Presentation on theme: "Research is Prevention HAIs and Needleless Connectors"— Presentation transcript:
1Research is Prevention HAIs and Needleless Connectors Enter Name and position as appropriateNote: This presentation is intended to be a discussion of the presentation and publication activity over the last several years on the topic of needleless connectors and the impact they MAY be having on BSI occurrence.Deb Richardson, RN, MS, CNS
3SHEA/IDSA Practice Recommendation October 2008 Compendium of Strategies to Prevent HAIs in Acute Care HospitalsContains four device- and procedure-associated HAI practice recommendationsPrevention of CLABSIPrevention of VAPPrevention of CAUTIPrevention of SSIContains 2 organism-specific HAI categoriesMRSA transmissionCDIAnnounced - October 8, 2008Available for free download on the SHEA and IDSA websitesSupported by:Joint CommissionAmerican Hospital Assoc.HICPAC (Healthcare Infection Control Practices Advisory Committee)APIC
4Practice Recommendation Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care HospitalsCatheter Insertion Recommendations- Catheter insertion checklistHand HygieneAvoid femoral vein in adultsAll inclusive catheter cart/kitMaximal sterile barrierCHG for skin preparationPost-Insertion RecommendationsDisinfect catheter hubs, needleless connectors, and injection ports before accessing the catheter with CHG/Alcohol or 70% alcoholRemove non-essential cathetersDressing changes with CHG-based antiseptic
5Practice Recommendation Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care HospitalsApproaches that should NOT be considered a routine part of CLABSI preventionNO antimicrobial prophylaxis for catheter insertion or dwellNO routine replacement of CVCs or arterial cathetersDo not routinely use positive-pressure needleless connectors with mechanical valves before a thorough assessment of risks, benefits, and education regarding proper useRoutine use of the currently marketed devices that are associated with an increased risk of CLABSI is not recommended.**This recommendation is supported by the three studies, Rupp, Salgado, and FieldPoint out that this recommendation comes with the same level of recommendation as the following:Perform hand hygiene before catheter insertion or manipulationDisinfect catheter hubs, needleless connectors, and injection ports before accessing the catheterUse a catheter checklist to ensure adherence to infection prevention practices at the time of CVC insertion.Use an all-inclusive catheter cart or kitPerform surveillance for CLABSIBe prepared to describe the recommendation criteria from the article
6Topics for Discussion Factual Information Technology Review HAI RatesReimbursement ImpactRegulatory IssuesMandatory ReportingTechnology ReviewEvolutionCurrent ProductsResearch/Publication UpdateQuestionsReview topics for discussion
7Presentation Objectives Participants will be able to:Discuss the current rates and financial impact of CR-BSI on the US Healthcare systemReview current needleless technologies available todayDescribe recent research/publication activities regarding needleless access device useRead the slideNote to presenter:These are the objectives to be met. These are most important if the facility is planning to provide nursing continuing education credits for the presentation. They will need to provide the participants an evaluation form with these objectives listed.
8The Facts Healthcare Acquired Infections (HAIs) 1.7 Million patients diagnosed with HAIs each year33,269 Newborns in High Risk Nurseries19,059 Newborns in Well Baby Nurseries417,946 Adults and Children in ICUs1,266,851 Adults and Children Outside the ICUReview current state around HAI’s in the US – Read the statsThis is the most current info availableKlevens, R. Monina. Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, Public Health Reports. Vol. 122, March-April 2007.
9The Facts 98,987 estimated deaths annually associated with HAIs 35,967 Pneumonia30,665 BSIs13,088 UTIs8,025 SSIs11,062 Other sitesReview current state around HAI’s in the US – Read the statsKlevens, R. Monina. Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, Public Health Reports. Vol. 122, March-April 2007.
