Catheter Care Research Articles

1162. An Evaluation of Metrics for Catheter-Associated Urinary Tract Infections (CAUTIs): A Statewide Comparison

BackgroundThe Standardized Infection Ratio (SIR) is a metric used to gauge catheter-associated urinary tract infection (CAUTI) prevention, both locally and nationally. The device utilization ratio (DUR) is a process metric that captures catheter harm. More recently, the cumulative attributable difference (CAD) was introduced, which identifies the number of excess infections that need to be prevented to reach the desired goal. Our objective was to evaluate these metrics across all acute care hospitals in Connecticut (CT) by facility size.MethodsA CAUTI Targeted Assessment for Prevention (TAP) Report for acute care hospitals across CT was generated from 1/1/2018 to December 31/2018, using the National Healthcare Safety Network (NHSN) database. CAUTI events, SIR, DUR, and CAD were compared across all hospitals. The SIR goal of 0.75 was used to calculate the CAD. Hospitals were stratified into large ( >425 beds), medium (250 to 424 beds), and small ( <249 beds) based on the Healthcare Cost and Utilization Project NIS Description of Data Elements, Agency for Healthcare Research and Quality for urban hospitals in the northeast region.ResultsA comparison of CAUTI metrics for 29 acute care hospitals across CT is shown in Table 1. Median SIR and DUR were 0.97, 1.02, 0.77, and 22%, 14%, 14.5% for large, medium and small hospitals, respectively. Of the 20 small hospitals, SIR could not be calculated for 5 hospitals, while 2 hospitals had an SIR = 0, as they had no reported infections. Median CAD for large, medium and small hospitals was 6.17, 1.3 and 0.25, respectively. Of note, 40% of small hospitals (J – CC, as in Table 1) had a negative CAD. Interestingly, 5 of these 8 hospitals with a negative CAD had a DUR higher than 16%.ConclusionBased on CT hospital data, metrics like CAD and SIR may be more suitable for larger hospitals or hospitals with higher CAUTI events, whereas DUR may be a more useful metric for smaller hospitals or hospitals with rare events. Hospitals with high SIR and low DUR may represent a population with high-risk catheter use, poor catheter care or higher rates of urine culturing. On the other hand, hospitals with high DUR and low SIR may represent low-risk populations, better catheter care practices or lower rates of urine culturing. Ultimately, we need a combination of metrics to measure preventable catheter harm. DisclosuresLouise Dembry, MD, MS, MBA, ReadyDock: Consultant, Stock options.

1155. CAUTI Path to Zero: A Triple-Pronged Approach to Minding Our Pees and Cues

BackgroundCatheter-associated urinary tract infections (CAUTIs) account for nearly 30% of all hospital-acquired infections. From 2009 to 2013, the frequency of CAUTIs increased by 6% with associated increases in length of stay, antibiotic usage and mortality (2.3%); they are also a risk factor for secondary bloodstream infections. In 2017, the CAUTI SIR for the UTSW University hospitals was 0.990 for Clements University Hospital (CUH) and 1.224 for Zale-Lipshy (ZL), placing UTSW above the 50th percentile compared with similar academic medical centers. By the end of 2018, the aim of the quality improvement project was to reduce CAUTIs by 25% or improve the SIR to 0.78, which is at or below the 50th percentile.MethodsBaseline data included identifying indications and duration of catheter placement as well as performing debriefings on all CAUTIs along with analysis of adherence to the CAUTI bundle. Using evidence-based guidelines, the three primary interventions were (1) streamlining indications for insertion, (2) ensuring prompt removal and (3) providing alternative care pathways after removal. We observed insertion technique and catheter care; nursing services were engaged to understand barriers to catheter removal and subsequently informed of other options such as in-and-out protocols, bladder scanners and female external catheters. Nursing leadership also performed daily necessity audits of all patients with indwelling catheters.ResultsUrine output monitoring in acute/critical illness and urinary obstruction/retention were the top two indications for use. Catheter utilization rates have decreased since 2016. The average dwell time at CUH was 51 hours (excl. urology) and 40 hours at ZL. There was actually a 34% decrease in the total number of CAUTIs from 38 in 2017 to 25 in 2018, exceeding the goal of 25% reduction; the 2018 SIR for CUH was 0.818 and 0.496 for ZL. The prevention of 13 CAUTI events from 2017 to 2018 resulted in ~$180,000 savings.ConclusionSuccessful reduction of CAUTI is an interdisciplinary effort requiring consistent attention and support from infection prevention, nursing, education, quality improvement, IT and hospital administration. Empowering nursing staff, providing clear protocols post-removal and options for alternative external urinary devices is key. Disclosures All authors: No reported disclosures.

