Bloodstream infection related to catheter connections: a prospective trial of two connection systems

Esteve, Francisco; Pujol, Miquel; Cáceres, Enrique Limón; Saballs, M.; Argerich, M.J.; Verdaguer, Ricard; Máñez, Rafael; Ariza, Xavier; Gudiol, Francisco

doi:10.1016/j.jhin.2007.05.021

Cited by 48 publications

(25 citation statements)

References 14 publications

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“…Reasons for this include the frequent insertion of multiple catheters, the use of specific types of catheters that are almost exclusively inserted in ICU patients and associated with substantial risk (eg, arterial catheters), and the fact that catheters are frequently placed in emergency circumstances, repeatedly accessed each day, and often needed for extended periods. 1,2 b. Non-ICU population: Although the primary focus of attention over the past 2 decades has been the ICU setting, recent data suggest that the greatest numbers of patients with central lines are in hospital units outside the ICU, where there is a substantial risk of CLABSI. [3][4][5] 2.…”

Section: Purposementioning

confidence: 99%

Strategies to Prevent Central Line–Associated Bloodstream Infections in Acute Care Hospitals

Marschall

Mermel

Classen

et al. 2008

Infect. Control Hosp. Epidemiol.

387

251

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Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections. The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their central line–associated bloodstream infection (CLABSI) prevention efforts. Refer to the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections” Executive Summary and Introduction and accompanying editorial for additional discussion.1. Patients at risk for CLABSIs in acute care facilitiesa. Intensive care unit (ICU) population: The risk of CLABSI in ICU patients is high. Reasons for this include the frequent insertion of multiple catheters, the use of specific types of catheters that are almost exclusively inserted in ICU patients and associated with substantial risk (eg, arterial catheters), and the fact that catheters are frequently placed in emergency circumstances, repeatedly accessed each day, and often needed for extended periods.b. Non-ICU population: Although the primary focus of attention over the past 2 decades has been the ICU setting, recent data suggest that the greatest numbers of patients with central lines are in hospital units outside the ICU, where there is a substantial risk of CLABSI.2. Outcomes associated with hospital-acquired CLABSIa. Increased length of hospital stayb. Increased cost; the non-inflation-adjusted attributable cost of CLABSIs has been found to vary from $3,700 to $29,000 per episode

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Section: Purposementioning

confidence: 99%

Strategies to Prevent Central Line–Associated Bloodstream Infections in Acute Care Hospitals

Marschall

Mermel

Classen

et al. 2008

Infect. Control Hosp. Epidemiol.

387

251

View full text Add to dashboard Cite

show abstract

“…At the same time, the health care system expects the highest standards of nursing and outcomes in those units, as documented in the study by Saudan et al 1 Unfortunately, the literature pays little attention to how effective medical or nursing connection devices are at preventing adverse effects, their ease of use, or their safety for HD patients fitted with a CVC. 28 A recent systematic review by Ravani et al stated that "persons using catheters for HD seem to have the highest risks for death, infections and cardiovascular events compared with other vascular access types" (p. 465). 10 Although most of the available literature focuses on the types of catheters, it does not consider their ease of use and safety or whether they increase the quality of care and corresponding outcomes.…”

Section: Discussionmentioning

confidence: 99%

Point prevalence of complications between the Y connection technique and the usual care technique for blood restitution in patients of an outpatient hemodialysis unit: a comparison

Tacchini-Jacquier¹,

Verloo²

2017

IJNRD

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Background: Central venous catheter-related infections (CVCIs) in patients on maintenance hemodialysis (HD) have been documented due to unsafe/unsterile manipulations by nurses during HD machine deconnection and reconnection. Given the gravity of CVCIs in HD patients using catheter access, precise, safe installation of the device, and good nursing technique are crucial. Aim: To assess and compare safety performance and complications of a Y-connection (n=133) versus the usual tunneled central venous catheter (CVC) technique (n=73) among HD patients and then explore preferences between techniques among patients and frontline HD nurses. Materials and methods: A prospective, comparative, 3-month point prevalence survey was conducted among HD outpatients and frontline HD nurses in a 600-bed teaching hospital in the canton of Valais. Results: Nine HD outpatients (average age, 68.3 years; SD=12.3) were recruited. The two techniques showed no differences in C-reactive protein levels (p=0.465), pain (p=1.00), or local complications due to dressings soiled by exudate at the catheter insert point (p=0.066). The relative risk ratio (RR) indicated that CVCI was 1.667 times (95% CI; 0. 437, 6.358, p=0.50 (RR 0.58; [95% CI; 0.277, 1.217]; p=0.13) were significant relative risk factors for complications. Fifty-seven percent of HD patients stated that they felt more secure and comfortable using the Y-connection technique than the usual care technique. Eleven of the 12 nurses involved preferred the Y-connection technique, feeling that is was safer and easier in use. Conclusion: No difference was found in the complication rates of two blood restitution techniques -the Y-connection versus the usual CVC technique. HD outpatients and nurses preferred the Y-connection for blood restitution.

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“…Alcoholic chlorhexidine performed consistently well or better than other disinfection agents in multiple studies [21,24,131,168,172,179,182]. In the research by Hong et al, a 5 second scrub with alcoholic chlorhexidine fully disinfected NC surfaces treated with Pseudomonas Aeruginosa [179].…”

Section: Disinfection Practicesmentioning

confidence: 99%

Disinfection of Needleless Connector Hubs: Clinical Evidence Systematic Review

Moureau¹

2015

Journal of the Association for Vascular Access

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Background. Needleless connectors (NC) are used on virtually all intravascular devices, providing an easy access point for infusion connection. Colonization of NC is considered the cause of 50% of postinsertion catheter-related infections. Breaks in aseptic technique, from failure to disinfect, result in contamination and subsequent biofilm formation within NC and catheters increasing the potential for infection of central and peripheral catheters. Methods. This systematic review evaluated 140 studies and 34 abstracts on NC disinfection practices, the impact of hub contamination on infection, and measures of education and compliance. Results. The greatest risk for contamination of the catheter after insertion is the NC with 33-45% contaminated, and compliance with disinfection as low as 10%. The optimal technique or disinfection time has not been identified, although scrubbing with 70% alcohol for 5-60 seconds is recommended. Studies have reported statistically significant results in infection reduction when passive alcohol disinfection caps are used (48-86% reduction). Clinical Implications. It is critical for healthcare facilities and clinicians to take responsibility for compliance with basic principles of asepsis compliance, to involve frontline staff in strategies, to facilitate education that promotes understanding of the consequences of failure, and to comply with the standard of care for hub disinfection.

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Bloodstream infection related to catheter connections: a prospective trial of two connection systems

Cited by 48 publications

References 14 publications

Strategies to Prevent Central Line–Associated Bloodstream Infections in Acute Care Hospitals

Strategies to Prevent Central Line–Associated Bloodstream Infections in Acute Care Hospitals

Point prevalence of complications between the Y connection technique and the usual care technique for blood restitution in patients of an outpatient hemodialysis unit: a comparison

Disinfection of Needleless Connector Hubs: Clinical Evidence Systematic Review

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