Peer Reviewed Scholarly Articles on Femoral Lines on Cardiac Cath Patients
Rev Lat Am Enfermagem. 2016; 24: e2787.
Evidence-based measures to prevent primal line-associated bloodstream infections: a systematic review ane
Daniele Cristina Perin
2MSc. in Nursing Care Direction, RN, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil.
Alacoque Lorenzini Erdmann
3PhD, Full Professor, Departamento de Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil.
Giovana Dorneles Callegaro Higashi
4Post-doctoral boyfriend, Departamento de Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil.
Grace Teresinha Marcon Dal Sasso
3PhD, Total Professor, Departamento de Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil.
Received 2015 Sep 11; Accepted 2016 February 29.
Abstruse
Objective:
to identify evidence-based care to foreclose CLABSI amid adult patients hospitalized in ICUs.
Method:
systematic review conducted in the following databases: PubMed, Scopus, Cinahl, Web of Science, Lilacs, Bdenf and Cochrane Studies addressing care and maintenance of central venous catheters, published from January 2011 to July 2014 were searched. The 34 studies identified were organized in an instrument and assessed past using the classification provided by the Joanna Briggs Institute.
Results:
the studies presented care bundles including elements such as paw hygiene and maximal barrier precautions; multidimensional programs and strategies such every bit impregnated catheters and bandages and the interest of facilities in and delivery of staff to preventing infections.
Conclusions:
care bundles coupled with education and the delivery of both staff and institutions is a strategy that can contribute to decreased rates of primal line-associated bloodstream infections among adult patients hospitalized in intensive care units.
Descriptors: Catheter-Related Infections, Primal Venous Catheters, Intensive Care Units, Evidence-Based Practice
Introduction
Primal Venous Catheters (CVC) play an important office in the treatment of hospitalized patients, specially critically sick patients 1 . Intensive Care Units (ICU) use measures such as diagnostic procedures and invasive devices that may trigger complications such as healthcare-associated infections (HAI) ii . The challenges imposed to the prevention of nosocomial infections are even greater in an ICU due to the variety of microorganisms, oftentimes multiresistant, which require the employ of broad-spectrum antibiotics. ICUs are characterized by performing invasive procedures intended for diagnostic purposes or to enable the cure of patients, just which complicate the control of infections 3 . Note that cardinal line-associated bloodstream infection (CLABSI) is the master complication of primal venous catheters 4 .
In the United States, from 250,000 to 500,000 CLABSIs are estimated to occur every year, which issue in a rate from 10% to 30% of mortality 5 . A study was conducted in Brazil with 33 patients hospitalized in an adult ICU using a total of 50 CVCs. Of these, 18 were diagnosed with CLABSI. In regard to clinical effect, twenty% of the patients who presented CLABSI died. The incidence of primary bloodstream infection was 1.52/1,000 catheters-day and the CVC utilization rate 0.80 six . Critical care workers should be aware of CLABSI rates in the ICUs in which they piece of work and devise quality control programs to attain rates not higher than 0.5-1/i,000 CVC/day 7 .
In this sense, there is a concern over the risk of infections to which patients are exposed, the prevalence of CLABSI, the demand to improve care concerning the implantation and maintenance of CVCs, and the adoption of prove-based measures to ground the care provided by the health staff. Therefore, systematized intendance defined by evidence-based guidelines confers condom and quality onto the intendance provided by the intensive intendance team and tin can effectively reflect decreased HAI rates.
Seeking to contribute to safer care provided to critically ill patients, this study's aim was to place evidence-based care to prevent key line-associated bloodstream infection amidst adult patients hospitalized in intensive care units.
Method
A systematic review was conducted in accordance with the protocol proposed past the Federal Academy of São Paulo (UNIFESP), together with Cochrane Brazil, namely: establishing the enquiry question (using the PICO strategy); identifying and selecting studies; critically assessing studies; collecting data; analyzing and presenting data; and interpreting results eight .
