Infusion Therapy Team Research Articles

Protection of Intraluminal Pathway with Zero Fluid Displacement Connector Reduces Catheter-Related Bloodstream Infections in a Comprehensive Cancer Center

Background/PurposeAlthough annual rates of catheter-related bloodstream infections (CR-BSI) in a comprehensive cancer center were below the national average, further reductions were sought. Research indicates that contamination of a catheter's intraluminal pathway is a major cause of CR-BSI. Connectors are the gateway to the intraluminal pathway and studies link positive displacement, negative displacement, and split septum connectors to CR-BSI. Project DescriptionThe infusion therapy team piloted a zero fluid displacement (ZFD) connector based on the design of the ZFD, which appeared uniquely suited to CR-BSI prevention. A product trial was performed in intensive care units to compare the CR-BSI rates associated with the current split septum connector to the ZFD connector. The design was quantitative and quasiexperimental. ResultsDuring the trial, CR-BSI rates decreased from 4.2 (2,331 catheter days) with the split septum connector, to 0.4 (2,477 catheter days) with the ZFD connector. Six months after institutional implementation of the ZFD connector there were zero CR-BSI in the intensive care units across 4,424 catheter days, despite the complexity and acuity of a largely immunocompromised oncology patient population. The previous 6 months with the split septum the CR-BSI rate was 2.24 across 4,920 catheter days. ConclusionsOur institution's success suggests that protecting the intraluminal pathway with a properly designed connector may be more crucial to the prevention bundle than is widely understood or practiced. Other hospitals may achieve comparable results by implementing a similar device.

Strategic Patient Education Program to Prevent Catheter-Related Bloodstream Infection

Central venous catheters (CVCs) are used commonly for venous access during treatment, and catheter-related bloodstream infection (CRBSI) is a frequent, yet highly preventable, hospital-acquired infection. One of the performance elements of the Joint Commission's 2012 National Patient Safety Goals addresses the education of patients and family members on CVC care and management, as well as CRBSI prevention before a central catheter is inserted. This article presents the history and roles of the Infusion Therapy Team at the University of Texas MD Anderson Cancer Center in CVC care and describes an organized patient education program that plays a key part in the institution's strategy to reduce and prevent CRBSI. Institutional standard policies and procedures for patient care should be in compliance with guidelines of the Centers for Disease Control and Prevention and the Joint Commission before any patient educational initiative is implemented. Such standards will serve as a guide to set up, organize, and implement an effective program.

The Making of an Infusion Therapy. Nurse: Orientation of the Registered Nurse on an Infusion Therapy Team at a Comprehensive Cancer Center

Orientation to a new job can be an anxiety-producing experience, particularly when the job is specialized, such as that of an infusion therapy nurse at a comprehensive cancer center. With a team approach and using a variety of teaching/learning strategies, as well as individualizing the education plan on the basis of the learner, the orientation process at The University of Texas M.D. Anderson Cancer Center has evolved. The current orientation program fosters the initial development of nurses who, in time, are recognized as experts in infusion therapy.

A Chronicle of Experience-Past, Present & Future

Abstract Infusion Therapy and vascular access devices have had a profound impact on nursing practice over the years. The domain of nursing practice lends itself to providing an open window of opportunity for the nurse to enter different arenas of nursing practice and to develop expertise in a chosen field. That is what happened at the M.D. Anderson Cancer Center, Houston, TX, in the 1970s. This article provides an overview of the history of the Infusion Therapy Team along with current and future practice.

A Chronicle of Experience-Past, Present & Future: M.D. Anderson Cancer Center Infusion Therapy Team

Infusion Therapy and vascular access devices have had a profound impact on nursing practice over the years. The domain of nursing practice lends itself to providing an open window of opportunity for the nurse to enter different arenas of nursing practice and to develop expertise in a chosen field. That is what happened at the M.D. Anderson Cancer Center, Houston, TX, in the 1970s. This article provides an overview of the history of the Infusion Therapy Team along with current and future practice.

Get a grip on patient safety: outcomes in the palm of your hand.

Documentation of what nurses do and the consequential impact on the care and safety of the patient is essential for the optimal use of intravascular devices. The University of Louisville Hospital's infection control department collaborated with the infusion therapy team on a project designed to provide an easier and more reliable way to quantify what the infusion therapy team did and the resultant patient outcomes. This project was based on software developed by the infection control department for use with the handheld personal digital assistant (PDA). This article will discuss how use of the PDA and software meet individual departmental needs and impact patient outcomes and patient safety by using evidence-based decision-making.

