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1.
Br J Nurs ; 29(2): S24-S26, 2020 Jan 23.
Artículo en Inglés | MEDLINE | ID: mdl-31972108

RESUMEN

PURPOSE: Preventing CLABSI events in the dialysis inpatient population represents significant challenges. Bacteremia associated with lines or grafts are common health-associated infections that lead to adverse patient outcomes. Dialysis patients represent a much higher infection risk due to health frequency needs, more frequent hospitalizations, multiple comorbidity issues, fistula functionality, and multiple attempts for line access leading to additional complications, costs, morbidity, and mortality. METHODS: An observational study was conducted including central line device days, CLABSI events, and possible confounding variables in admitted dialysis patients. All CLABSI data were identified according to the Centers for Disease Control and Prevention's National Healthcare Safety Network's definitions for CLABSIs. The intervention involved the removal of 70% alcohol swabs and alcohol hub disinfecting caps, then replacing with swabs containing 3.15% chlorhexidine gluconate/70% alcohol for central line hub disinfection and vascular graft access skin disinfection. RESULTS: The 5-year preintervention period (2008-2012) involved 7568 central line days, 11 CLABSI events, and a 1.45 per 1000 device day rate. The 6-month trial period involved 1559 central line days and no CLABSI events. The 5-year postimplementation period (2013-2017) involved 9787 central line days, 5 CLABSI events, and a 0.51 per 1000 device day rate. The postimplementation period represented a statistically significant (P value=0.0493) reduction with 65% fewer CLABSI events compared with the preimplementation period. LIMITATIONS: A limitation was variations in scrub time and dry time during central venous catheter hub access. While we were comparing 2 products, behavioral practices using these 2 products were possible influencers and represent a possible confounding variable. CONCLUSIONS: This study found that using alcohol with chlorhexidine gluconate prior to accessing central line hubs and vascular grafts allows for reduction in CLABSI events and sustains statistically significant lower CLABSI rates in the inpatient dialysis population. HIGHLIGHTS Using alcohol with chlorhexidine gluconate (CHG) before accessing central line hubs helps reduce central line-associated bloodstream infection (CLABSI) events Using alcohol with CHG before accessing vascular grafts helps reduce CLABSI events A statistically significant reduction (65%) in CLABSI events occurred after use. Statistically significant lower CLABSI rates are sustainable with use of alcohol with CHG.


Asunto(s)
Bacteriemia/prevención & control , Infecciones Relacionadas con Catéteres/prevención & control , Infección Hospitalaria/prevención & control , Desinfección/métodos , Diálisis Renal/enfermería , Alcoholes/administración & dosificación , Cateterismo Venoso Central/efectos adversos , Clorhexidina/administración & dosificación , Clorhexidina/análogos & derivados , Humanos , Investigación en Evaluación de Enfermería
2.
Nephrol Nurs J ; 46(6): 587-590, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31872988

RESUMEN

Central venous catheter (CVC) vascular access is common among patients on hemodialysis. CVC use carries a substantial risk of central line-associated bloodstream infections (CLABSIs), costly events that place patients at a high risk of mortality. Our hospital and dialysis organization developed a cooperative strategy to reduce the rate of CLABSI among hospitalized patients on hemodialysis with a CVC. The program included the use of training and reporting tools to guide hospital staff with CLABSI prevention, as well as leadership committees to oversee the process. Fourteen CLABSIs were reported in the 17-month period prior to the implementation of the program, while no new CLABSIs occurred in the 30 months following implementation of the program. This prevention program effectively reduced the frequency of CLABSIs. Broader implementation of such programs may result in better outcomes and lower costs for hospitalized patients on hemodialysis.


Asunto(s)
Bacteriemia , Infecciones Relacionadas con Catéteres , Cateterismo Venoso Central , Catéteres Venosos Centrales , Bacteriemia/prevención & control , Infecciones Relacionadas con Catéteres/prevención & control , Humanos , Diálisis Renal
3.
Br J Nurs ; 28(19): S22-S28, 2019 Oct 24.
Artículo en Inglés | MEDLINE | ID: mdl-31647725

RESUMEN

Health professionals are responsible for preventing and minimising complications related to vascular access devices. This is important from the perspectives of both the patient and the health economy. Practitioners have many tools at their disposal and evidence is available to assist in using these tools to enhance best practice. A relatively new tool has been acknowledged as having a role in vascular access as well as previously recognised roles in other areas of healthcare. Cyanoacrylate tissue adhesive has been approved for use with vascular access devices and the benefits of this aid to device securement are now being recognised.


