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Research is Prevention HAIs and Needleless Connectors

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1 Research is Prevention HAIs and Needleless Connectors
Enter Name and position as appropriate Note: 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


3 SHEA/IDSA Practice Recommendation October 2008
Compendium of Strategies to Prevent HAIs in Acute Care Hospitals Contains four device- and procedure-associated HAI practice recommendations Prevention of CLABSI Prevention of VAP Prevention of CAUTI Prevention of SSI Contains 2 organism-specific HAI categories MRSA transmission CDI Announced - October 8, 2008 Available for free download on the SHEA and IDSA websites Supported by: Joint Commission American Hospital Assoc. HICPAC (Healthcare Infection Control Practices Advisory Committee) APIC

4 Practice Recommendation Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals Catheter Insertion Recommendations - Catheter insertion checklist Hand Hygiene Avoid femoral vein in adults All inclusive catheter cart/kit Maximal sterile barrier CHG for skin preparation Post-Insertion Recommendations Disinfect catheter hubs, needleless connectors, and injection ports before accessing the catheter with CHG/Alcohol or 70% alcohol Remove non-essential catheters Dressing changes with CHG-based antiseptic

5 Practice Recommendation Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals Approaches that should NOT be considered a routine part of CLABSI prevention NO antimicrobial prophylaxis for catheter insertion or dwell NO routine replacement of CVCs or arterial catheters Do not routinely use positive-pressure needleless connectors with mechanical valves before a thorough assessment of risks, benefits, and education regarding proper use Routine 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 Field Point out that this recommendation comes with the same level of recommendation as the following: Perform hand hygiene before catheter insertion or manipulation Disinfect catheter hubs, needleless connectors, and injection ports before accessing the catheter Use a catheter checklist to ensure adherence to infection prevention practices at the time of CVC insertion. Use an all-inclusive catheter cart or kit Perform surveillance for CLABSI Be prepared to describe the recommendation criteria from the article

6 Topics for Discussion Factual Information Technology Review
HAI Rates Reimbursement Impact Regulatory Issues Mandatory Reporting Technology Review Evolution Current Products Research/Publication Update Questions Review topics for discussion

7 Presentation Objectives
Participants will be able to: Discuss the current rates and financial impact of CR-BSI on the US Healthcare system Review current needleless technologies available today Describe recent research/publication activities regarding needleless access device use Read the slide Note 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.

8 The Facts Healthcare Acquired Infections (HAIs)
1.7 Million patients diagnosed with HAIs each year 33,269 Newborns in High Risk Nurseries 19,059 Newborns in Well Baby Nurseries 417,946 Adults and Children in ICUs 1,266,851 Adults and Children Outside the ICU Review current state around HAI’s in the US – Read the stats This is the most current info available Klevens, R. Monina. Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, Public Health Reports. Vol. 122, March-April 2007.

9 The Facts 98,987 estimated deaths annually associated with HAIs
35,967 Pneumonia 30,665 BSIs 13,088 UTIs 8,025 SSIs 11,062 Other sites Review current state around HAI’s in the US – Read the stats Klevens, R. Monina. Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, Public Health Reports. Vol. 122, March-April 2007.

10 Healthcare 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 expenditures Resistant organisms are of major concern, because antibiotics to treat these infections are often extremely limited. 90,000 deaths/yr  over 240 per day2 Average 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)2 1 PHC4 Research Brief. Hospital-acquired Infections in Pennsylvania. Issue No. 9. March 2006 2 Campaign to prevent antimicrobial resistance in healthcare settings.

11 The Facts HAIs Cost More Than $4.5 billion annually
JCAHO and NQF are focused on prevention efforts HAI prevention is a top focus for professional organizations such as: SHEA and APIC AND As of October 2008 Medicare no longer pays for certain preventable conditions CRBSIs included in this list Reder A. Public Reporting of HAIs: Where do we stand now? Infection Control Today. August 2007.

