Clinical Nurse Specialist Practice: Impact on Emergency Department Blood Culture Contamination.

PURPOSE/OBJECTIVES: Blood culture collection is a common procedure performed in emergency departments. Rate of blood culture contamination is a metric that is tracked by organizations to ensure appropriate treatment for patients suspected of having bacteremia and ensure appropriate use of hospital resources. A team of nurses and technicians undertook a quality improvement project to decrease blood culture contamination rates in a suburban emergency department. DESCRIPTION OF THE PROJECT: The project included use of standardized blood culture collection kits, creation of a dedicated collection team, and implementation of a new blood culture collection device. OUTCOME: Through this work, blood culture contamination rates decreased from greater than 3.0% to less than 1.5% consistently for nearly 24 months. CONCLUSIONS: Providing feedback and continued monitoring has made this quality improvement initiative a success for the department and the organization and has resulted in cost savings of nearly 2 million dollars.

Enhanced infection control interventions reduced catheter-related bloodstream infections in the neonatal department of Hung Vuong Hospital, Vietnam, 2011-2012: a pre- and post-intervention study.

Background: Catheter-related bloodstream infections (CR-BSI) cause high neonatal mortality and are related to inadequate aseptic technique during the care and maintenance of a catheter. The incidence of CR-BSI among neonates in Hung Vuong Hospital was higher than that of other neonatal care centres in Vietnam. Methods: An 18-month pre- and post-intervention study was conducted over three 6-month periods to evaluate the effectiveness of the intervention for CR-BSI and to identify risk factors associated with CR-BSI. During the intervention period, we trained all nurses in the Department of Neonatology on BSI preventive practices, provided auditing and feedback about aseptic technique during catheter care and maintenance, and reorganised preparation of total parenteral nutrition. All neonates with intravenous catheter insertion ≥48 h in the pre- and post-intervention period were enrolled. A standardised questionnaire was used to collect data. Blood samples were collected for cultures. We used Poisson regression to calculate rate ratio (RR) and 95% confidence interval (CI) for CR-BSI incidence rates and logistic regression to identify risk factors associated with CR-BSI. Results: Of 2225 neonates enrolled, 1027 were enrolled in the pre-intervention period, of which 53 CR-BSI cases occurred in 8399 catheter-days, and 1198 were enrolled in the post-intervention period, of which 32 CR-BSI cases occurred in 8324 catheter-days. Incidence rates of CR-BSI significantly decreased after the intervention (RR = 0.61, 95% CI 0.39-0.94). Days of hospitalisation, episodes of non-catheter-related hospital-acquired infections, and the proportion of deaths significantly decreased after the intervention (p < 0.01). The CR-BSI was associated with days of intravenous catheter (odds ratio [OR] = 1.05, 95% CI 1.03-1.08), use of endotracheal intubation (OR = 2.27, 95% CI 1.27-4.06), and intravenous injection (OR = 8.50, 95% CI 1.14-63.4). Conclusions: The interventions significantly decreased the incidence rate of CR-BSI. Regular refresher training and auditing and feedback about aseptic technique during care and maintenance of catheters are critical to reducing CR-BSI.

The value of the infection prevention and control nurse led MRSA ward round.

Meticillin-resistant S. aureus (MRSA) is prevalent in most parts of the world. The study took place at Queen Elizabeth Hospital Birmingham (QEHB) a UK tertiary referral hospital. At QEHB innovative nurse led daily ward rounds for patients that acquire hospital acquired MRSA during their hospital stay are undertaken. The aim is to optimise care delivered for these patients whilst at QEHB, thereby reducing the risk of infection in patients with healthcare-acquired MRSA. A segmented Poisson regression model suggests that the MRSA bacteraemia rate was affected where an 88.94% reduction (p = 0.0561) in bacteraemias was seen by the introduction of these ward rounds. We describe a nurse led MRSA ward round which was associated with a lower rate of MRSA bacteraemias.

[Nursing sensitive outcomes and staffing: a review on healthcare associated infection]. / Esiti sensibili alle cure infermieristiche e staffing:le infezioni correlate all'assistenza.Revisione della letteratura.