The PICO strategy resulted in the post-obit question: "What are the CLABSI-related preventive measures implemented among adult patients hospitalized in an ICU?"
The search was conducted from July 21st to August xth 2014 in international databases such as Web of Science, Pubmed/Medline, Scopus, Cochrane, Cinahl and Latin American databases, Lilacs/BDENF, through the Coordination of Improvement of Higher Level Personnel (CAPES) platform. The terms used in the search were selected from the MeSH (Medical Bailiwick Headings) equally MeSH terms and All Fields, and from DeCS (Wellness Sciences Descriptors) as descriptors and primal words. The Boolean operators AND and OR were used.
The search included studies that answered the enquiry question, were related to the topic, and addressed interventions regarding the care and maintenance of catheters. Inclusion criteria were: original research studies, published from January 2011 to July 2014; written either in Portuguese, English language or Castilian; included adult patients; conducted in adult ICUs; included short-term CVCs; and presented abstracts or titles that addressed the discipline.
Exclusion criteria were: papers addressing a pediatric or neonatal population; did non originate from research; addressed peripherally inserted key catheter (PICC), hemodialysis, or peripheral and arterial catheters; or did non accost preventive measures to prevent fundamental line-associated bloodstream infections.
The search strategy resulted (Figure 1) in ane,611 references, 126 of which were duplicated and were excluded with the aid of Mendeley software. A total of 1,485 studies were initially selected, merely after reading the titles and abstracts, ane,333 were excluded and so that 152 studies remained. Two researchers read the full texts of the 152 studies and any disagreement was discussed until consensus was reached. After this stage, 118 studies were excluded for not meeting the inclusion criteria or considering the full text was not bachelor, so that 34 studies were included in this review.
Search strategies used in database search
The 34 studies that remained were synthesized and analyzed. They were organized in an assay tool in Microsoft Word that included Reference, Method, Care, Result and Level of bear witness. Data were assessed according to the level of evidence classified by the Joanna Briggs Found 9 .
Results
This report presents the results with the highest level of bear witness concerning measures implemented to prevent CLABSI among developed patients in ICUs. The studies included in the review (Figure 2) tested care bundles, additional interventions across established care, and multidimensional interventions addressing both care maintenance and implantation, as well as staff educational activity and institutional interventions.
In regard to the type of report, the following were found: 6 randomized clinical trials (17.six%), 8 cohort studies (23.5%), 10 pre- and posttest studies (29.4%), 3 observational studies (8.8%), three quasi-experimental studies (8.viii%), 2 systematic reviews (5.8%): i included cohort studies and the other included economical evaluations, and 2 in-vitro tests/bench studies (five.8%).
Discussion
Nine studies (26.four%) primarily addressed care bundles coupled with education, rubber civilisation or organizational strategies 23 - 24 , 26 , 28 - 29 , 32 , 37 - 39 . Ane written report presented a bundle that contained 5 elements: hand hygiene; maximal sterile barrier precautions during CVC insertion; prepare make clean pare with chlorhexidine; avert the femoral site, if possible; and remove unnecessary catheters. These elements were implemented along with command of measures implementation, collection of information to calculate infection rates, monitoring of adherence to hand hygiene, and feedback of results to the squad 26 . Level of evidence: ii.d.
One intervention that focused on quality included two distinct bundles, both contained hand hygiene every bit the primary element. The starting time bundle of CVC insertion as well contained the following: maximal sterile barrier, prepare skin with chlorhexidine and avoid femoral vein, while the 2d referred to CVC maintenance: appropriate cast replacement, hygienic technique to access and modify connectors without needles, and daily checking the need of CVC. The intervention was allied with an educational program implemented through conferences and teaching videos, surveillance of procedure and results 28 . Level of show: 2.d.