Asunto(s)
Cateterismo Venoso Central/métodos , Cianoacrilatos/uso terapéutico , Adhesivos Tisulares/uso terapéutico , Adulto , Anciano , Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/instrumentación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto Joven
4.
Top Spinal Cord Inj Rehabil ; 25(3): 228-240, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31548790

RESUMEN

Urinary tract infections (UTIs) are among the most common microbial infections in humans and represent a substantial burden on the health care system. UTIs can be uncomplicated, as when affecting healthy individuals, or complicated, when affecting individuals with compromised urodynamics and/or host defenses, such as those with a urinary catheter. There are clear differences between uncomplicated UTI and catheter-associated UTI (CAUTI) in clinical manifestations, causative organisms, and pathophysiology. Therefore, uncomplicated UTI and CAUTI cannot be approached similarly, or the risk of complications and treatment failure may increase. It is imperative to understand the key aspects of each condition to develop successful treatment options and improve patient outcomes. Here, we will review the epidemiology, pathogen prevalence, differential mechanisms used by uropathogens, and treatment and prevention of uncomplicated UTI and CAUTI.


Asunto(s)
Infecciones Relacionadas con Catéteres/microbiología , Infecciones Relacionadas con Catéteres/prevención & control , Infecciones Urinarias/microbiología , Infecciones Urinarias/prevención & control , Antibacterianos/uso terapéutico , Humanos , Inmunoterapia , Inmunoterapia Activa
5.
Lancet ; 394(10208): 1530-1539, 2019 10 26.
Artículo en Inglés | MEDLINE | ID: mdl-31522843

RESUMEN

BACKGROUND: Insertion of a ventriculoperitoneal shunt for hydrocephalus is one of the commonest neurosurgical procedures worldwide. Infection of the implanted shunt affects up to 15% of these patients, resulting in prolonged hospital treatment, multiple surgeries, and reduced cognition and quality of life. Our aim was to determine the clinical and cost-effectiveness of antibiotic (rifampicin and clindamycin) or silver shunts compared with standard shunts at reducing infection. METHODS: In this parallel, multicentre, single-blind, randomised controlled trial, we included patients with hydrocephalus of any aetiology undergoing insertion of their first ventriculoperitoneal shunt irrespective of age at 21 regional adult and paediatric neurosurgery centres in the UK and Ireland. Patients were randomly assigned (1:1:1 in random permuted blocks of three or six) to receive standard shunts (standard shunt group), antibiotic-impregnated (0·15% clindamycin and 0·054% rifampicin; antibiotic shunt group), or silver-impregnated shunts (silver shunt group) through a randomisation sequence generated by an independent statistician. All patients and investigators who recorded and analysed the data were masked for group assignment, which was only disclosed to the neurosurgical staff at the time of operation. Participants receiving a shunt without evidence of infection at the time of insertion were followed up for at least 6 months and a maximum of 2 years. The primary outcome was time to shunt failure due the infection and was analysed with Fine and Gray survival regression models for competing risk by intention to treat. This trial is registered with ISRCTN 49474281. FINDINGS: Between June 26, 2013, and Oct 9, 2017, we assessed 3505 patients, of whom 1605 aged up to 91 years were randomly assigned to receive either a standard shunt (n=536), an antibiotic-impregnated shunt (n=538), or a silver shunt (n=531). 1594 had a shunt inserted without evidence of infection at the time of insertion (533 in the standard shunt group, 535 in the antibiotic shunt group, and 526 in the silver shunt group) and were followed up for a median of 22 months (IQR 10-24; 53 withdrew from follow-up). 32 (6%) of 533 evaluable patients in the standard shunt group had a shunt revision for infection, compared with 12 (2%) of 535 evaluable patients in the antibiotic shunt group (cause-specific hazard ratio [csHR] 0·38, 97·5% CI 0·18-0·80, p=0·0038) and 31 (6%) of 526 patients in the silver shunt group (0·99, 0·56-1·74, p=0·96). 135 (25%) patients in the standard shunt group, 127 (23%) in the antibiotic shunt group, and 134 (36%) in the silver shunt group had adverse events, which were not life-threatening and were mostly related to valve or catheter function. INTERPRETATION: The BASICS trial provides evidence to support the adoption of antibiotic shunts in UK patients who are having their first ventriculoperitoneal shunt insertion. This practice will benefit patients of all ages by reducing the risk and harm of shunt infection. FUNDING: UK National Institute for Health Research Health Technology Assessment programme.