514. Shedding of Multidrug-Resistant Gram-Negative Bacilli by Colonized Patients during Procedures and Patient Care Activities

BackgroundContaminated environmental surfaces contribute to transmission of healthcare-associated pathogens such as multidrug-resistant gram-negative bacilli. We hypothesized that medical procedures and patient care activities facilitate environmental dissemination of multidrug-resistant gram-negative bacilli in hospitalized patients.MethodsWe conducted a cohort study of hospitalized patients in contact precautions for carriage of extended-spectrum β-lactamase (ESBL)-producing or carbapenem-resistant gram-negative bacilli (CR-GNB) to determine the frequency of environmental shedding during procedures and care activities. Perirectal, wound, and skin were cultured for the gram-negative bacilli of interest. Prior to each procedure or activity, surfaces in the room and portable equipment used for procedures were disinfected. After procedures, high-touch surfaces and portable equipment were cultured; negative control cultures were collected after 1 hour in the absence of a procedure.ResultsOf 60 participants, 38 (63%) were in contact precautions for ESBL-producing gram-negative bacilli and 22 (37%) for CR-GNB. Thirty-four (57%) participants had positive perirectal, wound, or skin cultures. Contamination of surfaces with the colonizing multidrug-resistant gram-negative bacilli occurred frequently during procedures and activities such as wound care, assistance with meals, and urinary catheter or colostomy care (11% to 29% of procedures/activities), whereas contamination was rare in the absence of a procedure (1%). Contamination was recovered from 6 of 56 (10%) portable devices used for procedures.ConclusionEnvironmental shedding of multidrug-resistant gram-negative bacilli occurs frequently during medical and non-medical procedures in hospitalized patients. Our results suggest that there is a need for effective strategies to disinfect surfaces and equipment after procedures.Disclosures All authors: No reported disclosures.

1153. National Trend of Urinary Catheter Device Utilization by Hospital Type, National Healthcare Safety Network (2015–2019)

BackgroundReducing unnecessary urinary catheter use and optimizing insertion techniques and catheter maintenance and care practices are the most important urinary tract infection (CAUTI) prevention strategies. To monitor device use (DU) as quality improvement activity, the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) developed the risk adjusted, standardized urinary catheter device utilization ratio in 2015. This study aims to assess national trends of DU from the baseline year 2015 through 2019.MethodsFor our trend analysis, we analyzed DU data (catheter days per 100 inpatient-days) that acute care hospitals (ACHs), long-term acute care hospitals (LTACHs), inpatient rehabilitation facilities (IRFs), and critical access hospitals (CAHs) reported to NHSN from 2015Q1 through 2019Q1. The ward and intensive care unit patient care locations included in our analysis are those that ACHs, LTACHs, IRFs and CAHs are required to report to CMS to comply with CMS Inpatient Quality Reporting program requirements. We regressed DU by quarterly period using generalized estimating equation modeling with the negative-binomial distribution, after adjusting for factors associated with corresponding SUR models of 2015 baseline and accounting for autocorrelation of error terms within a location. For graphic display, we also computed quarterly DU using marginal predictive models.ResultsThe DU decreased over time (P ≤ 0.05, average percent change per quarter (%change): −0.54 [95% CI: −0.54, −0.53]) among ACHs (Table 1, Figure 1), and −0.54 [95% CI: −0.58, −0.49] among LTACHs (Table 1, Figure 2). Among IRFs, quarterly DU in 2015Q2–2016Q3 were similar relative to 2015Q1, but decreased from 2016Q4 onward (P ≤ 0.05, % change: −0.51 [95% CI: −0.61, −0.40]) (Table 1, Figure 3). Among CAHs, quarterly DU in 2015Q2–2016Q4 were similar relative to 2015Q1, but decreased from 2017Q1 onward (P ≤ 0.05, % change: −0.22 [95% CI: −0.39, −0.04]) (Table 1, Figure 4).ConclusionThere was a statistically significant decrease in National DU of urinary catheter during 2015–2019 across NHSN, although the magnitude of change per quarter was not large. Further research is needed to explore causal factors associated with such reduction. Disclosures All authors: No reported disclosures.