Following the line of care bundles, one report audited the implementation of a CVC insertion parcel and a maintenance packet for the Institute for Healthcare Improvement (IHI) associated with checklists and results feedback to the squad. The study showed that the medical and nursing approach combined through care bundles reduced the boilerplate charge per unit of infection from half-dozen.43 to 1.83 23 . Level of bear witness: two.d.
Another report addressing care bundles presented, in add-on to care already mentioned, the use of ultrasound to seek the target vein and ostend intraluminal insertion to reduce complications. The studies accomplished marked reduction of global rates of infection with the strategies implemented 24 . Level of evidence: two.d.
To testify the importance of complying with all the elements included in a bundle for it to exist constructive, ane study associated a care parcel proposed past the Institute for Healthcare Comeback (IHI) with a verification listing and monitored compliance with the package elements. Only 38% reported a high level of compliance. The study emphasizes that only when compliance with a care bundle is high, is it associated with reduced rates of infections 39 . Level of evidence: iii.e.
Three studies (8.8%) presented multidimensional programs that resulted in reduced rates of infections 13 , 25 , 33 . Two studies implemented the multidimensional arroyo INICC - International Nosocomial Infection Command Consortium, which consists of half-dozen simultaneous interventions: bundle of interventions; education; outcome surveillance; process surveillance; feedback on infection rates; and performance feedback on infection command practices ( 25 , 33 . Level of evidence: 2.c.
A randomized controlled clinical trial tested the multifaceted approach developed past Johns Hopkins Quality and Safety Research Group, which presents evidence-based practices to forbid CLABSI and a plan to better rubber, communication, and teamwork. Strategies, such as an intervention team, verification lists, recognition of nurses as potential leaders of interdisciplinary team interventions, data collection to summate rates, and control of compliance with measures was used. The intervention grouping achieved a decrease of 81% in non-adjusted CLABSI rates in the 19 months after implementation and the command group achieved a decrease of 69% in 12 months after the intervention. The study emphasized that the role of the nurse equally a leader of the multi-professional person team was key for the success of interventions 13 . Level of bear witness: i.c
Iv studies (eleven.7%) addressed educational strategies as the study's main focus, among which two too assessed the price-effectiveness of this type of intervention 11 , 19 , 21 , 31 . Two studies presented a training program based on the simulation of sterile techniques during CVC insertion and showed that the program decreased infection rates from three.6 to 1/1,000 catheters-day subsequently the intervention in the first report 11 (1.c) and the second study reported a subtract of 3.82 to 1.29/1,000 catheters-day 31 . Level of evidence: three.c.
One study assessed the cost-effectiveness of the strategy previously mentioned, associated with a care bundle, a catheter insertion cart and a verification list as mandatory in the programme in which a nurse had the power to interrupt the procedure if the items contained in the listing were not complied with. The simulation training was mandatory for all the hospital'south physicians and included a pre-course, self-guided reading of papers and instructional books, a 4-hr simulation form supervised by banana physicians and intensive care workers. The educational strategy resulted in a decrease of 58% in the incidence of CLABSI 21 . Level of show: ii.d. One study assessed the efficacy and cost-effectiveness of educational interventions and suggested that a multifariousness of educational approaches could be toll effective and decrease the facility's costs nineteen . Level of evidence of economic analysis: 2.
Institutional strategies are considered important when seeking compliance with measures concerning the implantation and maintenance of central catheters. One study focused on external audits to assess compliance with CVC insertion and maintenance practices, presenting monthly feedback to the squad. Compliance with care practices increased during the intervention period, showing a significant decrease in the global incidence of infections, though the incidence charge per unit either increased or remained stable afterward the intervention. The study emphasized the value of auditing- and feedback-based interventions, though reports of lack of leadership and the staff'due south high turnover represent weaknesses, indicating the need for studies focused on behavioral change strategies 16 . Level of bear witness: 2.c.