Asunto(s)
Infecciones Relacionadas con Catéteres/prevención & control , Stents Liberadores de Fármacos/economía , Derivación Ventriculoperitoneal/economía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Infecciones Relacionadas con Catéteres/sangre , Infecciones Relacionadas con Catéteres/líquido cefalorraquídeo , Niño , Preescolar , Análisis Costo-Beneficio , Stents Liberadores de Fármacos/efectos adversos , Femenino , Humanos , Hidrocefalia/cirugía , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Plata/economía , Método Simple Ciego , Derivación Ventriculoperitoneal/efectos adversos , Adulto Joven
6.
BMC Health Serv Res ; 19(1): 636, 2019 Sep 05.
Artículo en Inglés | MEDLINE | ID: mdl-31488150

RESUMEN

BACKGROUND: Peripheral intravenous catheters (PIVCs) account for a mean of 38% of catheter associated bloodstream infections (CABSI) with Staphylococcus aureus, which are preventable if deficiencies in best practice are addressed. There exists no feasible and reliable quality surveillance tool assessing all important areas related to PIVC quality. Thus, we aimed to develop and test feasibility and reliability for an efficient quality assessment tool of overall PIVC quality. METHODS: The Peripheral Intravenous Catheter- mini Questionnaire, PIVC-miniQ, consists of 16 items calculated as a sum score of problems regarding the insertion site, condition of dressing and equipment, documentation, and indication for use. In addition, it contains background variables like PIVC site, size and insertion environment. Two hospitals tested the PIVC-miniQ for feasibility and inter-rater agreement. Each PIVC was assessed twice, 2-5 min apart by two independent raters. We calculated the intraclass correlation coefficient (ICC) for each hospital and overall. For each of the 16 items, we calculated negative agreement, positive agreement, absolute agreement, and Scott's pi. RESULTS: Sixty-three raters evaluated 205 PIVCs in 177 patients, each PIVC was assessed twice by independent raters, in total 410 PIVC observations. ICC between raters was 0.678 for hospital A, 0.577 for hospital B, and 0.604 for the pooled data. Mean time for the bedside assessment of each PIVC was 1.40 (SD 0.0007) minutes. The most frequent insertion site symptom was "pain and tenderness" (14.4%), whereas the most prevalent overall problem was lack of documentation of the PIVC (26.8%). Up to 50% of PIVCs were placed near joints (wrist or antecubital fossae) or were inserted under suboptimal conditions, i.e. emergency department or ambulance. CONCLUSIONS: Our study highlights the need for PIVC quality surveillance on ward and hospital level and reports the PIVC-miniQ to be a reliable and time efficient tool suitable for frequent point-prevalence audits.


Asunto(s)
Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Periférico/normas , Adulto , Servicio de Urgencia en Hospital/normas , Estudios de Factibilidad , Femenino , Hospitales/normas , Humanos , Masculino , Persona de Mediana Edad , Noruega , Reproducibilidad de los Resultados , Infecciones Estafilocócicas/prevención & control , Staphylococcus aureus , Encuestas y Cuestionarios/normas
7.
Artículo en Inglés | MEDLINE | ID: mdl-31500390

RESUMEN

Reusable tourniquets and conventional securement dressings are considered risk factors for the occurrence of reported complications and catheter-related bloodstream infections. This study's purpose is to assess the impact of single-use disposable tourniquets and advanced occlusive polyurethane dressings with reinforced cloth borders on peripheral intravenous catheter (PIVC)-related complications and contamination. A pre- and post-interventional prospective observational study was conducted in a cardiology ward of a tertiary hospital between April 2018 and February 2019. Overall, demographic and clinical data from 156 patients and PIVC-related outcomes were collected (n = 296) as well as PIVC tips for microbiological analysis (n = 90). In the pre-intervention phase (n = 118), complication rates of 62.1% were reported, while 44.1% of the PIVCs were contaminated (n = 34). In the post-intervention phase (n = 178), complication rates decreased to 57.3%, while contamination rates significantly decreased to 17.9% (p = 0.014; n = 56). Through a logistic regression, it was found that the use of innovative technologies reduces the chance of PIVC contamination by 79% (odds ratio (OR): 0.21; 95% confidence interval (CI): 0.05-0.98; p = 0.046). Meanwhile, PIVC-related complications and fluid therapy emerged as predictors for PIVC contamination. Findings suggest that the adoption of these innovative devices in nurses' practice contributes to the significant reduction of PIVC contamination.