. Nursing sensitive outcomes and staffing: a review on healthcare associated infection. INTRODUCTION: Healthcare associated infections (HAI) continue to be an unresolved problem in hospital settings. AIM: To assess the relationship between nurse staffing and healthcare associated infections in different settings. METHODS: From April to May 2015 a review of literature was conducted consulting PubMed, CINAHL and Cochrane Library. RESULTS: An increased amount of Registered Nurse Hours Per Patient Day (RNHPPD) and nurse-to-patient ratio was associated to a decreased occurrence of HAI. In particular an increase of RNHPPD was associated to a reduction of postoperative (OR 0.83, IC95% 0.0.70-0.99), and ventilator-associated pneumonia (OR 0.21, IC95% 0.08-0.53). Even the number of urinary tract infections (-34%) and sepsis (OR 0.54, IC95%: 0.31-0.92) decreased significantly. The most significant results associated to an increase of HPPD were obtained in intensive care units. CONCLUSIONS: The review showed the correlations between nurse staffing and the most frequent HAIs. Nursing managers should be aware of the adequate nurse-to-patient ratios and skill-mix in order to inform decision making and improve the quality and safety of patients care.

Impacto del programa de prevención de infección del catéter venoso central en Unidades de Cuidados Intensivos / Impact of infecion prevention program central venous catheter in Intensive Care Units

Introducción. La canalización de vías venosas centrales (CVC) es una técnica utilizada en unidades de cuidados intensivos (UCI) no exenta de riesgo de infección en la colocación y en su posterior manipulación. Objetivo. Evaluar la efectividad de un programa de prevención e infección tras la incorporación de nuevas estrategias multifactoriales, en el programa de prevención de la bacteriemia relacionada con catéter (BRC) en UCI. Metodología. Estudio descriptivo comparativo en dos periodos. Incluidos todos los pacientes ingresados en dos UCI polivalentes de un hospital de tercer nivel el año 2014. Se analizaron los datos de 2014 en comparación con los de 2013 para comprobar el impacto de las nuevas medidas del programa de prevención de BRC. Variables: n.º de catéteres, n.º infecciones/1000 días de catéter y vía de acceso. Las actuaciones realizadas han sido: vigilancia prospectiva de la tasa de incidencia, programa de prevención multifactorial secuencial con implantación de diferentes medidas, lista de comprobación de la inserción de nuevos catéteres, introducción de monitorización semanal, notificación de episodios al equipo asistencial, formación continuada al personal sanitario e implantación de los apósitos transparentes semipermeables con gel de clorhexidina. Resultados. La tasa de incidencia descendió de 3.1 episodios/ 1000 días de catéter en 2013 a 2.3 episodios/1000 días de catéter en 2014, lo que supone una mejora en las diferentes unidades. La ratio de utilización de los diferentes accesos fue: 35 % humeral; 33 % yugular; 25 % subclavia; 10 % femoral, y 13 % Shaldon. Conclusiones: Las nuevas medidas aplicadas para reducir la bacteriemia han permitido una disminución en la tasa de infección, lo que nos acerca al objetivo del programa Bacteriemia Zero (AU)

Introduction. The channeling of central venous catheters (CVC) is a technique used in intensive care units (ICUs ) but it doesn’t come without the risk of infection in the placement and subsequent handling. Objective. Evaluate the effectiveness of a prevention of infection following the introduction of new multifactorial strategies in the prevention program Central line-associated bloodstream infection (CLABSI) at ICU. Methodology. Comparative descriptive study in two periods, including all patients admitted in multipurpose ICUs of a tertiary hospital 2014. Were analyzed 2014 data comparated with 2013, to test the impact of new measures CRB prevention program. Variables: number of catheters, number of infections/1000 catheter days and path. Actions carried out were: prospective surveillance of the incidence rate, sequential program multifactorial prevention implementation of different measures, checklist for insertion of new catheters, introduction of weekly monitoring compliance, reporting episodes team care, continuing education for sanitary personal and implementation of the semipermeable transparent dressings with chlorhexidine gel. Results. The overall incidence density rate decreased from 3.1 episodes/1000 catheter days in 2013 to 2.3 episodes/1000 catheter days in 2014, improving in different units. The utilization ratio of the different accesses was: 35 % humeral; 33 % jugular; 25 % subclavian; 10 % femoral, and 13 % hemodialysis catheter. Conclusions. The new measures applied to reduce the bacteremia have allowed a decrease in the rate of infection, what brings closer to the objective of the Bacteremia Zero program (AU)

Meningitis: Know the Symptoms.

This app is intended to be a reference resource for the symptoms of meningitis and septicaemia.

CLABSI Reduction Strategy: A Systematic Central Line Quality Improvement Initiative Integrating Line-Rounding Principles and a Team Approach.