Observation on the effect of DMAIC in reducing catheter-related urinary tract infection

Objective To explore the effect of DMAIC(Define, Measure, Analyze, Improve, Control) in reducing catheter-related urinary tract infection. Methods A retrospective case control method was used to select 578 patients admitted and treated in comprehensive ICU of Tianjin First Central Hospital from January to December 2018 with catheters as research objects.The 283 patients from January to June 2018 were the control group, and 295 patients from July to December 2018 were the observation group.Routine methods were used in the control group, and DMAIC method with 6 sigma management was used in the observation group. The correct rate of implementation of each measure, the utilization rate of urinary catheter and the infection rate between the two groups were compared. Results Implementation rate of early extubation assessment, urine collection accuracy, urine tube fixed correctly, urine tube cleaning time, urine collection bags location accuracy were 60.42%(171/283), 69.61%(197/283), 79.86%(226/283), 89.40%(253/283), 92.58%(262/283)in the control group, 80.34%(237/295), 90.85%(268/295), 94.92%(280/295), 96.27%(284/295), 97.97%(289/295) in the observation group, the differences were statistically significant (χ2= 9.411-41.415, P < 0.01). The rate of urinary catheter usage was 75.31%(3 856/5 120) in the observation group and 82.60%(4 098/4 961) in the control group, the differences was statistically significant (χ2=80.475, P < 0.01). The rate of catheter associated urinary tract infection was 0.26‰ (1/3 856) in the observation group and 1.95 ‰ (8/4 098) in the control group, the differences was statistically significant (χ2=5.832, P< 0.05). Conclusions DMAIC can improve the accuracy of nursing measures, optimize the catheter care process, and reduce catheter-related urinary tract infections. Key words: Intensive care unit; Indwelling catheter; Nursing care; Catheter-related urinary tract infection; DMAIC

The Effect of a Guide Based Application Bundle on the Catheter-Related Infection.

Central venous catheters are used extensively in intensive care units but can sometimes lead to catheter related blood stream infections. This study was carried out to determine the effect of guideline-based care bundle on possible catheter-related bloodstream infection in the application and care of central venous catheter in patients receiving follow-up and treatment in anesthesia intensive care unit. The study is a retrospective and experimental one. The study population consisted of patients who were treated in an anesthesia intensive care unit of a university hospital between June 2015 and June 2016, to whom the central line was inserted in this unit by the team working in the unit and who required central line insertion for at least 48 hours. The patients in the study population also comprised the study sample. The guideline-based application and care bundle was administered under the supervision of the researcher in the intensive care unit and the patients were evaluated on a daily basis for bloodstream infection. When comparing data obtained from the study with data from the previous period, it was found that the guideline-based application and care bundle decreased the catheter-related bloodstream infection rate from 10.59/1000 to 2.88/1000 and this reduction was considered statistically significant (p<0.05). According to this study's data, the guideline-based care bundle is an effective and useful way to reduce infection.

Journal Club: Surveillance of home health central venous catheter care outcomes: Challenges and future directions

Journal Club: Surveillance of home health central venous catheter care outcomes: Challenges and future directions

Cateter de gastrostomias em crianças: elaboração de protocolos operacionais padrão

Objetivo: elaborar dois Protocolos Operacionais Padrão (POP), sendo um para troca do cateter de gastrostomia em crianças e outro para os cuidados com o mesmo, e sua validação junto a enfermeiros estomaterapeutas. Método: trata-se de uma pesquisa metodológica realizada em duas etapas: processo de construção de dois Protocolos Operacionais Padrão (POP) e sua validação por juízes. A busca da literatura ocorreu nas bases/portal: Caribe em Ciências da Saúde (LILACS); Scientific Electronic Library Online (SCIELO); Medical Literature Analysis and Retrieval System Online (MEDLINE). Em seguida deu-se a elaboração dos POPs que foram avaliados por juízes estomaterapeutas. A análise foi realizada por meio do cálculo do Índice de Validade de Conteúdo (IVC). Resultados: como resultados da revisão integrativa foram selecionados quatro estudos. A amostra dos juízes foi composta por seis profissionais. O POP acerca da troca e do cateter obteve IVC= 0,87 e o POP sobre os cuidados com o cateter recebeu IVC= 0,83, sendo considerados válidos quanto ao conteúdo e aparência. Conclusão: a avaliação dos juízes culminou na validação dos POPs, sendo sugeridas alterações que foram acatadas e discutidas com a literatura.&#x0D;

