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Chlorhexidine Dressing Reduces Incidence of Catheter-related Bloodstream Infections

Chlorhexidine Dressing Reduces Incidence of Catheter-related Bloodstream Infections

he application of chlorhexidine dressings may reduce the incidence of definite or probable catheter-related bloodstream infections (CRBSI) in patients with chemotherapy-induced neutropenia, according to a study published in the journal Annals of Oncology. CRBSI frequently causes morbidity and mortality of patients with cancer who experience neutropenia during chemotherapy. Because chlorhexidine-containing catheter securement dressings may reduce the risk of CRBSI, researchers evaluated dressing efficacy by enrolling 613 patients who received care in 10 German hematology departments. Patients with neutropenia were randomly assigned to receive chlorhexidine-containing dressings or control dressings. Incidence of definite CRBSI within the first 14 days of central venous catheter placement was 2.6% in the chlorhexidine group and 3.9% in the control group (P = .375), which did not meet the study’s primary endpoint. It was found, however, that the combined incidence of definite or probable CRBSI within 14 days and the overall incidence of definite or probable CRBSI were significantly lower for patients who received chlorhexidine dressings, versus those who had control dressings (P = .047 and P = .019, respectively). The frequency of dressing intolerance with cutaneous and soft tissue abnormalities at the contact area was similar in both arms (P = .901). Although the study did not achieve its primary endpoint, the findings suggest that the use of chlorhexidine dressings decreases the incidence of definite or probable CRBSI in this at-risk patient...
Medical Simulation in Interventional Cardiology

Medical Simulation in Interventional Cardiology

Use of medical simulation has grown considerably over the past decade because it helps physicians overcome many training challenges, such as work-hour restrictions and the pace at which technology is evolving. According to John C. Messenger, MD, FSCAI, interventional cardiology is particularly well-suited for simulation. “These procedures are often complex,” he says. “The learning curves can be steep, and complications can be life-threatening. Simulation provides a safe arena to develop and refine skills that improve overall patient care. It’s especially helpful in interventional cardiology because of the field’s ever-changing technological and procedural environment.” A Call to Action In Catheterization and Cardiovascular Interventions, the Society for Cardiovascular Angiography and Interventions (SCAI) examined the current state of medical simulation in interventional cardiology. SCAI also issued recommendations for expanding and standardizing the use of this training technology by interventional cardiologists and fellows-in-training. “We need to increase use of medical simulation and accessibility to this training for highly complex procedures, such as structural heart interventions,” says Dr. Messenger, who chairs SCAI’s Simulation Committee. “Simulation can also improve training in areas where procedural volumes are low.” A key recommendation from SCAI is to integrate formal simulation programs into annual meetings and other training programs for fellows and practicing physicians. However, one of the major issues with integrating simulation is the high cost of simulators. “The key is for clinicians and simulation vendors to collaborate and find ways to alleviate the financial burden associated with simulation,” says Dr. Messenger. “Using simulation at annual meetings and establishing regional or central simulation centers could ease this burden.”   The key is for clinicians and simulation vendors to...

Improving Care for Patients Receiving PVCs

Catheter-associated blood stream infections (CABSI) can have a significant impact on patient morbidity while increasing healthcare utilization costs. CABSIs are preventable, and several strategies are used to reduce these infections, including training healthcare workers, ensuring compliance with proper placement technique, promptly removing catheters associated with a high risk of infection or that are no longer needed, and providing feedback to improve healthcare worker accountability. These strategies have focused largely on central venous catheters and ICUs, but few data are available in the non-ICU setting. Peripheral venous catheters (PVCs) are commonly used in hospitals, but previous studies have reported poor compliance with the care of these catheters and serious events relating to infectious complications. “In many hospitals, there is room for improvement in the maintenance and care of PVCs,” says Mohamad G. Fakih, MD, MPH. “Improving the process will help reduce the risk of CABSI.” Testing an Intervention to Improve PVC Care In the May 2012 issue of Infection Control and Hospital Epidemiology, Dr. Fakih and colleagues had a study published evaluating the effect of education and feedback on process measures to improve PVC care and infectious complications. Nurses and patients in 10 non-ICUs were involved in the analysis, and the intervention was applied during four periods, each one lasting 3 months in duration. The four periods included a pre-intervention phase and three staggered real-time education and feedback interventions. “Our study intervention included use of formal lectures, printed educational materials, audits, and immediate feedback to the nurses on their performance,” adds Dr. Fakih. Five units participated in the intervention (Group A), while the other five served as a control group...

A Quality Improvement Strategy to Reduce Infection Rates

An estimated 80,000 patients each year experience catheter-related bloodstream infections during treatment in hospitals, about 31,000 of whom die, and the cost of treating these infections may be as high as $3 billion nationally. In 2009, the United States Department of Health and Human Services called for a 50% reduction in catheter-related infections nationwide by 2012. Institutions throughout the U.S. have initiated different interventions to accomplish this feat, but with varying degrees of success. Reducing Bloodstream Infection Rates Several years ago, the Keystone ICU Project was launched. Developed by Johns Hopkins University in partnership with the Michigan Hospital Association, the project utilizes a checklist for healthcare providers to follow when placing catheters. The checklist highlights five basic steps to decrease catheter-related bloodstream infection rates: 1. Promoting hand washing. 2. Full barrier precautions. 3. Skin antisepsis with chlorhexidine. 4. Avoiding the femoral site during catheter insertion. 5. Removing unnecessary catheters. Along with the checklist, the Keystone ICU Project promotes a culture of safety consisting of safety science education, training in the identification of potential safety problems, development of evidence-based solutions, and measurement of improvements. A key aspect of the program was to empower all caregivers—regardless of their level of experience—to question each other and stop procedures if safety is compromised. Profound New Data on Eliminating Infections In the January 31, 2011 issue of BMJ, my colleagues and I had a study published. It found that the virtual elimination of catheter-related bloodstream infections in ICUs throughout Michigan through the Keystone Project correlated with a 10% reduction in mortality rates in the state when compared to surrounding states. Using Medicare claims data, we...
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