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S. Nersinger - One of the best experts on this subject based on the ideXlab platform.
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increased incidence of central venous catheter associated bloodstream infections possible link to Transparent Dressing configuration
American Journal of Infection Control, 2005Co-Authors: Ann Marie Pettis, Mark Shelly, S. Knapp, J. Henderson, S. NersingerAbstract:BACKGROUND/OBJECTIVES: As part of routine surveillance of nosocomial bacteremia, we noted an increase in the hospital-wide rate of catheter-related bloodstream infection (CRBSI) over our baseline of 0.66 per 1000 patient days (ptpd, July 2002–June 2004). We launched an investigation to determine the cause for this increase. Transparent polyurethane Dressings are a popular Dressing that does not significantly increase the risk of CRBSI. These Dressings have been modified to incorporate a woven tape to help adherence to skin. These Dressing designs may change infection rates. One of these new Dressings was introduced in our Dressing kits before this outbreak. METHODS: Examination of case details was used to look for common factors and exposures. After a multidisciplinary review, we implemented stepwise changes in the Dressing used for central line care: we changed to a Dressing that put the tape on top of, rather than below, the Transparent polyurethane. RESULTS: In surveillance of our 280-bed community teaching hospital, we expect no more than six CRBSI a month; we exceeded this threshold in August 2004. The rate peaked with 14 cases in 5718 patient days in September 2004, a rate of 2.45 ptpd (95% confidence interval 1.3-4.1). Cases occurred with several different types of catheters and on different clinical units. Organisms varied, with an increase in the relative contribution of Candida infections. Procedures for insertion and care of central lines were consistent with CDC guidelines. We found no common risk factors for infection, such as total parenteral nutrition, in a majority of cases. Examination of the epidemiology curve showed an increase that corresponded to the introduction of a new central line Dressing. Changing to more frequent Dressing changes did not stop the outbreak. Replacing the Dressing with a new type of Dressing resulted in the rates falling toward baseline (1.3 ptpd, CI 0.51-2.6, in December 2004), even with a return to 7-day Dressing change intervals. Compliance was incomplete; surveillance continues following the removal of old Dressing. CONCLUSION: Shortly after implementing a tape-reinforced Transparent Dressing, we detected a fourfold increase in the incidence of CRBSI. By changing Dressings to a Transparent Dressing with a different design, we saw a return in our rate of infection to baseline. This suggests that the presence of woven tape under a Transparent Dressing may increase the rate of CRBSI.
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Increased incidence of central venous catheter–associated bloodstream infections: Possible link to Transparent Dressing configuration
American Journal of Infection Control, 2005Co-Authors: Ann Marie Pettis, Mark Shelly, S. Knapp, J. Henderson, S. NersingerAbstract:BACKGROUND/OBJECTIVES: As part of routine surveillance of nosocomial bacteremia, we noted an increase in the hospital-wide rate of catheter-related bloodstream infection (CRBSI) over our baseline of 0.66 per 1000 patient days (ptpd, July 2002–June 2004). We launched an investigation to determine the cause for this increase. Transparent polyurethane Dressings are a popular Dressing that does not significantly increase the risk of CRBSI. These Dressings have been modified to incorporate a woven tape to help adherence to skin. These Dressing designs may change infection rates. One of these new Dressings was introduced in our Dressing kits before this outbreak. METHODS: Examination of case details was used to look for common factors and exposures. After a multidisciplinary review, we implemented stepwise changes in the Dressing used for central line care: we changed to a Dressing that put the tape on top of, rather than below, the Transparent polyurethane. RESULTS: In surveillance of our 280-bed community teaching hospital, we expect no more than six CRBSI a month; we exceeded this threshold in August 2004. The rate peaked with 14 cases in 5718 patient days in September 2004, a rate of 2.45 ptpd (95% confidence interval 1.3-4.1). Cases occurred with several different types of catheters and on different clinical units. Organisms varied, with an increase in the relative contribution of Candida infections. Procedures for insertion and care of central lines were consistent with CDC guidelines. We found no common risk factors for infection, such as total parenteral nutrition, in a majority of cases. Examination of the epidemiology curve showed an increase that corresponded to the introduction of a new central line Dressing. Changing to more frequent Dressing changes did not stop the outbreak. Replacing the Dressing with a new type of Dressing resulted in the rates falling toward baseline (1.3 ptpd, CI 0.51-2.6, in December 2004), even with a return to 7-day Dressing change intervals. Compliance was incomplete; surveillance continues following the removal of old Dressing. CONCLUSION: Shortly after implementing a tape-reinforced Transparent Dressing, we detected a fourfold increase in the incidence of CRBSI. By changing Dressings to a Transparent Dressing with a different design, we saw a return in our rate of infection to baseline. This suggests that the presence of woven tape under a Transparent Dressing may increase the rate of CRBSI.