Profiles of the bacterial community in short-term indwelling urinary catheters by duration of catheterization and subsequent urinary tract infection

Urinary catheterization, even of short duration, increases the risk of subsequent urinary tract infection (UTI). Whether the bacteria found on the surface of catheters placed for <3 days are associated with UTI risk is unknown. We screened the biofilms found on the extraluminal surface of 127 catheters placed for <3 days in women undergoing elective gynecologic surgery, using targeted quantitative polymerase chain reaction and an untargeted 16S rRNA taxonomic screen. Using quantitative polymerase chain reaction, Enterococcus spp were found on virtually all catheters and lactic acid bacteria in most catheters regardless of duration, but neither genus was associated with UTI development during follow-up. Enterococcus, Streptococcus, and Staphylococcus were the most commonly identified genera in the taxonomic screen but were not associated with subsequent UTIs. Although the most common cause of UTI following catheter removal was Escherichia coli, detectable E coli on the catheter surface was not associated with subsequent UTIs. Our analysis does not suggest that the presence of bacteria on the surface of catheters placed for <3 days leads to subsequent UTIs. Other aspects of catheter care are likely more important than preventing bacterial colonization of the catheter surface for preventing UTIs following short-term catheter placement.

Risk Factors Analysis for Catheter-Associated Urinary Tract Infection in Medan, Indonesia.

BACKGROUND:Catheter-associated urinary tract infection (CAUTI) is one of the most common infections in health care caused by several risk factors.AIM:This study aims at analysing the risky factors triggering CAUTI.METHODS:This research was designed by applying prospective study. It was conducted from July to November 2018 by involving 82 patients attached to the catheter and treated in the General Hospital of Medan as the sample. The study instrument used observational sheets by measuring the occurrence of urinary tract infection using urine culture analysis ≥ 105 CFU/ml.RESULTS:The results showed that there was a relationship (p < 0.05) amongs age (p = 0.01; RR = 0.51), diabetes mellitus (p = 0.00; RR = 7.61), duration of catheterization (p = 0.00; RR = 0.01), indications for catheter use (p = 0.00; RR = 0.34) with CAUTI, and there were not significant relationship (p > 0.05) amongs genre (p = 0.06; RR = 1.72), drainage system (p = 0.43; RR = 0.43) and catheter care (p = 0.08; RR = 0.50) with CAUTI. Diabetes mellitus (p = 0.00; OR = 8.92 95% CI = 1.02-11.83) and duration of catheterization (p = 0, 00; OR = 32.84 95% CI = 3.81-322.74) were the most significant factor related to CAUTI.CONCLUSION:CAUTI is influenced by various factors, and it can be controlled by understanding those factors so that the right interventions to prevent the infections can be taken and the quality of nursing care can be increased as well.

Monitoring quality of care for peripheral intravenous catheters; feasibility and reliability of the peripheral intravenous catheters mini questionnaire (PIVC-miniQ)

BackgroundPeripheral 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.MethodsThe 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.ResultsSixty-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.ConclusionsOur 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.

