Failure of central venous catheter insertion and care bundles in a high central line-associated bloodstream infection rate, high bed occupancy hospital.

BACKGROUND: Our hospital has several characteristics different from the settings in which the central venous catheter (CVC) care bundle has been implemented so far, that is, care bundles or protocols are not systematically used, and the prevalence of central line-associated bloodstream infections (CLABSI) is high, as is bed occupancy rate. We examined the effectiveness of CVC care bundles. METHODS: Modified CVC bundles were implemented across all settings of our hospital. During both phases of the study, we collected data on CLABSI, and we monitored CVC insertion and management practices with direct observation audits. RESULTS: We have studied 913 CVC insertions (454 in PRE and 459 in POST) for 11,871 catheter-days. The incidence of CLABSI was 8.3 per 1,000 catheter-days PRE, and 7.6 per 1,000 catheter-days POST (incidence rate ratio, 0.92; 95% confidence interval, 0.60-1.40). Compliance with the CVC insertion bundle increased from 8.4%-74.3% (P < .0001). The CVC management bundle compliance also increased from 11.4%-57.7% (P < .0001). CONCLUSIONS: Despite improved compliance after the intervention, implementation of a modified CVC bundle failed to decrease CLABSI incidence. Higher bundle compliance rates may be necessary for a significant decrease in the incidence of CLABSI, along with the appropriate organizational culture and levels of staffing.

Comparison of blind intubation through the I-gel and ILMA Fastrach by nurses during cardiopulmonary resuscitation: a manikin study.

OBJECTIVES: To investigate whether nursing staff can successfully use the I-gel and the intubating laryngeal mask Fastrach (ILMA) during cardiopulmonary resuscitation. BACKGROUND: Although tracheal intubation is considered to be the optimal method for securing the airway during cardiopulmonary resuscitation, laryngoscopy requires a high level of skill. METHODS: Forty five nurses inserted the I-gel and the ILMA in a manikin, with continuous and without chest compressions. RESULTS: Mean intubation times for the ILMA and I-gel without chest compressions were 20.60 ± 3.27 and 18.40 ± 3.26 s, respectively (p < 0.0005). ILMA proved more successful than the I-gel regardless of compressions. Continuation of compressions caused a prolongation in intubation times for both the I-gel (p < 0.0005) and the ILMA (p < 0.0005). CONCLUSION: In this mannequin study, nursing staff can successfully intubate using the I-gel and the ILMA as conduits with comparable success rates, regardless of whether chest compressions are interrupted or not.

Emergency airway management by paramedics: comparison between standard endotracheal intubation, laryngeal mask airway, and I-gel.

The aim of this study was to investigate whether briefly trained paramedics would be able to successfully intubate by endotracheal intubation (ETI) and using the laryngeal mask airway (LMA) and the I-gel in a manikin model. After the completion of a questionnaire, a brief educational session, and presentation of ETI, LMA, and I-gel, 72 paramedics were randomly allocated to intubate an adult manikin. The success rate for I-gel was higher than that for LMA (P<0.001) and ETI (P<0.001), and the insertion time for I-gel was significantly shorter than that for LMA (P<0.001) or during ETI (P<0.001). There was a statistically significant association between the experience level of paramedics and insertion time only for the LMA (P=0.012). In addition, the mean insertion time values were significantly affected by the accuracy of the answers to the theoretical questions (P<0.05 for all questions). Paramedics should lay greater emphasis on airway management using supraglottic devices, especially I-gel because of its shorter time of insertion.