Extra strategies added to already implemented care concerning the insertion and maintenance of catheters were tested as a means to lower risk of colonization and infection of CVCs 14 , 17 , 27 , 30 , 34 - 36 , forty - 41 .
Due to the association of CVC with parenteral diet (PN), which incurs an increased risk of CLABSI occurring, and seeking to clarify the touch on of the infusion system on infection rates, a multi-middle study compared sterile multichamber numberless for parenteral nutrition (PN). This is considered to be a closed infusion organisation, with compounded parenteral nutrition (ii compounds). The charge per unit of CLABSI was 35.3% greater amidst patients who received compounded PN in comparison to those who received PN through the closed arrangement xiv . Level of evidence: i.c.
In regard to bandages impregnated with antiseptic and antibiotics intended to reduce the colonization of bacteria on the catheter insertion site, one study assessed the potential of a bandage containing chlorhexidine to decrease infection. The facility where the study was conducted had already implemented care apropos the insertion and maintenance of catheters, surveillance and education. CLABSI rates were significantly lower amongst patients using bandages with chlorhexidine, 1.51/one,000 CVS days in comparison to 5.87/1,000 CVC days in patients with conventional bandages 27 . Level of evidence: 2.d.
The influence of dissimilar types of catheters on CLABSI prevention and decreasing biofilm germination was addressed in 3 studies 34 - 36 . The utilise of catheters impregnated with Rifampicin and Miconazole (RM-C) in the femoral site in comparison to standard catheters (SC) showed an incidence significantly lower with the impregnated catheter: 8.61 vs. 0 CLABSI/1,000 catheters-day 34 . Level of evidence: 3.c. Catheters impregnated with Chlorhexidine and Silver sulfadiazine (CHSS) in the internal jugular vein presented lower CLABSI rate than conventional catheters: 0% vs. two.0%, incidence density of 0 vs. five.04 CLABSI/1,000 catheters-day 36 . Level of evidence: 3.c.
Three gradual interventions were implemented by a report focusing on the maintenance of catheters in three ICUs: rubbing the insertion site with chlorhexidine swabs for 15s; daily bathing with chlorhexidine-impregnated washcloth; and daily nursing rounds to ensure compliance with the items from a verification list that included infection control measures. The facility where the study was conducted had already been implemented the following list: bandages and catheters impregnated with chlorhexidine or with minocycline/rifampin; skin antisepsis with chlorhexidine; and intravenous connectors without needles. The study reports a progressive decrease in CLABSI rates later on the gradual implementation of interventions 17 . Level of evidence: 2.c.
As identified in the bundles presented by the studies, fugitive the femoral site when inserting CVCs is a recommended measure, too as giving preference to the subclavian vein. One study assessed the employ of the subclavian vein in the presence of tracheostomy in comparison to the femoral vein. The "subclavian + tracheostomy" group presented lower incidence of CLABSI when compared to "femoral without tracheostomy", three.9 vs. x.0 CLABSI episodes/1,000 catheter days, while there was a tendency for the incidence of CLABSI in the "subclavian + tracheostomy" group to be lower, 3.9 vs. 11.2I CLABSI/one,000 catheters-days 40 . Level of evidence: 3.e.
Studies tested some interventions that did not obtain pregnant results in reducing infections rates and colonization 10 , 12 , xv , eighteen , twenty , 22 , 42 - 43 . A study investigated whether non-return valves, designed to prevent the backflow of fluids, would be efficacious in reducing infections. The conclusion, nonetheless, was that non-return valves do not prevent backflow nor serve equally a bacterial filter 42 . Level of bear witness: 5.c. 1 CVC impregnated with silver nanoparticles was assessed, but no pregnant effect was found and for this reason it cannot be recommended 10 , nor tin can the use of CVC Certofix(r) Protect (B Braun), which promised to foreclose biofilm germination through a charged surface 43 . Level of evidence: 5.c.