Asunto(s)
Vendajes , Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Periférico/efectos adversos , Cateterismo Periférico/métodos , Torniquetes , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Poliuretanos , Estudios Prospectivos , Factores de Riesgo , Centros de Atención Terciaria
8.
J Appl Microbiol ; 127(6): 1876-1888, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31502331

RESUMEN

AIMS: To investigate the efficiency of triclosan, ethylenediaminetetraacetic acid (EDTA) and cranberry alone or in combinations against Escherichia coli strains as urinary catheter lock solutions to reduce catheter-associated urinary tract infections. METHODS AND RESULTS: Viable counting was used to assess antibiofilm activities for triclosan, EDTA and cranberry alone or in combinations against E. coli strains embedded in biofilm onto all-silicon Foley catheter surface. The results revealed that combination of triclosan (10 mg ml-1 /EDTA 30 mg ml-1 ) when filling the catheter balloon was able to eradicate and prevent biofilm formation among all tested E. coli including the resistant strains, whereas triclosan (8·5 mg ml-1 )/ cranberry (103 mg ml-1 ) combination was a successful catheter lock solution by preventing all tested strains from adhering onto catheter surface when filled via the eye hole. CONCLUSIONS: The combinations of triclosan/EDTA and triclosan/cranberry were significantly effective in eradicating and preventing biofilm formation of the tested E. coli strains on Foley catheters. SIGNIFICANCE AND IMPACT OF THE STUDY: Combinations of triclosan/EDTA and triclosan/cranberry have a promising application as nonantibiotic catheter lock solution.


Asunto(s)
Biopelículas/efectos de los fármacos , Catéteres/microbiología , Ácido Edético/farmacología , Triclosán/farmacología , Vaccinium macrocarpon/química , Antibacterianos/farmacología , Biopelículas/crecimiento & desarrollo , Infecciones Relacionadas con Catéteres/prevención & control , Escherichia coli/efectos de los fármacos , Escherichia coli/crecimiento & desarrollo , Humanos
9.
Expert Rev Med Devices ; 16(9): 809-820, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31478395

RESUMEN

Introduction: Catheter-associated urinary tract infection (CAUTI) is one of the most common nosocomial infections in hospitals, accounting for 36% of all health care-associated infections. Areas covered: We aimed to address the potential impact of antimicrobial coating of catheter materials for the prevention of CAUTI and to analyze the progress made in this field. We conducted literature searches in the PubMed, Embase, and Cochrane Library databases, and found 578 articles. Data from 60 articles in either the preclinical or clinical stage were analyzed in this expert review. Expert opinion: The literature review revealed many promising methods for preventing CAUTI. Recent studies have suggested the combination of silver-based products and antibiotics, owing to their synergistic effect, to help address the problem of antibiotic resistance. Other coating materials that have been tested include nitric oxide, chlorhexidine, antimicrobial peptides, enzymes, and bacteriophages. Because of heterogeneity among studies, it is difficult to reliably comment on the clinical efficacy of different coating materials. Future research should focus on double-blind randomized clinical trials for evaluating the role of these potential coating agents.


Asunto(s)
Antiinfecciosos/farmacología , Infecciones Relacionadas con Catéteres/prevención & control , Materiales Biocompatibles Revestidos/farmacología , Catéteres Urinarios/microbiología , Infecciones Urinarias/prevención & control , Animales , Infecciones Relacionadas con Catéteres/microbiología , Humanos , Plata/farmacología
10.
Lett Appl Microbiol ; 69(4): 271-278, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31385615

RESUMEN

Antifungal lock therapy has received significant interest in the last few years because the frequently usage of intravascular devices is associated with an increasing number of catheter-related bloodstream infections caused by Candida species. Antifungal combinations with synergistic interaction can be a good choice for antifungal lock therapy; therefore, interactions were examined between two echinocandins (caspofungin and micafungin) and the chitin synthesis inhibitor nikkomycin Z against Candida albicans and C. parapsilosis biofilms. Susceptibility was evaluated using the XTT-based checkerboard microdilution method, while the nature of interactions was assessed by calculating fractional inhibitory concentration indices and using the Bliss independence model. Mathematic-based evaluations were supplemented with fluorescent LIVE/DEAD viability assay. The results obtained by statistical interaction analyses correlated well with the viability assay. The tested echinocandins with nikkomycin Z caused an extended cell death and the structure of the biofilm was sparse compared to the control, especially for C. albicans. The findings support the simultaneous usage of nikkomycin Z and caspofungin or micafungin in alternative therapies such as the antifungal lock therapy. SIGNIFICANCE AND IMPACT OF THE STUDY: Antifungal lock therapy can be a potential therapeutic approach to eradicate the intraluminal Candida biofilms; however, there is no approved lock strategy against fungal species so far. The results of this study provide valuable evidence that nikkomycin Z acts synergistically in combination with caspofungin or micafungin against biofilms. In addition, this synergy was more pronounced for micafungin combined with nikkomycin Z. Therefore, nikkomycin Z can be considered as a potential agent in antifungal lock therapy especially with micafungin against C. albicans or C. parapsilosis biofilms.