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) are the most common hospital-acquired infections costing hospitals millions of dollars annually. An evidence-based practice literature review revealed that utilizing a systematic team approach for proper line maintenance is effective in reducing CLABSI rates. PURPOSE: The purpose of this quality improvement initiative was to reduce the CLABSI rate in the neonatal intensive care unit from 3.9 per 1000 line days in 2011 by at least 50% in 2014. Policies, protocols, team members utilized, competencies, and techniques were created and a formal line-rounding and dressing change competency was established. The competency included specific criteria for performing daily line rounds and a 2-person sterile technique for dressing changes. FINDINGS/RESULTS: Central line-associated bloodstream infection rate was effectively reduced from 3.9 in 2011 to 0.3 per 1000 line days in 2014, with an overall 92% improvement. IMPLICATIONS FOR PRACTICE: Introduction of a dedicated CLABSI team has been shown to be effective in the reduction of CLABSI rates in the neonatal intensive care unit. IMPLICATIONS FOR RESEARCH: Further research is needed to evaluate how a team approach could be used to reduce other hospital-acquired conditions; catheter-associated urinary tract infection, and hospital-acquired pressure ulcers.

Evaluación de la efectividad y satisfacción del apósito con Gluconato de Clorhexidina 3M(TM) Tegaderm(TM) en el cuidado del catéter central tunelizado para hemodiálisis / Evaluation of the effectiveness and safety of 3M(TM) Tegaderm(TM) chlorhexidine gluconate dressing in the care of the central vascular catheter tunneled for hemodialysis

Introducción: Son múltiples los métodos y materiales utilizados para el manejo del orificio de inserción del catéter venoso central tunelizado para hemodiálisis con el fin de prevenir infecciones asociadas a su uso. El objetivo de este estudio es analizar el uso del Apósito con Gluconato de Clorhexidina 3M™ Tegaderm™ con respeto al Apósito formado por gasa y esparadrapo en la cura del orificio de inserción del catéter tunelizado para hemodiálisis. Material y método: Se ha llevado a cabo un estudio prospectivo durante 32 semanas en el que se han incluido 9 pacientes portadores de catéter venoso central tunelizado. Se han recogido datos referentes al estado del orificio de inserción del catéter, del túnel, de la zonza colindante, aplicabilidad del material, satisfacción del paciente, percepción del profesional y costes. Resultados: No se ha evidenciado diferencias en la eficacia para la prevención de infecciones entre ambos apósitos. En el análisis de satisfacción, se constata una mayor percepción de seguridad con el uso del apósito con clorhexidina además de una reducción de coste de la técnica. Discusión: Basándonos en los costes, satisfacción del paciente y en la percepción del personal de enfermería responsable de la técnica, el Apósito con Gluconato de Clorhexidina es una buena alternativa para el cuidado del orificio de inserción del catéter tunelizado para hemodiálisis (AU)

Introduction: There are multiple methods and materials used for handling the insertion hole of the central venous catheter tunneled for hemodialysis, in order to prevent infection associated with their use. The aim of this study is to analyze the use of 3M™ Tegaderm™ CHG dressing with respect to the dressing formed by gauze and tape in the cure of insertion hole of the tunneled hemodialysis catheter. Material and methods: A prospective study for 32 weeks was conducted, in which 9 patients with central venous catheter tunneled were included. Data on the state of: catheter insertion hole, tunnel, neighboring area, applicability of the material, patient satisfaction, perception of professional and costs were collected Results: No significant difference in efficacy for the prevention of infections between the two dressings was found. In the analysis of satisfaction a greater perception of safety with the use of the dressing with chlorhexidine was observed as well as a reduction of cost of the technique. Discussion: Based on cost, patient satisfaction and perception of the nursing staff responsible for the technique, the dressing with chlorhexidine gluconate is a good alternative for the cure of insertion hole of the tunneled hemodialysis catheter (AU)

Magnet® Hospital Recognition Linked to Lower Central Line-Associated Bloodstream Infection Rates.

Central-line-associated bloodstream infections (CLABSI) are among the deadliest heathcare-associated infections, with an estimated 12-25% mortality rate. In 2014, the Centers for Medicare and Medicaid Services (CMS) began to penalize hospitals for poor performance with respect to selected hospital-acquired conditions, including CLABSI. A structural factor associated with high-quality nursing care and better patient outcomes is The Magnet Recognition Program®. The purpose of this study was to explore the relationship between Magnet status and hospital CLABSI rates. We used propensity score matching to match Magnet and non-Magnet hospitals with similar hospital characteristics. In a matched sample of 291 Magnet hospitals and 291 non-Magnet hospitals, logistic regression models were used to examine whether there was a link between Magnet status and CLABSI rates. Both before and after matching, Magnet hospital status was associated with better (lower than the national average) CLABSI rates (OR = 1.60, 95%CI: 1.10, 2.33 after matching). While established programs such as Magnet recognition are consistently correlated with high-quality nursing work environments and positive patient outcomes, additional research is needed to determine whether Magnet designation produces positive patient outcomes or rewards existing excellence.

