Determinar a incidência de infeções da corrente sanguínea associadas ao uso de cateter venoso central, após reforço de medidas multidisciplinares de boa prática e a sua comparação com a taxa de incidência de infeções da corrente sanguínea associadas ao uso de cateter venoso central prévia. Results: Seventy five children were included, with a median age of 23 months: 22 (29.3%) newborns; 28 (37.3%) with recent surgery and 32 (43.8%) with underlying illness. A total of 105 central venous catheter were inserted, the majority a single central venous catheter (69.3%), with a mean duration of 6.8 ± 6.7 days. The most common type of central venous catheter was the short-term, nontunneled central venous catheter (45.7%), while the subclavian and brachial flexure veins were the most frequent insertion sites (both 25.7%). There were no cases of central-line associated bloodstream infection reported during this study. Comparing with historical controls (group 1), both groups were similar regarding age, gender, department of origin and place of central venous catheter insertion. In the current study (group 2), the median length of stay was higher, while the mean duration of central venous catheter (excluding peripherally inserted central line) was similar in both groups. There were no statistical differences regarding central venous catheter caliber and number of lumens. Fewer children admitted to Pediatric Intensive Care Unit had central venous catheter inserted in group 2, with no significant difference between single or multiple central venous catheter. Discussion: After multidimensional strategy implementation there was no reported central-line associated bloodstream infection Conclusions: Efforts must be made to preserve the same degree of multidimensional prevention, in order to confirm the effective reduction of the central-line associated bloodstream infection rate and to allow its maintenance.

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Section: Discussionunclassified

Section: Methodsunclassified

Section: Introductionunclassified

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Estratégia Multidimensional na Redução de Infeção Associada a Cateter Venoso Central em Pediatria

et al. 2016

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“…Root cause analysis is an effective tool to assist a health care team that is fully engaged in quality improvement interventions. 49 When combined with CVC insertion and maintenance bundles, RCA assists in identifying additional processes and systems that may contribute to CLABSIs and additional areas of improvement. 50 Nurses are uniquely positioned to participate in the process of RCA due to their frontline involvement of CVC care.…”

Section: Clabsi Follow-upmentioning

confidence: 99%

Pediatric central venous access devices: nursing interventions

Duffy¹,

Nelson²

2017

NRR

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A central venous catheter (CVC) is an indwelling catheter that provides permanent or temporary stable venous access for both acute and chronically ill pediatric patients. These catheters provide stable venous access that can be used for a variety of medical purposes including drawing blood, hemodynamic monitoring, infusion of intravenous medications, infusion of intravenous fluids, chemotherapy, blood products, and parenteral nutrition. Each day, nurses access and care for CVCs in infants, children, and adolescents; the precision of this care can prevent life-threatening complications. The purpose of this review and the case study is to highlight the importance and components of evidence-based nursing practice in pediatric CVC care. A historical perspective of CVC care is provided in conjunction with current national initiatives to improve patient outcomes for children with CVCs. Infection prevention, clinical practice guidelines, quality improvement, and evidence-based care bundles are discussed. Keywords: pediatric nursing, central venous catheters, central line-associated bloodstream infection, care bundles, pediatric case study Case studyRyker is a previously healthy 9-year old boy. He was brought to the emergency department by ambulance after being hit by a car while riding his bicycle. His injuries included fractures of the pelvis and femur, a pulmonary laceration, and a laceration of spleen. He required multiple surgeries to manage his injuries. During his second surgery, a right subclavian central venous catheter (CVC) was placed. This catheter provides stable venous access for administration of fluids, medications, and labs during his recovery. On hospital day #10, Ryker developed a fever, and labs and blood cultures were drawn. His labs were significant for a white blood cell count of 22,000 cells/mm 3 . The initial gram stain of his blood revealed gram-positive cocci in clusters with a culture positive for coagulase-negative staphylococcus. Ryker was started on antibiotics and his CVC was removed. He continued to recover from his injuries, and he responded well to treatment with antibiotics for his bloodstream infection. He was discharged to an inpatient rehabilitation program on hospital day #18.After further review, and ruling out other potential sources of infection such as a urinary tract infection, surgical site infections, and pulmonary infections, Ryker's positive bloodstream infection was classified as a central line associated-bloodstream infection (CLABSI) using the Center for Disease Control and Prevention (CDC) criteria. This health care-associated infection (HAI) triggered a review by the health care team. Physicians, nurses, respiratory therapists, pharmacists, and other interdisciplinary staff Correspondence: elizabeth A Duffy

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Variability in Surgical Site Preparation Technique: An Opportunity for Improvement

Kovar¹,

Joiner²,

Leonard³

et al. 2022

AORN Journal

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Beyond the bundle - journey of a tertiary care medical intensive care unit to zero central line-associated bloodstream infections

Cited by 61 publications

References 34 publications

Estratégia Multidimensional na Redução de Infeção Associada a Cateter Venoso Central em Pediatria

Estratégia Multidimensional na Redução de Infeção Associada a Cateter Venoso Central em Pediatria

Pediatric central venous access devices: nursing interventions

Variability in Surgical Site Preparation Technique: An Opportunity for Improvement

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