Asunto(s)
Aminoglicósidos/farmacología , Antifúngicos/farmacología , Biopelículas/crecimiento & desarrollo , Candida albicans/efectos de los fármacos , Candida parapsilosis/efectos de los fármacos , Caspofungina/farmacología , Micafungina/farmacología , Infecciones Relacionadas con Catéteres/tratamiento farmacológico , Infecciones Relacionadas con Catéteres/microbiología , Infecciones Relacionadas con Catéteres/prevención & control , Sinergismo Farmacológico , Humanos , Pruebas de Sensibilidad Microbiana
11.
Int J Infect Dis ; 87: 154-165, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31442627

RESUMEN

OBJECTIVES: It remains uncertain which catheter lock solution (CLS) to prevent catheter-related bloodstream infections (CRBSI) works best and is safest for patients. This study was performed to compare the efficacy of different CLSs for the prevention of CRBSI and ranked these CLSs for practical consideration. METHODS: The PubMed, Web of Science, Embase, and MEDLINE databases, earlier relevant meta-analyses, and the reference lists of included studies were searched. The primary outcome was CRBSI; secondary outcomes were catheter-related thrombosis and exit-site infections. A network meta-analysis was performed to estimate odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: A total of 52 randomized controlled trials involving 9099 patients and evaluating 13 CLSs (single and combinations) were included. With regard to the quality of the evidence, the risk of bias was typically low or unclear (45 out of 52 trials, 86.5%). In the network meta-analysis, saline (OR 8.44, 95% CI 2.19-32.46), gentamicin+citrate (OR 2.92, 95% CI 1.32-6.42), ethanol (OR 5.33, 95% CI 1.22-23.32), and cloxacillin+heparin (OR 2.07, 95% CI 1.19-5.49) were associated with a greater effect on CRBSI than heparin. CONCLUSIONS: This network meta-analysis showed that minocycline-ethylenediaminetetraacetic acid (EDTA) seemed to be the most effective for the prevention of CRBSI and exit-site infection, and cefotaxime+heparin seemed to be the most effective for catheter-related thrombosis.


Asunto(s)
Antibacterianos/administración & dosificación , Bacteriemia/prevención & control , Infecciones Relacionadas con Catéteres/prevención & control , Humanos , Metaanálisis en Red , Ensayos Clínicos Controlados Aleatorios como Asunto
12.
J Infus Nurs ; 42(2): 249-253, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31464833

RESUMEN

Every health care facility aims to achieve and maintain a zero central line-associated bloodstream infection (CLABSI) rate. Infections can be costly for institutions of any size and are often not covered by health insurance. The interventions put in place in this quality improvement project were implemented in 4 phases: (1) develop a new standard of care for central lines and give nurses full responsibility for the care and handling of these lines (including blood sampling); (2) revise policy and provide educational sessions to support nurses; (3) document compliance with the new policy; and (4) document CLABSI rates. The project took place during a 15-month period between January 1, 2016 and March 30, 2017, in 4 critical care units in a university medical center in Lebanon. The results revealed a reduction in CLABSI rates from a maximum rate of more than 17 per 1000 catheter days to zero per 1000 catheter days, which was sustained for 10 months. Nurse compliance with the new policy after 3 months ranged from 95% to 99%.


Asunto(s)
Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/normas , Enfermería de Cuidados Críticos/educación , Adhesión a Directriz/normas , Control de Infecciones/normas , Unidades de Cuidados Intensivos , Centros Médicos Académicos , Adulto , Adhesión a Directriz/estadística & datos numéricos , Humanos , Líbano , Mejoramiento de la Calidad
13.
Medicine (Baltimore) ; 98(32): e15837, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31393341

