Prolonged use of intravenous administration sets on central line associated bloodstream infection, nursing workload and material use: A before-after study.

OBJECTIVES: One of the interventions to reduce risk of central line associated bloodstream infection (CLABSI) is routine replacement of the intravenous administration sets. Guidelines advises a time interval that ranges between four and seven days. However many hospitals replace intravenous administration sets every four days to prevent CLABSI. RESEARCH METHODOLOGY: In this single centre retrospective study we analysed whether the extension of the time interval from four to seven days for routine replacement of intravenous administration sets had impact on the incidence of CLABSI and colonization of the central venous catheter. Secondary outcomes were the effects on nursing workload, material use and costs. RESULTS: In total, 1,409 patients with 1,679 central lines were included. During the pre-intervention period 2.8 CLABSI cases per 1,000 catheter days were found in comparison with 1.3 CLABSI cases per 1,000 catheter days during the post-intervention period. The rate difference between the groups was 1.52 CLABSI cases per 1,000 catheter days (95% CI: -0.50 to +4.13, p = 0.138). The intervention resulted in a saving of 345 intravenous single use plastic administration sets and 260 hours nursing time, and reduced cost with an estimate of at least 17.250 Euros. CONCLUSION: Extension of the time interval from four to seven days for routine replacement of intravenous administration sets did not negatively affect the incidence of CLABSI. IMPLICATIONS FOR CLINICAL PRACTICE: Additional benefits of the prolonged time interval were saving of nursing time by avoiding unnecessary routine procedures, the reducing of waste because of reducing the use of disposable materials and healthcare costs.

Does decreasing the frequency of changing intravenous administration sets (>24 h) increase the incidence of sepsis in neonates receiving total parenteral nutrition?

BACKGROUND: The optimal timing for changing intravenous (IV) administration sets that contain total parenteral nutrition (TPN), with and without lipids, in neonates remains unknown. OBJECTIVE: To determine whether decreasing the frequency of changing IV administration sets (>24 h versus every 24 h) in neonates increases the incidence of sepsis within seven days of discontinuation of TPN and microbial contamination of the infusate. METHODS: The databases searched to identify studies that evaluated the frequency of IV administration sets on sepsis and microbial contamination of the infusate included MEDLINE, EMBASE, CINAHL, Cochrane Library, Scopus and Web of Science. The Evidence Evaluation Worksheet adapted from the American Heart Association's International Liaison Committee on Resuscitation was used to evaluate eligible studies for quality, level of evidence and direction of support. RESULTS: Two studies were reviewed; however, neither of the studies reported on the outcome of sepsis. One study reported that changing IV administration sets every 48 h did not increase the rate of infusate (amino acid or lipid) contamination compared with change every 24 h, while the other study reported an increase in the lipid infusate contamination rate when IV administration sets were changed every 72 h. CONCLUSIONS: There is insufficient evidence to support or refute routinely changing IV administration sets every 48 h or that decreasing the frequency of set changes increases the incidence of sepsis.

HISTORIQUE: On ne connaît pas le moment optimal pour changer les dispositifs de transfusion intraveineuse (IV) de l'alimentation parentérale totale (APT), avec et sans lipides, chez les nouveau-nés. OBJECTIF: Déterminer si le fait de réduire la fréquence des changements de dispositif de transfusion IV (plus de 24 heures plutôt que toutes les 24 heures) chez les nouveau-nés accroît l'incidence de septicémie dans les sept jours suivant l'arrêt de l'APT ainsi que la contamination microbienne du soluté. MÉTHODOLOGIE: Les chercheurs ont consulté les bases de données MEDLINE, EMBASE, CINAHL, Bibliothèque Cochrane, Scopus et Web of Science pour repérer les études qui évaluaient la fréquence des changements de dispositif de transfusion IV sur la septicémie et la contamination microbienne du soluté. Ils ont utilisé la feuille d'évaluation des données probante adaptée de l'International Liaison Committee on Resuscitation de l'American Heart Association pour déterminer les études admissibles en matière de qualité, de qualité des preuves et d'orientation du soutien. RÉSULTATS: Les chercheurs ont analysé deux études, mais aucune des deux ne signalait l'issue de la septicémie. Une étude a établi que le fait de changer le dispositif de transfusion IV toutes les 48 heures n'accroissait pas le taux de contamination du soluté (acide aminé ou lipide) par rapport à un changement toutes les 24 heures, tandis que l'autre étude indiquait une augmentation du taux de contamination du soluté de lipide lorsque le dispositif de transfusion IV était changé toutes les 72 heures. CONCLUSIONS: Les données probantes sont insuffisantes pour étayer ou réfuter les changements systématiques de dispositif de transfusion IV toutes les 48 heures ou établir que la diminution de la fréquence des changements de dispositif de transfusion accroît l'incidence de septicémie.