10Healthcare Associated Infections Deaths/yr.Of key interest here is that more patients are dying from HAI’s than other major diseases. Take 90K and divide by # of days = over 240 deaths per day!!!!ALOS (Average Length of Stay) Extended length of stay has a major impact on the expendituresResistant organisms are of major concern, because antibiotics to treat these infections are often extremely limited.90,000 deaths/yr over 240 per day2Average length of stay 21.1 days vs. 4.5 days1 (with/without HAI)70% due to organisms resistant to at least one key antibiotic (i.e., MRSA, VRE)21 PHC4 Research Brief. Hospital-acquired Infections in Pennsylvania. Issue No. 9. March 20062 Campaign to prevent antimicrobial resistance in healthcare settings. ww.cdc.gov/drugresistance/healthcare/problem.htm
11The Facts HAIs Cost More Than $4.5 billion annually JCAHO and NQF are focused on prevention effortsHAI prevention is a top focus for professional organizations such as: SHEA and APICANDAs of October 2008 Medicare no longer pays for certain preventable conditionsCRBSIs included in this listReder A. Public Reporting of HAIs: Where do we stand now? Infection Control Today. August 2007.
12Attributed Financial Burden is High Study of 232,651 admissions from 13 hospitals63%Reductionin profitsNoHAIsWithHAIsThe 5% of patients acquiringinfection eroded $56MM in profitsThis study demonstrates the impact HAIs have on hospital revenues.Of note, only a small number of patients developing an HAI can have major impact on the revenue picture% Patients# Patients95%221,2255%11,426100%232,651Reference: MedMined, June 2005
13The Facts Regulatory Impact JCAHO CDC 2009 National Patient Safety GoalsReduce the risk of HAIsManage as sentinel events all identified cases of death or major loss of function associated with a HAIImplement best practices or evidence-based guidelines to prevent CLABSICDCNational Healthcare Safety Network (NHSN)Previously National Nosocomial Infection Surveillance (NNIS)Available to all hospitalsData available to all healthcare facilities and the general publicJCAHO– 2 of the Patient Safety Goals speak to HAIsThe CDC has announced the implementation of a web-based reporting network that lets facilities track infections. They currently have over 600 participants from 45 States.
14Public Awareness Headlines Government and Consumer Groups AARP Bulletin (March 2009)“Killer Germs”; Superbugs Kill 90,000 patients a year.Government and Consumer GroupsConsumers UnionGo to: State Hospital Infection Disclosure Laws”Leapfrog GroupProvides ratings of 1,300 US HospitalsCenters for Medicare and Medicaid Services (CMS)Reports quality information on hospitalsCommittee to Reduce Infection DeathsVictoria Nahum, patient advocateA great deal of media attention. Public much more aware.Safecarecampaign.org is a website that offers information and references to HAI preventative strategies. Victoria Nahum lost a 24 year old son to an HAI. She has become a spokes person for prevention efforts.
15Mandatory Reporting Mandatory Reporting of Infections States that have passed legislationStates with study billsNC, IN, AZ, OH, NM, and AK
16Mandatory Reporting of HAIs Map of the previous slideInteractive opportunity:Depending on the state the presentation is being presented, we discuss activity in that area.
17Pennsylvania Pennsylvania Health Care Cost Containment Council (PHC4) 1st State with Public Reporting Data, 2004This is a sample of Pennsylvania’s output from this type of legislation.11,668 HAIs, $613.7 Million (estimate total additional payment)PHC4 Research Brief. Hospital-acquired Infections in Pennsylvania. Issue No. 9. March 2006
18Mandatory Reporting Issues No StandardizationSome states publish info/some don’tSome measure processes/some HAIsSome use administrative dataSome report organisms (e.g., MRSA)Will we see mandatory reporting move from a State to a Federal level?Some of the discussion around mandatory reporting is the inconsistency in the effort. Very similar to Needlestick safety. Until there was a federal law, there was variables in practice changes.Review bullet points. Ask the audience for participation here:Do they have opinions on this topic?