David R Thompson - One of the best experts on this subject based on the ideXlab platform.
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a randomized trial comparing arglaes a Transparent Dressing containing silver ions to tegaderm a Transparent polyurethane Dressing for Dressing peripheral arterial catheters and central vascular catheters
Intensive and Critical Care Nursing, 1998Co-Authors: Maurice Madeo, Colin R Martin, Caroline Turner, Victoria Kirkby, David R ThompsonAbstract:The purpose of this trial was to prepare for a large randomized trial comparing Arglaes film Dressing, a recent innovation containing silver ions, against Tegaderm, a Transparent polyurethane Dressing. Thirty-one patients admitted to the intensive care unit and requiring the insertion of an arterial line or central venous catheter were recruited into the study. Skin swabs were taken from the insertion sites prior to catheterization and on removal of the intravascular device to measure skin colonization rate between the two Dressings. The catheter tips were also cultured on removal to establish if there was a difference between the two groups. No statistical differences were found in bacterial growth between the two Dressings.
Ann Marie Pettis - One of the best experts on this subject based on the ideXlab platform.
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increased incidence of central venous catheter associated bloodstream infections possible link to Transparent Dressing configuration
American Journal of Infection Control, 2005Co-Authors: Ann Marie Pettis, Mark Shelly, S. Knapp, J. Henderson, S. NersingerAbstract:BACKGROUND/OBJECTIVES: As part of routine surveillance of nosocomial bacteremia, we noted an increase in the hospital-wide rate of catheter-related bloodstream infection (CRBSI) over our baseline of 0.66 per 1000 patient days (ptpd, July 2002–June 2004). We launched an investigation to determine the cause for this increase. Transparent polyurethane Dressings are a popular Dressing that does not significantly increase the risk of CRBSI. These Dressings have been modified to incorporate a woven tape to help adherence to skin. These Dressing designs may change infection rates. One of these new Dressings was introduced in our Dressing kits before this outbreak. METHODS: Examination of case details was used to look for common factors and exposures. After a multidisciplinary review, we implemented stepwise changes in the Dressing used for central line care: we changed to a Dressing that put the tape on top of, rather than below, the Transparent polyurethane. RESULTS: In surveillance of our 280-bed community teaching hospital, we expect no more than six CRBSI a month; we exceeded this threshold in August 2004. The rate peaked with 14 cases in 5718 patient days in September 2004, a rate of 2.45 ptpd (95% confidence interval 1.3-4.1). Cases occurred with several different types of catheters and on different clinical units. Organisms varied, with an increase in the relative contribution of Candida infections. Procedures for insertion and care of central lines were consistent with CDC guidelines. We found no common risk factors for infection, such as total parenteral nutrition, in a majority of cases. Examination of the epidemiology curve showed an increase that corresponded to the introduction of a new central line Dressing. Changing to more frequent Dressing changes did not stop the outbreak. Replacing the Dressing with a new type of Dressing resulted in the rates falling toward baseline (1.3 ptpd, CI 0.51-2.6, in December 2004), even with a return to 7-day Dressing change intervals. Compliance was incomplete; surveillance continues following the removal of old Dressing. CONCLUSION: Shortly after implementing a tape-reinforced Transparent Dressing, we detected a fourfold increase in the incidence of CRBSI. By changing Dressings to a Transparent Dressing with a different design, we saw a return in our rate of infection to baseline. This suggests that the presence of woven tape under a Transparent Dressing may increase the rate of CRBSI.
