Catheter associated bloodstream infection (CRBSI) occurring in the neonatal intensive care unit (NICU) are frequent, complication related to it are potentially fatal and costly (Kim & Sandra, 2009). According to the center of disease control, an approximate of two hundred and fifty thousand cases of CRBSIs have been estimated to occur annually which cause health care to cost approximately twenty five thousand dollars per case, and between 500 to 4,000 patient die due to blood stream infection (CDC, 2002). Approximately 90 percent of blood stream infection occurs from central venous insertion (CVC). Even though CRBSI occurs from different ways, the most common source is contamination of the catheter by skin flora on insertion, skin flora contaminating the external catheter, hub or both. In pediatric and neonatal ICUs, CRBSIs vary from 3.8 to 11.3 per thousand catheter days and account for around 30% of all nosocomial infections (Kim & Sandra, 2009). These statistics make preventing central venous catheter related bloodstream infections extremely important. Also, effective October 1, 2008, the Centers for Medicare and Medicaid Services have stopped reimbursing hospitals for conditions that have evidence-based prevention guidelines, which includes catheter-related bloodstream infections Center for Medicaid & Medicare service, ( n.d.).
CRBSIs could lead to result in additional therapy and prolonged hospital stay. However, these vascular access devices are essential aspects of neonatal care for administer intravenous fluid and medication. Nurses perform much of the daily care of central venous catheters. Therefore, nurses play an integral role in preventing bloodstream infections. As CDC recommend, changing form standard practi...
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According to an article by Timsit, J., et al. an estimated 5 million central venous catheters are inserted in patients each year. CBIs, most of which are associated with central venous catheters, account for more than 11% of all health-care associated infections. Additionally, more than 250,000 central-line associated blood stream infections also occur annually, with an estimated mortality rate of 12-25%. For patients within the intensive care unit, the numbers were even higher. Each episode significantly increases the patient’s hospital stay, as well as increasing costs from $4,000 to $56,000 per episode.
Tesfahunegn Z, Asrat D, Woldeamanuel Y, Estifanos K (2009) Bacteriology of surgical site and catheter related urinary tract infections among patients admitted in Mekelle Hospital, Mekelle, Tigray, Ethiopia. Ethiop Med J. 47(2):117-27.
Ventilator Associated Pneumonia (VAP) is a very common hospital acquired infection, especially in pediatric intensive care units, ranking as the second most common (Foglia, Meier, & Elward, 2007). It is defined as pneumonia that develops 48 hours or more after mechanical ventilation begins. A VAP is diagnosed when new or increase infiltrate shows on chest radiograph and two or more of the following, a fever of >38.3C, leukocytosis of >12x10 9 /mL, and purulent tracheobronchial secretions (Koenig & Truwit, 2006). VAP occurs when the lower respiratory tract that is sterile is introduced microorganisms are introduced to the lower respiratory tract and parenchyma of the lung by aspiration of secretions, migration of aerodigestive tract, or by contaminated equipment or medications (Amanullah & Posner, 2013). VAP occurs in approximately 22.7% of patients who are receiving mechanical ventilation in PICUs (Tablan, Anderson, Besser, Bridges, & Hajjeh, 2004). The outcomes of VAP are not beneficial for the patient or healthcare organization. VAP adds to increase healthcare cost per episode of between $30,000 and $40,000 (Foglia et al., 2007) (Craven & Hjalmarson, 2010). This infection is also associated with increase length of stay, morbidity and high crude mortality rates of 20-50% (Foglia et al., 2007)(Craven & Hjalmarson, 2010). Currently, the PICU has implemented all of the parts of the VARI bundle except the daily discussion of readiness to extubate. The VARI bundle currently includes, head of the bed greater then or equal to 30 degrees, use oral antiseptic (chlorhexidine) each morning, mouth care every 2 hours, etc. In the PICU at children’s, the rates for VAP have decreased since the implementation of safety ro...
Pseudomonas aeruginosa (P. aeruginosa) is a gram-negative, rod-shaped aerobic bacterium. It is a primary cause of hospital-acquired infections. P. aeruginosa is primarily a nosocomial pathogen. It also acts as an opportunistic pathogen, which can only infect a host that is immunocompromised, due to an underlying disease or medication. Although, P. aeruginosa can cause damage to virtually any tissue in the body, it almost never affects the tissues of healthy individuals. It is a problematic pathogen in hospitals; infecting individuals with cancer, burn wound, catheters and cystic fibrosis. P. aeruginosa is most recognized for its resistance to a wide range of antibiotics. In its planktonic form, P. aeruginosa has been found to have many virulence factors. However, P. aeruginosa within biofilms have been found to have a resistance to antibiotics 1,000 times greater than that of its planktonic counterparts [4]. Infections that are caused by bacterial biofilms are very persistent and very difficult to treat.