[The impact of closed system and 7 days intravascular administration set replacement on catheter related infections in a general intensive care unit: a before-after study]. / Efficacia della linea chiusa e sostituzione delle linee infusionali ogni 7 giorni sulle infezioni da catetere vascolare in una terapia intensiva polivalente: studio pre-post.

INTRODUCTION: The incidence of catheter related Bloodstream infections (BSI) is high in intensive care units (ICU). AIM: To evaluate the BSI rate in a population of patients admitted to a General ICU before and after the implementation of the 2011 CDC guidelines. METHODS: Retrospective observational study on patients admitted from January 2009 to December 2013. The infusion and monitoring lines were changed every 96 hours for the first 30 months, and every 7 days for the next 30. In all patients a closed infusion line with needle-free connectors pressure was used (Microclave). The following catheters were considered in the study: central venous catheter (CVC), arterial cannula (ART) and Swan Ganz catheter (SG). RESULTS: During the period with change every 96 hours 15 BSI were observed over 13395 catheters/days (C/D), 1.12 per 1000 C/D, while when lines where changed every 7 days 11 BSI were observed over 13120 C/D, 0.83 per 1000 C/D. A statistically significant reduction of BSI was observed in SG catheters (4.17 vs. no BSI p = 0.02), while the CVCS (1.12 vs 1.45 - p = 0.37) and ART (0.35 vs 0.36 - p = 0.61) infection rates remained unchanged. CONCLUSIONS: The replacement of infusion lines every 7 days in our sample did not increase the BSI, helping to reduce the costs.

Epidemiology and outcomes of bloodstream infections in patients discharged from the emergency department.

OBJECTIVE: To determine the outcomes of patients discharged from the emergency department (ED) with a bloodstream infection (BSI) and how these outcomes are influenced by antibiotic treatment. METHOD: We identified every BSI in adult patients discharged from our ED to the community between July 1, 2002, and March 31, 2011. The medical records of all cases were reviewed to determine antibiotic treatment in the ED and at discharge. Microorganism sensitivities were used to determine whether antibiotics were appropriate. These data were linked to population-based administrative data to determine specific patient outcomes within the subsequent 2-week period: death, urgent hospitalization, or an unplanned return to the ED. RESULTS: A total of 480 adults with BSI were identified (1.49 cases per 1,000 adults discharged from the department). Compared to controls (321,048 patients), BSI patients had a significantly higher risk of urgent hospitalization (adjusted OR 2.1 [95% CI 1.6-2.8]) and unplanned return to the ED (adjusted OR 4.1 [95% CI 3.3-4.9]). Outcome risk was significantly lowered in BSI patients who received appropriate antibiotics in the ED and at discharge. In elderly patients, the risk of urgent hospitalization increased significantly as the time to appropriate antibiotics was delayed. CONCLUSIONS: BSI patients discharged from the ED have a significantly increased risk of urgent hospitalization and unplanned return to the ED in the subsequent 2 weeks. These risks decrease significantly with the timely provision of appropriate antibiotics. Our results support the aggressive use of measures ensuring that such patients receive appropriate antibiotics as soon as possible.

[The effect of bundle care on central line associated bloodstream infection in a medical intensive care unit].

BACKGROUND & PROBLEMS: While the central line catheter is a common device used in intensive medical care, it is a frequent source of nosocomial infection. The central line associated bloodstream infection (CLABSI) rate at our medical ICU had increased steadily, with an average rate between January and May 2011 of .47%. We used a cross-team approach to implement bundle care as a strategy to reduce the CLABSI rate. PURPOSE: We designed a project to reduce the CLABSI rate below .3% in our ICU. RESOLUTION: This project was conducted between June 2011 and May 2012. Our strategy included providing a sterile towel, implementing maximal barrier precautions (head to toe), designing an illustration explaining how to use 2% CHG, establishing a procedures and care checklist, implementing quality assurance for procedures and care, and providing education on bundle care. RESULTS: The CLABSI rate reduced to .24% after project implementation. This result was below the target of .30%. CONCLUSIONS: We want to share this experience to help other hospitals and units improve critical care quality and to continue working to achieve a zero-tolerance infection rate.

