Catheter-associated Complications Research Articles

Catheter-associated vascular complications

Catheter-associated vascular complications

Screening, risk stratification and CT imaging for assessment of coronary artery disease

Early treatment of cardiovascular risk factors and characterization of coronary plaques is essential to collect prognostic information about coronary artery disease (CAD) and prevent cardiovascular events. Discussion of the most important risk factors of CAD, basic diagnostic of CAD, prevention, and prognostic factors of CAD with focus on cardiac computed tomography (CT). Prevalence and prognostic impact of CAD risk factors; description of specific assessment of risk profiles; estimation of pretest probability; conventional prevention of CAD; prognostic assessment of CAD using the Calcium Scoring and coronary CT angiography. Assessment of risk profiles and estimation of pretest probability for obstructive coronary stenosis necessitates athorough evaluation of medical history and laboratory values. The composition and extent of calcified and noncalcified plaques in CT exams based on the criteria of the Coronary Artery Disease-Reporting and Data System give important prognostic information about the risk of cardiovascular events, which increases with high plaque burden and vice versa. Initial imaging with CT for evaluation of CAD leads to areduction of invasive coronary angiographies and catheter-associated complications. Besides early detection of cardiovascular risk factors, the additional assessment of plaque burden and significant stenosis in CT gives further prognostic information to facilitate effective therapies to prevent cardiovascular events and in the case of low plaque burden avoid invasive coronary angiography. However, systmatic screening using Calcium Scoring is not established yet due to insufficient data, although it could potentially be used for an early risk stratification in patients with multiple risk factors.

Heparin versus normal saline for the care of peripheral intravenous catheters in pediatrics: a meta-analysis of randomized controlled trials

BackgroundIt is still controversial for neonates or children to choose normal saline or heparin solution in the care of peripheral intravenous catheters. This meta-analysis aimed to evaluate the effects of heparin versus normal saline for the care of peripheral intravenous catheters in pediatrics, to provide reliable evidence support for clinical care.MethodsTwo authors searched the PubMed, EMbase, Ovid Medline, Cochrane Library, Web of Science, CBM, WanFang Data and China National Knowledge Infrastructure (CNKI) databases for randomized controlled trial (RCT) of heparin versus normal saline for the care of peripheral intravenous catheters in pediatrics until July 16, 2023. The bias of risk tool recommended by Cochrane was used for the quality evaluation of included RCTs. Meta-analysis was carried out by using RevMan 5.4 software.ResultsA total of 22 RCTs involving 3988 peripheral intravenous catheters were finally included. Compare with normal saline, heparin could significantly increase the catheter indwelling time (MD = 9.10, 95%CI:3.30 ~ 14.90). Subgroup analysis indicated that for compare with normal saline, heparin could significantly increase the catheter indwelling time in the neonate (MD = 9.63, 95%CI: 0.38 ~ 18.88) and neonate + children population (MD = 6.22, 95%CI:2.72 ~ 9.73, P < 0.001). Heparin could significantly reduce the incidence of catheter-associated complications (RR = 0.84, 95%CI: 0.70 ~ 0.95). Subgroup analysis indicated that heparin could significantly reduce the incidence of catheter-associated complications in the neonate (RR = 0.70, 95%CI: 0.61 ~ 0.89). There was no publication bias amongst the synthesized outcomes by Egger’s test (all P > 0.05).ConclusionsHeparin may be worthy of being applicated in the neonate population in terms of prolonged indwelling time and less complications. Limited by the evidence quality, more studies from different area and populations with rigorous design are needed to investigate the role of heparin versus normal saline for the care of peripheral intravenous catheters in pediatrics.

Reports on vascular catheter-associated thromboembolic events in a burn unit - a gap in the literature?

Indwelling intravascular catheters are important tools in the care of critically ill patients; however, they have an inherent risk of infection or thromboembolic events. Reports on catheter associated thromboembolic events in burn units are rare, despite being well recognized that burn patients bear an increased baseline risk for thromboembolic events. We describe two catheter-associated thromboembolic complications in burn patients in a burn unit and the morbidity associated with these events. Patients with endovascular catheters in burn units may be at increased risk for severe thromboembolic events associated with intravascular catheters, but specific guidelines for prevention and management of these patients are still missing.

Antibiofilm potential of nanonized eugenol against Pseudomonas aeruginosa.