Prevention of vascular catheter-related infections

Infection is the most common serious complication of intravascular catheters. Most cases of catheter-related infection are caused by staphylococci that originate either from the skin of the patient and migrate along the external surface of the catheter or from a contaminated catheter hub and migrate along the internal surface of the catheter. Major risk factors predisposing to catheter-related infection include prolonged duration of catheter placement, frequent manipulation of the catheter, use of thrombogenic catheter material, location of the catheter, and use of occlusive transparent plastic dressings. A number of measures have been reported in prospective, randomized clinical trials to protect against vascular catheter-related infection. This paper summarizes the clinical efficacy of various preventive measures, such as placement and maintenance of vascular catheters by a skilled infusion therapy team, institution of maximal sterile barriers, use of silver-impregnated subcutaneous cuff, antimicrobial coating of catheters with either antibiotics or antiseptics, use of an antiseptic catheter hub, application of topical disinfectants, and flushing catheters with the combination of antimicrobial and antithrombotic agents.

Prevention of infections associated with vascular catheters

Catheter-related bloodstream infection is the most common life threatening complication of intravascular catheters. Most cases of catheter-related infection are caused by skin organisms that originate either from the skin of the patient and migrate along the external surface of the catheter or from the skin of the medical personnel causing hub contamination and subsequent bacterial migration along the internal surface of the catheter. A number of measures have been reported in clinical trials to protect against vascular catheter-related infection. Preventive measures that utilize antimicrobial agents include application of topical disinfectants, flushing catheters with the combination of antimicrobial and antithrombotic agents, use of silver-impregnated subcutaneous cuffs for short-term central venous catheters, antimicrobial coating of catheters either with antiseptics or with antibiotics, and use of an antiseptic catheter hub. Protective measures that do not utilize antimicrobial agents include placement and maintenance of vascular catheters by a skilled infusion therapy team and institution of maximal sterile barriers.

Infusion therapy team and dressing changes of central venous catheters.

To determine whether central venous catheter (CVC) dressing changes could be performed by ward nurses rather than by the infusion therapy team (ITT) nurses without increasing the risk of catheter-related infection. Retrospective cohort study using prospectively collected data. The study extended from January 1995 to June 1996. The University of Texas M.D. Anderson Cancer Center, a referral cancer center. The study group was a random sample of 483 patients who received CVC dressing changes by ward nurses during the study period. A random sample of 483 patients who received CVC dressing changes by the ITT constituted the control group. The risks of catheter-related septicemia were 1.7% among cases and 1.4% among controls (risk ratio, 1.14; 95% confidence interval [CI95], 0.26-6.42; P=.70). There also were no significant differences between the two groups in the risks of catheter-related site infection (risk ratio, 0.50; CI95, 0.02-4.12; P=.25) or any catheter-related infection (risk ratio=1.00; CI95, 0.27-3.64; P=.59). Provided that aseptic techniques (including maximal barrier precautions during insertion) are maintained, the responsibility of CVC dressing changes could be delegated to the ward nurses without increasing the low risk of CVC-related infection, resulting in an estimated cost saving in excess of $90,000 per year.

Prevention of catheter-related infections: The skin

Although intravascular devices have become indispensable tools in the care of seriously ill patients, the morbidity and mortality resulting from catheter-related infections and the high cost of managing such complications may offset the benefits derived from these devices. A scientific understanding of the pathogenesis, microbiology, and risk factors involved in catheter-related infection is the cornerstone of any effective preventive approach. Prevention of vascular catheter-related infection mostly centers around inhibiting the adherence to the catheter of microorganisms originating from either the skin or the catheter hub. Two general approaches can be used nonexclusively for successful prevention of vascular catheter-related infection. The first approach does not use antimicrobial agents and includes measures such as placement and maintenance of vascular catheters by a skilled infusion therapy team and use of maximal sterile barriers. The second approach uses antimicrobial agents and involves the application of topical disinfectants such as chlorbexidine, use of silver-impregnated subcutaneous cuffs (for short-term central venous catheters), flushing catheters with a combination of antimicrobial and antithrombotic agents, and coating of catheters with either antiseptic (chlorhexidine and silver sulfadiazine) or antimicrobial agents (minocycline and rifampin).