Prevalencia de bacteriemias relacionadas con el catéter de hemodiálisis en una unidad hospitalaria / Prevalence of catheter-related bacteraemia in a hospital haemodialysis unit

En la actualidad ha aumentado el uso de catéteres tunelizados como acceso vascular permanente para los pacientes en hemodiálisis a pesar de las complicaciones que tiene asociadas, como puede ser la bacteriemia relacionada con el catéter. El objetivo de este trabajo es mostrar la tasa de prevalencia de bacteriemia relacionada con el catéter para hemodiálisis, obtenida con la aplicación estricta de un protocolo de cuidados del catéter tunelizado por un personal bien entrenado en la unidad de hemodiálisis del Hospital Universitario Infanta Leonor entre abril de 2008 y abril de 2013, así como describir las posibles causas de bacteriemia relacionada con el catéter, la relación con alguna de las variables y su evolución en los últimos años. Durante los 5 años de estudio tuvimos 9 episodios de bacteriemia relacionada con el catéter, lo que supone una tasa global de prevalencia de 0,25/1000 días de catéter. La tasa por cada uno de los años fue menor de 1/1000 días de catéter. Los pacientes que tuvieron una bacteriemia relacionada con el catéter tuvieron implantados mayor número de catéteres que los que no la tuvieron, siendo esta diferencia significativa (p=0,027). No se encontraron diferencias con respecto a la edad, el sexo, la diabetes mellitus, el índice de comorbilidad de Charlson y la localización de los catéteres entre los pacientes que padecieron una bacteriemia relacionada con el catéter de los que no (AU)

Currently has increased the use of tunneled catheters as permanent vascular access for hemodialysis patients despite having associated complications, such as bacteremia. The aim of this work is to show the incidence of catheter-related bacteremia for hemodialysis obtained with the strict implementation of a protocol tunneled catheter care by well-trained personnel in the Hemodialysis Unit of University Hospital Infanta Leonor between April 2008 and April 2013, and to describe possible causes of bacteremia, the relationship with any of the variables and their evolution in recent years. During 5 years of study there had been 9 episodes of catheter-related bacteremia which is an overall incidence rate of 0.25 / 1000 catheter days. The fee for each of the years was less than 1/1000 catheter days. Patients who had bacteremia had catheters implanted more than those who had not, and this difference was significant (p = 0.027). No differences were found with respect to age, sex, diabetes mellitus, the Charlson comorbidity index and location of catheters among patients who developed bacteremia from those without (AU)

Bioconectores: ¿Son realmente eficaces en la reducción de las bacteriemias relacionadas con el catéter permanente para hemodiálisis? / Bioconnectors: Are they really effective in reducing bacteraemia related to permanent catheters for haemodialysis?

Uno de los mayores problemas que presentan los catéteres venosos centrales tunelizados para hemodiálisis son las infecciones, por su gravedad y los elevados costes que generan. Por ello, es importante su prevención, ya que, además, el número de catéteres ha aumentado considerablemente en los últimos años. Objetivos: Realizamos este estudio en nuestra unidad para analizar: • Eficacia de unos conectores con sistema cerrado (TEGO(R)) en la prevención de bacteriemia relacionada con el catéter. • Incidencia de Staphylococcus aureus y gérmenes causantes más frecuentes. Material y método: Se realizó un estudio retrospectivo, comparativo y transversal durante 800 días, que dividimos en dos periodos iguales. En los primeros 400 se aplicó el protocolo de la unidad a 24 pacientes y en los 400 días siguientes se aplicó el mismo protocolo más los conectores anteriormente citados a 25. En ambos periodos, 19 fueron los mismos pacientes. Resultados: En el primer periodo se contabilizaron 4 infecciones en 7062 días de catéter y en el segundo 2 infecciones en 8622 días de catéter. Índice de bacteriemia en ambos periodos: 0,56/1000 y 0,23/1000 respectivamente. Ninguna infección se produjo por Staphylococcus aureus, siendo el germen más frecuente Staphylococcus coagulasa negativo. Conclusión: Nuestra conclusión es que los conectores fueron eficaces en la prevención de las bacteriemias ya que redujeron notablemente nuestros, ya bajos, índices de las mismas (AU)

