Care bundle for the prevention of peripheral venous catheter blood stream infections at a secondary care university hospital: Implementation and results.

BACKGROUND: Venous catheterization for diagnostic and therapeutic purposes is part of routine hospital practice, as approximately 70% of hospitalized patients have a peripheral venous catheter (PVC). This practice, however, can lead to both local complications, (e.g., chemical, mechanical and infectious phlebitis) and systemic complications (e.g., PVC-related bloodstream infections [PVC-BSIs]). Surveillance data and activities are central to preventing nosocomial infections, phlebitis and improving patient care and safety. The aim of this study was to evaluate the impact of a care bundle on reducing PVC-BSI rates and phlebitis at a secondary care hospital in Mallorca, Spain. METHODS: Three-phase intervention study targeting hospitalized patients with a PVC. The VINCat criteria were used to define PVC-BSIs and calculate incidence. In phase I (August-December 2015), we retrospectively analyzed baseline PVC-BSI rates at our hospital. In phase II (2016-2017), we conducted safety rounds and developed a care bundle with the goal of reducing PVC-BSI rates. In phase III (2018), we expanded the PVC-BSI bundle to prevent phlebitis and analyzed its impact. RESULTS: The incidence of PVC-BSIs decreased from 0.48 episodes per 1000 patient-days in 2015 to 0.17 episodes per 1000 patient-days in 2018. The 2017 safety rounds also detected a reduction in phlebitis (from 4.6% of 2.6%). Overall, 680 healthcare professionals were trained in catheter care and five safety rounds were conducted to assess bedside care. CONCLUSION: Implementation of a care bundle significantly reduced PVC-BSI rates and phlebitis at our hospital. Continuous surveillance programs are needed to adapt measures to improve patient care and guarantee safety.

Efectividad de un programa formativo para disminuir los hemocultivos contaminados / Effectiveness of an educational program for reducing blood culture contamination

INTRODUCCIÓN: Los hemocultivos contaminados (HC) conllevan un incremento de pruebas diagnósticas, tratamientos innecesarios, aumento de la carga asistencial, estancia hospitalaria y costes. Objetivos Disminución de los HC a través de un programa educacional. Material y métodos Periodo preintervención (Ppre): valoración clínica restrospectiva de los hemocultivos positivos y análisis de indicadores de contaminación. Periodo postintervención (Ppos), tras programa educacional, se comparó la incidencia de contaminación entre ambos periodos. La formación comprendió: un cuestionario donde se valoraba el grado de conocimientos acerca de la técnica de extracción, el significado de los HC, su diagnóstico y prevención, la impartición de sesiones y la revisión de resultados. ResultadosSe impartieron sesiones formativas en todas las unidades de hospitalización. La mediana de participación fue del 64% (40,8-78,5). La mediana de aciertos en el cuestionario fue del 69% en el Ppre (54,1-83,3) y de 85,7% (83,3-100) en el Ppos, mejorando en el 85,7% de las unidades que pudieron compararse. Durante el Ppre hubo 136 (4,2%) HC y 186 (6,05%) fueron HC en el Ppos (p = 0,005). La mediana de HC por unidades entre 2011 y 2012 fue del 5 vs. 7,5% (p = 0,79). Solo en 2 unidades se objetivó una reducción del 2 y del 2,5% que no fue significativa. CONCLUSIONES: Nuestro programa formativo no consiguió reducir los HC en el periodo del estudio pero logró una mejoría en la capacitación de las enfermeras. Los resultados nos permitieron identificar los problemas que necesitan modificarse de cara a conseguir mejores resultados y poder implantar un programa continuado

INTRODUCTION: Blood culture contaminations can lead to unnecessary diagnostic procedures and treatments, increasing workload, length of stay, and costs. OBJETIVES: Development of an educational program to reduce contamination rates. MATERIAL AND METHODS: Our study compared contamination rates (CR) between a pre-intervention period (Ppre) and post-intervention period (Ppos), where clinical charts from patients with positive blood cultures were reviewed. Intervention consisted of a questionnaire where knowledge of blood culture practice and its significance was assessed. Results are discussed and explained. RESULTS: A presentation on blood culture guidelines was discussed in every nurse station. There was a median of 64% (40.8-78.5) attendance rate. The median of correct answers was 69% in the Ppre (54.1-83.3) with 85.7% (83.3-100) in the Ppos, indicating an improvement in 85.7% of the departments that could be compared. There were 136 (4.2%) contaminants in the Ppre and 186 (6.05%) in the Ppos (P=.005). Among the different departments the average of CR varied from 5% vs 7.5% (P=.79) between 2011 and 2012. Only 2 departments reduced CR by 2% to 2.5%, the difference was not significant. CONCLUSIONS: The intervention failed to reduce overall contamination rates, but knowledge of blood culture practice improved. Our results identified the errors that will help us to design a successful approach in future follow-up programs

[Effectiveness of an educational program for reducing blood culture contamination]. / Efectividad de un programa formativo para disminuir los hemocultivos contaminados.

INTRODUCTION: Blood culture contaminations can lead to unnecessary diagnostic procedures and treatments, increasing workload, length of stay, and costs. OBJETIVES: Development of an educational program to reduce contamination rates. MATERIAL AND METHODS: Our study compared contamination rates (CR) between a pre-intervention period (Ppre) and post-intervention period (Ppos), where clinical charts from patients with positive blood cultures were reviewed. Intervention consisted of a questionnaire where knowledge of blood culture practice and its significance was assessed. Results are discussed and explained. RESULTS: A presentation on blood culture guidelines was discussed in every nurse station. There was a median of 64% (40.8-78.5) attendance rate. The median of correct answers was 69% in the Ppre (54.1-83.3) with 85.7% (83.3-100) in the Ppos, indicating an improvement in 85.7% of the departments that could be compared. There were 136 (4.2%) contaminants in the Ppre and 186 (6.05%) in the Ppos (P=.005). Among the different departments the average of CR varied from 5% vs 7.5% (P=.79) between 2011 and 2012. Only 2 departments reduced CR by 2% to 2.5%, the difference was not significant. CONCLUSIONS: The intervention failed to reduce overall contamination rates, but knowledge of blood culture practice improved. Our results identified the errors that will help us to design a successful approach in future follow-up programs.