12 Attributed Financial Burden is High
Study of 232,651 admissions from 13 hospitals 63% Reduction in profits No HAIs With HAIs The 5% of patients acquiring infection eroded $56MM in profits This 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 # Patients 95% 221,225 5% 11,426 100% 232,651 Reference: MedMined, June 2005

13 The Facts Regulatory Impact JCAHO CDC
2009 National Patient Safety Goals Reduce the risk of HAIs Manage as sentinel events all identified cases of death or major loss of function associated with a HAI Implement best practices or evidence-based guidelines to prevent CLABSI CDC National Healthcare Safety Network (NHSN) Previously National Nosocomial Infection Surveillance (NNIS) Available to all hospitals Data available to all healthcare facilities and the general public JCAHO– 2 of the Patient Safety Goals speak to HAIs The 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.

14 Public Awareness Headlines Government and Consumer Groups
AARP Bulletin (March 2009) “Killer Germs”; Superbugs Kill 90,000 patients a year. Government and Consumer Groups Consumers Union Go to: State Hospital Infection Disclosure Laws” Leapfrog Group Provides ratings of 1,300 US Hospitals Centers for Medicare and Medicaid Services (CMS) Reports quality information on hospitals Committee to Reduce Infection Deaths Victoria Nahum, patient advocate A great deal of media attention. Public much more aware. 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.

15 Mandatory Reporting Mandatory Reporting of Infections
States that have passed legislation States with study bills NC, IN, AZ, OH, NM, and AK

16 Mandatory Reporting of HAIs
Map of the previous slide Interactive opportunity: Depending on the state the presentation is being presented, we discuss activity in that area.

17 Pennsylvania Pennsylvania Health Care Cost Containment Council (PHC4)
1st State with Public Reporting Data, 2004 This 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

18 Mandatory Reporting Issues
No Standardization Some states publish info/some don’t Some measure processes/some HAIs Some use administrative data Some 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?

19 Bloodstream Infections Facts
87% of primary bacteremia attributed to vascular access Crude mortality 10% - 40% Prolonged hospitalization days Attributable cost $34,000 - $56,000 per stay 80,000 CRBSIs occur in ICUs each year million occur outside ICU Annual cost to the healthcare system is $296 million - $2.3 billion (US) HAI’s consist of primarily: Ventilator Associated Pneumonia Urinary Tract Infections Surgical Site Infections Bloodstream Infections This 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:

20 How Infections Are Transmitted
Means of Transmission Reservoir Susceptible Host Causative Agent Review 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 & Entry 20

21 Susceptible Host Risk Factors Acuity of illness
Less than 1 year of age or over 60 Immunocompromised Underlying disease processes Loss of skin integrity Prolonged hospitalization Existing infections Malnutrition In ICU Type of catheter Frequency of manipulation of the catheter Discuss risk factors that are often out of the control of the clinician.

22 Portals of Entry Inadequate hand washing Insertion experience
Disinfection of skin site Contaminated infusate Field or ER insertion Multiple entries into the system (hubs, injection ports, stopcocks) This slide demonstrates all the “portals of entry” . Note that multiple entries increase risk. 22

23 CRBSI Reduction Strategies
Procedure Procedure Process CVC Insertion Cart Insertion Checklist/Bundle Review 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: Procedure CVC Bundle CVC Kits Process Education/hand washing Tubing Changes Surveillance Product Design Coated CVCs– some review indicates positive impact ?? Needleless Access Process Product Staff Awareness Measuring Compliance Coated CVCs/NCs CHG dressings/discs

24 Product Evaluation Needleless Access Devices
Procedure Process Procedure You can even take the graphic down another level, to the product itself: Procedure Change Frequency Process Aseptic Technique Clean before each access Product Design Needleless Access has evolved from very Simple to Complex Can design have an impact??? Change Frequency Blood draw via cap Process Design Smooth Surface Any gaps or crevices Clear vs. Opaque Complex Fluid Path Aseptic Technique Cleaning cap prior to each access Flushing effectiveness

25 Needleless Access Devices
Technology Review Transition slide to discuss technology

26 This 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

27 This 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.

28 Simple vs. Complex Simple Complex More Complex Split Septum Mechanical
Valve More Complex Positive Fluid Displacement Use 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



31 Publication History 2004 University of Virginia observed a 61% increase in BSI rates after switching from split septum technology to a mechanical valve Made the switch due to pump supplier change 2005 Wake Forest observed an increase in BSI’s after switching from split septum technology to mechanical valve Repeated in-service of nursing staff on proper device use did not lower BSI rates Dr. William Jarvis formed first study group to study BSI outbreak 5 hospitals reported increases in BSI rates after switching from split septum technology to a mechanical valves 2006 Wake Forest reports gross bacterial contamination of two mechanical valves after removal from patients In 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.