One of the greatest problems presented by tunnelled central venous catheters for haemodialysis is infections, on account of their seriousness and the high costs they generate. Prevention is therefore important because, in addition, the number of catheters has increased considerably in recent years. Objectives: We carried out this study in our unit to analyse: • Efficacy of closed-system connectors (TEGO®) in the prevention of catheter-related bacteraemia. • Incidence of Staphylococcus aureus and most frequent infection-causing germs. Material and method: A transversal retrospective comparative study was carried out over 800 days, which we divided into two equal periods. In the first 400 days, the unit protocol was applied to 24 patients and in the next 400 days the same protocol was applied plus the above-mentioned connectors to 25 patients. In both periods, 19 of the patients were the same. Results: In the first period, 4 infections were counted in 7062 catheter days and in the second period, 2 infections in 8622 catheter days. Bacteraemia index in each period: 0.56/1000 and 0.23/1000 respectively. No Staphylococcus aureus infection occurred, the most frequent germ being Coagulase-negative Staphylococcus . Conclusion: Our conclusion is that the connectors were effective in preventing bacteraemia as they notably reduced our already low indices (AU)

Improving outcomes for patients receiving transarterial chemoembolization for hepatocellular carcinoma.

Hepatocellular carcinoma is a cancer with increasing incidence in the veteran population. This type of cancer can be treated with transarterial chemoembolization, an invasive procedure performed by specially trained interventional radiologists. The most common serious complications are liver failure, sepsis secondary to ischemic cholecystitis or liver abscess, gastrointestinal bleeding, and death. However, nursing staff and physicians often have little or no experience in caring for patients in the hospital who have had this procedure. Patient safety can be threatened by this lack of knowledge. Sources of threat to patient safety are described by the Institute of Medicine as falling into 4 categories: management, workforce, work processes, and organizational culture. To promote patient safety, defenses need to be deployed to address each category. In this article, the author provides a case example, describes threats to the patient's safety, and describes a plan to improve the care of all patients undergoing this procedure.

Developing blood borne virus services across prisons in Wales, UK.

PURPOSE: This paper aims to describe the strategies being put in place to develop blood borne virus (BBV) services across prisons in Wales, UK, in response to the recommendations for prisons within the Welsh Government's Blood Borne Viral Hepatitis Action Plan for Wales. DESIGN/METHODOLOGY/APPROACH: A task and finish group was established to ensure multidisciplinary engagement between healthcare and custody staff. A service improvement package was developed focusing on awareness raising and/or development of clinical services for prisoners, prison officers and prison healthcare staff. FINDINGS: Prison healthcare staff have undergone training in BBVs and are being supported to deliver clinical services to prisoners. Training has been delivered in pre/post test discussion and dried blood spot testing; care pathways have been established between prison and community specialists for treatment referrals. An e-learning module is being rolled out to raise awareness amongst custody staff and encourage occupational hepatitis B vaccination. Literature on "liver health" has been produced to be given to every prisoner across Wales. SOCIAL IMPLICATIONS: It is envisaged that BBV services will become a routine part of prison care in Wales. Data on activity are being collected for evaluation and it is hoped that tackling BBVs in prisons will help reduce rates of infection both within prisons and in the wider community. ORIGINALITY/VALUE: This paper describes new initiatives that have been established to tackle BBVs across Welsh prisons and will be relevant to any prison healthcare staff looking to develop similar services.

Use of a 1-piece chlorhexidine gluconate transparent dressing on critically ill patients.

BACKGROUND: New transparent dressings with chlorhexidine gluconate in the dressing are available. OBJECTIVES: To compare the effectiveness of a new 1-piece occlusive dressing that incorporates chlorhexidine gluconate with that of a dressing plus a chlorhexidine gluconate patch in maintaining the low rate of catheter-related bloodstream infections in the intensive care unit and to evaluate nurses' satisfaction with and cost of the new dressing. METHODS: A quality improvement observational study was done in an adult medical-surgical intensive care unit. All patients with a central venous catheter had initial and/or subsequent dressing changes done with the new dressing. The central catheter bundle elements of the Institute for Healthcare Improvement were followed. Patients were monitored for catheter-related bloodstream infections, and the rate of infection was calculated. RESULTS: During the study period of 1881 device days, the infection rate was 0.051 per 1000 device days, compared with a rate of 0.052 in 2008. Nurses preferred the new dressing. Cost savings were $3807. CONCLUSION: A low rate of catheter-related bloodstream infections can be maintained, nurses' satisfaction achieved, and cost savings realized with the new dressing.