19Bloodstream Infections Facts 87% of primary bacteremia attributed to vascular accessCrude mortality 10% - 40%Prolonged hospitalization daysAttributable cost $34,000 - $56,000 per stay80,000 CRBSIs occur in ICUs each yearmillion occur outside ICUAnnual cost to the healthcare system is $296 million - $2.3 billion (US)HAI’s consist of primarily:Ventilator Associated PneumoniaUrinary Tract InfectionsSurgical Site InfectionsBloodstream InfectionsThis slide breaks out CRBSI from the bigger picture. Review the numbers and bullet points.Note: Most of this data comes from reports out of ICUs and relate to CVLs only.William R. Jarvis, M.D., “Preventing Central Venous Catheter (CVC)-Associated Bloodstream Infections in 2005: Is Zero Realistic?” Oral presentation at the Infusion Nurses Society Annual Meeting (May 2005, Ft. Lauderdale, FL).Mermel LA. New Technologies to prevent intravascular catheter-related bloodstream infections. Emerging Infectious Diseases. 2001;7:
20How Infections Are Transmitted Means of TransmissionReservoirSusceptible HostCausative AgentReview how infections occur.All the puzzle pieces must be present in order for transmission to occur. Take away one piece and the infection will not happen.Causative agent = the microorganism, or germ, that can cause illness or disease.Means of transmission = the mechanism for transfer of infectious agent from reservoir to susceptible host.Reservoir = [or carrier] place in which the infectious agent can survive. [rats are reservoirs for plague; mosquitoes are reservoirs for malaria]Portals of entry & exit = the paths by which the infectious agent leaves the reservoir and enters the susceptible host.Susceptible host = in this case, the patient-Portals of Exit & Entry20
21Susceptible Host Risk Factors Acuity of illness Less than 1 year of age or over 60ImmunocompromisedUnderlying disease processesLoss of skin integrityProlonged hospitalizationExisting infectionsMalnutritionIn ICUType of catheterFrequency of manipulation of the catheterDiscuss risk factors that are often out of the control of the clinician.
22Portals of Entry Inadequate hand washing Insertion experience Disinfection of skin siteContaminated infusateField or ER insertionMultiple entries into the system (hubs, injection ports, stopcocks)This slide demonstrates all the “portals of entry” . Note that multiple entries increase risk.22
23CRBSI Reduction Strategies ProcedureProcedureProcessCVC Insertion CartInsertion Checklist/BundleReview this graphic to describe the factors that may impact risk of BSI.Much of the focus has been on process and compliance to procedures. However, another major factor contributing to the rise in CRBSIs may be product design.Examples of these:ProcedureCVC BundleCVC KitsProcessEducation/hand washingTubing ChangesSurveillanceProduct DesignCoated CVCs– some review indicates positive impact?? Needleless AccessProcessProductStaff AwarenessMeasuring ComplianceCoated CVCs/NCsCHG dressings/discs
24Product Evaluation Needleless Access Devices ProcedureProcessProcedureYou can even take the graphic down another level, to the product itself:ProcedureChange FrequencyProcessAseptic TechniqueClean before each accessProduct DesignNeedleless Access has evolved from very Simple to ComplexCan design have an impact???Change FrequencyBlood draw via capProcessDesignSmooth SurfaceAny gaps or crevicesClear vs. OpaqueComplex Fluid PathAseptic TechniqueCleaning cap prior to each accessFlushing effectiveness
25Needleless Access Devices Technology ReviewTransition slide to discuss technology
26This chart is used to review the evolution of needleless technology. Some audiences may need more explanation than others about these different technologies. Explain that all of these IV sites are available in both primary and secondary positions in the IV set up.Review the generations in relation to simple vs complex
27This poster demonstrates the Simple, Complex and More Complex evolution. Another discussion point is that all the devices look similar and that confusion exists in the clinical setting as to the requirement around clamping.