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Increased incidence of central venous catheter–associated bloodstream infections: Possible link to Transparent Dressing configuration
American Journal of Infection Control, 2005Co-Authors: Ann Marie Pettis, Mark Shelly, S. Knapp, J. Henderson, S. NersingerAbstract:BACKGROUND/OBJECTIVES: As part of routine surveillance of nosocomial bacteremia, we noted an increase in the hospital-wide rate of catheter-related bloodstream infection (CRBSI) over our baseline of 0.66 per 1000 patient days (ptpd, July 2002–June 2004). We launched an investigation to determine the cause for this increase. Transparent polyurethane Dressings are a popular Dressing that does not significantly increase the risk of CRBSI. These Dressings have been modified to incorporate a woven tape to help adherence to skin. These Dressing designs may change infection rates. One of these new Dressings was introduced in our Dressing kits before this outbreak. METHODS: Examination of case details was used to look for common factors and exposures. After a multidisciplinary review, we implemented stepwise changes in the Dressing used for central line care: we changed to a Dressing that put the tape on top of, rather than below, the Transparent polyurethane. RESULTS: In surveillance of our 280-bed community teaching hospital, we expect no more than six CRBSI a month; we exceeded this threshold in August 2004. The rate peaked with 14 cases in 5718 patient days in September 2004, a rate of 2.45 ptpd (95% confidence interval 1.3-4.1). Cases occurred with several different types of catheters and on different clinical units. Organisms varied, with an increase in the relative contribution of Candida infections. Procedures for insertion and care of central lines were consistent with CDC guidelines. We found no common risk factors for infection, such as total parenteral nutrition, in a majority of cases. Examination of the epidemiology curve showed an increase that corresponded to the introduction of a new central line Dressing. Changing to more frequent Dressing changes did not stop the outbreak. Replacing the Dressing with a new type of Dressing resulted in the rates falling toward baseline (1.3 ptpd, CI 0.51-2.6, in December 2004), even with a return to 7-day Dressing change intervals. Compliance was incomplete; surveillance continues following the removal of old Dressing. CONCLUSION: Shortly after implementing a tape-reinforced Transparent Dressing, we detected a fourfold increase in the incidence of CRBSI. By changing Dressings to a Transparent Dressing with a different design, we saw a return in our rate of infection to baseline. This suggests that the presence of woven tape under a Transparent Dressing may increase the rate of CRBSI.
Claire M. Rickard - One of the best experts on this subject based on the ideXlab platform.
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Devices and Dressings to secure peripheral venous catheters: A Cochrane systematic review and meta-analysis.
International journal of nursing studies, 2016Co-Authors: Nicole Marsh, Joan Webster, Gabor Mihala, Claire M. RickardAbstract:Peripheral venous catheterisation is the most frequent invasive procedure performed in hospitalised patients; yet over 30% of peripheral venous catheters fail before treatment ends. To assess the effects of peripheral venous catheter Dressings and securement devices on the incidence of peripheral venous catheter failure. We searched the Cochrane Wounds Group Register, The Cochrane Central Register of Controlled Trials, MEDLINE; EMBASE and CINAHL for any randomised controlled trials comparing different Dressings or securement devices used to stabilise peripheral venous catheters. The reference lists of included studies were also searched for any previously unidentified studies. We included six randomised controlled trials (1539 participants) that compared various Dressings and securement devices (Transparent Dressings versus gauze; bordered Transparent Dressings versus a securement device; bordered Transparent Dressings versus tape; and Transparent Dressing versus sticking plaster). Trial sizes ranged from 50 to 703 participants. The quality of evidence ranged from low to very low. Catheter dislodgements or accidental removals were lower with Transparent Dressings compared with gauze (two studies, 278 participants, risk ratio (RR) 0.40; 95% confidence interval (CI) 0.17-0.92, P=0.03%). However, the relative effects of Transparent Dressings and gauze on phlebitis (RR 0.89; 95% CI 0.47-1.68) and infiltration (RR 0.80; 95% CI 0.48-1.33) are unclear. A single study identified less frequent dislodgement or accidental catheter removal with bordered Transparent Dressings compared to a securement device (RR 0.14, 95% CI 0.03-0.63) but more phlebitis with bordered Dressings (RR 8.11, 95% CI 1.03-64.02). A comparison of a bordered Transparent Dressing and tape found more peripheral venous catheter failure with the bordered Dressing (RR 1.84, 95% CI 1.08-3.11) but the relative effect on dislodgement was unclear. There is no strong evidence to suggest that any one Dressing or securement product for preventing peripheral venous catheter failure is more effective than any other product. All of the included trials were small, had high or unclear risk of bias for one or more of the quality elements we assessed, and wide confidence intervals, indicating that further randomised controlled trials are necessary. There is a need for suitably powered, high quality trials to evaluate the newer, high use products and novel - but expensive - securement methods, such as surgical grade glue. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.