The purpose of this study was to synthesize a nanoform of eugenol (an important phytochemical with various pharmacological potentials) and to investigate its antibiofilm efficacy on Pseudomonas aeruginosa biofilm. Colloidal suspension of eugenol-nanoparticles (ENPs) was synthesized by the simple ultrasonic cavitation method through the emulsification of hydrophobic eugenol into hydrophilic gelatin. Thus, the nanonization process made water-insoluble eugenol into water-soluble nano-eugenol, making the nanoform bioavailable. The size of the ENPs was 20-30 nm, entrapment efficiency of eugenol within gelatin was 80%, and release of eugenol from the gelatin cap was slow and sustained over 5 days. Concerning the clinically relevant pathogen P. aeruginosa, ENPs had higher antibiofilm (for both formation and eradication) activities than free eugenol. Minimal biofilm inhibitory concentration and minimal biofilm eradication concentration of ENP on P. aeruginosa biofilm were 2.0 and 4.0 mM, respectively. In addition, the measurement of P. aeruginosa biofilm biomass, biofilm thickness, amount of biofilm extra-polymeric substance, cell surface hydrophobicity, cell swarming and twitching efficiencies, cellular morphology, and biofilm formation in catheter demonstrated that the antibiofilm efficacy of nano-eugenol was 30%-40% higher than that of bulk eugenol. These results signify that future pharmacological and clinical studies are very much required to investigate whether ENPs can act as an effective drug against P. aeruginosa biofilm-mediated diseases. Thus, the problem of intrinsic antibiotic tolerance of biofilm-forming cells may be minimized by ENPs. Moreover, ENP may be used as a potential catheter-coating agent to inhibit pseudomonal colonization on catheter surfaces and, therefore, to reduce catheter-associated infections and complications.

Insights From an Expert Roundtable Discussion: Navigating Intermittent Catheterisation-Associated Complications

With a pre-specified aim of improving the standard of care of those living with intermittent catheter use, a roundtable discussion led by a panel of esteemed international experts convened in early 2023. The discussion provided valuable insights and recommendations regarding understanding the challenges associated with intermittent catheter use and catheter-associated complications (CAC). Key issues centred on the myriad of complications associated with intermittent catheterisation (IC), including urinary tract infections (UTI), discomfort, urethral trauma, haematuria, and their impact on patient-reported outcomes. The heterogeneity of patient groups included in IC research evidence, and discrepancies in current guidelines emerged as key concerns. The panel acknowledged the lack of consensus and clarity surrounding definitions and classification of several complications related to IC and the heterogenous range of reported outcome measures, highlighting the critical need for establishing unified definitions of IC-associated complications (ICAC), and better-defined patient groups in future research, in order to avoid these issues, and produce more definitive research conclusions. To promote clarity and consistency in terminology and clinical practice, the roundtable discussion proposed an overarching consensus definition for catheter-related complications of IC and associated endpoints, referring to these as “events that disrupt catheterisation.” The panel also considered the potential of education and innovative catheter technology as an effective means to address these common issues. Recognising the importance of education, the experts highlighted the need for new definitions and descriptions to improve clarity and consistency in clinical practice, and more research involving the array of complications associated with intermittent catheter use. Furthermore, the discussion shed light on advancements in catheter technology, exploring the potential contributions of emerging innovations, such as next-generation catheter technology like FeelClean™ Technology (Convatec, Paddington, London, UK), in minimising complications and enhancing patient outcomes.

Therapeutic Strategies for the Prevention of Catheter-Associated Complications in Hemodialysis Patients

Therapeutic Strategies for the Prevention of Catheter-Associated Complications in Hemodialysis Patients

Bacterial complications after liver transplantation. Promising directions for further research

This article is presented in form of a current literature review on bacterial complications of the early post-liver transplantation period and promising areas for studying the effect of bacterial flora in patients after liver transplantation. The paper describes the problem of the emergence, spread, and pathogenesis of various bacterial complications, as well as current concepts of various bacterial complication’s impact on the results of liver transplantation. The results of ventilatorassociated pneumonia in patients after liver transplantation are given. A theoretical analysis of bacterial complications from the standpoint of microbiota effects on the biliary tree was carried out. The review also highlights a relatively new conceptual approach in examining the results of scientific research using the "Machine Learning Method”. The so-called CDC “Big Four” was chosen as the main infectious nomenclature in this article. However, catheter-associated bacterial complications, which pathogenesis has been sufficiently studied to date, have been replaced by a relatively new group of complications – bacteriobilia. This review also contains a brief statistical data collected in the frames of the NCT04281797 study. Own cohort data consisted of 57 patients who underwent orthotopic liver transplantation from a post-mortem donor. Surgical site infection was the most common bacterial complication of the early postoperative period. The most common causative agent of bacterial infection was Klebsiella pneumonia and Enterococcus.