28Simple vs. Complex Simple Complex More Complex Split Septum Mechanical ValveMore ComplexPositiveFluid DisplacementUse this graphic to demonstrate the Simple, Complex, More Complex that evolved in the designs.Discuss that in the more simple technology, the cannula is the fluid path, which is removed following administration.In the complex devices, there is some part that moves to open the fluid path, leaving a space where fluid particles could adhere.In the More complex, there is an actual “reservoir” that fills and then is expelled during disconnection. This space/reservoir is at risk of being coated with TPN or blood products.28
31Publication History2004University of Virginia observed a 61% increase in BSI rates after switching from split septum technology to a mechanical valveMade the switch due to pump supplier change2005Wake Forest observed an increase in BSI’s after switching from split septum technology to mechanical valveRepeated in-service of nursing staff on proper device use did not lower BSI ratesDr. William Jarvis formed first study group to study BSI outbreak5 hospitals reported increases in BSI rates after switching from split septum technology to a mechanical valves2006Wake Forest reports gross bacterial contamination of two mechanical valves after removal from patientsIn 2004 UVA presented this poster at the annual SHEA meeting. From our knowledge most of the information presented around this topic in the past has been related “open vs closed” systems. This is the first info that we are aware of that identified a difference in needleless access device designs.This initial presentation prompted Dr. Jarvis (previously with the CDC) to gather info from other IC professionals who had experienced increases in BSI rates when moving from the Interlink system to a variety of the newer more complex mechanical valves. That data has been presented an various venues around the country over the last several years and has generated interest and research into this topic around the world.Wake Forest University even went to the extent of cutting the devices open and evaluating contamination rates.
32Tobi Karchmer, et al, SHEA 2006 Poster Contamination of Mechanical Valve Needleless Devices May Contribute to Catheter-related Bloodstream InfectionsTobi Karchmer, et al, SHEA 2006 PosterDevices: “MVDs from 2 different manufacturers (Device A and B) and a spilt septum device (SSD) (device C) were examined over four time periods: Phase I: Device A; Phase II: Device A after ICU nursing staff education on disinfection; Phase III: Device B; Phase IV: Device C. Utilization of Device B and C was after ICU nursing staff education on use and disinfection of each device.”Key Results: “There was no difference in the proportion of contaminated devices between the 3 that were evaluated after education, although Device A and B had significantly more colony-forming units cultured.”Device A (MVD): 83% TNTC*Device B (MVD): 60% TNTCDevice C (SSD): 0% TNTC**TNTC = "Too numerous to count"... categorized as "Highly Contaminated Devices“Conclusions: “CRBSI significantly increased in this tertiary care hospital upon the introduction of an MVD and only modestly improved following nursing staff education on device utilization. Bacterial contamination of blood drawn from all three needleless devices was common, and although it is less following improved device use, it is still considerable. Device C (SSD) appeared to have lower internal contamination. Further studies on the impact of SSD on overall CRBSI need to be preformed.”Discuss Karchmer presentationQ-syte is Device CRead the conclusion
33Potential Risk Factors for Bloodstream Infections Associated with Mechanical Valves Dr. William Jarvis presented his thoughts around potential risk factors for BSI’s associated with mechanical valves as follows:FactorDifficulty cleaning access surfacePotential ImpactHCWs may not adequately clean the intricate surface details before access, leading to fluid path contamination.Gap around plunger harbors bacteriaGap cannot be accessed for disinfection and can lead to fluid path contaminationOpaque housing hides incomplete flushing of media based fluidsDuring normal manipulation, small amounts of bacteria and media-like fluids contaminate the valve. If these organisms proliferate, then they can be infused with subsequent manipulations.Dr. Jarvis’ presentation refers to 4 distinct risk factors that may influence the findings:List all of these, next slides show examples of the characteristics of different devices. Important to note that ALL of these may have an influence.Internal mechanisms obscure fluid pathImpossible to visually confirm complete flushing.W. Jarvis, M.D., “Increased Central Venous Catheter-Associated Bloodstream Infection Rates Temporally Associated With Changing From A Split Septum To A Leur Access Mechanical Valve Needleless Device: A Nation-wide Outbreak? CHCA Meeting, Chicago, IL Sept. 24, 2005.