Atualização profissional frente às práticas de enfermagem: um relato de experiência

Objetivo: Relatar a experiência de acadêmicos de enfermagem na realização de uma atualização profissional frente às técnicas de enfermagem em um hospital público de Porto Velho/RO. Relato da experiência: Trata-se de um relato de experiência, na visão de dois acadêmicos de enfermagem da disciplina supervisionado I, do segundo semestre de 2018, sobre a realização e aplicação de um Projeto Aplicativo (PA) que aconteceu em um Hospital público de Porto Velho/RO que atende todos os tipos de urgências e emergências da capital. O projeto aplicativo é uma atividade coletiva, desenvolvida em pequeno grupo com foco na construção de uma intervenção na realidade. Foi realizada a abordagem das práticas de enfermagem com sondas (com ênfase em cuidados com sondas enterais e vesicais); higiene corporal (com ênfase em higiene oral, limpeza concorrente e, principalmente, a mobilização do paciente durante o banho no leito); administração de medicamentos (com ênfase em vias parenterais); oxigenoterapia (com ênfase em máscara de Venturi e seu fluxo correto); aspiração das vias aéreas e cuidados de enfermagem com traqueostomia. Considerações finais: Faz-se necessário que os profissionais de enfermagem se mantenham atualizados acerca de suas práticas, pois, assim, evitarão ações iatrogênicas e poderão prestar uma assistência mais segura.

Reduction in Central Line-Associated Bloodstream Infection Rates After Implementations of Infection Control Measures at a Level 3 Neonatal Intensive Care Unit.

Advances in neonatology led to survival of micro-preemies, who need central lines. Central line-associated bloodstream infection (CLABSI) causes prolonged hospitalization, morbidities, and mortality. Health care team education decreases CLABSIs. The objective was to decrease CLABSIs using evidence-based measures. The retrospective review compared CLABSI incidence during and after changes in catheter care. In April 2011, intravenous (IV) tubing changed from Interlink to Clearlink; IV tubing changing interval increased from 24 to 72 hours. CLABSIs increased. The following measures were implemented: July 2011, reeducation of neonatal intensive care staff on Clearlink; August 2011, IV tubing changing interval returned to 24 hours; September 2011, changed from Clearlink back to Interlink; November 2011, review of entire IV process and in-service on hand hygiene; December 2011, competencies on IV access for all nurses. CLABSIs were compared during and after interventions. Means were compared using the t test and ratios using the χ2 test; P <.05. CLABSIs decreased from 4.4/1000 to 0/1000 catheter-days; P < .05. Evidence-based interventions reduced CLABSIs.

Spinal Cord Injury Creates Unique Challenges in Diagnosis and Management of Catheter-Associated Urinary Tract Infection.

Background: Catheter-associated urinary tract infection (CAUTI) is associated with increased morbidity and mortality and influences the quality of life of patients with spinal cord injury (SCI). Objectives: This clinical review aims to highlight the unique surveillance, prevention, diagnosis, and management challenges of CAUTI in the SCI population. Methods: Narrative review of the current literature on catheter use in persons with SCI was conducted to determine gaps in knowledge and opportunities for improvement. Results: Surveillance of CAUTI is challenging in the SCI population as the ability to detect symptoms used to diagnose CAUTI (ie, suprapubic pain, dysuria) is impaired. In terms of prevention of CAUTI, current strategies refocus on appropriate catheter insertion and care and early removal of catheters, which is not always feasible for persons with SCI. Prophylactic antibiotics, nutraceuticals, and coated catheters show limited efficacy in infection prevention. Diagnosing CAUTI after SCI is challenging, often resulting in an overdiagnosis of CAUTI when truly asymptomatic bacteriuria exists. In the management of CAUTI in patients with SCI, the use of multiple antibiotics over time in an individual increases the rate of multidrug-resistant organisms; therefore, the exploration of novel non-antibiotic treatments is of importance. The patient experience should be at the center of all these efforts. Conclusion: Better diagnostic tools or biomarkers are needed to define true CAUTI in people with SCI. SCI-specific evidence to inform catheter management and CAUTI treatment guidelines is needed, with the goal to minimize catheter-related harm, reduce antibiotic resistance, and improve satisfaction and overall quality of life for SCI patients.

TRAINING OF CHILDREN'S AND ADOLESCENTS' FAMILY MEMBERS IN HOME PARENTERAL NUTRITION CARE.