P215 Intravenous antibiotic administration in children and adolescents with cystic fibrosis and catheter-associated complications: a 5-year experience

To describe the intravenous (IV) administration of antibiotics, both hospital-based and home-based therapy, in children and adolescents diagnosed with Cystic Fibrosis (pwCF), and to evaluate related complications.

456 Urinary catheterisation in the nursing home setting: challenges and opportunities in catheter use and design: a questionnaire study

Abstract Introduction Urinary catheter use is associated with a range of complications including infection, encrustation, blockage, leakage, pain and discomfort (1). There is a limited evidence-base regarding prevalence of catheterisation, and issues experienced in using urinary catheters in the nursing home (NH) population. Aim To explore the prevalence of urinary catheterisation and the types of catheters used by NH residents in a region of the United Kingdom (UK), to investigate the most common issues associated with catheter use, and to explore urinary catheter services in NHs. Methods Three different versions of a questionnaire for self-completion were designed (for NH managers, nurses and non-registered healthcare assistants), piloted and distributed to NH staff in a region of the UK, via post or online. NH managers were recruited through postal distribution to all registered NHs in the region (n=243) and via email distribution facilitated by a non-profit membership organisation representing health and social care providers. Nurses and healthcare assistants in 83 nursing homes across the region were recruited through a gatekeeper (GM: an academic care home nurse specialist and link-link lecturer from the School of Nursing and Midwifery, QUB. Questionnaires contained 47 items (managers), 48 (nurses), and 18 items (healthcare assistants), with a mixture of Likert scale questions, yes/no questions and a small number of open questions. Data were anonymised and entered into SPSS (V27) for statistical analysis. Descriptive analysis was conducted for closed-ended questions, and thematic analysis was used for open-ended questions. Results Questionnaires were completed between March and June 2022 by 162 participants. Eighty-eight responses were received from NH managers (response rate = 36.2%; 88/243). Seventy-four responses were received from nurses and healthcare assistants (31 and 43, respectively). Prevalence of catheterisation among NH residents was 6.4% (206/3226) and numbers of catheter users ranged between zero and eight per NH. Most residents (78.6%; 162/206) used indwelling urethral catheters. Almost one third of NH managers (29.5%; 26/88) and nurses (32.3%; 10/31) reported that catheters cause UTIs often and almost one in ten (8.0%; 7/88 and 9.7%; 3/33, respectively) reported a UTI occurring every time a catheter is used. Two-thirds (67.0%; 59/88) of NH managers and 58.1% (18/31) of nurses reported that catheter care training is not mandatory for all staff. Most managers and nurses agreed or strongly agreed that they had adequate catheter training in the past (80.7%; 71/88 and 74.2% 23/31, respectively), but less than half of managers and nurses reported good availability of catheter care retraining (45.5%; 40/88 and 48.4%; 15/31, respectively). Around 64.8% (57/88) of managers and 71.0% (22/31) of nurses wanted catheters to be reviewed more often than they currently are. NH managers and nurses reported difficulty in contacting specialists regarding catheter-associated problems in complex cases; only one third of managers and nurses indicated this was easy or very easy (34.1%; 30/88 and 38.7%; 12/31, respectively). Improvements to catheter design were not considered feasible by many respondents; approximately one third of managers, nurses and healthcare assistants thought improvements could be made (35.2%; 31/88, 32.3%; 10/31 and 30.2%; 13/43, respectively). Conclusion These findings highlight issues in catheter care training and management of catheter-related complications in the NH setting. Providing all NH staff, including healthcare assistants, with adequate urinary catheter training in managing catheter-associated complications has the potential to improve patient quality of life and reduce unplanned hospital visits and represents a priority for research and clinical practice. This study is the first to examine catheter prevalence and issues with use in NHs in this region of the UK. However, findings may not be generalisable to other parts of the UK or internationally.