In September 2006, at Clarian’s Methodist Hospital in Indianapolis, six infants in the Neonatal Intensive Care Unit (NICU) were accidentally given excessive doses of heparin, resulting in the death of three of the infants (Thew, 2006). This day started out just like any other day in the newborn intensive care unit at Methodist. The nurse went to the medication cabinet to dispense Heparin, a blood thinner, for a handful of premature babies. This was a normal routine for the nurses in the NICU. Reports indicated that a pharmacy technician stocked the wrong vial dose of heparin in the NICU medication storage cabinet. The correct dosage of heparin for the use in flushing intravenous catheters is 10 units per mL, but unfortunately the technician stocked the 10,000 units per mL vials. Both vials are quite small and resemble a similar color of blue (Simpson, 2008, p. 135).
The topic that I chose is interventions used to reduce catheter associated urinary tract infections(CAUTI). This type of infection is acquired from the use of urinary catheter while in the hospital. According to the Institute for Healthcare Improvement, urinary tract infections are responsible for 40 percent of all hospital-acquired infections annually, with 80% of these hospital acquired infection caused by use of indwelling urinary catheters. When any type of tubes or catheters are introduced in the body it serves as a medium for infection. Urinary catheters are used during surgery to prevent injury to the bladder. It is also used for urinary retention or bladder obstruction. The implementation of evidenced based practice when providing care
Catheter Acquired Urinary Tract Infections (CAUTIs) has become to be classified as one among the leading infections which most individuals end up being susceptible to acquire while at the hospital. Healthcare-associated or acquired infections (HAIs) are a significant cause of illness, death, and more often than not, have resulted to cost the tax payers potentially high medical expenses in most health care settings. ("Agency for Healthcare Research and Quality," para. 1) Due to this, 1 out of every 20 patients will end up with CAUTI within the US hospitals and this has caused Agency for healthcare research and quality (AHRQ) to embark on nationwide plans to help in the eradication and control of CAUTI incidences. ("Agency
A urinary tract infection (UTI) is an infection of the urinary tract. The urinary tract is the body's drainage system for removing wastes and extra water. Urinary tract infections can have different names, depending on what part of the urinary tract is infected. The infection can include the bladder, kidneys, ureters, or the urethra. If the infection is in the bladder it is called “cystitis” or a bladder infection. If the infection is in the kidneys is it called “pyelonephritis” or a kidney infection? If the infection is in the urethra it is called “urethritis”. Most urinary tract infections are bladder infections. Infections in the ureters are very rare. Everyone is at risk of getting a UTI allowing bacteria to grow in the urine that stays
This literature review will analyze and critically explore four studies that have been conducted on hand hygiene compliance rates by Healthcare workers (HCWs). Firstly, it will look at compliance rates for HCWs in the intensive care units (ICU) and then explore the different factors that contribute to low hand hygiene compliance. Hospital Acquired infections (HAI) or Nosocomial Infections appear worldwide, affecting both developed and poor countries. HAIs represent a major source of morbidity and mortality, especially for patients in the ICU (Hugonnet, Perneger, & Pittet, 2002). Hand hygiene can be defined as any method that destroys or removes microorganisms on hands (Centers for Disease Control and Prevention, 2009). According to the World Health Organization (2002), a HAI can be defined as an infection occurring in a patient in a hospital or other health care facility in whom the infection was not present or incubating at the time of admission. The hands of HCWs transmit majority of the endemic infections. As
Health care facilities - whether hospitals, nursing homes or outpatient facilities - can be dangerous places for the acquisition of infections (EHA). The most common type of nosocomial infections are surgical wound infections, respiratory infections, genitourinary infections and gastrointestinal infection (EHA). Nosocomial infections are those that originate or occur in health care setting (Abedon). They can also be defined as those that occur within 48 hours of hospital admission, 3 days of discharge or 30 days of an operation (Inweregbu). These infections are often caused by breaches of infection control practices and procedures, unclean and non-sterile environmental surfaces, and ill employees (EHA). Immunocompromised patients, the elderly and young children are usually more susceptible to these types of infections. Nosocomial infections are transmitted through direct contact from the hospital staff, inadequately sterilized instruments, aerosol droplets from other ill patients or even the food and water provided at the hospital (EHA). The symptoms of nosocomial infections vary by type but may include inflammation, discharge, fever, abscesses, and pain and irritation at the infection site (Stubblefield).