34Potential Risk Factors for Bloodstream Infections Associated with Mechanical Valves “Difficulty cleaning access surface”Rough vs smooth surface areaRough surface, harder to clean and may harbor bacteria
35Potential Risk Factors for Bloodstream Infections Associated with Mechanical Valves “Gap around plunger harbors bacteria”Gap around plunger vs tight sealGap may allow bacteria to migrate into the device
36Potential Risk Factors for Bloodstream Infections Associated with Mechanical Valves “Opaque housing hides incomplete flushing of media based fluids”Opaque vs clearDifficult to tell if the flushing has been adequate. Point out that INS standards of practice state to flush until clear or the device should be removed.2006 INS Standards of Practice state: “If the integrity of the injection or access cap is compromised or if residual blood remains within the cap, it should be replaced immediately…” (S36)
37Potential Risk Factors for Bloodstream Infections Associated with Mechanical Valves “Internal mechanisms obscure fluid path”Internal mechanisms: simple vs. complexReinforce the issue that in the simple split septum design, the cannula is the “fluid chamber/path”, where in other more complex devices, the fluid chamber/path remains after disengagement.37
38Baxter Interlink® Smooth Surface No Gap Clear Simple Internal Design High Flow RatesAccepts Needle in EmergencyBD Bifurcated Cannula Improves FlushabilitySmall & Light WeightLatex-freeSo how do BD Q-Syte and Baxter Interlink products match up to the Jarvis List:Good time to show barrel demoQ-Syte and Interlink meet ALL four strengthsReview other attributes38
39BD Q-Syte™ Luer Access Split Septum Smooth SurfaceNo GapClearSimple Internal DesignAccepts both Luer Lock and Luer Slip ConnectionsHigh Flow RatesSmall & Light WeightLatex-freeSo how do BD Q-Syte and BD Interlink products match up to the Jarvis List:Good time to show barrel demoQ-Syte and Interlink meet ALL four strengthsReview other attributes39
402007 Publications2007Geelong Hospital, Victoria, Australia reports a 2.2 fold increase in BSI’s after switching from split septum to mechanical valveInfection Control and Hospital EpidemiologyThe University of Nebraska Medical Center reports a 3.3 fold Increase in BSI’s after switching from split septum to mechanical valveClinical Infectious DiseasesMedical University of South Carolina reports a 2.7 fold increase in BSI’s after switching from split septum to mechanical valveAll three facilities returned to split septum and their BSI rates returned to original levelsIn the summer of 2007, 3 publications highlighted this same experience.