A needleless intravenous system: an effective risk management strategy.

Historically, healthcare workers have not taken accidental needlesticks seriously and often have not even reported them. In the last five years, healthcare workers' awareness that needlesticks are a serious source of workplace exposure to hepatitis B virus (HBV) or the human immunodeficiency virus (HIV) has resulted in far more reported needlestick injuries. The risk of seroconversion following a needlestick with HIV-infected blood is approximately 1 in 300.1 Along with the risks of HIV and HBV numerous other infections can be transmitted by needlesticks. There is also the psychological effect on healthcare workers who may fear the possibility of contracting an infection every day while at work. In October 1989, at Columbia Hospital in Milwaukee, Wisconsin, a 394-bed facility, a needlestick task force was formed to address the number of employee needlestick occurrences reported to the occupational health department Members of the task force included an infectious disease physician and representatives from the infection control department, emergency department, pharmacy, operating room, intensive care unit, occupationalhealth department, laboratory department, housekeeping department, infusion therapy team, and materials distribution department. The goal of the needlestick task force was to reduce the number of blood exposure needlesticks to employees. The first strategy to reduce needlesticks was to re-educate staff to practice safety by avoiding recapping and properly taping all connections with needles on intravenous tubing lines and intravenous piggyback lines. This attempt was unsuccessful. Healthcare workers continued to have needlestick injuries bec us changing their clinical practice was too difficult. Studies have indicated that healthcare workers, in gene al, are not compliant with intravenous needle safety issues such as recapping and p operly taping intravenous lines. In a report on the epidemiology of hospital sharps injuries, Dennis G. Maki, MD, states, As have others, we have come to the conclusion that the greatest impact in reducing sharps injuries in HCW (healthcare workers) might be achieved by innovative technology-based approaches to prevention that implicitly reduce the risk of injury, despite carelessness or apathy on the part of an HCW ...analogous to mandating airbags in cars. Making impervious disposal units conveniently available was a first step. However, we need far more: systems that permit vascular access in drawing blood in which the user is implicitly shielded from contact with the used needle such as 'needleless systems' for administrating parenteral medications.2 Having learned this, the next step for the task force at Columbia Hospital was to investigate new products designed to eliminate needlestick injuries. After many months of testing and evaluating new roducts, a needleless intravenous system was approved. The product consisted of a reflux valve that locks on the end of the angiocatheter and a protector needle that can be used with the reflux valve on a rubber port anywhere on the intravenous line. The plastic reflux valve is accessible only by intravenous tubing or syringes without needles. Once the initial venipuncture is performed, the intravenous tubing system is completely needleless. Intravenous piggyback medications are con-

4359815 Machining center with a robot: Kenichi Toyoda assigned to Fujitsu Fanue Limited

Infection is the most common serious complication of intravascular catheters. Most cases of catheter-related infection are caused by staphylococci that originate either from the skin of the patient and migrate along the external surface of the catheter or from a contaminated catheter hub and migrate along the internal surface of the catheter. Major risk factors predisposing to catheter-related infection include prolonged duration of catheter placement, frequent manipulation of the catheter, use of thrombogenic catheter material, location of the catheter, and use of occlusive transparent plastic dressings. A number of measures have been reported in prospective, randomized clinical trials to protect against vascular catheter-related infection. This paper summarizes the clinical efficacy of various preventive measures, such as placement and maintenance of vascular catheters by a skilled infusion therapy team, institution of maximal sterile barriers, use of silver-impregnated subcutaneous cuff, antimicrobial coating of catheters with either antibiotics or antiseptics, use of an antiseptic catheter hub, application of topical disinfectants, and flushing catheters with the combination of antimicrobial and antithrombotic agents.

Long-Term I.V. Therapy: A New Approach

1MILLIE LAWSON, H.N., B.S.N., is supervisor, infusion therapy team, M.D. Anderson Hospital and Tumor Institute, Houston, Texas 2JOSEPH C. BOTTINO, M.D., is clinical assistant professor of medicine, New York Medical College. He was a fellow and faculty associate at M.D. Anderson Hospital when the article was written 3KENNETH MCCREDIE, M.D., is professor of medicine and chief of the leukemia service at M.D. Anderson Hospital