Assessment of an umbilical venous catheter dwell-time of 8–14 days versus 1–7 days in very low birth weight infacts (UVC – You Will See): a pilot single-center, randomized controlled trial

BackgroundUmbilical venous catheters (UVCs) are used for central vascular access in preterm infants, but controversy exits with regard to the optimum dwell-time. Patients and methodsProspective, randomized controlled trial at a level III University neonatal intensive care unit (NICU), comparing a UVC dwell-time of 1–7 days (control group) to 8–14 days (intervention group) in very low birth weight (VLBW) infants. Primary outcome parameterNumber of infants requiring additional peripherally inserted central catheters (PICC) after removal of UVC. Secondary outcome parametersTotal number of central lines (CL = UVC and PICCs) until time point of full enteral feeds (130–160 mL/kg/d), total number of intravenous vascular catheters, number of CL-associated complications (infection, thrombosis/emboli, organ injury, secondary CL dislocation), number of X-rays for assessment of CL positioning, and days of therapy (DOT) (teicoplanin) for CL-associated blood stream infections (CLABSI). ResultsOf 116 patients screened for eligibility, 63 patients were enrolled – control group: 31 infants, mean gestational age (GA) 280 weeks (standard deviation (SD) 2.6 weeks), mean birth weight (BW) 988.9 g (SD 322.0 g); intervention group: 32 infants, mean GA 285 weeks (SD 3.0 weeks), mean BW 1078.9 g (SD 324.6 g). In the control group, 28 infants required additional PICCs versus 16 in the intervention group (p < 0.001); total number of CLs: control group n = 58 versus intervention group n = 28; p < 0.001, and the total number of venous vascular devices was also significantly higher in the control group (109 versus 61; p = 0.04). No significant differences were seen with regard to CL-associated complications (p = 0.09). The number of X-rays for assessment of correct CL-position significantly lower in the intervention group (144 versus 96; p = 0.03). In the intervention group, length of hospital stay was significantly shorter (88.1 (SD: 35.3 days) versus 68.1 (SD: 32.6 days); p = 0.03) and GA significantly lower at discharge from the hospital (404: SD: 33 weeks) versus 385: SD: 25 weeks; p = 0.02. No differences existed with regard to neonatal morbidities and mortality at 36 weeks gestational age. ConclusionsA longer UVC dwell-time of up to 14 days significantly decreased the number of painful invasive vascular procedures and radiation exposure, and shortened the length of the hospital stay. The findings of our pilot study should be confirmed in a larger, multi-center RCT with the primary focus on catheter-associated complications.

Assessing the utility of ultrasound-guided vascular access placement with longer catheters in critically ill pediatric patients.

Critically ill pediatric patients can have difficulty with establishing and maintaining stable vascular access. A long-dwelling peripheral intravenous catheter placement decreases the need for additional vascular interventions. The study sought to compare longevity, catheter-associated complications, and the need for additional vascular interventions when using ultrasound-guided longer peripheral intravenous catheters comparing to a traditional approach using standard-sized peripheral intravenous catheters in pediatric critically ill patients with difficult vascular access. This single-center retrospective cohort study included children 0-18 years of age with difficult vascular access admitted to the pediatric intensive care unit between 01/01/2018-06/01/2021. One hundred and eighty seven placements were included in the study, with 99 ultrasound-guided long intravenous catheters placed and 88 traditionally placed standard-sized intravenous catheters. In the univariate analysis, patients in the traditional approach were at a higher risk of intravenous failure compared to those in the ultrasound-guided approach (HR=2.20, 95% CI [1.45-3.34], p=.001), with median intravenous survival times of 108 and 219 h, respectively. Adjusting for age, patients in the traditional approach remained at higher risk of intravenous failure (HR=1.99, 95% CI: [1.28-3.08], p=.002). Adjusting for hospital length of stay, patients in the ultrasound-guided approach were less likely to have additional peripheral intravenous access placed during hospitalization (OR=0.39, 95% CI [0.18-0.85] p=.017). In critically ill pediatric patients with difficult vascular access, ultrasound-guided long peripheral intravenous catheters provide an alternative to traditional approach standard-sized intravenous catheters with improved longevity, lower failure rates, and reduced need for additional vascular interventions.