RESUMEN

Peripherally inserted central catheters (PICCs) can provide nutritional and medical support for very low birth weight or critically ill newborns. The aim of this study was to retrospectively analyze the use of PICCs in our clinic for critically ill newborns to evaluate the relationship between catheter related factors and the occurrence of complications.Retrospective analysis was conducted for all newborns consecutively admitted at the Neonatal Intensive Care Unit (NICU), Chongqing Health Center for Women and Children, who underwent PICC insertion between May 2011 and March 2018. Data collected included total puncture success rate, one puncture success rate, infection rate, complication rate, unplanned catheter withdrawal rate, device days, and catheter indwelling time.Five-hundred eighty-eight infants (304 males and 284 females) aged 3.4 ±â€Š3.9 days, mean gestational age of 30.9 ±â€Š2.7 weeks and a mean body mass of 1.38 ±â€Š0.47 kg at insertion were included. Total puncture success rate was 99.65%, one puncture success rate was 77.77%. The mean catheter retention was 13.6 ±â€Š6.7 days: more than 30 days in 15 (2.61%) cases, 20 to 30 days in 60 (10.43%) cases, 10 to 19 days in 372 (64.70%) cases, and 62 days in 1 case. Complications occurred in 63 (10.71%) cases: with PICC insertion within 24 hours after birth in 29 (15.43%), within 48 hours in 13 (6.63%), and after 48 hours in 21 (10.99%) cases. Catheter tip culture was positive in 3 cases and there was 1 case of catheter-related bloodstream infection.Nursing measures of the maintenance of body temperature and the evaluation of blood vessels were important conditions for improving the success rate of one puncture in critically ill neonates. PICC catheterization as early as 48 hours will not increase the difficulty of PICC puncture. Nor did it increase the incidence of PICC complications.


Asunto(s)
Cateterismo Periférico/estadística & datos numéricos , Catéteres de Permanencia/estadística & datos numéricos , Enfermedad Crítica , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/prevención & control , Catéteres de Permanencia/efectos adversos , Femenino , Edad Gestacional , Humanos , Recién Nacido , Recién Nacido de muy Bajo Peso , Masculino , Estudios Retrospectivos
14.
Future Microbiol ; 14: 1023-1034, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31469013

RESUMEN

Aim: This study proposes the impregnation of Foley catheters with chlorpromazine (CPZ) to control biofilm formation by Escherichia coli, Proteus mirabilis and Klebsiella pneumoniae. Materials & methods: The minimum inhibitory concentrations (MICs) for CPZ and the effect of CPZ on biofilm formation were assessed. Afterward, biofilm formation and the effect of ciprofloxacin and meropenem (at MIC) on mature biofilms grown on CPZ-impregnated catheters were evaluated. Results: CPZ MIC range was 39.06-625 mg/l. CPZ significantly reduced (p < 0.05) biofilm formation in vitro and on impregnated catheters. In addition, CPZ-impregnation potentiated the antibiofilm activity of ciprofloxacin and meropenem. Conclusion: These findings bring perspectives for the use of CPZ as an adjuvant for preventing and treating catheter-associated urinary tract infections.


Asunto(s)
Antiinfecciosos/administración & dosificación , Biopelículas/efectos de los fármacos , Infecciones Relacionadas con Catéteres/prevención & control , Clorpromazina/administración & dosificación , Infecciones por Enterobacteriaceae/prevención & control , Cateterismo Urinario/métodos , Infecciones Urinarias/prevención & control , Biopelículas/crecimiento & desarrollo , Escherichia coli/efectos de los fármacos , Escherichia coli/crecimiento & desarrollo , Humanos , Klebsiella pneumoniae/efectos de los fármacos , Klebsiella pneumoniae/crecimiento & desarrollo , Pruebas de Sensibilidad Microbiana , Proteus mirabilis/efectos de los fármacos , Proteus mirabilis/crecimiento & desarrollo
15.
World Neurosurg ; 131: e474-e481, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31382072

RESUMEN

OBJECTIVE: To lower external ventricular drain (EVD)-related infection rates, in April 2013, our institution enacted a major protocol change, switching from routine EVD replacement every 5 days to EVD replacement only when clinically indicated. In the present study, we evaluated the effect of this change on nosocomial EVD-related infections. METHODS: We performed a retrospective cohort study to compare the EVD-related infection rates between 2 groups (group A, elective EVD replacement; group B, clinically indicated EVD replacement). We analyzed the data from 142 patients (group A, n = 43; group B, n = 99), with a total of 227 EVDs for 5 years and 3 months (1721 catheter days). RESULTS: The overall EVD-related infection rates were elevated in group A (0.14; 32% of patients) compared with group B (0.08; 8%; P = 0.001). The median hospital stay (33 vs. 24 days; P = 0.001) and neurosurgical intensive care unit stay (30.5 vs. 17 days; P < 0.0001) were also longer for group A. The requirement for multiple EVDs was an independent risk factor (P = 0.003), with a 4.6 times greater risk in group A (odds ratio, 4.64; 95% confidence interval, 1.7-12.6). CONCLUSIONS: The findings from our study strengthen an increasing body of evidence suggesting the importance of inoculation of skin flora as a critical risk factor for EVD-related infections, underscoring the importance of drain changes only when clinically indicated and that, as soon as clinically permitted, catheters should be removed.