41Research Summary Recent Publications Summary: Incidence of Catheter-Related Bloodstream Infection Among Patients with a Needleless, Mechanical Valve-Based Intravenous Connector in an Australian Hematology-Oncology UnitKathryn Field, MBBS et al. Infection Control and Hospital Epidemiology, May 2007, Vol. 28, No 5.Summary:400-bed regional public hospital/Victoria AustraliaSS/Baxter Interlink® vs MV/Abbott Clave® and CLC 2000Study period July 2004 through June 200598 patients with Hickman Catheters (SL and DL)Hem/Onc Unit2.6 infections vs 5.8 infections per 1000 catheter-daysSplit Septum === Baxter InterlinkVs Mechanical Valve (Clave and CLC 2000)Study period July 2004 through June 200598 patients with Hickman Tunneled Catheters32 confirmed BSI in 25 patients20 in the MV period and 12 in SS period62 patients in MV period = 3468 catheter days83 patients in SS period = 4539 catheter daysMedian Time to 1st BSI in MV period = 44 daysMedian Time to 1st BSI in SS period = 65 days(p value .17 by log rank test)The authors breakout the results by tumor types:Leukemia; solid organ; other hemotologic conditionsLooked at DL vs SL
42Research Summary Recent Publications Outbreak of Bloodstream Infection Temporally Associated with the Use of an Intravascular Needleless ValveMark E. Rupp, et al. Clinical Infectious Diseases, June 2007, Vol. 44Summary:SS/Interlink vs PDMV/Alaris Smartsite Plus vs SS/InterlinkIncrease in CRBSI rates with the introduction of a positive displacement connector valve and decrease after return to SSCC = 3.87/1000 vs 10.64/1000 (p<.001)Six month period following return to SS 5.59/1000 (p = .02)Inpatient = 3.47/1000 vs 7.3/1000 (p=.02)Six month period following return to SS 2.88/1000 (p = .57)Similar results seen in 2 cooperative care transplantation unitsSplit –Septum vs Mechanical ValveInterlink vs Alaris SmartsiteCritical Care Areas: 8 critical care units and transplantation unitsTotal 38,250 CVC days over 26 months (Baseline) with SS10,340 CVC days over 6 months (PDMV period)SS 3.87/1000 to PDMV 10.64/1000 p value < .001In the six months following discontinued use of PDMV the rate returned to 5.59/1000 with a p value of .02 compared to baseline (3.87/1000).9 inpatient units:#2 one month observation periods3745 CVC daysSS 3.47/1000 baselinePDMV 7.3/10002.88/1000 during post intervention period 11, 475 CVC daysNo significant difference from baseline2 Cooperative Transplant Units:Baseline 5.31/1000 patient daysTotal Patient Days: 7535 over 26 months1383 patient days over 6 months (PDMV period)SS 5.31/1000 to PMVD 15.18/1000 patient days p value<,0016 months following rate returned to baseline
43Research Summary Recent Publications Increased Rate of Catheter-Related Bloodstream Infection Associated with Use of a Needleless Mechanical Valve Device at a Long-Term Acute Care HospitalCassandra D. Salgado, et al. Infection Control and Hospital Epidemiology, June 2007, Vol. 28, No. 6Summary:59 bed long-term care facilitySS/Interlink vs Alaris Smartsite vs SS/InterlinkThree-fold increase in BSI ratesLocation: 59 bed long-term acute care hospital, Sth Carolina switched from NSSD to Smartsite in Q1 2004Study Design:Comparison of rate and microbiology of CR-BSI before and after MV use (2 year’s CR-BSI data)Results:CR-BSIs increased significantly from 1.79 to 5.95 per 1000 catheter days (RR 3.32, 95%CI p<.001) during the time the MV system65% relative increase in BSIs that were polymicrobialContributed to 46 excess BSIs of which likely there were 5-12 excess deaths and additional cost of between $USD millionIn the 6/12 following return to SS CR-BSI rate reduced to 1.70 per 1000 catheter days (95% CI, p<.001)Conclusion:Sustained, significantly increased CRBSI rate associated with MV use despite repeated education regarding proper use.Decrease in rates associated with return to SS technologyFormal assessment of MVs in warranted as likely that the current design/ and or protocols for disinfection may not be safe or adequate for patient useFacilities using MVs need active surveillance systems in place.