1846. Outcomes in Intravenous to Oral Antimicrobial Therapy in Beta-Streptococcus Species

Abstract Background Uncomplicated bloodstream infections (uBSI) are common and often receive prolonged courses of intravenous (IV) antibiotics, increasing risk for catheter-associated complications and hospitalization costs. β-hemolytic Streptococcus spp. are a common cause of BSI and have reliable susceptibility to many oral antibiotics. Clinically improving patients without persistent BSI and a controlled source of infection are candidates for oral antimicrobial therapy (OAT) but despite anecdotal practice, there are few studies affirming the practice of OAT for gram-positive uBSI. We evaluated IV to OAT transitions for treating β-hemolytic streptococcal uBSI. Methods This retrospective cohort study included patients &amp;gt;18 years old hospitalized between 1/1/2013 and 12/31/2019 diagnosed with uBSI due to β-hemolytic Streptococcus. Patients were excluded if BSI was due to endovascular, central nervous, or bone/joint infection without source control. We compared outcomes in patients treated with IV only to those transitioned to OAT including: 30-day mortality, antimicrobial therapy, BSI relapse, 30-day rehospitalization, adverse drug events, and reversion to IV therapy. Fisher’s exact test was used for categorical variables; Mann-Whitney test and independent t-test for continuous variables. Results A total of 238 Streptococcus BSI (of 321 BSI screened) were included (83 excluded as complicated, pediatric, or outpatient). OAT was used in 153 (64%). Cohort demographics were similar (table 1). Infectious disease (ID) consultation was not statistically associated with OAT transition; in fact, ID consults tended to use less OAT (66% IV vs. 54% OAT p=0.10). Hospital length of stay was statistically shortened in the OAT cohort with a median of 5 (interquartile range 4) vs. 7.5 (10.5) (p&amp;lt; 0.0001). Patients transitioned to OAT were more likely to finish their antibiotic course outpatient (93 vs. 61% p&amp;lt; 0.001). Thirty-day mortality was decreased in the OAT cohort (2% vs. 13% p&amp;lt; 0.0001). Adverse events were not statistically significant between the groups. Conclusion Opportunities exist to modify practice management of uBSI. For β-hemolytic Streptococcus uBSI, OAT was associated with decreased length of stay without adverse clinical outcomes. Disclosures Bryan T. Alexander, PharmD, BCIDP, AAHIVP, Astellas Pharma: Advisor/Consultant Trevor C. Van Schooneveld, MD, bioMerieux: Advisor/Consultant|bioMerieux: Grant/Research Support|Insmed: Grant/Research Support|Merck: Grant/Research Support|Thermo-Fischer: Advisor/Consultant Jasmine R. Marcelin, MD, Pfizer (Grant reviewer): Honoraria.

Recent Advances in Antimicrobial Coatings and Material Modification Strategies for Preventing Urinary Catheter-Associated Complications.

In recent years, we have witnessed prominent improvements in urinary catheter coatings to tackle the commonly occurring catheter-associated urinary tract infection (CAUTI) in catheterized patients. CAUTIs are claimed to be one of the most frequent nosocomial infections that can lead to various complications, from catheter encrustation to severe septicaemia and pyelonephritis. Besides general prevention hygienic strategies, antimicrobial-coated urinary catheters show great potential in the prevention of urinary catheter-associated complications. The aim of this review is to present and evaluate recent updates on the development of antimicrobial urinary catheters in the context of the aetiology of urinary malfunction. Subsequently, we shed some light on future perspectives of utilizing 3D printing and the surrounding regulatory directions.

Risk Factors of Catheter-Related Infection in Unplanned Extubation of Totally Implantable Venous-Accessportsin Tumor Patients.

Background Totally implantable intravenous ports (TIVAPs) are mostly used for long-term intravenous infusion therapy in cancer patients and can be left in the body for long periods of time for easy management, making them a simple and safe infusion device. Although the risks associated with long-term retention of fully implantable IV ports are less than those associated with other intravenous catheters, various complications may still occur at the time of implantation or during long-term use. Purpose To provide a scientific basis for clinical reduction of implantable intravenous port-associated infection complications by studying the risk factors for catheter-associated infection complications in patients applying implantable intravenous ports. Methods A retrospective study was conducted on oncology patients treated with TIVAP at our hospital between January 2017 and November 2021, with a review of patients who were unplanned for extubation. Their demographic data, underlying disease status, and surgery-related data were counted to summarize and analyze the complications and related influencing factors of implantation and postimplantation. Results A total of 70 individuals with a mean age of 56.49 ± 12.19 years were included in the study. Among them, 39 were male and 64 had the highest percentage of epithelial tumors, followed by tumors of the lymphopoiesis system and mesenchymal tumors with 4 and 2 cases, respectively. Forty-eight of these patients did not have their ports removed as planned due to the occurrence of catheter-related hematogenous infections. In univariate analysis, BMI and neutropenia were risk factors for catheter-associated infections. In the multivariate analysis, BMI (OR = 1.38, 95% CI: 1.07–1.78, p=0.013) was an independent risk factor for catheter-associated infections. Conclusions The overall complication rate of fully implanted intravenous ports was high, but most complications improved with symptomatic management, and no deaths due to port complications were identified. Infection was the most common complication, with catheter-associated bloodstream infection being the most common cause of unplanned port extraction. Patients with a higher BMI were at high risk of developing implantable IV port-associated infections, which may be an independent risk factor for implantable IV port-associated infections.