Asunto(s)
Infecciones Relacionadas con Catéteres/prevención & control , Ventriculitis Cerebral/prevención & control , Infección Hospitalaria/prevención & control , Meningitis/prevención & control , Reoperación/métodos , Infección de la Herida Quirúrgica/prevención & control , Ventriculostomía/métodos , Adulto , Anciano , Líquido Cefalorraquídeo/metabolismo , Líquido Cefalorraquídeo/microbiología , Técnicas de Cultivo , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo
17.
Br J Nurs ; 28(14): S22-S27, 2019 Jul 25.
Artículo en Inglés | MEDLINE | ID: mdl-31348703

RESUMEN

Catheter-related bloodstream infections (CRBSIs) are a signification cause of infection. When CRBSI rates are high, the cost to the patient and the organisation can be significant. More than ever before, there is a high demand for vascular access. Advances in treatment often entail extended indwell times for central vascular access devices. The care and maintenance of these devices is crucial in avoiding complications such as infection. Using care bundles in conjunction with other simple interventions, such as passive disinfecting caps, can help reduce CRBSI rates. The published evidence demonstrates that passive disinfecting caps can help reduce infection rates associated with different types of central venous catheters by protecting needlefree connectors from colonisation by pathogens and serving as a clear indicator that the line has been disinfected.


Asunto(s)
Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/instrumentación , Catéteres Venosos Centrales , Desinfección/métodos , Cateterismo Venoso Central/efectos adversos , Catéteres Venosos Centrales/efectos adversos , Diseño de Equipo , Humanos
18.
J Infus Nurs ; 42(4): 193-196, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31283661

RESUMEN

Central line-associated bloodstream infections (CLABSIs) account for one-third of all hospital-acquired infections and can cost the health care system between $21,000 and $100,000 per infection. A dedicated vascular access team (VAT) can help develop, implement, and standardize policies and procedures for central line usage that address insertion, maintenance, and removal as well as educate nursing staff and physicians. This article presents how 1 hospital developed a VAT and implemented evidence-based guidelines. Central line utilization decreased by 45.2%, and CLABSI incidence decreased by 90%. The results of the study demonstrated that a reduced utilization of central lines minimized the risk of patients developing a CLABSI.


Asunto(s)
Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/normas , Control de Infecciones/métodos , Grupo de Atención al Paciente/normas , Bacteriemia/prevención & control , Infecciones Relacionadas con Catéteres/epidemiología , Cateterismo Venoso Central/métodos , Adhesión a Directriz , Humanos , Estudios Retrospectivos
19.
Cardiovasc Intervent Radiol ; 42(9): 1302-1310, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31187229

RESUMEN

BACKGROUND: To evaluate risk factors of infection and effectiveness of preprocedural single-dose intravenous prophylactic antibiotic (PABX) during totally implantable venous access port (TIVAP) placement in preventing procedure-related infections. METHODS: This was a retrospective single-institution multicenter study evaluating short-term (30-day) infection outcomes after TIVAP placement. Correlation between infection rates and clinical factors, including hematologic versus non-hematologic malignancy, inpatient versus outpatient status, single versus double lumen and PABX, was investigated using univariate and multivariable analysis in the overall study population as well as the propensity-score-matched cohort. RESULTS: Overall, 5967 patients underwent TIVAP placement from 2005 to 2016, of which 3978 (67%) patients received PABX. On propensity score matching, 1952 patients with PABX were matched to the same number of patients without PABX. TIVAP was removed due to infection concern in 48 patients in unmatched and 30 patients in matched population. There was no difference in the rate of infection between those who received PABX and those who did not in both unmatched and matched population (p = 0.5387 and 0.9999). Although infection rate was significantly higher in patients who had TIVAP placement in inpatient setting (p < 0.0001), who received a double-lumen TIVAP (p < 0.0001), or who had hematologic malignancy (p = 0.0004) on univariate analysis, inpatient status was the sole factor associated with higher rate of TIVAP infection on multivariable analysis of both overall (odds ratio 2.31, p < 0.0001) and matched populations (odds ratio 4.36, p = 0.0004). CONCLUSION: Placement of TIVAP in inpatient setting increases the risk of TIVAP infection. PABX before TIVAP placement does not prevent short-term procedure-related infections.