44Research SummaryStudy to evaluate effectiveness of closed, luer SS device in reducing CRBSIAdult Medical ICUPreviously used PPMVCRBSI rate (PPMV): per 1,000 catheter daysCRBSI rate (CLSS): 0 at 3, 6, 8 months after implementationIdentified significant reduction in infection rates for adult medical-ICU populationLove, K. Catheter-related bloodstream infection rates decrease to zero in the ICU after implementing a closed luer access split-septum device. Poster Presentation, AVA 22nd Annual Conference, Savannah, GA. 2008
45Research Summary 410 bed acute care facility in SE Study performed in MSICU ( )Utilized PPMVCRBSI rate (PPMV): 7.9 per 1,000 catheter daysEvaluated CLSS deviceCRBSI rate (CLSS): 4.4 per 1,000 catheter days & eventually achieved a rate of 2.36Kirley, D., et al. Impact of changing from a luer access mechanical valve to a luer access split septum device on the reduction of central line-associated bloodstream infections in a medical surgical intensive care unit. Poster Presentation; AVA 22nd Annual Conference, Savannah, GA. 2008
46Portal of Entry and a Reservoir? Recent data suggests that the needleless connector could not only be a portal of entry, but also a “reservoir”Portals of Exit & EntryReservoirThe question now is… can the needleless device be the reservoir where the bacteria are seeding and multiplying. Then a flush or drug administration causes release of high numbers into the patient bloodstream, increasing the risk of BSI.46
47Microbial Colonization of Needleless Connectors In vitro study to evaluate presence/distribution of bacteria on external surfaces/internal fluid path of NCs after clinical useMICU patientsAll had silicone ss & internal collapsible silicone mechanical valveResults: prevalent microorganisms (multiple species) on external surface in biofilms; internal path revealed mixed species of microorganismsBiofilm observed covering all areas of surface in various stages of development“Transfer of microorganisms as single cells or biofilm fragments through the connector allows for biofilm colonization on the internal lumen of the catheter and potential bacteremia”Ryder, M. et al. Microscopic examination of microbial colonization of needleless connectors. Poster Abstract 5-36, APIC 35th Annual Education Conference & International Meeting, June 15-19, 2008, Denver, CO.
48CRBSI & NCs Based on the information available today…….. Patients are 3 times more likely, on average, to develop a CRBSI with the use of a mechanical valves versus a split septum needleless system.1,2Did you know that patients are 3 times more likely to develop a CRBSI with a more complex mechanical valve system than with your current Interlink system!Cassandra D. Salgado, et al. Infection Control and Hospital Epidemiology, June 2007, Vol. 28, No. 6.Mark E. Rupp, MD. Outbreak of bloodstream infection temporally associated with the use of an intravascular needleless valve. CID 2007; 44 (1 June):
49M. D. Anderson Cancer Center Experience 2003- closed luer split-septum/prior-SSBCAvoided MV’s due to concerns related to contamination and increased risk of infectionBenefits of CLSS:Easy to use/cleanClear housingSimple deviceStraight/free flowing fluid pathNo internal mechanism to harbor bacteria
50Infection Prevention Measures Hand washing!!Wear gloves/PPESkin prep prior to access and maintenanceClean access sites prior to each entryFrequent observation of siteEvaluate continued need for accessIncorporate central line bundle/line cart/kitsEvaluate ALL changes in the infusion system independently for any change in BSI outcomes!Hand hygiene = 1ST LINE OF DEFENSE. Soaps, disinfectants, alcohol-based gels/lotionsGloves = could be either sterile or un-sterile; depends on policy and procedure; patient condition, etcSkin preps – CDC prefers CHG but 70% alcohol, 10% iodophors, tincture [alcohol] of iodine are all OK too.Persist = iodophor/alcohol/protective barrierDressing changes: choose the best prep, use friction, use clean to dirty in circular motion using friction or back and forth motion [as in ChloraPrep label]Site – look for S/S of inflammation, redness, pain, purulent drainageEvaluation – Need to continue using vs. need to remove due to a possible complicationIV start paks and custom dressing change kits keep required supplies in one place.>Increases ability for staff to follow hospital protocols and procedures>Decreases waste>Saves nursing time
51Summary Be Informed about the product Be aware of changes in products that may have an impact on your outcomesCommunicate with others in your institution who may be involved in the introduction of new technologyUtilize available resources/information to assist in making informed decisions & improving patient outcomesSummarize discussionEncourage looking at outcomes not just clinician preference.Emphasize the quote from Trish Perl at Johns Hopkins