32 Tobi Karchmer, et al, SHEA 2006 Poster
Contamination of Mechanical Valve Needleless Devices May Contribute to Catheter-related Bloodstream Infections Tobi Karchmer, et al, SHEA 2006 Poster Devices: “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% TNTC Device 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 presentation Q-syte is Device C Read the conclusion

33 Potential 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: Factor Difficulty cleaning access surface Potential Impact HCWs may not adequately clean the intricate surface details before access, leading to fluid path contamination. Gap around plunger harbors bacteria Gap cannot be accessed for disinfection and can lead to fluid path contamination Opaque housing hides incomplete flushing of media based fluids During 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 path Impossible 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.

34 Potential Risk Factors for Bloodstream Infections Associated with Mechanical Valves
“Difficulty cleaning access surface” Rough vs smooth surface area Rough surface, harder to clean and may harbor bacteria

35 Potential Risk Factors for Bloodstream Infections Associated with Mechanical Valves
“Gap around plunger harbors bacteria” Gap around plunger vs tight seal Gap may allow bacteria to migrate into the device

36 Potential Risk Factors for Bloodstream Infections Associated with Mechanical Valves
“Opaque housing hides incomplete flushing of media based fluids” Opaque vs clear Difficult 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)

37 Potential Risk Factors for Bloodstream Infections Associated with Mechanical Valves
“Internal mechanisms obscure fluid path” Internal mechanisms: simple vs. complex Reinforce 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

38 Baxter Interlink® Smooth Surface No Gap Clear Simple Internal Design
High Flow Rates Accepts Needle in Emergency BD Bifurcated Cannula Improves Flushability Small & Light Weight Latex-free So how do BD Q-Syte and Baxter Interlink products match up to the Jarvis List: Good time to show barrel demo Q-Syte and Interlink meet ALL four strengths Review other attributes 38

39 BD Q-Syte™ Luer Access Split Septum
Smooth Surface No Gap Clear Simple Internal Design Accepts both Luer Lock and Luer Slip Connections High Flow Rates Small & Light Weight Latex-free So how do BD Q-Syte and BD Interlink products match up to the Jarvis List: Good time to show barrel demo Q-Syte and Interlink meet ALL four strengths Review other attributes 39

40 2007 Publications 2007 Geelong Hospital, Victoria, Australia reports a 2.2 fold increase in BSI’s after switching from split septum to mechanical valve Infection Control and Hospital Epidemiology The University of Nebraska Medical Center reports a 3.3 fold Increase in BSI’s after switching from split septum to mechanical valve Clinical Infectious Diseases Medical University of South Carolina reports a 2.7 fold increase in BSI’s after switching from split septum to mechanical valve All three facilities returned to split septum and their BSI rates returned to original levels In the summer of 2007, 3 publications highlighted this same experience.

41 Research 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 Unit Kathryn Field, MBBS et al. Infection Control and Hospital Epidemiology, May 2007, Vol. 28, No 5. Summary: 400-bed regional public hospital/Victoria Australia SS/Baxter Interlink® vs MV/Abbott Clave® and CLC 2000 Study period July 2004 through June 2005 98 patients with Hickman Catheters (SL and DL) Hem/Onc Unit 2.6 infections vs 5.8 infections per 1000 catheter-days Split Septum === Baxter Interlink Vs Mechanical Valve (Clave and CLC 2000) Study period July 2004 through June 2005 98 patients with Hickman Tunneled Catheters 32 confirmed BSI in 25 patients 20 in the MV period and 12 in SS period 62 patients in MV period = 3468 catheter days 83 patients in SS period = 4539 catheter days Median Time to 1st BSI in MV period = 44 days Median 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 conditions Looked at DL vs SL