Asunto(s)
Profilaxis Antibiótica/métodos , Infecciones Relacionadas con Catéteres/prevención & control , Catéteres de Permanencia/efectos adversos , Catéteres de Permanencia/microbiología , Dispositivos de Acceso Vascular/efectos adversos , Dispositivos de Acceso Vascular/microbiología , Profilaxis Antibiótica/estadística & datos numéricos , Estudios de Cohortes , Diseño de Equipo , Femenino , Humanos , Pacientes Internos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios/estadística & datos numéricos , Puntaje de Propensión , Estudios Retrospectivos , Factores de Riesgo
20.
Cochrane Database Syst Rev ; 5: CD004680, 2019 05 31.
Artículo en Inglés | MEDLINE | ID: mdl-31149735

RESUMEN

BACKGROUND: Peritonitis is one of the limiting factors for the growth of peritoneal dialysis (PD) worldwide and is a major cause of technique failure. Several studies have examined the effectiveness of various catheter-related interventions for lowering the risk of PD-related peritonitis. This is an update of a review first published in 2004. OBJECTIVES: To evaluate the role of different catheter implantation techniques and catheter types in lowering the risk of PD-related peritonitis in PD patients. SEARCH METHODS: We searched the Cochrane Kidney and Transplant Register of Studies up to 15 January 2019 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA: Studies comparing different catheter insertion techniques, catheter types, use of immobilisation techniques and different break-in periods were included. Studies of different PD sets were excluded. DATA COLLECTION AND ANALYSIS: Two authors independently assessed study quality and extracted data. Statistical analyses were performed using a random effects model and the results expressed as risk ratio (RR) with 95% confidence intervals (CI). MAIN RESULTS: Forty-two studies (3144 participants) were included: 18 evaluated techniques of catheter implantation, 22 examined catheter types, one assessed an immobiliser device, and one examined break-in period. In general, study quality was variable and almost all aspects of study design did not fulfil CONSORT standards for reporting.Catheter insertion by laparoscopy compared with laparotomy probably makes little or no difference to the risks of peritonitis (RR 0.90, 95% CI 0.59 to 1.35; moderate certainty evidence), exit-site/tunnel infection (RR 1.00, 95% CI 0.43 to 2.31; low certainty evidence), catheter removal/replacement (RR 1.20, 95% CI 0.77 to 1.86; low certainty evidence), technique failure (RR 0.71, 95% CI 0.47 to 1.08; low certainty evidence), and death (all causes) (RR 1.26, 95% CI 0.72 to 2.20; moderate certainty evidence). It is uncertain whether subcutaneous burying of catheter increases peritonitis (RR 1.16, 95% CI 0.37 to 3.60; very low certainty evidence). Midline insertion compared to lateral insertion probably makes little or no difference to the risks of peritonitis (RR 0.65, 95% CI 0.32 to 1.33; moderate certainty evidence) and may make little or no difference to exit-site/tunnel infection (RR 0.56, 95% CI 0.12 to 2.58; low certainty evidence). Percutaneous insertion compared with open surgery probably makes little or no difference to the exit-site/tunnel infection (RR 0.16, 95% CI 0.02 to 1.30; moderate certainty evidence).Straight catheters probably make little or no difference to the risk of peritonitis (RR 1.04, 95% CI 0.82 to 1.31; moderate certainty evidence), peritonitis rate (RR 0.91, 95% CI 0.68 to 1.21; moderate certainty evidence), risk of exit-site infection (RR 1.12, 95% CI 0.94 to 1.34; moderate certainty evidence), and exit-site infection rate (RR 1.05, 95% CI 0.77 to 1.43; moderate certainty evidence) compared to coiled catheter. It is uncertain whether straight catheters prevent catheter removal or replacement (RR 1.11, 95% CI 0.73 to 1.66; very low certainty evidence) but straight catheters probably make little or no difference to technique failure (RR 0.82, 95% CI 0.51 to 1.31; moderate certainty evidence) and death (all causes) (RR 0.95, 95% CI 0.62 to 1.46; low certainty evidence) compared to coiled catheter. Tenckhoff catheter with artificial curve at subcutaneous tract compared with swan-neck catheter may make little or no difference to peritonitis (RR 1.29, 95% CI 0.85 to 1.96; low certainty evidence) and incidence of exit-site/tunnel infection (RR 0.96, 95% CI 0.77 to 1.21; low certainty evidence) but may slightly improve exit-site infection rate (RR 0.67, 95% CI 0.50 to 0.90; low certainty evidence). AUTHORS' CONCLUSIONS: There is no strong evidence that any catheter-related intervention, including the use of different catheter types or different insertion techniques, reduces the risks of PD peritonitis or other PD-related infections, technique failure or death (all causes). However, the numbers and sizes of studies were generally small and the methodological quality of available studies was suboptimal, such that the possibility that a particular catheter-related intervention might have a beneficial effect cannot be completely ruled out with confidence.


Asunto(s)
Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo/métodos , Diálisis Peritoneal , Peritonitis/prevención & control , Catéteres de Permanencia , Humanos , Diálisis Peritoneal/instrumentación , Ensayos Clínicos Controlados Aleatorios como Asunto
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