Increased Bloodstream Infection Rates in Surgical Patients Associated with Variation from Recommended Use and Care following Implementation of a Needleless Device
| Autor: | Shailen N. Banerjee, Alan I. Hartstein, William R. Jarvis, Mark A. Denny, Edward M. O'Mara, Helen M. Volk, Melanie Ihrig, Susan T. Cookson |
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| Rok vydání: | 1998 |
| Předmět: |
Microbiology (medical)
medicine.medical_specialty Denominator data Epidemiology business.industry Medical record Incidence (epidemiology) Retrospective cohort study medicine.disease Catheter Infectious Diseases Bacteremia Emergency medicine medicine Risk factor Intensive care medicine business Cohort study |
| Zdroj: | Infection Control and Hospital Epidemiology. 19:23-27 |
| ISSN: | 1559-6834 0899-823X |
| DOI: | 10.1086/647702 |
| Popis: | Objective: To determine if an apparent increase in bloodstream infections (BSIs) in patients with central venous catheters (CVCs) was associated with the implementation of a needleless access device. Design: Retrospective cohort study using a derived CVC-days factor for estimating appropriate denominator data. Setting: A 350-bed urban, acute, tertiary-care hospital. Methods: BSI surveillance data were obtained, and high-risk areas for BSIs were determined. A random 5% sample of medical records was used to estimate CVC days, and a cohort study was conducted to compare BSI rates before and during needleless device use. A survey was conducted of nursing needleless-device practices. Results: The surgical intensive-care unit (SICU), the medical intensive-care unit, and the solid organ transplant unit (OTU) were identified as high-risk units. Using existing surveillance BSI data and the estimated CVC days, the catheter-related BSI rates in the high-risk surgical patients were significantly higher during the needleless-device period compared with the preneedleless-device period (SICU, 9.4 vs 5.0/1,000 CVC days; OTU, 13.6 vs 2.2/1,000 CVC days). A survey of the nurses revealed that 60% to 70% were maintaining the needleless devices correctly. Conclusion: We observed a significant increase in the BSI rate in two surgical units, SICU and OTU, associated with introduction of a needleless device. This increase occurred shortly after the needleless device was implemented and was associated with nurses' unfamiliarity with the device, and needless-device use and care practices different from the manufacturer's recommendations. |
| Databáze: | OpenAIRE |
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