ABSTRACTObjective: To report the experience of the training in home parenteral nutrition (PN) directed to family members of children and adolescents participating in a multidisciplinary intestinal rehabilitation program of a tertiary public hospital.Methods: Cross-sectional descriptive study with family caregivers of patients from the Intestinal Rehabilitation Program of Hospital de Clínicas de Porto Alegre, RS, Brazil, from July/2014 to January/2017. Inclusion criteria: family members of children aged 30 days to 17 years and estimated PN use ≥8 weeks; and family members motivated to care for the child. The training covered: hand washing and disinfection; infusion pump handling; and central venous catheter (CVC) and PN care. Outcomes assessed: catheter-related bloodstream infection (CRBSI) rate, accidental CVC exit, end of PN infusion with more than 60minutes of delay or advance compared to the time predicted, mechanical obstruction, bleeding in the CVC insertion site, and death.Results: Twenty-seven family members of 17 children were trained. Their median age was 28 (18-60) years, and 63% were mothers. The mean CRBSI rate was 1.7/1,000 days of CVC use, and 29.4% of patients had at least one episode of accidental CVC exit. There were no complications related to PN infusion, bleeding, or death.Conclusions: The training of family caregivers allowed the safe implementation of home PN, with the active participation of families, making the procedure feasible in the public health system in Brazil.

Navel to Knees With Chlorhexidine Gluconate

Urinary tract infections are the most common type of health care-associated infection, and greater than 75% of them are attributed to an indwelling urinary catheter. A catheter-associated urinary infection may lead to a longer hospital length of stay by as many as 4 days. A new patient care standard requiring twice-daily chlorhexidine cleansing from umbilicus to knees was implemented on all patients of the pilot unit with a urinary catheter. This same technique was used after a patient with a urinary catheter had an incontinent bowel movement. The 9-month average catheter-associated urinary infection rate decreased from 3.06/1000 urinary catheter days to 0.46/1000 urinary catheter days after implementation of the new standard. The use of chlorhexidine for routine urinary catheter care and after bowel movements from umbilicus to knees for patients with urinary catheters may significantly decrease catheter-associated urinary tract infections when compared with the standard of care using soap and water. Standards for Quality Improvement Reporting Excellence guidelines were used in reporting these data.

Peripheral intravenous catheter dressing and securement practice is associated with site complications and suboptimal dressing integrity: A secondary analysis of 40,637 catheters

BackgroundWith over 2 billion peripheral intravenous catheters used globally each year, avoiding complications is crucial for patients and healthcare organisations. Effective catheter dressing and securement is a key nursing strategy to reduce catheter failure and resultant patient harm. ObjectivesTo describe global catheter dressing and securement practices and policy; and identify factors associated with catheter insertion site complications, and suboptimal dressing and securement. DesignSecondary analysis of a global cross-sectional study of peripheral intravenous catheter characteristics, management and outcomes. SettingFour hundred and seven rural, regional and metropolitan hospitals in 51 countries. ParticipantsPaediatric and adult patients with 40,637 catheters. MethodsPatient-, catheter-, and institution-related factors which could be associated with catheter site complications and suboptimal dressings were extracted from the parent database. Global trends in catheter dressing and securement policy and practice were described. Potential predictors of catheter and dressing complications were explored using logistic regression. ResultsDressing and securement practices, and local hospital policy regarding dressing change frequency varied. One fifth of dressings (21%, n = 8519) were not clean, dry and intact. The prevalence of catheter insertion site complications was 16% (n = 6503), with signs of phlebitis commonly observed (11.5%, n = 4587). Compared to non-bordered polyurethane dressings, sterile gauze and tape dressings were associated with fewer insertion site complications (odds ratio 0.58, 95% confidence interval 0.50–0.68) and better dressing integrity (odds ratio 0.68; 95% confidence interval 0.59–0.77); whereas, compared with no securement, non-sterile tape at the insertion site was associated with more site complications (odds ratio 2.39, 95% confidence interval 2.22–2.57) and poorer dressing integrity (odds ratio 1.64, 95% confidence interval 1.51–1.75). Two ‘bundled’ dressing and securement combinations were associated with fewer site and dressing complications, when compared with the reference category. Local catheter care guidelines which advocate 4th hourly insertion site inspection and dressing replacement between 1–3 days were associated with better catheter dressing integrity. ConclusionModifiable risk factors for peripheral intravenous catheter site and dressing complications were identified and are amendable to further interventional testing.

