Central Line Clinical Practice Guideline & Rational
Central venous catheters (CVCs) are frequently used in intensive care units (ICUs) for a number of reasons (measure central venous pressure, when peripheral veins are unable to be accessed, administration of medications/therapies and aspiration of blood samples) (Conroy, 2006, p. 98). Patients in this environment already have an increased risk of infection because of their treatments. Patient treatments commonly involve invasive devices or interventions (major surgery), antibiotic therapy (raises the risk of bacterial resistance) while steroid, chemotherapy and radiation therapy all suppress the immune system (Hatler, Hebden, Kaler, & Zack, 2010).
NSWHealth (2005) found that 20-40% of all healthcare associated bloodstream infections may be linked to an inserted CVC. These incidences of central line associated bloodstream infections (CLABSIs) have a negative impact on the patient, whose hospital stay is increased, further exposing them to potential complications while significantly contributing to hospital costs (Soufir et al., 1999). Therefore clinical practices associated with CVC management are integral to nursing practice in high acuity areas too ensure patient safety and minimising costs to health care providers.
Sarah Dobinson is a patient at increased risk of infection she is an older patient in a hyper metabolic state secondary to trauma. To ensure Sarah’s safety a set of CVC guidelines have been developed using the most recent primary sources. These guidelines will focus on nursing interventions post insertion in an adult ICU setting they have been developed under four sections addressing the importance of hand hygiene and aseptic technique, changing of administra...
... middle of paper ...
...ter-Related Infections in Critically Ill Adults. The Journal of the American Medical Association, 301(12), 1231-1241. doi: 10.1001/jama.2009.376
Timsit, J.-F., Schwebel, C., Bouadma, L., Geffroy, A., Garrouste-Orgeas, M. t., Pease, S., . . . Lucet, J.-C. (2009). Chlorhexidine-Impregnated Sponges and Less Frequent Dressing Changes for Prevention of Catheter-Related Infections in Critically Ill Adults: A Randomized Controlled Trial. The Journal of the American Medical Association, 301(12), 1231-1241. doi: 10.1001/jama.2009.376
Ye-benes, J., Vidaur, L., Serra-Prat, M., Sirvent, J., 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
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.
Vegas AA, Jodra VM, García ML (1993) Nosocomial infection in surgery wards: a controlled study of increased duration of hospital stays and directs cost of hospitalization. Eur J Epidemiol. 9:504–510.
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.
Rello, J., Kollef, M., Diaz, E., & Rodriguez, A. (2000).Infectious diseases in critical care. (2nd ed., pp. 352-
In clinical experience, it is seen that many patients in the Intensive Care Unit (ICU) are on mechanical ventilation. These patients range from having head trauma, heart surgery and respiratory problems yet there is no clear, concise systematic standard oral care procedures noted on the different floors in the hospital. Oral care is a basic nursing care activity that can provide relief, comfort and prevention of microbial growth yet is given low priority when compared to other critical practices in critically ill patients. The Center for Disease Control reveals that Ventilator-Associated Pneumonia (VAP) is the second most common nosocomial infection that affects approximately 27% of critically ill patients (Koeman, Van der Ven & Hak, 2006). The purpose of this paper is to explore Lewin’s change theory in the clinical setting by implementing standard oral care on preventing VAP thereby improving patient care.
We as a nurse should be aware about the causes, risk factors and complications about the nosocomial infections associated to catheterization. As it is found in various surveys and research that the catheter associated UTI is one of the most common and frequently occurring type of hospital acquired infection due to various risk factors and causes, we have to follow the guidelines and strategies for the prevention and management of those infection. Catheter associated UTI is the patient safety indicator by which we can improve the health care and provide patient safety and quality care. There is a vital role of nurses in improving health care system which is possible by following the principles and guidelines of assessment, surveillance and nursing management of the patient.
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).
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...
Catheter-related bloodstream infection (CRBSI) is defined as a bacterial infection in the blood that originates from an intravenous catheter.[9][13] Intravascular catheters are essential to modern day medical practices and are inserted in critically-ill patients for the administration of fluids, blood products and medication.[11] Central venous catheters (CVCs) pose as a major risk above all device-related infections and are major attributors of morbidity and mortality.[11] They are also the main source of bacteremia and septicemia in hospitalized patients. Patients are 64 times greater in developing a catheter-related blood stream infections as a result of central venous catheter use than with peripheral venous catheters.[12][13][14]
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...
Holmes, A., Castro-Sanchez, E., & Ahmad, R. (2015). Guidelines in infection prevention: Current challenges and limitations. British Journal Of Healthcare Management, 21(6), 275-277 3p.
(2014) shed light on two key components for infection control, which includes protecting patients from acquiring infections and protecting health care workers from becoming infected (Curchoe et al., 2014). The techniques that are used to protect patients also provide protection for nurses and other health care workers alike. In order to prevent the spread of infections, it is important for health care workers to be meticulous and attentive when providing care to already vulnerable patients (Curchoe et al., 2014). If a health care worker is aware they may contaminate the surroundings of a patient, they must properly clean, disinfect, and sterilize any contaminated objects in order to reduce or eliminate microorganisms (Curchoe et al., 2014). It is also ideal to change gloves after contact with contaminated secretions and before leaving a patient’s room (Curchoe, 2014). Research suggests that due to standard precaution, gloves must be worn as a single-use item for each invasive procedure, contact with sterile sites, and non-intact skin or mucous membranes (Curchoe et al., 2014). Hence, it is critical that health care workers change gloves during any activity that has been assessed as carrying a risk of exposure to body substances, secretions, excretions, and blood (Curchoe et al.,
The annual cost of catheter-associated urinary tract infection (CAUT) is about three hundred and fifty million, in the United States (Saint et al., 2014). This cost affects the hospital, due to the fact that CAUTIs are preventable through nursing implementation and evidence- based practice. Catheter use is associated with physiologic complications, such as bladder calculi, bladder inflammation, and catheter-associated urinary tract infections. They can contribute to further complications, especially in older adults, leading to falls and delirium (Carter et al., 2014). The Centers for Disease Control and Prevention has specific guidelines that detail high priority recommendations for controlling catheter-associated infection prevention. Inserting catheters for only appropriate indications and leaving them in place for as long as medically necessary is their main concern and priority (Carter et al., 2014). The safety and comfort of the patient should be most important in the practice for all nurses when inserting and taking care of catheters. Unfortunately, this is not always the case, and the consequences of nursing implementation are left with the
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