Nursing Practices toward Prevention of Indwelling Catheter Associated Urinary Tract Infection: An Interventional Study for nursing staff

Background: The placement of a urinary catheter is the single most important predisposing factor for Catheter-associated Urinary Tract Infections, which causes significant morbidity in hospitalized patients, including pain, fever, and malaise. Urinary tract infections are responsible for around 13,000 fatalities each year. Catheter-associated Urinary Tract Infections complications lead to an increase in length of stay, patient pain, higher healthcare expenses, and death. Urinary tract infections are the second most frequent illness after respiratory infections. This has an impact on patients' health outcomes and periods of hospital stay. The aim of this study is to improve nurses' practices by involving them in an interventional program after assessing nurses' practices regarding preventing male catheter-associated urinary tract infections. Methods: A pre-experimental design had been applied with the use of one group pre-test/post-test design of samples of 45 nurses to assess of nursing staff's practices toward the prevention of indwelling catheter-associated urinary tract infection in Al-Diwaniyah Teaching Hospital. The reliability of the questionnaire was achieved through a pilot study and then presented to experts to prove its validity. The total number of items included in 15 items distributed on two domains in the observational checklist for nurses' practices. The data was collected by using the semi-structured interview and analyzed by the application of a descriptive and inferential statistical data analysis approach. Results: there were highly significant statistical differences between pre and post-program at p<0.001for nurse’s practices about nursing staff practice about urinary catheter insertion and practice about catheterization follow up to preventing Indwelling Catheter-Associated with Urinary Tract Infections in Pre and Post Program. And the results showed there is no significant statistical correlation between knowledge and practices with nurse's age and years of experience at a p-value of ˃ 0.05. Conclusions: The study results accepted the alternative hypotheses and an interventional program has a significant effect on nursing staffsꞌ practices about preventing Indwelling Catheter-Associated with Urinary Tract Infections. The study confirmed that prior to the interventional program; the nurses had erroneous practices about preventing indwelling catheter-associated urinary tract infections. The study showed that the interventional

527 The Challenge to Improve Patient Education for Newly Inserted Urinary Catheters on Discharge from the Emergency Department

Abstract Aim To improve education in patients with new urinary catheters on discharge from the Emergency Department (ED), decreasing the incidence and healthcare burden of subsequent catheter-associated complications. Method Qualitative study design was employed to survey all Healthcare Professionals (HCPs) working in the ED and establish the quality and means of information currently provided. A novel trust-endorsed proforma with information leaflet was created with urology team input and uploaded to the ED website. Staff were updated via email, WhatsApp and verbally and re-surveyed after 6 months. Survey responses were evaluated with descriptive statistical analysis. Results The majority of HCPs in the department reported nearly always/often providing information verbally to patients, with similar findings on re-surveying. The most commonly discussed topic with patients remained: “Common complications and where to seek advice”. HCPs reported never/rarely offering written information (75%, 74% before and after respectively) and nearly all HCPs surveyed did not know where to find patient information resources (81%, 79% respectively). Conclusions Written information provision remained poor despite creation of a proforma with information leaflet. A high departmental turnover of HCPs, alongside varying seasonal Covid burden may have reduced the efficacy of interventions. The findings may also be as a result of HCPs still not knowing where to locate such resources. ‘Nudge theory’ through placing leaflets next to catheter supplies, combined with improved education of new staff rotating through the department at individual inductions and the introduction of checklists are changes that have been since actioned and due to be re-surveyed in February 2022.