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The Cochrane Library - Devices and Dressings to secure peripheral venous catheters to prevent complications
The Cochrane database of systematic reviews, 2015Co-Authors: Nicole Marsh, Joan Webster, Gabor Mihala, Claire M. RickardAbstract:Background A peripheral venous catheter (PVC) is typically used for short-term delivery of intravascular fluids and medications. It is an essential element of modern medicine and the most frequent invasive procedure performed in hospitals. However, PVCs often fail before intravenous treatment is completed: this can occur because the device is not adequately attached to the skin, allowing the PVC to fall out, leading to complications such as phlebitis (irritation or inflammation to the vein wall), infiltration (fluid leaking into surrounding tissues) or occlusion (blockage). An inadequately secured PVC also increases the risk of catheter-related bloodstream infection (CRBSI), as the pistoning action (moving back and forth in the vein) of the catheter can allow migration of organisms along the catheter and into the bloodstream. Despite the many Dressings and securement devices available, the impact of different securement techniques for increasing PVC dwell time is still unclear; there is a need to provide guidance for clinicians by reviewing current studies systematically. Objectives To assess the effects of PVC Dressings and securement devices on the incidence of PVC failure. Search methods We searched the following electronic databases to identify reports of relevant randomised controlled trials (RCTs): the Cochrane Wounds Group Register (searched 08 April 2015): The Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 3), Ovid MEDLINE (1946 to March 7 2015); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, March 7 2015); Ovid EMBASE (1974 to March 7 2015); and EBSCO CINAHL (1982 to March 8 2015). Selection criteria RCTs or cluster RCTs comparing different Dressings or securement devices for the stabilisation of PVCs. Cross-over trials were ineligible for inclusion, unless data for the first treatment period could be obtained. Data collection and analysis Two review authors independently selected studies, assessed trial quality and extracted data. We contacted study authors for missing information. We used standard methodological procedures expected by Cochrane. Main results We included six RCTs (1539 participants) in this review. Trial sizes ranged from 50 to 703 participants. These six trials made four comparisons, namely: Transparent Dressings versus gauze; bordered Transparent Dressings versus a securement device; bordered Transparent Dressings versus tape; and Transparent Dressing versus sticking plaster. There is very low quality evidence of fewer catheter dislodgements or accidental removals with Transparent Dressings compared with gauze (two studies, 278 participants, RR 0.40; 95% CI 0.17 to 0.92, P = 0.03%). The relative effects of Transparent Dressings and gauze on phlebitis (RR 0.89; 95% CI 0.47 to 1.68) and infiltration (RR 0.80; 95% CI 0.48 to 1.33) are unclear. The relative effects on PVC failure of a bordered Transparent Dressing and a securement device have been assessed in only one small study and these were unclear. There was very low quality evidence from the same single study of less frequent dislodgement or accidental catheter removal with bordered Transparent Dressings than securement devices (RR 0.14, 95% CI 0.03 to 0.63) but more phlebitis with bordered Dressings (RR 8.11, 95% CI 1.03 to 64.02) (very low quality evidence). A small single study compared bordered Transparent Dressings with tape and found very low quality evidence of more PVC failure with the bordered Dressing (RR 1.84, 95% CI 1.08 to 3.11) but the relative effects on dislodgement were not clear (very low quality evidence). The relative effects of Transparent Dressings and a sticking plaster have only been compared in one small study and are unclear. More high quality RCTs are required to determine the relative effects of alternative PVC Dressings and securement devices. Authors' conclusions It is not clear if any one Dressing or securement device is better than any other in securing peripheral venous catheters. There is a need for further, independent high quality trials to evaluate the many traditional as well as the newer, high use products. Given the large cost differences between some different Dressings and securement devices, future trials should include a robust cost-effectiveness analysis.
Maurice Madeo - One of the best experts on this subject based on the ideXlab platform.
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a randomized trial comparing arglaes a Transparent Dressing containing silver ions to tegaderm a Transparent polyurethane Dressing for Dressing peripheral arterial catheters and central vascular catheters
Intensive and Critical Care Nursing, 1998Co-Authors: Maurice Madeo, Colin R Martin, Caroline Turner, Victoria Kirkby, David R ThompsonAbstract:The purpose of this trial was to prepare for a large randomized trial comparing Arglaes film Dressing, a recent innovation containing silver ions, against Tegaderm, a Transparent polyurethane Dressing. Thirty-one patients admitted to the intensive care unit and requiring the insertion of an arterial line or central venous catheter were recruited into the study. Skin swabs were taken from the insertion sites prior to catheterization and on removal of the intravascular device to measure skin colonization rate between the two Dressings. The catheter tips were also cultured on removal to establish if there was a difference between the two groups. No statistical differences were found in bacterial growth between the two Dressings.