In regard to antiseptic solutions to prepare the skin to receive a central venous catheter, a study compared the efficacy, ease of use, and cost of an antiseptic solution with chlorhexidine and a povidone-iodine solution, both alcoholic. The study reports small-scale significant decreases only for the colonization of the catheter and limited ease of utilise, without meaning effects for infection rates or lower cost 22 . Level of evidence: ii.d.
The studies show that deportment that include care bundles, the education of workers, the promotion of prophylactic culture, and the implementation of regular assessments controlling compliance with such measures, surveilling infection rates and providing feedback to workers coupled with additional strategies, such as using differentiated catheters and bandages, are important to subtract CLABSI rates amidst patients hospitalized in adult ICUs.
Decision
This study presents intendance measures to prevent key line-associated bloodstream infections recently addressed among patients hospitalized in intensive care units. Twenty-6 out of the 34 studies analyzed presented significant results concerning decreased central line-associated bloodstream infection rates after the implementation of intendance. Care measures included with CVC insertion and maintenance to important strategies concerning the staff's education and appointment, safety civilization, and surveillance processes.
Nine studies mainly focused on care bundles that included elements such as hand hygiene, cleaning the insertion site with chlorhexidine, fugitive the femoral site, and removing the catheter as soon equally information technology is no longer necessary. Three studies presented multidimensional programs addressing bundles of interventions, education, surveillance, feedback on results, every bit well as assessment of rubber culture, preparation addressing rubber, and partnerships with leaders inside the unit of measurement.
3 studies addressed educational interventions such as training based on the simulation of sterile techniques. Institutional strategies were also addressed, such as auditing, recruiting of leaders, surveillance, and monthly feedback to the team.
Differentiated care, such every bit bandages and catheters impregnated with chlorhexidine or antibody and closed infusion systems, were also addressed. Eight studies did not nowadays significant results concerning decreased fundamental line-associated bloodstream infection rates like those that tested non-return valves to foreclose backflow or catheters using a new antiseptic solution.
This report's limitations include a lack of literature produced in Brazil in the scope of nursing and the fact that the study focuses on but one type of catheter. Studies addressing unlike types of catheters are of import, as are systematic reviews, in guild to run across the demand of clinical practitioners of implementing evidence-based intendance.
Footnotes
1Paper extrated from Master's Thesis "Show-based intendance for prevention of central venous catheter-related bloodstream infection: a systematic review without meta-analysis", presented to Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil.
References
1. Passamani RF, Souza SROS. Infecção relacionada a cateter venoso central um desafio na terapia intensiva. Med HUPE-UERJ. 2011;x(one):100–108. [Google Scholar]
2. Loftus K, Tilley T, Hoffman J, Bradburn E, Harvey EJ. Use of Six Sigma strategies to pull the line on central line-associated bloodstream infections in a neurotrauma intensive intendance unit. Trauma Nurs. 2015;22(ii):78–86. [PubMed] [Google Scholar]