Each year the number of health care associated infections (HAI) increases and has been estimated to be in the hundreds of millions of people around the world. In the United States this accounts for approximately 1 in 25 patients ("Hand Hygiene Basics," 2014). Health care associated infections are considered to be the most persistant adverse event in health care. Hand washing is considered to be one of the best methods for preventing the spread of infection and that poor hand hygiene places patients at high risk ("The Evidence for Clean," n.d.). Patients receiving care in hospitals, long term care facilities, and nursing homes are especially at high risk for developing infections while being cared for. Most health care associated infections
Central lines (CL) are used frequently in hospitals throughout the world. They are placed by trained health care providers, many times nurses, using sterile technique but nosocomial central line catheter associated blood stream infections (CLABSI) have been a dangerous issue. This is a problem that nurses need to pay particular attention to, and is a quality assurance issue, because CLABSI’s “are associated with increased morbidity, mortality, and health care costs” (The Joint Commission, 2012). There have been numerous studies conducted, with the objective to determine steps to take to decrease CLABSI infection rate, and research continues to be ongoing today. The problem is prevalent on many nursing units, with some patients at great risk than others, but some studies have shown if health care providers follow the current literature, or evidence based guidelines, CLABSIs can be prevented (The Joint Commission, 2012). The purpose of this paper is to summarize current findings related to this topic, and establish a quality assurance (QA) change plan nurses can implement for CL placement and maintenance, leading to decreased risk of nosocomial CLABSIs.
Hospital acquired infections are spread by numerous routes including contact, intravenous routes, air, water, oral routes, and through surgery. The most common types of infections in hospitals include urinary tract infections (32%), surgical site infections (22%), pneumonia (15%), and bloodstream infections (14%). ( book). The most common microorganisms associated with the types of infections are Esherichila coli, Enterococcus species, Staphylococcus auerus, Coagulase-negative staphylococci, or Pseudomonas aeruginosa.(secondary) Urinary tract infections occur when one or more of microorganisms enter the urinary system and affect the bladder and/or the kidneys. These infections are often associated improper catheterization technique. Surgical site infections occur after surgery in the part of the body where the surgery took place. These infections may involve the top of the skin, the tissue under the skin, organs, or blood vessels. Surgical site infections sometimes take days or months after surgery to develop. The infections can be cause by improper hand washing, dressing change technique, or improper surgery procedure. Pneumonia can also become a hospital acquired infection. Ventilator-associated pneumonia is a type of lung in...
There have been an incidents of prolonged hospital stay due to central line infections putting patients at risk for mortality, morbidity, and increase in medical cost. When central lines are placed at bedside or in interventional radiology, the inserter is required to document the steps and sterile procedure that took place in the electronic health record. Furthermore, with weekly and as needed dressing changes, nurses are required to use central line bundles and document what was used (ex: Chloraprep, biopatch, tegaderm, etc.) to track how the dressing was done. From these documented records, staff can gather data and measure the compliance of sterile procedure. Additionally, if a patient with a central line develops a fever without an unknown cause physician will order blood culture from the central line if catheter-related infection is suspected. If the test comes back positive, the team will initiate antibiotics immediately. By integrating electronic health records it can assist in CLABSI prevention strategies, raise the standard for best practices, and essentially reduce central line infections. With the quarterly results of CLABSI in our unit, CVC committee have re-educated the staff on appropriate dressing changes using sterile technique, transitioned to a different end
A urinary tract infection is a very common infection that can happen to anybody. A urinary tract infection usually occurs when bacteria enters the urethra and multiples in the urinary system. The Urinary tract includes the kidneys, the thin tubes that carry urine from the kidneys to the bladder (ureters), and the main tube that carries the urine from the bladder (urethra). Women, men, and children are all immune to this infection. Women have the highest chances of getting it. In the Urinary tract, the main links of the ureters help get rid of any bacteria that tries to enter the urine, and the bladder helps prevent urine from backing up into the kidneys.