Prevention of indwelling catheter associated urinary tract infection

Background: The placement of a urinary catheter is the single most important predisposing factor for Catheter-associated Urinary Tract Infections, which causes significant morbidity in hospitalized patients, including pain, fever, and malaise. Urinary tract infections are responsible for around 13,000 fatalities each year. Catheter-associated Urinary Tract Infections complications lead to an increase in length of stay, patient pain, higher healthcare expenses, and death. Urinary tract infections are the second most frequent illness after respiratory infections. This has an impact on patients' health outcomes and periods of hospital stay. The aim of this study is to improve nurses' knowledge and practices by involving them in an educational program after assessing nurses' knowledge regarding preventing male catheter-associated urinary tract infections. Methods: A pre-experimental design had been applied with the use of one group pre-test/post-test design of samples of 45 nurses to assess of nursing staff's knowledge, and practices toward the prevention of indwelling catheter-associated urinary tract infection in Al-Diwaniyah Teaching Hospital. The reliability of the questionnaire was achieved through a pilot study and then presented to experts to prove its validity.

A novel intervention to reduce noninfectious and infectious complications associated with indwelling urethral catheters in hospitalized older patients: a quasi-experimental study

BackgroundIndwelling urethral catheters are widely used in clinical settings. Catheter-associated urinary tract infection has been recognized as a common adverse event in older patients. However, noninfectious complications are almost 5 times as common as infectious complications, and insufficient attention has been given to noninfectious complications. Given this importance, a novel intervention related to removing unnecessary catheters in a timely manner to promote, after removal, the recovery of self-voiding function is herein developed to reduce infectious and noninfectious complications associated with indwelling urethral catheters in hospitalized older patients.MethodsA quasi-experimental study design was adopted. Patients aged 65 and older who had a urinary catheter placed within 24 h of hospital admission were included. All patients were allocated into either an intervention group, in which the novel intervention developed in the study was implemented, or a control group, who received care as usual. The outcomes of this study were to evaluate whether the novel intervention reduced the incidence of the following: catheter-associated urinary tract infections, catheter-associated noninfectious complications, decline in activities of daily living, and new nursing home admissions.ResultsOf 106 hospitalized older patients who consented to participate, 92 completed follow-up until discharge, including 49 in the control group and 43 in the intervention group. The patients in the intervention group were significantly older than those in the control group [83.72 ± 9.18 vs. 80.26 ± 7.66, p = 0.038], and no differences were found between the groups in other demographics or present health conditions. Multivariable logistic regression analysis showed that the control group was more likely to develop noninfectious complications [adjusted odds ratio: 3.01, 95% confidence interval: 1.32–6.81] and a decline in ADLs [adjusted odds ratio: 11.20, 95% confidence interval: 3.68–34.00].ConclusionsA novel intervention can be effective as a means of reducing noninfectious complications associated with indwelling urethral catheters in hospitalized older patients. This approach will help to standardize urethral catheter care, and it highlights the fact that health care professionals can play a crucial role in preventing harm from urethral catheters.

Dalbavancin as an option for treatment of S. aureus bacteremia (DOTS): study protocol for a phase 2b, multicenter, randomized, open-label clinical trial

BackgroundStaphylococcus aureus bacteremia is a life-threatening infection and leading cause of infective endocarditis, with mortality rates of 15–50%. Treatment typically requires prolonged administration of parenteral therapy, itself associated with high costs and potential catheter-associated complications. Dalbavancin is a lipoglycopeptide with potent activity against Staphylococcus and a long half-life, making it an appealing potential therapy for S. aureus bacteremia without the need for durable central venous access.MethodsDOTS is a phase 2b, multicenter, randomized, assessor-blinded, superiority, active-controlled, parallel-group trial. The trial will enroll 200 adults diagnosed with complicated S. aureus bacteremia, including definite or possible right-sided infective endocarditis, who have been treated with effective antibiotic therapy for at least 72 h (maximum 10 days) and with subsequent clearance of bacteremia prior to randomization to study treatment. Subjects will be randomized 1:1 to complete their antibiotic treatment course with either two doses of dalbavancin on days 1 and 8, or with a total of 4–8 weeks of standard intravenous antibiotic therapy. The primary objective is to compare the Desirability of Outcome Ranking (DOOR) at day 70 for patients randomized to dalbavancin versus standard of care. Key secondary endpoints include quality of life outcomes and pharmacokinetic analyses of dalbavancin.DiscussionThe DOTS trial will establish whether dalbavancin is superior to standard parenteral antibiotic therapy for the completion of treatment of complicated S. aureus bacteremia.Trial registrationUS National Institutes of Health ClinicalTrials.govNCT04775953. Registered on 1 March 2021