Improving PICC use and outcomes in hospitalised patients: an interrupted time series study using MAGIC criteria.

BACKGROUND: Although important in clinical care, reports of inappropriate peripherally inserted central catheter (PICC) use are growing. OBJECTIVE: To test whether implementation of the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) can improve PICC use and patient outcomes. DESIGN: Quasi-experimental, interrupted time series design at one study site with nine contemporaneous external controls. SETTING: Ten hospitals participating in a state-wide quality collaborative from 1 August 2014 to 31 July 2016. PATIENTS: 963 hospitalised patients who received a PICC at the study site vs 6613 patients at nine control sites. INTERVENTION: A multimodal intervention (tool, training, electronic changes, education) derived from MAGIC. MEASUREMENTS: Appropriateness of PICC use and rates of PICC-associated complications. Segmented Poisson regression was used for analyses. RESULTS: Absolute rates of inappropriate PICC use decreased substantially at the study site versus controls (91.3% to 65.3% (-26.0%) vs 72.2% to 69.6% (-2.6%); P<0.001). After adjusting for underlying trends and patient characteristics, however, a marginally significant 13.8% decrease in inappropriate PICC use occurred at the study site (incidence rate ratio 0.86 (95% CI 0.74 to 0.99; P=0.048)); no change was observed at control sites. While the incidence of all PICC complications decreased to a greater extent at the study site, the absolute difference between controls and intervention was small (33.9% to 26.7% (-7.2%) vs 22.4% to 20.8% (-1.6%); P=0.036). LIMITATIONS: Non-randomised design limits inference; the most effective component of the multimodal intervention is unknown; effects following implementation were modest. CONCLUSIONS: In a multihospital quality improvement project, implementation of MAGIC improved PICC appropriateness and reduced complications to a modest extent. Given the size and resources required for this study, future work should consider cost-to-benefit ratio of similar approaches.

Mediated Electron Transfer at Vertically Aligned Single-Walled Carbon Nanotube Electrodes During Detection of DNA Hybridization.

Vertically aligned single-walled carbon nanotube (VASWCNT) assemblies are generated on cysteamine and 2-mercaptoethanol (2-ME)-functionalized gold surfaces through amide bond formation between carboxylic groups generated at the end of acid-shortened single-walled carbon nanotubes (SWCNTs) and amine groups present on the gold surfaces. Atomic force microscopy (AFM) imaging confirms the vertical alignment mode of SWCNT attachment through significant changes in surface roughness compared to bare gold surfaces and the lack of any horizontally aligned SWCNTs present. These SWCNT assemblies are further modified with an amine-terminated single-stranded probe-DNA. Subsequent hybridization of the surface-bound probe-DNA in the presence of complementary strands in solution is followed using impedance measurements in the presence of Fe(CN)6 (3-/4-) as the redox probe in solution, which show changes in the interfacial electrochemical properties, specifically the charge-transfer resistance, due to hybridization. In addition, hybridization of the probe-DNA is also compared when it is attached directly to the gold surfaces without any intermediary SWCNTs. Contrary to our expectations, impedance measurements show a decrease in charge-transfer resistance with time due to hybridization with 300 nM complementary DNA in solution with the probe-DNA attached to SWCNTs. In contrast, an increase in charge-transfer resistance is observed with time during hybridization when the probe-DNA is attached directly to the gold surfaces. The decrease in charge-transfer resistance during hybridization in the presence of VASWCNTs indicates an enhancement in the electron transfer process of the redox probe at the VASWCNT-modified electrode. The results suggest that VASWCNTs are acting as mediators of electron transfer, which facilitate the charge transfer of the redox probe at the electrode-solution interface.