3. Barros LM, Bento JNC, Caetano JA, Moreira RAN, Pereira FGF, Frota NM. Prevalência de micro-organismo east sensibilidade antimicrobiana de infecções hospitalares em unidade de terapia intensiva de infirmary público no Brasil. Rev Ciênc Subcontract Básica Apl. 2012;33(iii):429–435. [Google Scholar]
4. Siqueira GLG, Hueb W, Contreira R, Nogueron MA, Cancio DM, Caffaro RA. Infecção de corrente sanguínea relacionada a cateter venoso central (ICSRC) em enfermarias estudo prospectivo comparativo entre veia subclávia e veia jugular interna. J Vasc Bras. 2011;10(3):211–216. [Google Scholar]
five. The Joint Committee Variability of surveillance practices for central line-associated bloodstream infections and its implications for health care reform. Joint Commission Benchmark. 2011;13(two):6–8. [Google Scholar]
half-dozen. Lopes APAT, De Oliveira SLCB, Sarat CNF. Infecc¸a~o relacionada ao cateter venoso central em unidades de terapia intensiva. Ensaios east C. 2012;16(ane):25–41. [Google Scholar]
vii. Timsit JF, 'Hériteau FL, Lelape A, Francais A, Ruckly S, Venier A G. A multicentre analysis of catheter-related infection based on a hierarchical model. Intensive Intendance Med. 2012;38(10):1662–1672. [PubMed] [Google Scholar]
10. Antonelli Yard, De Pascale G, Ranieri VM, Pelaia P, Tufano R, Piazza O. Comparison of triple-lumen cardinal venous catheters impregnated with argent nanoparticles (AgTive(r)) vs conventional catheters in intensive intendance unit patients. Jhin. 2012;82(ii):101–107. [PubMed] [Google Scholar]
eleven. Khouli H, Jahnes K, Shapiro J, Rose M, Mathew J, Gohil A. Functioning of medical residents in sterile techniques during key vein catheterization - randomized trial of efficacy of simulation-based preparation. Chest. 2011;139(1):fourscore–87. [PubMed] [Google Scholar]
12. Kwakman PH, Müller MC, Binnekade JM, Van Den Akker JP, de Borgie CA, Schultz MJ. Medical-course honey does non reduce pare colonization at central venous catheter-insertion sites of critically ill patients a randomized controlled trial. Crit Intendance. 2012;16(5):R214–R214. [PMC gratuitous commodity] [PubMed] [Google Scholar]
13. Marsteller JA, Sexton JB, Hsu YJ, Hsiao CJ, Holzmueller CG, Provonost PJ. A multicenter, phased, cluster-randomized controlled trial to reduce central line-associated bloodstream infections in intensive care units. Crit Care Med. 2012;40(11):2933–2939. [PubMed] [Google Scholar]
14. Pontes-Arruda A, Santos MCFC, Martins LF, González ERR, Kliger RG, Maia Yard. Influence of parenteral nutrition delivery organization on the development of bloodstream infections in critically sick patients an international, multicenter, prospective, open-label, controlled study-EPICOS report. JPEN J Parenter Enteral Nutr. 2012;36(5):574–586. [PubMed] [Google Scholar]
15. Yousefshahi F, Azimpour K, Boroumand MA, Najafi Chiliad, Barkhordari K, Vaezi Yard. Can a new clarified agent reduce the bacterial colonization charge per unit of central venous lines in postal service-cardiac surgery patients. J Teh Univ Centre Ctr. 2013;8(2):lxx–75. [PMC gratis article] [PubMed] [Google Scholar]
xvi. Cherifi S, Gerard M, Arias Due south, Byl B. A multicenter quasi-experimental study bear on of a central line infection control program using auditing and performance feedback in five Belgian intensive intendance units. Antimicrob Resist Infect Command. 2013;two(1):33–33. [PMC free commodity] [PubMed] [Google Scholar]
17. Munoz-Price LS, Dezfulian C, Wyckoff M, Lenchus JD, Rosalsky Thousand, Birnbach DJ. Effectiveness of stepwise interventions targeted to decrease cardinal catheter-associated bloodstream infections. Crit Care Med. 2012;40(five):1464–1469. [PubMed] [Google Scholar]