42 Research Summary Recent Publications
Outbreak of Bloodstream Infection Temporally Associated with the Use of an Intravascular Needleless Valve Mark E. Rupp, et al. Clinical Infectious Diseases, June 2007, Vol. 44 Summary: SS/Interlink vs PDMV/Alaris Smartsite Plus vs SS/Interlink Increase in CRBSI rates with the introduction of a positive displacement connector valve and decrease after return to SS CC = 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 units Split –Septum vs Mechanical Valve Interlink vs Alaris Smartsite Critical Care Areas: 8 critical care units and transplantation units Total 38,250 CVC days over 26 months (Baseline) with SS 10,340 CVC days over 6 months (PDMV period) SS 3.87/1000 to PDMV 10.64/1000 p value < .001 In 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 periods 3745 CVC days SS 3.47/1000 baseline PDMV 7.3/1000 2.88/1000 during post intervention period 11, 475 CVC days No significant difference from baseline 2 Cooperative Transplant Units: Baseline 5.31/1000 patient days Total Patient Days: 7535 over 26 months 1383 patient days over 6 months (PDMV period) SS 5.31/1000 to PMVD 15.18/1000 patient days p value<,001 6 months following rate returned to baseline

43 Research 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 Hospital Cassandra D. Salgado, et al. Infection Control and Hospital Epidemiology, June 2007, Vol. 28, No. 6 Summary: 59 bed long-term care facility SS/Interlink vs Alaris Smartsite vs SS/Interlink Three-fold increase in BSI rates Location: 59 bed long-term acute care hospital, Sth Carolina switched from NSSD to Smartsite in Q1 2004 Study 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 system 65% relative increase in BSIs that were polymicrobial Contributed to 46 excess BSIs of which likely there were 5-12 excess deaths and additional cost of between $USD million In 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 technology Formal assessment of MVs in warranted as likely that the current design/ and or protocols for disinfection may not be safe or adequate for patient use Facilities using MVs need active surveillance systems in place.

44 Research Summary Study to evaluate effectiveness of closed, luer SS device in reducing CRBSI Adult Medical ICU Previously used PPMV CRBSI rate (PPMV): per 1,000 catheter days CRBSI rate (CLSS): 0 at 3, 6, 8 months after implementation Identified significant reduction in infection rates for adult medical-ICU population Love, 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

45 Research Summary 410 bed acute care facility in SE
Study performed in MSICU ( ) Utilized PPMV CRBSI rate (PPMV): 7.9 per 1,000 catheter days Evaluated CLSS device CRBSI rate (CLSS): 4.4 per 1,000 catheter days & eventually achieved a rate of 2.36 Kirley, 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

46 Portal 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 & Entry Reservoir The 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

47 Microbial Colonization of Needleless Connectors
In vitro study to evaluate presence/distribution of bacteria on external surfaces/internal fluid path of NCs after clinical use MICU patients All had silicone ss & internal collapsible silicone mechanical valve Results: prevalent microorganisms (multiple species) on external surface in biofilms; internal path revealed mixed species of microorganisms Biofilm 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.

48 CRBSI & 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.1,2 Did 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):

49 M. D. Anderson Cancer Center Experience
2003- closed luer split-septum/prior-SSBC Avoided MV’s due to concerns related to contamination and increased risk of infection Benefits of CLSS: Easy to use/clean Clear housing Simple device Straight/free flowing fluid path No internal mechanism to harbor bacteria

50 Infection Prevention Measures
Hand washing!! Wear gloves/PPE Skin prep prior to access and maintenance Clean access sites prior to each entry Frequent observation of site Evaluate continued need for access Incorporate central line bundle/line cart/kits Evaluate ALL changes in the infusion system independently for any change in BSI outcomes! Hand hygiene = 1ST LINE OF DEFENSE. Soaps, disinfectants, alcohol-based gels/lotions Gloves = could be either sterile or un-sterile; depends on policy and procedure; patient condition, etc Skin preps – CDC prefers CHG but 70% alcohol, 10% iodophors, tincture [alcohol] of iodine are all OK too. Persist = iodophor/alcohol/protective barrier Dressing 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 drainage Evaluation – Need to continue using vs. need to remove due to a possible complication IV 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

51 Summary Be Informed about the product
Be aware of changes in products that may have an impact on your outcomes Communicate with others in your institution who may be involved in the introduction of new technology Utilize available resources/information to assist in making informed decisions & improving patient outcomes Summarize discussion Encourage looking at outcomes not just clinician preference. Emphasize the quote from Trish Perl at Johns Hopkins

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