The effect of indwelling catheter care risk assessment on unplanned extubation and nursing outcome in patients undergoing hepatobiliary surgery

Objective To explore the effect of indwelling catheter care risk assessment on unplanned extubation and nursing effects in patients undergoing hepatobiliary surgery. Methods A total of seventy-two patients undergoing routine care for liver and gallbladder surgery from September 2015 to September 2016 in this hospital were selected as the control group.In addition, 72 cases of liver and gallbladder surgery patients admitted by the hospital from October 2016 to October 2017 for nursing risk assessment were selected as the observation group.The unplanned extubation and nursing effect were compared between the two groups. Results The rate of T tube, gastric tube, abdominal drainage tube, deep venous catheter and unplanned catheter extubation in the observation group was lower than that in the control group, and the difference was statistically significant (P<0.05). The rate of catheter blockage, catheter folding, catheter slip and complaint in the observation group was lower than that in the control group, and the nursing satisfaction was higher than that in the control group, the difference was statistically significant (P<0.05). Conclusions The application of indent catheter nursing risk assessment in patients with hepatobiliary surgery can effectively reduce the rate of unplanned extubation and improve the nursing effect, which is worthy of clinical promotion. Key words: Indwelling catheter; Nursing risk assessment; Hepatobiliary surgery; Unplanned extubation; Nursing effect

Roles and Role Ambiguity in Patient- and Caregiver-Performed Outpatient Parenteral Antimicrobial Therapy

Complicated medical therapies traditionally performed in acute care hospitals are increasingly moving to the home, requiring patients and informal caregivers to perform complicated medical tasks. For example, in outpatient parenteral antimicrobial therapy (OPAT), patients and caregivers perform antimicrobial infusions and venous catheter care. The objective of this study was to characterize patient understanding of patient, caregiver, and health care worker roles in OPAT and barriers to fulfilling these roles, with the goal of understanding how to best support patients and their caregivers. A qualitative study using 40 semistructured telephone interviews and 20 contextual inquiries of patients and caregivers performing OPAT tasks was performed. Eligible participants were discharged from two academic medical centers on OPAT. Interview transcripts and notes from contextual inquiry were coded based on a human factors engineering model. Four main roles are described: communicator, advocate, learner-trainer, and lay health care worker doing "high-skilled tasks." Patients and caregivers experienced role ambiguity about OPAT task performance at the time of hospital discharge. Patients noted that their health care workers experienced role ambiguity as well, particularly regarding who was managing their care. Patients and caregivers used role transitions to achieve workload management, in which patients and caregivers transitioned OPAT tasks or non-OPAT tasks from one person to another. Clear delineation of roles in complicated home-based medical therapies and training of all who may perform these tasks could improve the safety and quality of home-based care.

Knowledge and Practices among Female Nurses on Insertion and Care of Indwelling Urinary Catheter to Female Patients in a Selected Teaching Hospital in Sri Lanka

Globally, catheter-associated urinary tract infection (CAUTI) is one of the most common hospital-acquired infections. By following proper guidelines and recommended practice regarding insertion and care of indwelling urinary catheter, one could prevent and reduce CAUTI. Knowledge and practices among nurses regarding the insertion and care of indwelling urinary catheter in female patients are highly essential to minimize complications related to indwelling urinary catheter among female patients. There are limited data available on this phenomenon in Sri Lanka. The purpose of this study was to determine knowledge and practices among nurses regarding the insertion and care of indwelling urinary catheter in female patients at a selected teaching hospital. A descriptive cross-sectional design was conducted among conveniently selected 122 nurses from a teaching hospital. A pre-tested (n=10), a semi-structured questionnaire, was used to collect data. Ethical approval was obtained from the ethics review committees of the Faculty of Medical Sciences, University of Sri Jayewardenepura, and Colombo South Teaching Hospital, Sri Lanka. Findings revealed that only 36% of the participants had a satisfactory level of knowledge on indwelling urinary catheter insertion. Most of the participants (79.5%) had a satisfactory level of practices regarding indwelling urinary catheter insertion. Majority of the participants (82%) had an unsatisfactory level of knowledge regarding indwelling urinary catheter care. Most of the participants (78.7%) had a satisfactory level of practices regarding indwelling urinary catheter care. In conclusion, the majority of the participants had an unsatisfactory level of knowledge regarding indwelling urinary catheter insertion and care. There is a need for education on indwelling urinary catheterization and care for nurses in Sri Lanka.