xviii. Thom KA, Shanshan L, Custer Thou, Preas MA, Rew CD, Cafeo C. Successful implementation of a unit-based quality nurse to reduce fundamental line-associated bloodstream infections. Am J Infect Command. 2014;42(2):139–143. [PMC complimentary article] [PubMed] [Google Scholar]
19. Frampton GK, Harris P, Cooper One thousand, Cooper T, Cleland J, Jones J. Educational interventions for preventing vascular catheter bloodstream infections in disquisitional care evidence map, systematic review and economic evaluation. Health Technol Assess. 2014;18(15):1–365. [PMC complimentary article] [PubMed] [Google Scholar]
20. Armellino D, Woltmann J, Parmentier D, Musa Northward, Eichorn A, Silverman R. Modifying the risk In one case-a-day bathing "at run a risk" patients in the intensive care unit with chlorhexidine gluconate. Am J Infect Command. 2014;42(5):571–573. [PubMed] [Google Scholar]
21. Brunt AR, Torjman MC, Dy GE, Jaffe JD, Littman JJ, Nawar F. Prevention of cardinal venous catheter-related bloodstream infections is it time to add simulation training to the prevention package? J Clin Anesth. 2012;24(7):555–560. [PubMed] [Google Scholar]
22. Girard R, Combyb C, Jacques D. Alcoholic povidone-iodine or chlorhexidine-based antiseptic for the prevention of central venous catheter-related infections In-use comparison. J Infect Public Health. 2012;v(1):35–42. [PubMed] [Google Scholar]
23. Hocking C, Pirret AM. Using a combined nursing and medical arroyo to reduce the incidence of fundamental line associated bacteraemia in a New Zealand disquisitional care unit a clinical audit. Intensive Crit Intendance Nurs. 2013;29(3):137–146. [PubMed] [Google Scholar]
24. Kim JS, Holtom P, Vigen C. Reduction of catheter-related bloodstream infections through the employ of a cardinal venous line bundle epidemiologic and economic consequences. Am J Infect Command. 2011;39(eight):640–646. [PubMed] [Google Scholar]
25. Leblebicioglu H, Öztürk R, Rosenthal VD, Akan AO, Sirmatel F, Ozdemir D. Impact of a multidimensional infection control approach on fundamental line-associated bloodstream infections rates in adult intensive intendance units of viii cities of Turkey findings of the International Nosocomial Infection Command Consortium (INICC) Ann Clin Microbiol Antimicrob. 2013;12(ten):415–423. [PMC free article] [PubMed] [Google Scholar]
26. Osório J, Álvarez D, Pacheco R, Gómez CA, Lozano A. Implementación de un manojo de medidas (bundle) de inserción para prevenir la infección del torrente sanguíneo asociada a dispositivo intravascular central en cuidado intensivo en Republic of colombia. Rev Chilena Infectol. 2013;30(5):465–473. [PubMed] [Google Scholar]
27. Scheithauer S, Lewalter K, Schröder J, Koch A, Häfner H, Krizanovic V. Reduction of central venous line-associated bloodstream infection rates by using a chlorhexidine-containing dressing. Infection. 2014;42(1):155–159. [PubMed] [Google Scholar]
28. Tang HJ, Lin HS, Lin YH, Leung PO, Chuang YC, Lai CC. The bear upon of primal line insertion parcel on central line-associated bloodstream infection. BMC Infect Dis. 2014;14:356–356. [PMC costless article] [PubMed] [Google Scholar]
29. Wu PP, Liu CE, Chang CY, Huang H-C, Syu SS, Wang CH. Decreasing catheter-related bloodstream infections in the intensive care unit interventions in a medical middle in central Taiwan. J Microbiol Immunol Infect. 2012;45(5):370–376. [PubMed] [Google Scholar]
30. Maki DG, Rosenthal VD, Salomao R, Franzetti F, Rangel-Frausto MS. Impact of switching from an open to a closed infusion system on rates of key line-associated bloodstream infection a meta-analysis of fourth dimension-sequence cohort studies in 4 countries. JSTOR: Infect Control Hosp Epidemiol. 2011;32(1):fifty–58. [PubMed] [Google Scholar]
