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Catheter bloodstream infection and literature review
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Because central venous catheters (CVCs), which are catheters inserted through a major vein with the tip resting near the heart, serve many purposes such as medication administration, parenteral nutrition, fluid therapy and central venous pressure measurement, their use has become increasingly common in the intensive care unit (ICU) (Polderman & Girbes, 2002). However, CVC use is associated with an increased risk for hospital-acquired infections (McLaws, Gold, King, Irwig, & Berry, 1988), with those in situ for more than six days contributing to increased infection rates compared to those in place for five days or less (McLaws & Taylor, 2003). Catheter-related bloodstream infection (CRBSI) is defined as a laboratory-confirmed bloodstream infection more likely caused by a CVC in place during or within 48 hours of insertion (Centers for Disease Control and Prevention, 2012). Increased expenditures associated with CRBSI episodes due to mechanical ventilation use and lengthened stay in the ICU can significantly impact the individual and unnecessarily tax an already burdened healthcare system (Blot et al., 2005).
Elderly patients, a particularly vulnerable population, may be predisposed to higher rates of CRBSI because the break in skin barrier may expose the bloodstream to the environment (Richard, 2001). Trauma sustained from injuries can also contribute to a weakened immune system, thus rendering one susceptible to infection (Richard, 2001). Nurses, as members of the interdisciplinary health team, play an essential role in preventing infection arising from CVC use. Minimising the occurrence of CRBSI can result in reduced costs, decreased length of hospitalisation, and more positive health outcomes. In this essay, the writer will di...
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...A., Canals, M., . . . Morón, A. (2008). Prospective Randomized Trial of 3 Antiseptic Solutions for Prevention of Catheter Colonization in an Intensive Care Unit for Adult Patients. Infection Control and Hospital Epidemiology, 29(9), 847-853.
Yébenes, J. C., Vidaur, L., Serra-Prat, M., Sirvent, J. M., Batlle, J., Motje, M., . . . Palomar, M. (2004). Prevention of catheter-related bloodstream infection in critically ill patients using a disinfectable, needle-free connector: A randomized controlled trial. American journal of infection control, 32(5), 291-295. doi: 10.1016/j.ajic.2003.12.004
Zingg, W., Imhof, A., Maggiorini, M., & Stocker, R. (2009). Impact of a prevention strategy targeting hand hygiene and catheter care on the incidence of catheter-related bloodstream infections. Critical Care Medicine, 37(7), 2167-2173; quiz 2180. doi: 10.1097/CCM.0b013e3181a02d8f
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.
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...
Aerosolized antibiotic used in this study that are proven to be effective are: amikacin, colistin, ceftazidime, gentamicin, tobramycin, sisomycin, and yancomycin. However, increasing antibiotic resistance patterns among intensive care unit pathogens, cultivated by empiric-broad spectrum antibiotic regimens, characterizes the variable concerns. Recent literature point that antibiotic use before the development of VAP is associated with increased risk for potentially resistant gran-negative infections and Methcillin-resistant Staphylococcus auereus (MRSA)
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 study conducted by the Centers for Disease Control and Prevention shows that “annually approximately 1.7 million hospitalized patients acquire infections while being treated for other medical conditions, and more than 98,000 of these patients will die as a result of their acquired infection” (Cimiotti et al., 2012, p. 486). It was suggested that nursing burnout has been linked to suboptimal patient care and patient dissatisfaction. Also, the study shows that if the percentage of nurses with high burnout could be reduced to 10% from an average of 30%, approximately five thousand infections would be prevented (Cimiotti et al., 2012). In summary, increasing nursing staffing and reduction burnout in RNs is a promising strategy to help control urinary and surgical infections in acute care facilities (Cimiotti et al.,
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).
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.
Prevention of hospital-acquired infections: review of non-pharmacological interventions. Journal of Hospital Infection, 69(3), 204-219. Revised 01/20 Haugen, N., Galura, S., & Ulrich, S. P. (2011). Ulrich & Canale's nursing care planning guides: Prioritization, delegation, and critical thinking. Maryland Heights, Mo. : Saunders/Elsevier.
As an ICU nurse I constantly watch how patients develop pressure ulcers, a pressure ulcer is an area of skin that breaks down due to having constant friction and pressure, also from having limited movement and being in the same position over a prolonged period of time. Pressure Ulcers commonly occur in the buttocks, elbows, knees, back, shoulders, hips, heels, back of head, ankles and any other area with bony prominences. According to Cox, J. (2011) “Pressure ulcers are one of the most underrated conditions in critically ill patients. Despite the introduction of clinical practice guidelines and advances in medical technology, the prevalence of pressure ulcers in hospitalized patients continues to escalate” (p. 364). Patients with critical conditions have many factors that affect their mobility and therefore predispose them to developing pressure ulcers. This issue is significant to the nursing practice because nurses are the main care givers of these patients and are the ones responsible for the prevention of pressure ulcers in patients. Nurses should be aware of the tools and resources available and know the different techniques in providing care for the prevention of such. The purpose of this paper is to identify possible research questions that relate to the development of pressure ulcers in ICU patients and in the end generate a research question using the PICO model. “The PICO framework and its variations were developed to answer health related questions” (Davies, K., 2011).
The systematic review; Interventions to improve hand hygiene compliance in patient care, conducted by the Cochrane Collaboration investigated inventions to improve hand hygiene compliance within patient care. The review included 2 original studies with an additional two new studies (Gould & Moralejo et al., 2010). Throughout the review it was affirmed that among hand hygiene is an indispensable method in the prevention of hospital-acquired infections (HAI), the compliance among nurses’ is inadequate. Nurses are identified within the public as dependable and trustworthy in a time of vulnerability due to their specialised education and skills (Hughes, 2008). Thus, it is imperative that evidence based practice is cond...
Medical asepsis plays an integral role in infection control within a health care facility. It includes procedures used to decrease and prevent direct contact with blood or bodily fluids and emphasizes keeping the environment clean on a regular basis (Curchoe, Astle, & Hobbs, 2014). In order to achieve optimal health, individuals depend on practices and techniques that control and ultimately prevent the transmission of infection. These practices and techniques can help avoid the transmission of infections by creating an environment that protects both health care workers and patients from communicable diseases. Good hand hygiene has been stressed as the single most important measure to prevent cross-infection to patients in health care facilities
Thomas J. Sandora and Donald A. Goldmann (2012) believe that basic infection control procedures are the way to decrease and stop antibiotic resistant bacteria strains from spreading and developing. Proper handwashing is one way to reduce the transmission and creation of new antibiotic resistant bacteria in the healthcare setting, “MDROs are transmitted mainly on the hands of caregivers who do not practice effective hand hygiene after every contact with patients and their environment” (p. 2168). Wet, lather, scrub, rinse, and dry must be done for at least 20 seconds with warm water and soap in order to be effective in the prevention against antibiotic resistant bacteria. Patients in a hospital are already immunocompromised, so acquiring a MDRO increases the chance of fatality. Sandora et al.
One day, this writer happened to see another nurse changing a Peripherally Inserted Central Catheter Line dressing. As a nurse leader, this writer asked the nurse why she is changing the dressing. The caregiver explained dressing changes can prevent infection to the site and there are lot of patients readmitted because of central line infections and subsequent complications. This nurse demonstrated good kn...