31. Barsuk JH, Cohen ER, Potts Due south, Demo H, Gupta Due south, Feinglass J. Broadcasting of a simulation-based mastery learning intervention reduces central line-associated bloodstream infections. BMJ Qual Saf. 2014;23(9):749–756. [PubMed] [Google Scholar]
32. Cooper K, Frampton G, Harris P, Jones J, Cooper T, Graves N. Are educational interventions to preclude catheter- related bloodstream infections in intensive care unit cost-effective. J Hosp Infect. 2014;86(ane):47–52. [PubMed] [Google Scholar]
33. Jaggi N, Rodrigues C, Rosenthal VD, Todi SK, Shahe S, Saini N. Impact of an International Nosocomial Infection Control Consortium multidimensional approach on central line-associated bloodstream infection rates in developed intensive care units in eight cities in Republic of india. Int J Infect Dis. 2013;17(12):1218–1224. [PubMed] [Google Scholar]
34. Lorente L, Lecuona Chiliad, Ramos MJ, Jiménez A, Mora ML, Sierra A. Lower associated costs using rifampicin-miconazole impregnated catheters compared with standard catheters. Am J Infect Control. 2011;39(10):895–897. [PubMed] [Google Scholar]
35. Lorente Fifty, Lecuona Yard, Ramos MJ, Jiménez A, Mora ML, Sierra A. Rifampicin-miconazole-impregnated catheters save cost in jugular venous sites with tracheostomy. Eur J Clin Microbiol Infect Dis. 2012;31(8):1833–1836. [PubMed] [Google Scholar]
36. Lorente L, Lecuona Thou, Jiménez A, Santacreu R, Raja Fifty, Gonzalez O. Chlorhexidine-silver sulfadiazine-impregnated venous catheters salvage costs. Am J Infect Command. 2014;42(3):321–324. [PubMed] [Google Scholar]
37. Palomar M, Álvarez-Lerma F, Riera A, Díaz MT, Torres F, Agra Y. Impact of a national multimodal intervention to forbid catheter-related bloodstream infection in the ICU the spanish experience. Crit Intendance Med. 2013;41(10):2364–2372. [PubMed] [Google Scholar]
38. Render ML, Hasselbeck R, Freyberg RW, Hofer TP, Sales AE, Almenoff PL. Reduction of fundamental line infections in veterans administration intensive care units an observational cohort using a central infrastructure to back up learning and improvement. BMJ Qual Saf. 2011;twenty(viii):725–732. [PubMed] [Google Scholar]
39. Furuya YE, Dick A, Perencevich EN, Pogorzelska M, Goldmann D, Rock PW. Central line bundle implementation in US intensive intendance units and affect on bloodstream infections. PLoS One. 2011;half-dozen(1):e2787 [PMC complimentary article] [PubMed] [Google Scholar]
forty. Lorente L, Jiménez A, Martín MM, Palmero S, Jiménez JJ, Mora ML. Lower incidence of catheter-related bloodstream infection in subclavian venous access in the presence of tracheostomy than in femoral venous access prospective observational study. Clin Microbiol Infect. 2011;17(6):870–872. [PubMed] [Google Scholar]
41. Pfaff B, Heithaus T, Emanuelsen G. Use of a 1-slice chlorhexidine gluconate transparent dressing on critically ill patients. Crit Care Nurse. 2012;32(4):35–40. [PubMed] [Google Scholar]
42. Ellger B, Kiski D, Diem D, Van Den Heuvel I, Freise H, Aken V. Non-render valves do not prevent backflow and bacterial contamination of intravenous infusions. J Hosp Infect. 2011;78(1):31–35. [PubMed] [Google Scholar]
43. Richards GA, Brink AJ, McIntosh R, Steel HC, Cockeran R. Investigation of biofilm formation on a charged intravenous catheter relative to that on a similar simply uncharged cateter. Med Devices. 2014;7:219–224. [PMC complimentary commodity] [PubMed] [Google Scholar]
Articles from Revista Latino-Americana de Enfermagem are provided here courtesy of Escola de Enfermagem de Ribeirao Preto, Universidade de Sao Paulo
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5016007/
0 Response to "Peer Reviewed Scholarly Articles on Femoral Lines on Cardiac Cath Patients"
Publicar un comentario